By Tacita Quinn
The Pandemic Century: A History of Global Contagion from the Spanish Flu to Covid-19
Mark Honigsbaum, WH Allen, 2020
The Rules of Contagion: Why Things Spread - and Why They Stop
Adam Kucharski, Wellcome Collection, 2020
Laura Spinney, Vintage, 2018
In 1918, when the world was hit by a highly contagious form of influenza, an array of social and political factors determined who was likely to come into contact with the disease, how people reacted to the developing crises and who was blamed for its emergence. Shrouded by the wider history of WWI, the influenza pandemic has, until recently, seen little historical consideration in its own right. However, historians and scientists now estimate that between 50 and 100 million people died of what would later become known as ‘Spanish flu’. Just over a century after this cataclysmic outbreak, the world is again in the midst of a pandemic, and writers have been keen to establish comparisons between the two crises. Such observations have illuminated a collective failure, during the outbreak of Covid-19, to learn from past mistakes and to establish an effective approach to global public health crises.
Spanish flu and Covid-19 have stark differences: not only do the diseases behave in distinct ways, but the context in which the current pandemic has been received and understood has also differed. Today’s world is far more connected, initiatives are global rather than national, public health infrastructures are far more advanced and understandings of infectious diseases have improved significantly. What should be recognised, however, are the similarities in human responses to pandemics. Both ‘Spanish flu’ and Covid-19 heightened global tensions by blaming particular countries for the emergence of the outbreak, exacerbated existing social inequalities, and were similarly met with complacent approaches that ultimately increased the death toll. In the case of Covid-19, many of these consequences could have been avoided had countries been more willing to follow the advice of epidemiologists who warned of the crisis that a pandemic with similar rates of infection to Spanish flu could provoke.
In The Pandemic Century, Mark Honigsbaum argues that the 1918 influenza virus most likely originated in American training camps, which were set up to accommodate the demand for soldiers when the USA entered WWI. He argues that young men from different immunological backgrounds, who were thrust together in close living quarters to complete their military training, created the perfect conditions for the virus to develop. This is just one of three prevailing theories about how this particular strain of the influenza virus first emerged: another concerns a farmhand in China who experienced flulike symptoms at the same time; the third is the hypothesis that the first case originated in a French hospital on The Western Front. Although seemingly inconclusive, theories of where the outbreak originated have narrowed considerably since the turn of the 21st century, and it has been reliably proven that Spanish flu did not originate in Spain.
In The Rules of Contagion, Adam Kucharski highlights the damage a ‘patient zero’ narrative can generate. In reference to both Spanish flu and the AIDs epidemic, he points out that during outbreaks of disease, the hunt for patient zero almost always takes on a derogatory political form. Unlike the majority of countries in western Europe, Spain was neutral throughout WWI and the Spanish press remained uncensored for the duration of the conflict. Reports of the spread of influenza in Spain surfaced first due to the absence of wartime media suppression, and the idea that it was a ‘Spanish’ affliction soon circulated. Spain was not the only nation to be falsely accused, and most countries had different origin theories, pinning the blame for the highly contagious and painful affliction on the most recognisable ‘other’. In Pale Rider Laura Spinney points out that Polish people ‘called it the Bolshevik disease, the Persians blamed the British, and the Japanese blamed their wrestlers’. Deepening resentment towards the ‘other’ fuelled national and international suspicion, giving way to class, racial and colonial conflict.
In the case of Covid-19, there was no ‘hunt’ for patient zero. Nevertheless, when doctors traced the initial infection to the Huanan Seafood Wholesale Market in Wuhan, China, derogatory associations between the Chinese and the coronavirus were made. In early 2020, Donald Trump began referring to Covid-19 as the ‘China virus’ . As Honigsbaum argues, ‘all Trump thought he needed to do to keep America safe [...] was to bar Chinese citizens and other foreign nationals from entering the US’. In late January, a man of East-Asian descent collapsed in Sydney, Australia and was refused CPR by bystanders because of the fear that he could be carrying Covid-19. He died at the scene of what was later discovered to be a heart attack.
