The Spanish Flu: Lessons

a virus acid wrapped in protein a

hundredth of breath of a human hair

somewhere likely Kansas somehow through

the nose the mouth the cut latches onto

a healthy human cell and begins to

duplicate itself first between cells

then between surfaces then to another

person then another and another its

unseen exponential unpredictable scoop

up a bottle of seawater and you'll

collect more viruses than there are

people on the planet some are more

dangerous than others some are a help

they constantly evolve changing their

shape evading the immune system

spreading through people and affecting

themselves if by some magic the tiny

particles of saliva and mucus could be

made visible as a black smudge we

quickly would realize and how many other

ways we are apt to scatter bacteria and

viruses all around us yes even during an

ordinary conversation saliva and cos

particles escape our mouth and easily

reach others who inhale them as they

breathe

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next to the Nashua River and Lao County

in Massachusetts men from all over the

country lumber in ten weeks they build

1,400 huts 2,200 showers 60 miles of

heating pipes a bakery restaurants a

theater a post office the camp has his

30,000 men from every corner of the

United States 40 others are built across

the country any tables in northern

France similar camp is built for a

hundred thousand men the largest of its

type that's ever existed 1 million

people would pass through these camps

brought men together from different

communities rural and urban in denser

urban areas the likelihood of catching

contagious diseases is higher in

childhood thus giving immunity in rural

areas this is less likely to be the case

in camp Devens Massachusetts tables in

France and hundreds of other camps like

them viruses jumped around in a great

petri dish of an experiment first came

the measles one dots reported that not a

troop train came into camp wheeler in

the fall of 1917 without bringing 1 to 6

cases of measles already in the eruptive

stage they quickly passed between those

with no immunity then came the flu

in 1918 the global population was 1.7

billion within a year up to a billion

would be infected

ten million had died in World War one up

to a hundred million would die from the

flu that's as many as 1 in 17 people

across the globe

the term Spanish flu was quickly adopted

because Spain being neutral in the war

and having less restrictions on the

press was the first to report the

disease The Times in Britain blindly and

erroneously reported that the dry windy

Spanish spring is an unpleasant and

unhealthy season at all times

a spell of wet weather or of moist winds

would probably check the progress of the

epidemic some argue that the pandemic

even changed the outcome of the war 80%

of all American war casualties were

caused by influenza when Russia withdrew

from the war Germany redirected a

million man to the Western Front giving

the Germans superiority they gained a

thousand square miles of French

territory and quickly reached the Marne

River just 30 miles from Paris a million

people fled the capital but then the flu

struck devastated the German army and

halted its advance the Allies

reorganized and pushed the Germans back

leading to the Armistice and the end of

the war despite the devastation that it

caused and the influence it had the

Spanish flu was considered an addendum

to World War one and was largely

forgotten little was written of the

pandemic in the novels of the era

ironically one of the greatest poets of

war remembrance John McCrae died not

from a bullet but from the virus he

wrote in Flanders Fields the poppies

blow between the crosses row on row that

mark our place and in the sky the larks

still bravely singing fly scarce heard

amid the guns below the pandemic and

like the war would not be commemorated

for Barbara looked for her the carefree

hours of happy play nor the busy hours

of work and study

what had happened to her that she lies

there so hot and feverish so weak and

busy not miserable with suffering and

pain like who historic memories

the cerebral impression of a virus can

be erased from neurons or lay dormant

the signifiers towards pathogens the

records of which lay idle in dust books

or in half forgotten subconscious

remembrances occasionally they're called

upon to answer questions about the past

to give assurances or warnings to the

present what happened why what have we

learnt the story of the Spanish flu has

been told instead I want to ask not what

happened not to reconstruct it

temporally automatically but instead ask

what its memory might teach us what can

we draw out and learn that might help us

today epidemics always call upon

memories of the past but always in new

ways always illuminated and shaped by

the problems of the present the virus

strikes have risky is it not too

dangerous look at historic false alarms

dangerous taken for granted ignored and

VOC the Spanish flu the historian

Patrick Silberman writes that historical

comparisons as in 1918 appear more as a

kind of seductive or intimidating trick

than as a way of hunting down a useful

analogy so historic comparisons are

often presented as choices a palette of

analogies to guide us memories drool now

it's called upon first the memories are

placed on trial

we are the jury where have you been why

have you not been here to warn us they

try and reply which ones of us whose

memories

there were two groups primarily

responsible for the response to the

Spanish flu the military and

bacteriologists the military denied the

links between war maneuvers and the

