Front Burner - Lessons from the 1918 Spanish Flu pandemic

Episode Date: April 8, 2020

The influenza outbreak of 1918 was the deadliest pandemic in recent history, killing an estimated 50 million to 100 million people aroundthe world. And it bears some striking similarities to the COVID-19 pandemic. Today, Laura Spinney, science journalist and author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World, talks about what we can learn from this century-old tragedy.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Pozzo. As the novel coronavirus continues its spread around the globe, some people are making comparisons to another devastating pandemic, the 1918 influenza pandemic, better known as the Spanish flu.

The flu was incredibly deadly. Most estimates put the death toll between 50 and 100 million people. And like COVID-19, it quickly reached countries all over the world. 50,000 Canadians were among the dead. So as we continue to make sense of what's going on during this pandemic, I wanted to know what lessons we should be taking from that other one, 102 years ago. Today, I'm talking to Laura Spinney. She's a science journalist and author of Pale Rider, The Spanish Flu of 1918 and How It Changed the World. Laura thinks that in the fight against COVID-19, we are employing many of the same tactics and making some of the same mistakes. I reached her in Paris. This is Fromper. Hi, Laura. Thank you so much for making the time to speak with me today. Hi, Jamie. It's my pleasure.

So I'm hoping that we can start with the basics here. What was the Spanish flu? So the Spanish flu was a pandemic of influenza. That means an epidemic that reached the entire globe. It struck in three waves. The first wave was relatively mild, not that different from a seasonal flu, and it erupted in the northern hemisphere spring of 1918. That receded towards the end of the spring, and then there was a second wave which erupted towards the end of August, and that was very much the most vicious wave. Leonard Gordon Davis was a mechanic with the RAF. The doctor was treating these people with aspirins and what have you, I suppose, and he ran out of all his supplies. The doctor said, well, we've got no means of bringing the temperature down, we've got to take some drastic action.

We were told to sit in our beds, and he came along with buckets of cold water and chucked them over us. And then that receded towards the end of the year, and there was a third one in the early months of 1919 that was intermediate in severity between the other two. The number of waves and the dates of the waves were staggered in the southern hemisphere with respect to the north. In fact, they came later in the southern hemisphere.

So that's why overall we tend to say that it went on for two to three years. In fact, there were cases still raging in the Pacific Islands in July of 1921. And so this flu, I understand, and correct me if I'm wrong here, was a lot like H1N1. And we're talking about at least 50 million people here, right? So it was H1N1. It was the subtype of influenza A called H1N1. But it was a strain that was different from the H1N1 that caused the 2009 pandemic. So the H1N1 of 1918 infected in total, about 500 million people in the world. That's one in three of the people who were alive back then. And it's estimated to have killed between 50 and 100 million of them. So that's

between 2.5 and 5% of the global population. And interestingly, the vast majority of those deaths took place in 13 weeks only. The 13 weeks between the middle of September and the middle of December 1918, so that was in the middle of that very bad second wave. The mortuaries were so full, we had the patients lying one on top of the other. And it was like the plague must have been. People were walking about with their eyes and noses running and their eyes red and sore. And they died like flies. So the undertakers couldn't cope with them and there weren't enough coffins to go around. Okay. This virus, as you mentioned, it first starts to spread in the spring of 1918 towards

the end of the First World War. And what were the factors at that time that caused it to spread so quickly around the world? So, I mean, the extraordinary conditions created in the world by World War I, namely that lots of people, not only troops, but also civilians were on the move, displaced persons and refugees. Many of them were in a poor state of health after four years of war, hungry, stressed, and with other underlying conditions. So all of that would have contributed to spreading the disease very quickly around the world. And we know also that, you know, that a pandemic strain can be more virulent early on. It takes time for a virus to moderate its virulence so that it can sort of live in harmony with the human species. It's in its sort of evolutionary interest to moderate

its virulence over time so that it keeps its host alive to spread it further, faster. And that means that when one emerges and it's virulent, it basically gradually becomes less virulent over time. And that's why we see pandemic strains, all seasonal strains of flu that exist in the world now once started as pandemic strains, because they went through that moderating process. But in 1918, if you imagine this virus getting into the trenches of the Western Front in Flanders, Belgium and France, of the Western Front in Flanders, Belgium and France, it would have encountered a lot of young men squashed together like sardines, many of them not able to go anywhere for weeks at a time, and perhaps also with lungs that were already compromised by being gassed with poison gases.