In 2015, the World Health Organisation (WHO) recommended that scientists should avoid place, people and animal specific virus names for this very reason, citing both the stigmatisation caused by ‘gay-related immune deficiency’, an early name for the AIDs epidemic, and the unnecessary slaughtering of pigs during the swine flu pandemic. Despite this, politicians and the press are still quick to point the finger. Authorities in Britain and America were swift to criticise the Chinese government for their poor handling of the crisis in early January, but were reluctant to implement quarantine measures themselves. The continued criticism of Chinese authorities follows a similar narrative to the accusations of blame that arose during the years of the Spanish flu.
On a national level, public health crises tend to exacerbate inequality, but they also make pre-existing structures of prejudice based on socio-economic conditions more apparent. In the late 19th century, Louis Pasteur’s ‘Germ Theory’ (1861) converged with imperialist and hierarchical concerns to form the idea that the ‘racially inferior’ were more likely to cause or spread disease. The ‘fittest’ thrived, while other people were doomed to live in poverty because they ‘lacked rigour, self-discipline and ambition’. These attitudes informed the resolve of both the oppressor and the oppressed; the better off understood their minor losses as a token of their racial superiority, whereas those less fortunate saw it as an example of their maltreatment by the dominant class.
In 1918, when Spanish flu arrived in South Africa, the Dutch Boers (farmers) used the rhetoric that accompanied the pandemic to incarcerate Xhosa and Zulu figureheads and inform theories of racial difference. A Xhosa ixwhele, or herb doctor, named Nontetha Nkwenkwe fell ill during the first wave of the disaster and recovered, but her fever dreams inspired the growth of a new religious movement that linked the pandemic to the end of white domination in the Eastern Cape. Fearing the popularity of this sentiment, the Afrikaners declared Nkwenkwe clinically insane, and she was incarcerated in a psychiatric hospital in Fort Beaufort. Nkwenkwe was not the only South African prophet to have emerged at this time, and many of these religious figures were associated with the growth of liberation movements like the African National Congress. The disaster, though it killed a higher percentage of the native African population than Afrikaners, heightened anxieties about the long-term stability of Boer domination, leading to the ban on celebrating Nkwenkwe until the end of the apartheid regime in 1994. Spinney explicitly argues that the disaster pushed South Africa closer to apartheid, as the pandemic was a means to enforce a racist regime.
Conversely, in India, where an estimated 18.5 million people died of influenza, colonial rule was weakened by British inability to handle the disaster. Spinney notes that the rivers of Bombay City became ‘clogged with corpses’. The long-held indifference of British colonialists towards the conditions that the native population were living in became a significant cause for concern. When the colonial government finally appealed for help, the fullest response came from organisations closely linked to the developing Indian independence movement. Mahatma Gandhi had fallen ill with the flu in the summer of 1918, but he had recovered from his illness by the time mass grassroot support had begun to develop in opposition to the poor system of public health in 1919. Influenza undermined the authority of the British and increased disaffection amongst the native Indian population, exacerbating public disproval of the colonial regime and creating a base from which the Indian independence movement could formally begin.
Covid-19 has likewise stoked existing tensions and sparked movements for change. The morbidity rates for Covid-19 in Britain and the United States show that the risk of death from the coronavirus is higher for people from Black, Asian, and minority ethnic backgrounds (BAME). Public Health England found that people who are BAME have between 10% and 50% higher risk of death compared to white Britons. The British authorities delayed the publication of a report commissioned to investigate the reasons for this high death rate. Whether this is indicative of socio-economic inequality, racist attitudes, structural racism in the NHS, or a combination of all three, this injustice has strengthened the resolve of activists campaigning for the Black Lives Matter movement since the brutal murder of George Floyd by police in Minnesota. Civil rights activist Reverend Al Sharpton has suggested that the conditions of lockdown have accentuated the public attention given to this murder, as those confined to the home are even more attentive than ever to the 24-hour internet news cycle and have had to directly confront and contemplate the reality of racism and police brutality.