spread of disease in many countries war

departments were almost solely

responsible for dealing with influenza

so much so that in France for example

80% of the country's 22,000 doctors were

serving in the war historian and

Rasmussen writes that a hybrid

configuration of priorities guided

hygienic interventions during the

pandemic in which not only medical

reason but also unstaple knowledge

military logic and administrative

practice were applied responses were

guided by the need for military logic

winning the war was more important than

the flu but medical reason guided

choices - in medicine the laboratory had

recently become dominant this invading

army is so tiny that can be seen only

through a microscope

it soldiers are the germs of

communicable disease some of these

disease-causing organisms are so small

that they cannot be seen even with the

most powerful microscope they are

detected only because they can pass

through the tiny holes of this filter

after the discovery of bacteria through

the microscope and the confirmation of

the germ theory of disease the lab

across the West was where advances were

expected to be made scientists working

on influenza thought they'd found it

schools a bacteria called Pfeiffer's B

Kilis discovered at the end of the 19th

century what they didn't know was that

the bacteria was a secondary infection

the flu is caused by a virus

this wouldn't be confirmed until later

in the 1930s and the vaccines being

worked on at the time would be useless

in France in 1918 the Undersecretary of

State ordered all Health Service

directors in regions of France to make

bacteriological examinations as complete

as possible for all influenza cases by

war by experimentation in the wrong

directions time was wasted on a mass

scale and the waste was institutional

disease is shaped by us by our responses

to it disease then is institutional

lesson one who is guiding the response

what might their own institutional goals

be where are their blind spots how do

these institutions interact with each

other historian Ilan allowi suggests

that the Spanish flu some visibility in

history may be the result of the

difficulty in constructing a narrative

right of the failure to respond to it if

history is written by the victors or

rather accounting of historic moments in

visible history may be more important

than what is popularly or frequently

written about the poor the marginalized

the dead rarely have their voices

memorialized whether the military or the

bacteriologists how likely is it that

those

that failed recorded and discussed the

ways in which they failed one of the

scientists involved later recounted that

well we were just 100% wrong and it's a

chapter I wish I had never written

viruses tried to kill history silence

its victims shame those who fail into

not responding viruses aren't just a

scientific or a biological problem then

there are historical one as historian

Niall Johnson writes influenza or any

other virus cannot be studied in a

vacuum they must be considered in their

normal environment as it's the

environment that provides the

evolutionary pressure and stimulus that

drives evolution the stimulus that

provides the need for change and the

need for a survival advantage

George Hutchinson writes in 1965 that

evolutionary play must be studied in the

theater this is also the doctor and the

sanitary inspector leave at 6:00 in the

morning to examine the ships that have

arrived during the night the quarantine

stations are under the United States

Public Health Service in Washington and

the procedure is the same in all ports

officers know in advance which ships are

due to arrive before the inspection they

study the health record to be ships and

also health conditions and the porch the

ship's have visited since their last

American inspection these institutions

responded to the material conditions

through which the virus spread had

spread both quickly and slowly on

September the 23rd 1918 the first case

was reported in San Francisco one month

later 75% of the nurses were sick and

all of the hospital that's full a

British nurse later accounted that it

happened so suddenly in the morning we

received an order to open up a new unit

for flu and by night we'd moved into a

converted convent almost before the

desks arrived the stretchers were in

6080 to a classroom we could hardly

squeezed between the cots and oh they

were so sick the SS Tulum though was

later described as a death ship that

slowly delivered the pandemic to islands

in the South Pacific one by one

transports mostly ships and trains

delivered the flu both geographically

and hierarchically epidemiologist

suggests that viruses usually spread in

two ways hierarchically as the disease

spreads across a country in different

stages and contagiously as it spreads to

the right neighborhoods personally

between people you can hierarchies types

of spread urban areas will be quicker

because of density ports airports train

stations etc are also at the top of the

hierarchy in Britain a doctor wrote that

the spread of disease along the lines of

railway from London to scythe and Epping

Waltham Colchester and Cambridge to

overcrowding in railway carriages and

while this continues it's useless to ask

people not to attend churches cinemas

and meetings where they do not get half

so much crowded together as on the

railway The Times reported in Britain

that the ports were first involved next

the disease reached London to which no

diet was brought

by travelers in the three trains from

London radiated again visiting

Birmingham Nottingham and other centers

it's still raging full fury in the