And in those circumstances, it was just easy for the virus to transmit, to pass from man to man because they were so close together. So there was no sort of evolutionary pressure on it to moderate its virulence. So that's one of the theories, that it remained virulent for much longer. And in the meantime, of course, it's being spread very fast around the world and therefore had a very high lethality. Did the flu epidemic strike in India? Oh, God, yes. It swept right through India. My old regiment, the Queens, in three weeks of flu,

lost more men than all the casualties for the rest of the war. And I remember seeing the bodies being kept on the move in the river by bamboo canes because they couldn't possibly burn the bodies. There were too many of them. You mentioned that young men became ill with this virus, and of course at the time, at least 17 million soldiers and civilians died in World War I. And now we're talking about this flu on top of that.

And so can you paint a picture for me of what this might have been like for communities to lose so many people? So, overall, globally, not just amongst the troops, we know that the Spanish flu made a particular target of adults aged between 20 and 40, which is actually very untypical for flu. Flu normally targets the very young and the very old. So these adults in the prime of life were in the firing line, so to speak, in civilian as well as in military populations. For Caroline Reynolds, a child at the time, the flu would overshadow Armistice Day itself. My dad died two days before the Armistice, darling, and I loved my dad, you know. We were lucky we knew an undertaker so that my dad was buried within about a week or so, but some of the poor things were lying for two or three weeks they couldn't bury them and what that meant was that at a time when social welfare nets um were non-existent or very very thin even in the most advanced countries um this virus essentially ripped out the hearts of

communities because it took out the breadwinners it took out the parents it took out the pillars of those communities and so you suddenly see a kind of wrecked landscape after the war and the pandemic of communities with a lot of elderly people, a lot of young children and no visible means of support. And what's tragic about what was tragic for me as a researcher looking into that story was that those people kind of just vanish. They don't have a voice and they don't really show up in historical records. We have tiny little glimpses of them. So we know, for example, that a lot of old people vanished into workhouses or poorhouses and that a lot of children became vagrants or sort of were channeled into indentured labor or lives of crime. But because it was all unofficial

and there was no real organised system of adoption at the time, we just kind of lose sight of them. They just sort of drop through the cracks. That is so sad to think about how many lives were ripped apart by this after what the world had already been going through for so many years. Back then, Elsie Smith, now Elsie Miller, was six years old. That's my mother. She was a pretty lady. Within a week, Carrie Smith and five of her eight children were dead.

Life just seemed to go on. The neighbors were very good. I can remember some of them coming and, well, you have to keep on living and make the best of it. Before we move on, I actually have a question that might be a little bit of a silly one, but why was it called the Spanish flu? Did it originate in Spain? It's a very good question. It's a very important question, which is relevant again today, because what it shows is how very political a pandemic is. In fact, there are many, many unanswered questions about the 19 pandemic. But one of the few things we know for sure is that it did not start in Spain. So how did it get that name? Well,

because the world was at war when it first became visible, and the countries that were fighting in that war were censoring their press. So, for example, the United States, France and Britain all had cases of flu before Spain, but they kept that information out of their newspapers. Spain was neutral in the war. And when it had its first cases in the spring of 1918, it reported on them. And those cases included the King of Spain, Alfonso XIII, who went on to recover, but obviously, whose case lent a lot of visibility to the Spanish outbreak. And it suited the governments of the warring nations to blame Spain because they didn't want, you know, their enemies to think they had the disease behind their lines. Do we know anything about where it actually originated from?

We do not know. We may know one day because lots of people are working on that question, interestingly. But at the moment, we just have to work with three theories. And those three theories correspond to putative origins in China, in the province of Shaanxi, an interior province of northern China. Kansas in the United States, not far from the military camp, Camp Funston, where the very first cases of the pandemic were recorded in March of 1918. And the third possibility on the table at the moment is that it started in a British military camp in northern France at a place called Etaples. You mentioned before you alluded to this idea of a lack of systems put in place. So can you talk to me a little bit more about how well prepared authorities were in, say, Europe or North in after this pandemic. And then there was the problem of

the war. Almost everybody was distracted by the war. Their attention was elsewhere. And they had, in some cases, higher priorities. So for example, the city of New York, the health commissioner there wanted to put in place a citywide quarantine, but was prevented from doing so by President Woodrow Wilson, who considered that the transportation of troops to Europe, much of which happened through New York, took priority. So you saw the usual conflict, the usual tensions, and we're not at war now, but you see kind of tensions today between keeping the economy on track and managing the public health crisis. You saw them again at the time.