Although the news cycle continues to be an important way of spreading information quickly, the internet has become a vector of misinformation for Covid-19 and other political developments. Similarly, during the Spanish flu, the assumption that it would behave in a similar way to previous flu epidemics meant that most physicians dismissed it as inconsequential. This insouciance would have a profound effect on the way people would react to public health initiatives. In New York, many refused to comply with the quarantine measures introduced by the city’s health commissioner, as they regarded the flu as a superficial threat. Indifference towards outbreaks has been exhibited on a global scale in responses to Covid-19. In Wuhan, celebrations for the Chinese Lunar New Year were initially put before the health of the public. In England, the Cheltenham racing festival was given the go ahead just ten days before the start of a ‘lockdown’, and in Brazil, President Bolsanaro has thus far refused to implement any lockdown measures.
By the end of the influenza pandemic, Kucharski explains, there were ‘enough immune people to prevent transmission’. Spanish flu did not dissipate because there was a new understanding of the disease and a vaccine had become available, but because the disease ran out of susceptible hosts. Consequently, even after the pandemic had ended, not much was known about the disease and many were inspired to study influenza. An attack of influenza suffered by a medicine student, Macfarlane Burnet, at the University of Melbourne, had a profound impact on his direction of study and ignited, as Honigsbaum explains, ‘a lifelong fascination with flu and with [...] “the natural history of infectious disease”’. In 1960, he was awarded a Nobel Prize for his research into immunology. The inspiration kindled in individual scientists was replicated on a national level. Many countries set up or reconstructed ministries for public health in the 1920s. According to Spinney, Lenin was ‘ the first to implement a centralised, fully public healthcare system’. Similarly, under the Weimar Republic in Germany private healthcare began to shift into the public sector, and, in 1925, all US states were inquiring into national morbidity during the 1918 pandemic. Many nations were inspired to find new ways of supporting a population through a public health crisis to avoid the catastrophe and panic faced during the years of the Spanish flu.
There is no doubt that a similar sense of panic felt during the Spanish flu has been replicated during the coronavirus pandemic, and hopefully a greater effort will be made to support pandemic research and public health initiatives in the coming years. Despite coronavirus outbreaks such as SARS (2003) and MERS-CoV (2012), coronavirus research, according to Honigsbaum, ‘has been a victim of boom and bust funding’. After the SARS outbreak of 2003, US coronavirus funding increased from under $5 million to over $51 million annually. However, this dropped by over $30 million over the course of subsequent years. Further negligence is highlighted by Donald Trump’s decision in 2018 to disband the pandemic unit in the national security council and the global shortage of Personal Protective Equipment. Before the outbreak of the coronavirus there had been no end of warnings from the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) to end the ‘cycle of panic and neglect when it comes to pandemics’. It is therefore imperative that after Covid-19, nations, people and organisations remember why measures that protect public health are essential for the prosperity of citizens, just as they did after the Spanish flu.
There are numerous reasons as to why the 1918 pandemic has had little historical attention in its own right until the 21st century. The pandemic was felt far more severely by people that lay outside the realms of traditional western historiography, large scale epidemics were still commonplace and accounts of its impact have been obscured by the wider history of WWI. In addressing this deficit, Spinney, Honigsbaum and Kucharski all seek to understand and use the history of Spanish flu in different ways. Spinney focuses on the direct consequences of the disease worldwide, whereas Honigsbaum concentrates more acutely on the medical history of the outbreak and other 20th century epidemics. In contrast, Kucharski uses the pandemic more theoretically, to chart other types of contagion and assess the factors that influence infection. However, all three writers emphasise the importance of pandemic preparedness both infrastructurally on a national level, and globally, with regards to funding international initiatives and institutions dedicated to worldwide responses.
What has become increasingly clear is that there has been a significant loss of life from Covid-19, not because nothing like this had happened before, or that there have been no warnings from public health experts, but because of a collective failure to prepare for the pandemic that public health experts have warned about. More needs to be done, not only in addressing pandemic preparedness and our attitudes towards outbreaks of disease, but in attempting to eradicate the inequality that epidemics make more apparent. Covid-19 will certainly not be ‘forgotten’ as the Spanish flu has been for long, but it is essential that authorities readdress their failures in dealing with this crisis to avoid repeating the same mistakes.
TACITA QUINN reads History at St Edmund Hall. Overwhelmed by a sense of impending doom and the worry of writing a caption, she has resigned herself to the heavy drinking of her Celtic forbearers.
Art by Maria Nikolova