The Last Pandemic and its impact

By Tressa Maria Joseph 40 Minutes Read

INTRODUCTION

Wars in the 20^th century have shaped history and have led to many changes in the political and economic set up in various countries. In addition to this, pandemics and epidemics inflicted upon mankind from time to time have impacted nations in unique ways. Owing to the lack of technological advancements and resources, frequent endemics and epidemics were the major cause of raising mortality rates across the globe. Right from the Plague of Athens to Justinian plague to the Spanish Flu to the present threat of COVID-19, there are a plethora of pandemics and epidemics across centuries which have rewritten the books of history in an unprecedented manner. Microbes and life-threatening pathogens have become pen wielders of the history, reflecting the strong will power of mankind which refused to surrender to the vices of these microorganisms.

One of the deadliest pandemics in the history of mankind is the Spanish Flu which ravaged on about 1.2% of the global population between 1918 and 1920. It took place along the lines of the first world war which took place between 1914 and 1919. The impact of the flu was known across all parts of the world and it had huge ramifications on a variety of levels. The relevance of the Spanish Flu is particularly high now as the world is battling a widespread pandemic caused by a novel coronavirus, bringing the world to a standstill. This case study will divulge deep into the facts and details of Spanish Flu by analyzing its impact on four countries which were majorly affected by the pandemic in different continents.  A well-detailed analysis of the impact of the pandemic on India, Kenya, Britain, and the United States of America will be chalked out in this case study. The case study will focus on the lessons learned from the pandemic along with its similarities to the COVID-19 pandemic.

HISTORY OF SPANISH FLU

The origin of the worldwide influenza pandemic which later came to be known as the Spanish Flu is to date a debatable topic. Even though it is accredited with the name Spanish Flu, the deadly virus did not originate from Spain. Spain, being a neutral country to World War I, had no restrictions or censorships pertaining to the war on media. Hence, it became the first country to report a case of influenza and this led to the belief that the virus originated in Spain. The outbreak in 1918 was caused by the H1N1 and was spread through the water droplets in the air from the cough or sneeze of an infected person which made its transmission very easy. The pandemic ravaged upon the world population in four waves and has many sources explaining its origin.

Origin and First wave

According to Alfred Crosby, a famous historian. the virus originated in an army training camp in North America which was called Camp Funston in Kansas in mid- March 1918. The virus claimed the lives of 48 soldiers and this is recorded as the first wave of the pandemic which lasted for 20 months. The conditions of war where troops were made to live in unhygienic and cramped accommodations provided a favorable environment for the growth and spread of the virus. Unlike most subsequent influenza virus strains that have developed in Asia, the “first wave” or “spring wave” of the 1918 pandemic seemingly arose in the United States in March 1918.[1] However, the near-simultaneous appearance of influenza in March–April 1918 in North America, Europe, and Asia makes a definitive assignment of a geographic point of origin difficult.[2]

According to a Canadian historian Mark Humphries, the lethal influenza pandemic first appeared in China in 1917 and then exploded across the globe “as previously isolated populations came into contact with one another on the battlefields of Europe.” In his book called “The Last Plague: Spanish Influzena and the Politics of Public Health in Canada”, he has stated that in China, people were victims of a mysterious respiratory disease, the symptoms of which were similar to that of Spanish Flu.[3] Records also show that a shipment containing 94,000 Chinese men were transferred by Britain to Western France for the purpose of fighting the war in 1917. They arrived at Southern England in January 1918 and a major proportion of these men were sent to France which marked the spread of the strain of the deadly virus in Europe. A hospital named Noyelles-sur-Mor recorded deaths of Chinese troops from respiratory illness. The historian Mark Humphires has also stated that there are medical records indicating that more than 3,000 of the 25,000 Chinese Labor Corps workers were transported across Canada beginning in 1917 and ended up in medical quarantine, many with flu-like symptoms.[4]

A large number of troops succumbed to the influenzas and countries imposed strict censorship on the media which was not allowed to report or publish any information regarding the cases of deaths caused by the virus. This led to major underreporting of the proportional number of cases during the first wave of the pandemic. Between the months of May and July, the flu spread through the whole of North and Central America as well as Europe and Asia which marked the end of the first wave.

