Lessons of 1918-19 Spanish flu epidemic guiding preparedness

The old newspaper clippings spread out before Dr. Garry Humphreys tell a story that still packs a punch five years into the new millennium.

The tale that's documented in The Evening Examiner articles dates back to the fall of 1918 when an outbreak of Spanish influenza caused havoc and health concerns around the globe.

As many as 50 million people worldwide died from the Spanish influenza epidemic. Peterborough wasn't spared as several local residents died due to Spanish influenza or complications associated with it, such as pneumonia. From mid October to early November 1918, local health authorities ordered theatres, schools, churches and other public places in the city closed so people couldn't gather and possibly spread the disease. For many citizens, the closing battles of the First World War were temporarily forgotten as they tried to keep their homes free from Spanish influenza or cared for loved ones affected by the virus.

"It's fascinating to look at these articles," says Dr. Humphreys, the local medical officer of health who heads the Peterborough County-City Health Unit.

"I think it's important to pay attention to history because history teaches you a lot."

The lesson for Dr. Humphreys and other public health officials is to be prepared for the worst. As he casts one eye on the past, Dr. Humphreys has the other focused on the future for the next big influenza outbreak, or pandemic, which public health experts say isn't a matter of if but when.

"A pandemic is not like a plane crash, which is an isolated, one-time incident," Dr. Humphreys explains.

"An (influenza pandemic) will be ongoing for several weeks...and could make up to 30 per cent of people ill."

Influenza, or the flu, commonly hits in the winter months, affecting different people differently. Some get fevers, the sniffles, nausea or other mild symptoms. For some, especially young infants and frail older adults, influenza can be more serious and even lead to death. Many people get immunized with a flu shot every fall to reduce their risk of getting influenza.

Every 20 or 30 years, a new strain of influenza comes along that morphs into a potential killer. An influenza pandemic ensues as the new strain sweeps across continents and ravages people who are highly susceptible to getting sick or dying from it and for whom there is not a vaccine readily available to protect them.

In the 20th century, pandemics occurred in 1957, 1968 and 1976 but none took the toll that the Spanish influenza pandemic of 1918-19 did.

In many ways, the world in 1918 was not ready for such a pandemic. Modern medicine was still in its infancy and the resources of most Western countries were focused on winning the Great War raging in Europe. As a result of fighting, soldiers were moved around constantly or squeezed together into trenches and barracks, thus creating ideal conditions for the Spanish influenza to spread. It was akin to a perfect storm.

There are different theories on where the Spanish influenza pandemic originated. Many believe it started in Europe but author John M. Barry, in his recent book The Great Influenza: The Epic Story of the Deadliest Plague in History, speculates the pandemic began at a U.S. army base in Kansas and was spread by American soldiers sent to fight overseas.

The term "Spanish influenza" is a bit of a misnomer, according to Mr. Barry, since Spain experienced few cases of the disease early on. Spain was neutral in the war, so its newspapers were not censored like those in Britain, France and Germany. As a result, Spanish media were the only ones reporting regularly on the spread of the influenza virus, especially when the Spanish king became sick from it. Mr. Brooks surmises the name "Spanish influenza" stuck as Spanish news accounts were picked up in other countries.

Whatever the origin of its location and name, by the fall of 1918, the spread of Spanish influenza was leaving places like Peterborough bracing for the worst.

An ad placed by Bell Canada in the Oct. 10, 1918 edition of The Evening Examiner gives a hint of the trouble that was brewing. The ad, entitled "Telephone Service & Spanish Flu," notes that many of Bell's operating staff were off sick, and the remaining staff were stretched thin handling the large increase in calls from more people being at home ill themselves and using the telephone.

"Use your telephone only when absolutely necessary," the Bell ad implored.

"You will thus be helping to keep the service intact to meet the urgent needs of the community in the present emergency."

