Thursday, April 30, 2009
A worrisome comparison
John Long
Recent columns
From the RoundTable blog
The swine flu has hit the headlines again. As I write this, ground zero seems to be Mexico City, where perhaps 150 have died and where even President Obama may have been exposed. In the U.S., one death has been reported, and cases are appearing in multiple states. By the time you read this on Thursday, the numbers will doubtlessly be worse. Of course, it is too early for undue alarm. At this point we really don't know much. But caution and vigilance are certainly in order, especially since virologists are again openly mentioning 1918.
For non-history buffs, that may not mean much. But as a professor of 20th century history and a local historian, hearing "flu" and "1918" in the same sentence is portentous. What happened in 1918-19 was a disaster of global proportions, yet it remains largely an untold story.
In early 1918, doctors began to notice an increase in influenza cases. The particular strain was debilitating, a "three-day fever" that knocked victims flat for a miserable few days. Most recovered, but others succumbed quickly to respiratory distress. Some died so suddenly they were found in the streets trying to make it to a doctor.
Where the devilish infection began is a matter of debate. Some say China, others South Africa. But when one-third of the population of Madrid contracted the mysterious aliment, it was dubbed the Spanish Flu. (Spain, neutral in the Great War, was not under the wartime censorship rules that kept the outbreak quiet elsewhere in Europe.)
It spread rapidly through civilian populations across the globe, but struck military encampments particularly badly. Both my grandfathers contracted the flu in army barracks half a continent apart. That was not unusual -- for some reason the Spanish flu, unlike the seasonal flu strains we see every year, affected people in the prime of life more than the young or elderly. There is some evidence that is true of the current swine flu as well -- another troubling portent.
Our local communities were not unaffected. In Salem, the first outbreak came in September 1918 at the Baptist Orphanage, where the first fatality was the nurse who was attending the sick children. Some 500 cases were reported in the next few weeks, and 14 died by February. In Roanoke at the peak of the epidemic there were 200 new cases per day. The absence of doctors -- many were in the military -- made matters worse. Here, as elsewhere, quarantines were imposed, schools shut down, theaters and churches were shuttered. Salem, for some reason, forbade the sale of soft drinks, thinking that may quell the sickness. Life came to a standstill while death held sway.
Before it ran its course, the flu had claimed perhaps 40 million lives worldwide. That's far more than World War I had killed, more than the Medieval bubonic plague in its worst outbreak. One-quarter of all Americans contracted "the grippe" and some 675,000 died, enough to lower the average American lifespan for a while. There were smaller recurrences in 1920, but soon the epidemic had faded as mysteriously as it had begun.
I'm no epidemiologist, but from what I've read it seems the most virulent forms of influenza, including the 1918 strain, are cross-over infections affecting pigs, poultry and people. I heard one researcher opine that the current strain of swine flu shares genetic markers of all three species, as did the Spanish flu 90 years ago. That doesn't promise a pandemic, but is reason for worry.
There were worldwide flu outbreaks in 1957 and 1968, but 1918 set the bar, and when doctors mention that date, we need to pay attention. I often tell students in discussing the 1918 flu pandemic that historically this sort of thing seems to happen every 80 or 90 years. Then I watch the students who can do math realize the implications.
If a pandemic today reached the proportions of 1918, the loss of life would exceed 100 million people worldwide. Of course, there is not yet reason to think such a proportion is likely. Better antibiotics, greater awareness of contagion and such devices as artificial respirators would mitigate such losses, and would have saved many lives in 1918. Still, if chances of such a global threat are small, they are not zero.
The swine flu at this point warrants concern, but not panic. Still, wash your hands often, and if you feel feverish, don't breathe on me.
Long, a Roanoke Times columnist, is director of the Salem Museum and teaches history at Roanoke College.