And in fact, the result of those tensions was that you get a kind of patchwork of the rigor with which public health campaigns were put in place across the world. Some countries were just unable to do so, didn't have the infrastructure. Others did, but did it in a rather piecemeal way. And above all, they didn't necessarily keep those measures in place for long enough, because again, they had, you know, to let get the economy up and running again to get the effort back on track in the dragon's den a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization,

empowering Canada's entrepreneurs through angel investment and industry connections. So, you know, having all this knowledge about what was done in 1918, 1919, you know, what kind of parallels are you seeing today? Are we repeating any of these same mistakes now? What kind of lessons do you think need to be learned here? There are parallels. I have to always caveat my answer to that question by saying that, you know, I'm not quite sure why we immediately reach for the worst possible pandemic in human history to compare this one to. You know, I don't think it's going to be anywhere near on the scale of the Spanish flu, this one. Of course, we do not have all the data in yet and everything could change. But I don't think we're looking at 50 million dead with COVID-19. So that's the numbers question. Apart from that, I think there are a lot of parallels, particularly in human behavior. We do not yet have a vaccine, and we probably won't have one for 12 to 18 months if the experts are correct about that.

A paper published in the official Journal of the National Academy of Sciences highlighted past pitfalls that caused the immune system to backfire. Officials in Ottawa said safety is the priority. Any severe safety issues will immediately trigger a review of that trial. A vaccine is the only thing that can stop people getting sick from COVID-19. So in the meantime, while we're waiting for that vaccine, the only really effective measures we have for stopping people getting sick are containment measures, social distancing measures, the things we're talking so much about now, lockdown, quarantine, isolation, masks, hand washing. And what's fascinating is that those are very ancient techniques. Even before germ theory was invented in the 19th century,

human beings understood that in order to stop contagion spreading, you had to separate the sick and the healthy. And so, you know, quarantine dates from the 15th century, the Venetians invented it. Cordon sanitaire are even older. This idea of keeping people apart, keeping the sick and the healthy apart is very, very ancient, even before people understood the mechanisms of contagion. And they are the same ones they put in place in 1918, and they're the same ones we're using today. And in fact, in 1918, they had the exact same debates. They're talking about whether masks worked. Should you use them only when you're ill or all the time? Should we close schools? Shouldn't we? All the debates were exactly the same.

Phyllis Alcorn has written a history of the community of Alliance Alberta. It hasn't reached Alliance yet, but they're showing how to make a mask, giving instructions. And it also says if you go outdoors or travel, you must wear a mask. They also have a notice that all churches, schools, shows, pool rooms and public gatherings will be closed for now. And it also says no person can enter or leave Alliance by train until further notice. It's incredible to think that 100 years later, there's so much of this history that's repeating itself, hey? Yeah. And also, I mean, I mentioned human nature. If you think about it, I mean, it was clear to me when I was researching the Spanish flu

that pandemics bring out the very best and the very worst in human nature. And of course, we're seeing that exact same thing all over again. To begin with, in most countries, you saw a lot of bad behavior, I think, the stockpiling and so on. On a quick trip for essentials, good luck. Empty shelves, lineups that keep going. Yeah, it seems rather a little bonkers in there now today. I saw people with like five, six packages of toilet paper. And there are reports that, you know, organized crime is profiting from this crisis.

Inspo says there's been a surge in counterfeit medical goods. Thousands of counterfeited substandards, protective masks, corona, so-called corona spray, corona medicine. But on the other hand, you've seen communities pulling together, looking after each other, this great community spirit. I'm going to ring the bell. From her home. A retired nurse rings a bell to support all frontline health care workers.