Second Wave and subsequent waves

The second wave of the Spanish Flu made its appearance in September 1918 and continued till November. It is believed that during this period, the virus underwent rapid mutation which made it more deadly and lethal. This wave, also called as the fall wave, was characterised with a virus which had acquired more pathogenicity and virulence, spreading more quickly and to more places across the globe since most of the troops were returning home after the end of the World War. The war ended on 11^th November 1918 and its end did not mitigate or slow down the pace of transmission of the virus. Indeed, there were more opportunities for the virus to spread since the troops who were initially infected with the virus went to live with their families by which thousands of civilians became potential vectors of the disease.

The Spanish Flu spread to countries which were not previously affected by the first wave of the pandemic. It affected almost all corners of the world except for a few throughout autumn of 1918 to early winter of 1919. The influzena was a rare one in history since the virus was hardest on young adults between the ages of 20 and 30 who had previously been healthy.[5] A major proportion of young adult population lost their lives either due to the war or the virus. The virus spread to countries like India and Kenya during the second wave which will be discussed later in the case study.  The three major wartime ports such as Boston in America, Brest in France and Freetown in Sierra Leone were thriving grounds for the virus since there were frequent travels made to and from these ports by many ships carrying troops who continued to travel on land as well for the purposes of the war. The conditions of the war weakened the immune system of the soldiers who were subjected to malnourishment, making their bodies favourable hosts for the virus to attack. Effective quarantine measures were able to contain the virus to some extent which made its appearance again in two subsequent waves.

The third wave appeared in Spring 1919 at a time when most of the individuals acquired immunity to the virus. It lasted till June 1919 and was less severe than the second wave. It impacted China intensively where deaths were reported of individuals in the age group of 15 years to 34 years. By this time, the demography of the global population had been substantially altered since the pandemic had claimed lives of a large proportion of the young population which led to a steep in employment rates, loss of reproductive capacity of the population and significant changes in labour and family structures. The pandemic was a sudden demographic and economic catastrophe resulting in changes in health care systems, patterns of employment and labour among other consequences.

The fourth wave appeared in Spring 1920 and very few cases were reported in areas such as Scandinavia, South Atlantic and Sicily in Italy. Some regions reported mortality rates for the entire population as high as 5–10 percent. It is generally accepted that recorded statistics of influenza morbidity and mortality are likely to be a significant understatement. These limitations can include nonregistration, missing records, misdiagnosis, and nonmedical certification, and they may also vary greatly between locations.[6] Many deaths were not reported by hospitals or other authorities owing to lack of resources. Hence, the actual death rate of the pandemic is still not very clear since there are no proper scientific records to support the same. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide.[7]

IMPACT ON COUNTRIES

Impact on India

History and Statistics

The virus reached Indian shores by the way of a ship that was returning from Europe with war veterans. The ship returned in June 1918 and arrived at the port of Bombay. From Bombay, the deadly virus spread to the north, south, east and west of India. It killed almost 5% of the Indian population at that time. In the case of India, the Sanitary Commissioner in his report noted that “The railway played a prominent part as was inevitable.”[8] The flu was famously called Bombay fever and the weekly deaths in Bombay were more than 200 indicating the lethality of the virus in the city.

India bore a considerable burden of death, it lost 6% of its people. More women, relatively undernourished, cooped up in unhygienic and ill-ventilated dwellings, and nursing the sick died than men. The monsoon which followed was not favourable and various parts of India receive poor rainfall. This led to drought like conditions and there was shortage for food which weakened individuals making them vulnerable to the virus. People were weak and malnourished and rushed to different cities across the country as a last resort. By early July in 1918, 230 people were dying of the disease every day, up nearly three times from the end of June.[9]