On the same day the Bell ad ran, the newspaper carried a report that the city's medical officer of health at the time, Dr. Charles Hewitt Amys, had ordered schools, theatres, churches and other public places closed until further notice to reduce the spread of Spanish influenza. Dr. Amys also urged local factories to send home workers who may even be mildly sick so that other workers were protected and "Peterborough may escape the serious degree with which the epidemic has crippled many of the communities in this province, causing widespread distress and many deaths."

Dr. Amys went further, and by the end of October 1918, had arranged with city officials, other doctors and the local Board of Health to have an isolation hospital set up at the old Oriental Hotel to handle people suspected of having the virus. It was intended to take the strain off the regular hospitals in Peterborough and lessen the risk of influenza spreading to patients of these facilities.

By early November 1918, a news story appeared detailing the 'Many Cases of Hardship Throughout City as Result of Influenza Epidemic.' The anecdotal cases included the following:

* A family of five on Elm Street who were all sick with the flu but where the father, who could hardly get up, still kept the fire going and got hot drinks for his wife and kids. Unable to work, he received no pay and "his job hangs on the generosity of his employer," the newspaper article noted.

* A home in south-end Peterborough where everyone was sick except a young girl who cared for her family. Days passed and the mother gradually got better. Meantime, the little girl who has been acting as the family's nurse developed pneumonia and within two days was dead. "She practically killed herself," the attending physician was quoted as saying.

Conditions with the Spanish influenza gradually improved in Peterborough, so that by Nov. 11, 1918, people had even more reason to celebrate the signing of an armistice that ended the First World War. A day later, schools re-opened and life began to get back to normal. That same day, Dr. Amys reported to the Board of Health that the city had got through the crisis and that the "death rate had been very low considering the gravity of the situation."

To this day, Dr. Amys' actions are credited for saving lives and reducing the toll taken by Spanish influenza in Peterborough. But as Dr. Amys noted at the time, the experience for him and others in the medical community was challenging and "had taken the heart and soul out of them."

Fast forward to the present and Dr. Humphreys and others in public health ready to wage war with their own version of the 1918 Spanish influenza epidemic. In 2005, the World Health Organization has identified a lethal strain of avian influenza, known as H5N1, as the likely source of the next pandemic. H5N1 is now mainly spread to humans from sick chickens and has jumped around Southeast Asia for the last two years. There are fears it could go global as it moves westward to Europe.

The main fear of health authorities is the avian influenza could mutate and be spread directly from person to person. If that happens, a highly-contagious, ever-changing virus could spread in waves and infect many people. It would take several weeks or even a couple of months before the mass production of an effective vaccine could be made available to people.

According to its numbers, the local health unit estimates anywhere from 18,500 to 47,000 people in Peterborough city and county could become clinically ill from avian influenza. Not only would hospitals and doctors' clinics be overwhelmed, upwards of 21,000 local residents would require outpatient care.

Projections also show that avian influenza would cause 14 to 52 additional deaths per week in the Peterborough region. Currently, there are an average of 23 deaths per week locally.

Amid these forecasts, there is good news, says Dr. Humphreys. Unlike 1918, pandemic plans are in place at the local, provincial and federal levels to protect the health of residents. And there is also much greater awareness and co-operation among health officials worldwide to control any global epidemic.

In Peterborough, Dr. Humphreys notes the health unit is working with the Peterborough Regional Health Centre, city and county officials, and others for a co-ordinated response to a pandemic. Among other things, the contingency plan calls for creating a command centre to supervise the local response to a pandemic, close monitoring of avian influenza activity in the area, a mass immunization of all local residents within 10 days of a vaccine being made available, the distribution of anti-viral drugs to the sick to help fight the flu, and establishing an assessment centre to arrange for the care of people who are sick with influenza, be it recuperating at home or elsewhere.

An alternative site for influenza care is also foreseen should the hospital become overwhelmed with cases.

"An outbreak never occurs the way it is planned," Dr. Humphreys notes.

"But I think people should be aware that the Board of Health has developed plans (for a pandemic)...and we're as prepared as we will be."

The lessons of 1918 have been well learned.