smaller country districts which have now

become involved this suggests staggered

interventions based on predictable

patterns we know where it were at first

we know who it will hit first so lesson

two viruses interact with the material

world environmentally not just with

people

what can the distribution of transport

hubs global cities and different stages

of diffusion tell us about how a virus

will predictably spread can this help us

predict the future in pandemics we

resort to fences psychological and

physical quarantine is often being a

first resort at the Naval Base in San

Francisco they quarantine all 4,000 men

for nine weeks quote forbidding all

Liberty sterilizing drinking fountains

hourly with blow torches compelling new

trainees to exist 20 feet apart from one

another one village in New Zealand kept

people and the virus at bay with

vigilantes armed with shotguns

ultimately though quarantine was seen as

a poor strategy cordoning off entire

villages cities and countries might

slightly delay an outbreak but is

ineffective against viruses that number

in the billions somehow they'll creep in

one man remembered in 1988 that father

was selected as the health officer we

had never had a health officer in our

time before but we felt now that we

needed one so dad went high to the city

limit sign I went with him and we put a

sign that said this town is quarantined

do not stop so it purposely isolated

ourselves but it wasn't enough the

disease came anyway the mailman brought

it but while quarantine to keep the

virus out might be ineffective socially

distancing was not only effective but

one study found that those areas that

intervened earlier recovered faster

economically after

this is consistent with studies on

epidemics that show that early public

health interventions reduce overall

mortality rates local governments and

cities notably not at a federal or

national level banned mass gatherings

closed schools theaters and churches and

studies show that where this was done

lives were saved cities that enforced

social distancing policies sooner saw

their economies proving better after the

pandemic was over lesson three keeping

influenza out is difficult and costly

slowing it spread is more effective but

enforcing public health measures came

with risks to racism other ring and

blame of course were widespread

minorities the poor that marginalised

were hardest hit and often

disproportionately affected in sometimes

surprising ways in Britain the

government mostly left planning and

restrictions to local authorities there

was though one exception cinemas where

government restricted the length of

showings and imposed regulations for

ventilation

but this rather than being based on

science was a product of class bias over

the immorality of cinemas one

commentator at the time wrote that the

cinema was the greatest enemy of the

epoch too intellectual culture it being

a reflection of lower stages of

evolution the shiftiness of the monkey

the film star and the imbecile one local

council inexplicably declared that

although we're alive to the possibility

that the certain amount of infection is

spread through theatres music calls

churches and chapels we consider that a

great deal more of the risk of infection

is to be ascribed to the cinema so

ideology skewed official responses but

ideas and cultures were changed too as a

result of the pandemic across Africa for

example many saw the pandemic as being

God's punishment for turning to the

false religion of the white man many

communities turned back to their

traditional religions and some have

argued that this speeded up the colon

zatia later in south africa though the

case has been made that the restrictions

put in place sped up the path towards

apartheid lesson for cultural and

ideological beliefs both direct our

response often poorly and are changed by

pandemics today's children will grow up

in a world increasingly free of

infectious disease someday we may

completely be free of it

but that's not likely in your lifetime

or it there's ultimately though there is

a theme that runs through memories of

the Spanish flu failure the historian

Niall Johnson sums up Britain's failure

like this the perception of disease the

fact that it was only influenza the

relatively mild nature of the first wave

in the spring of nineteen imperialist or

racist views and the superiority of the

English the confidence in scientific

medicine to find a vaccine the quest for

professional status of the profession

the power of scientific medicine

prevailing over preventive and the

rejection of state intervention many of

these contributed to a delay in the

reaction and recognition of the

existence of a problem particularly when

the second wave arrived in the autumn of

1918 a lack of planning hesitancy a

hubris repressed memory and cultural

arrogance

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so how might we summarize our lessons I

might be learned from viruses of the

past it is difficult to summarize these

lessons without being trite the central

one is that pandemics are a human

problem and humans change over time

there are no singular lesson is rather

aphorisms from past experiences of

pandemic should not be buried in the

historical record but memorialized

commemorates it ready to be accessed a

warning from the past a guide for

effective critique when the next virus

inevitably comes protect yourself

against infection keep pencils and other

things out of your mouth never take

bites of other people's food do not use

somebody else's drinking straw or glass

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