Overall Impact

The death rate in India stood at 18 million. The pandemic wiped out 5%-6% of the population at the time. India was one of the countries with a high death rate and this led to major changes in the demography of the population. Villages and cities were affected equally. Caste distinction was a huge factor that is reflected from the death rate. More lower caste Hindus succumbed to the virus owing to poor economic and social condition. Many upper-class families and British families were able to afford healthcare and hygienic living conditions and hence were unaffected by the virus. Areas in the north and west of India saw death rates between 4.5% and 6% of their total populations, while the south and east where the virus arrived slightly later, as it was waning, generally lost between 1.5% and 3%. Among Indians in Mumbai, socioeconomic disparities in addition to race accounted for these mortality rates.[10]

Mahatma Gandhi, the leader of the nationalist movement in India, contracted and survived the virus. The pandemic, in addition to altering the population in the country, brought about significant changes in the political setup in the country. The pandemic shattered the economy of the country which was in a poor state owing to the policies of the colonial government. The lack of measures and efforts on the part of the colonial authorities were unacceptable to the general public and the public health care system was underdeveloped. The survivors of the pandemic had a common anger and hatred towards the colonial authorities who neglected their health care needs. The pandemic worked as a propellant to direct common anger and anguish towards the British authorities which directed by Gandhi and other like-minded people crystallized into an organised national movement across the country.

Impact on Kenya

History and Statistics

During the time when Spanish Flu was ravaging upon people across the globe, Kenya was under the British rule. It was one of the most important British colony owing to the Mombasa port which was its gateway to international trading with other major trading ports. At a time when other British colonies were infected with the virus, the entry point for the virus to Kenya was through its port Mombasa which was of strategic administrative value to its colonisers. Veterans who were returning from the war had strains of the virus from Europe and landed at Mombasa Port.

A single ship from India which docked in Mombasa may have played a large role in introducing the virus to East Africa, which then spread to the entire Coast Province in Kenya and then to Zanzibar in Tanzania, and Entebbe in Uganda[11]. In about nine months, the epidemic killed about 150,000 people, between 4% and 6% of the population at the time. From September 1918 to June 1919, there were approximately 31,908 cases and 4,593 deaths associated with the Spanish flu in Kenya’s coastal province.[12] Kenya was the first country in the continent of Africa which reported cases of the Spanish Flu. The Spanish Lady severely infected a large chunk of the population, women and young people, particularly. In a region that was bearing the brunt of high tax rates coupled with bad weather conditions, production of food reduced due to reduced supply of seeds and other farming requirements. This made the situation worse as more people were highly vulnerable to being contracted by the virus. The virus took a huge toll on the economic stability of the population along with a healthcare system that was underdeveloped with stringent resources and supplies to deal with an overwhelming number of cases.

Overall Impact

Being a British colony, data about the pandemic in Kenya was underreported owing to a lack of measures and steps on the part of the colonial authorities. There was no assistance from the colonial authorities and cases of infection among the natives were grossly underreported. Due to the pandemic, many people lost their jobs which intensified economical liabilities. The colonial authorities neglected the ever-increasing cases and took no concrete steps to combat or mitigate the transmission of the virus. There was an unprecedented effect on administrative operations owing to crumbling social and economic indexes. There were widespread food shortages, commercial losses, and an overwhelmed healthcare sector.[13] The health of the general public was too weak and poor, providing easy transmissible routes for the virus. Citizens had low-income rates and their access to health care was limited and restricted. There was a severe shortage of manual labor which directly affected food production. By 1920, doctors had developed improved mechanisms to deal with the disease, recording an abrupt decline in influenza-related deaths.[14] It can be undoubtedly concluded that Kenya suffered the most in the African subcontinent and took a long time to recover from the scars of the pandemic.

United States

History and Statistics

According to some sources, the Spanish Flu originated from an army training camp in Kansas called Camp Funston in mid- March 1918 which considered to be the first wave of the pandemic. It claimed the lives of 48 soldiers while a devastating second wave proved to be more disastrous than the first wave. The unhygienic conditions of the army camps during the war led to the widespread transmission of the disease which infected the civilian population. The rate of infected cases and death tolls were not uniform across the states in the country. Few states such as Pennsylvania, Maryland, and Colorado had the highest mortality rates, but these states had very little in common. Arguments have been made that mortality rates were lower in later-hit cities because officials in these cities were able to take precautions to minimize impending influenza, such as closing schools and churches and limiting commerce.[15] History records instances of many large public gatherings in different states which served as breeding grounds for the spread of the virus.

In some states like Chicago, the virus had killed 400,000 in a period of just three months. As the disease spread, medical officers sprayed the mouths and throats of 800 healthy men daily with a solution of dichloramine-T, a disinfectant. But when they compared their influenza rates with 800 untreated men, they were disappointed to find that “over a period of twenty days the incidence in the two groups was the same,” according to a public health report.[16] It is estimated that at the height of the American military involvement in the war, September through November 1918, influenza and pneumonia sickened 20% to 40% of U.S. Army and Navy personnel.[17] The total death toll in America stands at 675,000 and effective measures employed in different cities had a positive impact on the reduction of the number of cases.

Overall Impact

As many countries suffered a dip in the life expectancy rates due to the pandemic, America suffered on similar likes. The pandemic caused a reduction of twelve years in the average life expectancy in America in both men and women. The average age of those who died during the pandemic was 28 years old.[18] Undoubtedly, this led to major changes in labor patterns and employment rates. There were severe shortages of medical staff in some states as well. States which employed effective measures such as quarantine, social distancing, educating the public about personal hygiene, use of masks were successful in flattening the curve. Areas in the US that were hit by the pandemic experienced a sharp decline in economic activity, and the effects persisted until at least 1923. Most indicators of aggregate economic activity suffered modestly, and those that did decline more significantly right after the influenza outbreak, like industrial output, recovered within months.[19] Experts have observed that the pandemic did not have a landslide effect on the American economy. Stock prices continued to rise and the authorities in different states were able to evaluate the intensity of the virus and imposed measures and restrictions on transport and human contact which proved to be effective.

United Kingdom

History and Statistics

Britain was one of the major players in the great war and was severely hit by the pandemic. In 1918, a shipment containing 94,000 Chinese men who were carrying strains of the virus had arrived in south England. This is regarded as the possible entry of the virus into the country. The impact of the First World War on British society was inextricable from the influenza epidemic.[20] Troops returning from different parts of the world after fighting the war arrived at different ports and railway stations. They interacted with civilians and this led to the widespread of the virus into the civilian population. It was referred to as ‘Spanish Lady’ by British soldiers.

Troops traveling home by boat and train at the end of the war took the flu into the cities, from where it spread to the countryside. The disease swept across Britain in three waves: mild in spring 1918; devastating in autumn 1918, and moderate in early 1919. The port of Glasgow was the first place to record the flu, in May 1918, an unusual time of year for the sickness to appear. Young women, especially those working in factories, were worst affected. It reached London in June.[21] There were shortages of nurses and doctors since most of them either served during the war or were infected by the virus. The virus, particularly, attacked young men and especially women. Since Britain played a major role in the war, there was wartime censorship imposed on the media where newspapers were not allowed to report on the cases of infection to maintain the morale of people. A majority of cases went unreported due to this and authorities neglected the intensity of the virus which soon led to a pandemic across the globe. Britain was severely hit by the first and second wave of the pandemic. Most deaths, 64% in Britain, occurred during the second wave, lasting from September 1918 until January 1919.[22] Statistics show that the pandemic claimed 228,000 lives, killing almost 5%-6% of the population at the time.

Overall impact

The country was in poor conditions since most of the national resources had been exhausted by fighting the war. The virus, which mutated into a deadlier virus after the first wave, put the people who were already recovering from the war into greater misery. The second wave, between September and December 1918, was more virulent, attacking rapidly and often with fatal consequences. There had been 1,387 incidences of influenza between May 1918 and March 1919, 164 people being attacked twice and six people attacked three times, thus 1,311 people had been attacked altogether. The outbreak of the influenza pandemic in the summer of 1918 and its persistence until the spring of 1919 tested the public’s resolve and endurance to the utmost at a time when they were already under great stress.[23]  

Britain was one of the countries that was most hit by the pandemic and the early actions of the authorities helped to mitigate the consequences and number of cases. undoubtedly, the pandemic caused major changes in the labour patterns and employment rates in the country. The virus could be controlled and contained owing to measures deployed by concerned authorities and daily life activities were slowly resumed in various parts of the country. Extensive measures to create awareness about the virus were deployed by the way of distributing posters, leaflets which informed people about the ways they can use to protect themselves from contracting the virus. Techniques of social distancing, quarantine were used which yielded favourable results. Public places were disinfected on a regular basis and experts urged the public through newspapers to take precautionary measures.

LESSONS FROM THE PANDEMIC AND THE WAY AHEAD

In his forward to The Spanish Influenza Pandemic of 1918-19: New Perspectives, John Oxford referred to the event as ‘the largest outbreak of infectious disease the world has ever known.’[24] The ‘mother of all pandemics’ brought about historic changes in the dynamics of global demography. The deadly pandemic which originated when the great world war came to an end, gave birth to many practices and changes that continue to be prevalent in the modern world. At a time when a century has passed by after the pandemic, the world is now becoming a silent spectator to the alarming threat of coronavirus which has sent shock waves across the globe due to its fatality and pathogenicity. In this context, there are lessons that are significant takeaways from the great pandemic for countries combatting the present pandemic.

Firstly, information and data regarding the mortality and morbidity rates of the pandemic were either unreported or censored in countries that ignored and neglected the intensity of this microbe which killed millions of people in a span of just two years. This gross underreporting and underestimation of the number of causes contributed to the catastrophic aftereffects of the pandemic. Countries must take steps to ensure that the data regarding cases of coronavirus in their respective countries are recorded and accounted for. Free and unrestricted flow of correct and accurate data can help in building a population that is cautious about the risks posed by the virus.

Secondly, a major impediment to better management of the pandemic was the restricted access of the masses to public health care systems which were severely understaffed and underdeveloped. Access to health care was a far-fetched dream for the underprivileged in society. It is imperative that during the COVID pandemic, states formulate and incorporate policies that can assure access to affordable health care by all sections of the society. Public health care systems have to well equipped with adequate human and physical resources to carry out necessary operations with the purpose of mitigating the consequences of the pandemic.

Lastly, it was observed from the various incidents of the great pandemic that regions and states which imposed restrictive measures such as mandatory techniques of social distancing and quarantine were successful in flattening the otherwise rising upward curves. Records show that certain states in America where no strict measures such as these were not imposed reported a huge spike in the number of cases. Stringent measures warranting social distancing, quarantine, self-isolation, and use of masks and protective gear are being adopted now by states amidst the present pandemic that has a positive impact. States must ensure that such effective measures have to be imposed and employed immediately without any procedural or administrative delays.

The great pandemic bears certain similarities with the present pandemic. Both the pandemics were characterized by a virus that caused air borne respiratory illness. In both cases, no vaccines existed for curbing the pandemic, and measures such as social distancing, quarantine, lockdown, and masks are being used that have proved to be effective. At the same time, when Covid-19 pandemic has exposed the vulnerability of exiting healthcare systems and infrastructure of all the countries, the Spanish Flu interestingly, strengthened the idea of a welfare state under the constitutional framework.[25] It is pertinent to note that technological developments are the forerunner in the fight put up globally against the present pandemic. Cities under lockdown, are using drones to transport medical supplies, patient samples, and even spray disinfectants across large areas.[26] Online platforms have been developed by governments to keep a check on the infected and healthy portions of the population. The educational sector is heavily dependent on different modes of technology for its operations and these have removed hurdles or roadblocks in the continuance of academic functions for students and teachers alike amidst the pandemic. Many businesses have been able to carry out their services and operations on smooth lines owing to advancements in technology.

CONCLUSION

It is befitting to term the great pandemic as the mother of all pandemics which fundamentally altered history and gained more prominence than World War I. Medical experts defined the great pandemic as a medical holocaust and the lessons from the pandemic were utilized by countries to revamp and build support systems. The impact of the pandemic was very substantial and countries such as the US, UK, India, and Kenya paid a huge cost in terms of mortality rates as outlined in this research study. In a time where the world is facing new and strong challenges, the lessons from the pandemic should be used to build the roadmap for better and concrete health care and support systems across the globe. The resilience and perseverance of humankind will help the world to overcome the present pandemic which will rise as a better world for the future of tomorrow. There were positive and negative takeaways and lessons for each country to learn from an epidemic or pandemic which wiped out a substantial proportion of the global population. These have undoubtedly contributed to the development and strengthening of public health care systems across the globe.

