In 1918, the flu pandemic killed 9000 New Zealanders. Are we facing a repeat with the COVID-19 coronavirus?
Another answer to the question would be that history never repeats. It only appears to. Events are fixed in time, and cannot be exactly repeated. Historians are well aware of the lawyers’ maxim that ‘circumstances alter cases’: the same disease will have different impacts and outcomes depending on the context. The 1918 influenza pandemic occurred towards the end of the First World War, and was probably made worse by wartime conditions. In 2020, the world is mostly at peace and many countries are cooperating to fight this outbreak.
New Zealand has had early warning from events overseas but in 1918 the warning signs were largely ignored by a complacent and under-staffed Department of Public Health, and the government of the day was slow to react. Telegrams between the government and local councils about the influenza were sometimes delayed; Wellington's death rate was twice that of Christchurch, mostly because of such delay. By then Armistice celebrations had helped to spread the infection. There was no pandemic plan, and the army had to be asked to set up temporary influenza hospitals. It went on to kill 9000 people – no event has killed so many New Zealanders in such a short space of time.
The big lessons from 1918 were that delay is dangerous and complacency kills. Towns that organised early and well, like Nelson or Christchurch, kept their death rates low; places that delayed, like Wellington or Invercargill, suffered higher death rates. Fortunately, we now have a robust national Pandemic Plan, which incorporates lessons learned from 1918 and more recent outbreaks, and prescribes a ‘whole of government’ response. The Ministry of Health has been reminded of the threat from pandemic disease by the 1918 flu centenary events of 2018 and the unveiling of a national memorial to the victims late last year. We have stockpiles of antibiotics, anti-viral drugs, face-masks (and body-bags) for a major emergency. New Zealand is vastly better prepared for a pandemic than we were in 1918.
One key difference from 1918 is that the world is now much more connected and mass jet travel has enabled COVID-19 to spread far from its origin in China in a matter of weeks, rather than months. That makes the threat more urgent, and most governments have been responding with commendable alacrity. A more subtle difference is that this virus has a longer incubation period than influenza, and the role of symptomless ‘carriers’ appears to be much greater than it was in 1918. That makes border control more difficult, and although some countries have already imposed passenger screening at airports, infected individuals will inevitably slip through and cause local outbreaks. Health authorities need to find these people and trace their contacts, then isolate them from the general public. This is the ‘Stamp it out’ phase of our Pandemic Plan, which is starting to happen. In such cases individual civil rights must give way to the urgent needs of the common good.
But we are still at the ‘Prevention’ phase of this outbreak, and this would be a good time to start new habits of personal hygiene and protection. Keep your distance from people who have the sniffles. Cough or sneeze into your arm or shoulder. Avoid crowds and lifts. Avoid kissing, hugging or shaking hands with strangers. (Greet them with a Japanese bow, or a friendly elbow nudge, as became common in the Middle East during the 2012 MERS outbreak.) Wash and dry your hands thoroughly and frequently, especially after every visit to the toilet. (Kiwi males are notoriously negligent in this respect.) Don’t spit. (Another Kiwi male failing.) Use tissues to blow your nose, not a handkerchief. Regularly clean phones, computer keyboards, car steering wheels, doorknobs and handrails with sanitising pads. Listen to reliable official reports and ignore the rumours spread by social media.
There was much debate in 1918 about face-masks. Some countries and cities overseas made them mandatory, but New Zealand never did. Masks afford only limited protection against viral infection, and the WHO does not recommend their general public use. However, health professionals caring for influenza cases need to wear N95 masks with eye protection, and if a major COVID-19 pandemic were to develop, with many cases being nursed at home, carers would then be well-advised to wear a mask.
New Zealand now has one confirmed case, from Iran via Bali, in a woman who is in isolation in Auckland City Hospital. More cases are likely to appear, but we must take note of the scientific research from China which indicates very low case-fatality rates for children and most adults. As with influenza, those most at risk are the elderly and people with pre-existing health problems. As in 1918, the vast majority of those who catch this virus are likely to recover.
For the historian, the most remarkable difference between the 1918 flu and the COVID-19 outbreak is the unprecedented scale and promptness of the Chinese government’s response in isolating whole cities and regions, regardless of the economic cost. The rest of the world may yet be grateful for this. It is still early days, but so far we are doing all the right things to avoid a massive pandemic on the scale of 1918. The international scientific community has responded with astonishing speed to share information and start work on a vaccine. But we can also do our bit at local and individual levels to prepare for the worst, by reviving neighbourhood watch groups and prudently adding to our stocks of tinned food, bottled water, toilet paper, sanitiser sprays and paracetamol. Stay calm, avoid panic-buying, and follow the instructions of our health experts.
The Ministry of Health asks people who have visited countries or areas of concern and who have developed symptoms of fever, cough or shortness of breath to seek medical advice by first phoning Healthline’s dedicated COVID-19 number 0800 358 5453 or contact your GP, including phoning ahead of your visit.
Dr Geoffrey Rice is Emeritus Professor of History at the University of Canterbury and author of Black November: the 1918 Influenza Pandemic in New Zealand (2005) and Black Flu 1918: the story of New Zealand’s worst public health disaster (2017).