Historical lessons from Spanish Flu’s Black October

Spanish Flu emergency ward, 1918.

COVID 19, a virus with a crown of protein spikes, has been categorised by a number of politically dramatic metaphors that have served little purpose in helping us to understand it. For example, Britain’s Health minister saying we are “in a war against an invisible killer”.

Like George Bush in the war on terror, it is a philological absurdity. We are dealing with a medical question, not an army of invaders in military camouflage. No-one can shoot and kill abstract nouns, let alone a highly infectious virus. In this “war”, the response of world leaders has varied from lockdowns to Donald Trump’s, “I see the disinfectant .” 

Since Covid’s unwelcome appearance, social media conspiracy theorists – the one-eyed fundamentalists of our digital age – have run amok on Twitter, Facebook and WhatsApp, becoming epidemiological professors at a mouse-click, and sowing the seeds of mischief and malfeasance wherever they go. 

Recently, a well-cycled WhatsApp asserted that SAAF helicopters were spraying the virus over Mitchell’s Plain. And even if – a big remote if – if Covid 19 was cooked up in some lab in Wuhan or at a Bilderberg Conference, it is not the point right now. Our priority is not to chase the bolted horse, but to deal with what’s left in the stable. 

For indeed, what can’t be posted away by our WhatsApp naysayers is the shock and grief of South Africans who have lost their loved ones. Their tears cannot be wiped away by David Ickes claiming Fauci is a lizard. What the naysayers can’t ignore either, is the exhaustion and stress of doctors, nurses, paramedics and public officials. Their fatigue cannot be lifted by blaming Bill Gates. 

In South Africa, in less than a year, we have recorded over one million positive cases and over 35, 000 deaths. Globally, we have seen near 100 million positive cases and some two million fatalities. These are sobering figures.

However, if we zoom out for a moment and take a wider perspective by travelling back 100 years to the last major worldwide pandemic, the Spanish Flu of 1918-19, we can spot some interesting parallels to Covid, and perhaps learn a few historical lessons. 

Described as a strain of the avian H1N1 virus, Spanish Flu was said to be “universally deadly”, infecting 500 million (about a third of the world’s population at the time) and killing up to 50 million (10 per cent of the total) in two years. What is staggering is that more people died from Spanish Flu than all the civilians and combatants in World War One combined. 

Whilst the notion of locating a Patient Zero in any pandemic is difficult, it is believed that the first recorded instance of Spanish Flu was in a Kansas military camp. The movement of over 200, 000 troops during the latter stages of World War One from the US to Europe, and the homecoming of infected soldiers, caused a massive spread of the virus. 

The flu earned the moniker “Spanish Flu” because Spain had remained neutral during the war, and unlike the allied countries, did not have wartime media censorship.

Whilst soldiers travelling from different parts of the world fuelled Spanish Flu, the swift spread of Covid a century later is attributed to our high mobility, air travel shrinking the world, and making it fertile ground for viruses to spread rapidly across oceans and continents. 

When the Spanish Flu broke out, the world was ill-prepared. A great war was ending and for those suffering from Spanish Flu’s blistering fevers, nasal haemorrhaging and fluid filled lungs, few pharmaceutical interventions were available. In 1918, there were no anti-virals, no antibiotics, no mechanical ventilators and no flu vaccines. 

The only clinical medication was aspirin, which did more harm than good – as was reported in the Science Daily of 3 October 2009. This was because 30 grammes of aspirin a day was used, as opposed to a safer daily dose. It caused excessive bleeding and what some scientists believe, pulmonary oedema.

What has been common between Spanish Flu and Covid, so far, has been their mutation (scientifically normal), and their waves of super infection. We are well into a second Covid wave, which has proved some 50 percent more infectious than the first. Spanish Flu dropped off after its first summer, but afterwards it mutated, setting off a deadly second wave.

Social measures taken to mitigate the effects of the Spanish Flu were not dissimilar to Covid today: quarantine, mask wearing, hygiene, lockdowns and a restriction on public gatherings. However, their applications like today, were notedly uneven.  

For instance, the New York Health Commissioner ordered businesses to open and to close at staggered times to avoid overcrowding on the subway, but the city fathers of Philadelphia went on to hold a well-attended Liberty Loan Parade on 28 September. 

In 10 days, there were over 1, 000 dead after an estimated 200, 000 infections. In Saint Louis, