Spare a thought this morning as you open up or login to the Herald over breakfast. With their toast and porridge, Herald readers 100 years ago to the day – on January 25, 1919 – read the news of the suspected arrival in their midst of what was to become the most threatening health crisis Sydney has ever faced – the so-called Spanish flu epidemic.
Masks were made compulsory during the Spanish flu outbreak in Australia. Credit:National Museum of Australia
The epidemic had emerged in Europe in mid-1918 and, as that year unfolded, developed into a global pandemic, cutting a swathe through Europe, the Americas, Africa, Asia and, ultimately, neighbouring New Zealand. Quarantine procedures were introduced at all Australian ports in October 1918, and for a while public health authorities believed that Australia might be spared the pandemic’s ravages.
In retrospect that view was probably an understandable case of hope overriding realism. In early January 1919, cases of pneumonic flu were recorded in Melbourne, the disease probably having been introduced by one of the overseas vessels quarantined there.
From those small beginnings the epidemic spread across Australia, leaving a heavy mark on hundreds of communities, in all carrying off more than 12,000 people. The place to most feel its brunt was Sydney, where an estimated 36 to 37 per cent of the population went down with the flu and more than 3500 residents died over six months.
That attack and death rate in the city today would equate to something like 1.8 million cases and 22,000 fatalities. It is not difficult to imagine the hysteria that would engulf Sydney if a present-day epidemic of that magnitude was to hit.
Add too the fear that would be generated if, as in 1919, it disproportionately killed young people in the prime of life, and reports circulated of people waking fine in the morning and being dead from influenza by nightfall.
In an effort to contain the epidemic, the NSW government closed all theatres and places of public entertainment, schools and public telephones. It made wearing of masks compulsory on trains, trams and ferries and in public streets, places and buildings. It prohibited church services and race meetings.
Perhaps showing a peculiarly Australian quirk, pubs (and restaurants) were initially allowed to stay open, but on the proviso that patrons had 250 cubic feet of clear space to themselves. Later, when pubs were closed, there was a rush for bottled beer and whisky.
There were strict quarantine procedures for confirmed cases and contacts. Additional inoculation depots were opened.
Hopes were raised through February as no signs of an epidemic explosion seemed to be emerging. The government relaxed some of the restrictions regarding public gatherings and compulsory masking. In late March, new cases picked up, growing into a wave that peaked in the middle two weeks of April with about 1000 hospital admissions and close to 300 deaths in both weeks.
A Spanish flu military hospital camp in Funston, Kansas.
Whether the lifting of the regulations played any part in this rise in tempo can only remain conjecture, but masking regulations and tight restrictions on public gatherings were quickly reimposed, along with a fresh inoculation campaign. Deaths started to fall away, giving rise to hope that the epidemic was petering out. On the advice of its medical advisory body, the government lifted all restrictions.
An even stronger epidemic wave struck in June. In the second half of that month, more than a thousand people died and the city’s hospital and medical system were overwhelmed.
By early August, the the epidemic had tailed away to a trickle, but those six months of the epidemic still stand as the most intense health crisis the city has ever endured.
But the 1919 epidemic has numerous lessons to teach us. For starters, another global flu pandemic is inevitable, not necessarily of the same deadly magnitude, but certainly many lives will be lost.
For some, the H5N1 bird flu scare of 2005-07 was a frightening portent of such a possibility. Subsequent epidemic events (H1N1 swine flu, 2009; H7N9 bird flu, 2013-present) have raised similar fears. Fortunately, a "jumping the species" transformation of any of these viruses into a strain highly contagious and deadly among humans has not occurred.
That doesn’t remove the fact that flu pandemics are recurrent events and that the world is overdue for another one, whether from mutation of one of the above strains, or some other evolving variant. The US-based Institute for Disease Modelling has estimated almost 33 million people around the world would die in just six months in the event of a very contagious and virulent 1918-19-style airborne pathogen.
Public health preparedness for a serious future epidemic is thus essential. A lot of effort has been put into this by federal and state authorities (and international agencies) since the 2005 bird flu scare. They stand us in good stead. At the same time, we can virtually be certain that our health care facilities and medical personnel would again be overwhelmed.
Fear would again take strong hold in the community. Critical to keeping this in check would be responsible presentation of the epidemic to the public by the media. Any lurid reporting would be disastrous, inflaming public unease.
Finally, in any serious deadly outbreak, government authorities would be forced to bring in various preventative measures as in 1919 – inoculation, quarantining, prohibiting some public gathering, closing schools, and the like. In today’s very civil liberties-conscious society, winning community acceptance of these necessary restrictions over individual rights would be a major challenge.
Dr Kevin McCracken and Professor Peter Curson are health researchers at Macquarie University.
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