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By Larry Smith

Thursday, June 11, 2009.

“So vast was the catastrophe...that our minds, surfeited with the horrors of war, refused to realise it. It came and went, a hurricane across the green fields of life, sweeping away our youth in the hundreds of thousands and leaving a toll of sickness and infirmity which will not be reckoned in this generation.” -- article in the Times of London on the 1918 influenza pandemic.

One of the most devastating fires in human history began smouldering in March 1918 in the American midwest, and exploded that August to affect more than a third of the world's population.

New research confirms that the virus that caused the 1918 influenza pandemic is directly linked to the current swine flu virus, which has the potential to cause a new pandemic.

Scientists say the 1918 virus spread in pigs and eventually produced the current H1N1 swine flu virus, which has led health authorities to declare an international emergency.

The 1918 flu killed more than 50 million people around the world in just a few months - many more than the 16 million military and civilian deaths of the First World War, which was one of history's bloodiest. In fact, it killed more people than all the wars of the 20th century combined. More even than medieval Europe's horrifying Black Death.

A pandemic is a worldwide epidemic caused by a new virus to which people have no immunity. One of the big reasons for the 'mother of pandemics' in 1918 was that the virus had mutated so it could pass easily among people. And that is a feature of the current virus, which has infected over a thousand people in 21 countries since it was first reported on April 12.

There is another similarity too. A century ago, it was the young and fit who were most at risk from the flu – those in the prime of their lives. And that seems to be the case with the current outbreak. Dr Alan Hay, director of the World Influenza Centre says the most worrying aspect to this new virus is that it affects young, healthy adults.

The death rate from the current flu outbreak is low, but health experts fear that a second wave of infection this winter could be more lethal. That is also what happened in 1918. The first outbreak in Kansas was relatively mild, but a second outbreak in Europe later the same year produced alarmingly high death rates. People would go to work in the morning and be dead by evening.

Strangely, this terrible event in the world’s recent past kept a very low profile until recently. Parents and grandparents never mentioned it. University of London history professor, Dr David Killingray, noted that: “despite the fearsome impact, there seems to have been a collective amnesia...the full impact of the epidemic appears to have been cloaked by the pre-occupations of a horrendous war.”

At first, no-one knew what caused the epidemic, but rumours abounded. Many believed it was a bio-war unleashed by the Germans. Evangelist Billy Sunday - the Billy Graham of his day - thought it was a punishment for sin. "We can meet here tonight and pray down the epidemic," Sunday said. But even as he spoke people in the audience collapsed with the flu.

It was difficult to avoid. Everyone has to breathe and every sneeze spreads millions of infected droplets into the air. As a children's nursery rhyme of the day put it: "I opened the window and in-flu-enza."  The 1918 virus had a mortality rate of 2.5 per cent compared to less than 0.1 per cent in previous flu epidemics. Doctors reported that patients "died struggling to clear their airways of a blood-tinged froth that gushed from their nose and mouth."

The 1918 pandemic circled the globe in a few months, following trade routes and shipping lanes. In the early years of the 20th century public health systems were limited, and contemporary observers were often vague in recording causes of death, particularly in outlying colonies. But Killingray estimates about 100,000 flu deaths in the Caribbean, with nearly 30,000 in British territories including the Bahamas:

“Its spread and effects on certain islands and areas seemed to be arbitrarily selective, and there are no clear answers why one place suffered high morbidity and mortality rates, another widespread infection but low mortality, while other places remained virtually untouched by the disease. Such variations may have been due to prompt quarantine by the authorities, for example, in the Bahamas, which although in close proximity to the United States, must have been helped by a dearth of wartime shipping.”

We were luckier than most. The devastating effects of earlier cholera epidemics led to the Quarantine Act of 1905 and construction of an isolation station on Athol Island, which operated until the 1920s. This efficient quarantine system seems to have preserved the Bahamas from infection during the 1918 pandemic. Barbados was similarly fortunate.

However, a 1919 Colonial Office report did note that “many” of the 2,500-plus Bahamian migrant workers in the US became infected and died during the pandemic. Bahamian migration to America peaked during this period, and the population of the islands actually fell for the first time. The total recorded in1921 was marginally lower than that in 1901 – about 53,000.

As a non-notifiable disease, influenza was not covered by international quarantine regulations in 1918. And when the virus mutated in August of that year it spread rapidly and with unprecedented virulence, helped by wartime disruption and troop movements. Among British territories, Jamaica, Guyana and Belize were the most severely affected in the region.

“The virus raged through the plantations and slum housing of the low-lying coastal towns.” Killingray wrote in the 2003 edition of the Caribbean Quarterly. “East Indian labour was hard hit, but not as severely as Native Americans. By early October the influenza pandemic was well-established in Central America and from there it reached Belize on the eleventh of the month....and a little later that month it appeared in the Bahamas

In Jamaica the authorities restricted rail travel, fumigated money and suspended postal service. Schools and shops closed and social events were cancelled, but by early November the disease had affected the entire island, with the Gleaner reporting that “coolie labour on the estates has been reduced almost to vanishing point.”

Medical facilities were overwhelmed across the region. In Belize infection rates were as high as 80 per cent and crops went unharvested. In Guyana there were serious strains on burial society funds as plantation labourers were decimated. And some Amerindian tribes were said to have been wiped out.

“This epidemic has been the most severe visitation of disease within the memory of any colonist,” Guyana’s acting surgeon-general concluded at the time. “The almost universal prevalence and high mortality rate have caused untold suffering.”

As you might expect, rum was considered one of the most potent treatments for the flu at the time. Other popular remedies included Horlicks, insecticide, Palmolive soap and tobacco.

In the Bahamas there were no official reports of deaths from the flu, but recent estimates say as many as 60 may have died during the epidemic. In Guyana, with a population of 310,000, there were some 12,000 deaths. And perhaps 10,000 in Jamaica, out of a population of 850,000.

“These figures take account of unrecorded deaths, those reported as dying of other causes such as fevers and pneumonia – often complications of influenza - (and) long-term influenza infections such as encephalitis lethargica,” Killingray explained. “The pandemic of 1918-19 came suddenly and moved with deadly speed. The largely laissez-faire systems of government were caught ill-prepared, while the medical and scientific professions were unable to provide effective treatment or cure."

Today, the fear is that a flu pandemic will stall the global economy, overwhelm hospitals, and produce chaos in local communities. Bahamians rely on cross-border travel to make a living, for example, and it was only five years ago that Toronto’s tourist business collapsed overnight during the SARS outbreak. The strain of a collapse in travel added to the current economic meltdown could threaten our very social fabric.

But the 2003 SARS outbreak and a small but rising number of deaths from bird flu since 2005 has spurred world health authorities to make better preparations. Bird flu has claimed 257 lives and infected over 400 people around the world, but it is still considered "inefficient" in its transmission among humans. The good news, experts say, is that although the current swine flu virus is highly transmissable, it appears far less lethal than bird flu at this point.

Also, since 2007 the World Health Organisation's hand has been strengthened by a global agreement on surveillance and response measures to acute public health risks that have the potential to threaten people worldwide. These International Health Regulations aim to limit interference with travel and trade while ensuring public health through graded response levels.

That is good news, because experts say it can’t be ruled out that we could be facing the first flu pandemic in over 40 years.


Larry Smith writes a column called "Tough Call" every Wednesday for the Bahamas Nassau Tribune. A former reporter and editor, he now operates a communications agency in Nassau -http://www.bahamasmedia.com. He also blogs at Bahamapundit.


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