[1] Barry J M. The great influenza: The epic story of the deadliest plague in history. New York, Viking Press, 2004.
[2] Taubenberger J, The Origin and Virulence of the 1918 “Spanish” Influenza Virus, Proceedings of the American Philosophical Society, 2006
[3] China Epicenter of 1918 Flu Pandemic, Historian Says, History (08 May 2020 06:12PM) Source Link
[4] Ibid
[5] Spanish flu: The deadliest pandemic in history, Live Science (08 May 2020, 04:30PM) Source Link
[6] Johnson P, Mueller J, Updating the Accounts: Global Mortality of the 1918–1920 “Spanish” Influenza Pandemic, Bulletin of the history of medicine, 2002
[7] History, Influzena Flu, Centers for Disease Control and Prevention. (09 May 2020, 03:30PM) Source Link
[8] Chandra S, Noor E, The evolution of pandemic influenza: evidence from India, 1918–19, BMC Infectious Diseases, 2014
[9] Biswas S, Coronavirus: What India can learn from the deadly 1918 flu, BBC News (09 May 2020, 03:30PM) Source Link
[10]1918 flu pandemic killed 12 million Indians, and British overlords’ indifference strengthened the anti-colonial movement, The Conversation (09 May 2020 03:50PM) Source Link
[11] Andayi F, Chaves S, Widdowson M, Impact of the 1918 Influenza Pandemic in Coastal Kenya, Understanding, Special Issue: Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic, Journal of Tropical Medicine and Infectious Disease, 2019.
[12] How the Spanish flu affected Kenya – and its similarities to coronavirus, The Conversation, (09 May 2020, 04:30PM) Source Link
[13] Ibid
[14] How the Spanish flu affected Kenya – and its similarities to coronavirus, The Conversation (09 May 2020 06:40PM) Source Link
[15] Garrett T, Economic Effects of the 1918 Influenza Pandemic: Implications for a Modern-day Pandemic, Report of Federal Reserve Bank of St. Louis, 2007 (09 May 2020 06:40PM) Source Link
[16] Spanish Flu: How America Fought a Pandemic a Century Ago, AARP, (09 May 07:50PM) Source Link
17] Byerly C, The U.S. Military and the Influenza Pandemic of 1918–1919, Public Health Reports, 2010 (09 May 2020 07:30PM)
18] The 1918 Flu Pandemic: Why It Matters 100 Years Later, Centers for Disease Control and Prevention (09 May 2020 07:40PM) Source Link
[19] Frydman C, Benmelech, E, The 1918 influenza did not kill the US economy, Vox CEPR Policy Portal (09 May 2020, 07:20PM) Source Link
[20] Tomkins S M, ‘The failure of expertise: public health policy in Britain during the 1918–19 influenza epidemic’, The Journal of the Society for the Social History of Medicine, 1992, p. 453.
[21]“Far too little, too late”: what happened when Spanish Flu hit Britain a century ago? History Extra (09 May 08:20PM) Source Link
[22]Butler A R, Hogg J L, Exploring Scotland’s influenza pandemic of 1918–19: lest we forget, The Journal of the Royal College of Physicians of Edinburgh, Vol. 37, 2008
[23] Knight, J E, The social impact of the influenza pandemic of 1918-19: with special reference to the East Midlands, University of Nottingham. (09 May 2020 08:30PM) Source Link
[24] Ibid
[25] Dutta P K, Covid-19 and forgotten lesson from Spanish Flu that killed 4 crore people. India Today.(09 My 06:05PM) Source Link
[26] COVID-19: Making the Best Use of Technology, Data and Information, Express Computer (09 May 07:50PM) Source Link

Tressa Maria Joseph

I am a fourth-year law student studying at Symbiosis Law School, Hyderabad. I am passionate about writing and am always ready to learn and grow. I have always believed in the power of a pen to change history and I aspire to make a mark with my writing skills. I hope you can have great takeaways from the articles penned by me.