And restaurant owner Thomas Ha delivers free meals to emergency staff. And I think, you know, it's fascinating to watch it happening all over again. I know this flu, the 1918 flu is sometimes referred to as the forgotten pandemic, which is crazy considering this unbelievable death toll that it had, right? But I know you alluded to earlier, like, it actually changed the world in many ways. Can you tell me a little bit about how it changed the world? Yeah, I mean, first of all, I'd like to address the issue of it being forgotten. I mean, in many ways, it is forgotten. But what's ironic to me in a sort of tragic way is that I wrote that book because so little was known about the spanish flu my book came out um first in

2017 and two years later here i am talking about nothing else but the spanish flu and so in some ways i think that you know there is a kind of latent memory there even if all the facts connected with it in people's minds may not be accurate. And somehow this new pandemic, or perhaps each new pandemic, you know, revives that memory and the thing gets discussed again. Now, as the COVID-19 pandemic continues to grow, so are the parallels being drawn to the Spanish flu of 1918. There are lessons to be learned from that earlier time. And maybe some of those, you know, collective errors in how we understand it are, you know, have a chance to be aired and corrected again in a new pandemic. So in terms of how it changed the world, for example, yeah, I think it's responsible for us inventing a global health agency, forerunners of the WHO, because there was a realization that you needed to globally coordinate a response to a global crisis because viruses don't respect borders. It also gave a huge boost to the notion that had already been discussed before the pandemic of socialized medicine,

the idea that healthcare should be free at the point of delivery. There have been many, many debates about this beforehand. But to put in place such a system is a massive ask. You have to first of all, work out how you're going to pay for it. And before the pandemic, most doctors were either self employed, or they worked for charities or religious organizations, you were talking about completely reorganizing that. or they worked for charities or religious organizations. You were talking about completely reorganizing that. So they worked in a sort of nationwide system that was coordinated by the state or centrally. So it was a huge ask and basically nobody had managed to pull it off. But the pandemic, I think, in some way gave these needed stimulus for that to happen.

And so starting from the 1920s, Russia was the first country to put in place a socialized health care system. And then, you know, many nations in Europe followed. And we know, of course, Canada followed after that as well. I know we've talked throughout this conversation about potential lessons here, but before we go today, any other big takeaways for you looking at what's happening now and comparing it to the 1918 flu? Any other big lessons? I mean, I think there would have to be, again, what the WHO has been telling us to do for a very long time, which is to take measures to prepare ourselves for the next pandemic, because there will be one, unfortunately, you know, in peacetime, so to speak, to use a war analogy, outside of pandemics, we should be doing more to make

ourselves pandemic proof. We'll never be completely pandemic proof, but we could be investing in our health infrastructure in a way that would mean we would cope with this kind of crisis better in future. And that means not just in our own countries, but also in globally, because we're only as safe as the least safe place. So that means that we need to collectively fund health infrastructure in some of the poorer nations on Earth. on earth. We need to understand better where these viruses come from and why zoonoses, which is the word for human infections of animal origin, why they have been coming more frequently in recent decades, to see if we can stop that or slow it. We need to obviously have better surveillance, police better that interface between animals and us over which they spill. In this particular pandemic, that seems to have been Chinese so-called wet markets.

But we know also that agricultural fairs in Europe and America are dangerous places for spillover events. So we have to think about all these different levels in order to make ourselves more pandemic proof for the future. Okay, Laura Spinney, thank you so much. Let's hope we actually do some of this this time around. I know these are things experts have been calling for for a very long time. Thank you. Thank you, Jamie. So Laura and I talked about pressure on countries to restart their economies during the Spanish flu pandemic. And before we go today, I just want to draw your attention to a fascinating and recent paper out of the U.S. Board of Governors of the Federal Reserve System and the New York Fed. It examined the effects of social distancing on the economy back in 1918 and ultimately found that cities that intervened fast and came down hardest didn't perform worse economically.

And actually came out the other side better off. They grew faster once the pandemic was over. The authors of this paper argue this happened because pandemic economics are different than regular economics. If people go back to normal with a disease still spreading around, there's a lot of anxiety And so people don't actually go back to normal. They don't go out. They don't spend a bunch of money. Anyways, something interesting to think about. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner and talk to you soon. For more CBC Podcasts, go to cbc.ca slash podcasts.