Class of 1969 ‘Old Girl’ Dr Jane Orr is a leading expert on the history of the 1918 Spanish Flu pandemic and its military impact.
Exclusively for FHS, Dr Orr reveals the similarities between the two pandemics, one hundred years apart. What can history teach us?
Since my retirement from clinical medicine I have studied, and become a lecturer in, the History of Medicine. As I am married to a military historian, my interest has always been in the history of military medicine, and over the last few years I have specialised on the “Spanish” influenza pandemic of 1918 and ’19, and its effect on the fighting in 1918, and the peace negotiations of 1919.
It seems very weird now to be living through something quite similar – but how similar is it?
Officially, the 1918/19 influenza pandemic started in a recruit camp in Kansas – the only reason it is labelled “Spanish” is that they were neutral during World War I and so could report it in their newspapers as they had no censorship. However, like a good Hollywood blockbuster, there was a prequel, and this (thank goodness) appears to be absent in this case. At the time, nobody could work out what the mystery disease was that appeared in Europe in the autumn of 1916. It was labelled purulent bronchitis at the time, and at one stage was thought to be caused by poison gas or biological warfare. It only appeared to attack fit, healthy people and had a horrendous 25% mortality. The only good thing about it was that it was not very easily spread, so “only” 146 British soldiers died of it – not that many in the context of the war. Rather more of our Indo-Chinese (Vietnamese) Labour Corps died, so they may have been the origin; however, it also caused 2,000 deaths amongst young people in Vienna and about half that number in Copenhagen, so it might be unfair to blame South East Asia. The 75% who recovered were later found to be immune to Spanish Flu, so it was obviously a similar bug. In the so-called purulent bronchitis it killed by causing a massive immune response which ended up breaking blood vessels in the lungs so that the victims drowned in their own blood. You can see why they thought it was some sort of biological weapon.
Because people were killed by their own immune response, it particularly attacked fit men in their 20s and early 30s, as they have the most efficient immune system.
The purulent bronchitis continued causing a few cases through 1917 and into 1918, but then in March 1918 the first wave of the official Spanish influenza started. This was quite the opposite, and rather more like what we are going through at the moment. It was very infectious, and swept through all the fighting armies, a unit at a time. The soldiers would feel absolutely rotten for three or four days, but be back to normal in a week. Up to 40% of a single unit would be off sick one week, but by the following week would be at 90% strength, only for the next unit to be affected. It made planning by the generals very difficult, and the German General Erich Ludendorff blamed the flu for the failure of his Spring Offensive. When it spread to the civilian population it did cause deaths in the elderly, the very young and those with underlying conditions at about 2%. This is similar to the coronavirus, though in this case babies are not affected.
The influenza peaked in late June 1918 and had appeared to have gone by the beginning of August, which is when the “Final Push” was launched, leading eventually to the defeat of Germany and its allies. However, towards the end of August, disaster struck. Somehow, the two viruses met and caused a mutation that although only a quarter as infectious as the first wave Spanish flu, was much more infectious than the purulent bronchitis. This mutation caused a 20% mortality and swept around the world as the deadly second wave. The mortality varied from country to country – India lost 21 million people, about 5% of their population. Western Samoa lost over 20% of their population. In UK we lost 250,000, about 0.6% of our population. Altogether between 50 and 100 million people died, most of them in the 12 weeks from early October until the end of the year. There was a third wave the following spring which caused about a quarter of the deaths.
What can we learn? Obviously times are different, and at least we are not fighting a war and can communicate with other countries. Certainly, they showed then that social distancing works. It swept through the military, but was not too bad in UK until the Armistice. As you can imagine, telling people not to meet up and celebrate when the Armistice was signed, was a waste of time, and there was a huge surge in cases in the third week of November 1918.
What about schools? It depends what you read. Malta acted proactively and closed all the schools, and started a rigorous public health campaign before they had a single case. They had much the lowest mortality in Europe. On the other hand, in the USA New York State was the only state that kept its schools open, and they had the lowest mortality within the country. In England we were very late and reactive – schools were closed in mid-July, reopened in September, then closed again in mid-December. On each occasion they were closed after the peak of cases, and just at the end of term, reopening at the beginning of the next one.
So, although they are things to learn, there is no evidence that this disease will have the deadly effect on fit, young people that the Spanish influenza had. It is quite an unpleasant disease for a lot of the people who get it, regardless of age. One of my daughters has had a fever every day for two weeks now. She is starting to get better, but watching her (via WhatsApp) you can see how the frail, elderly and otherwise weak are not going to find the energy to survive in many cases.
It will go away in the end!
Keep your distance, wash your hands, wear gloves on public transport – and keep well!
Top, masked US soldiers. Above right, Spanish flu ward
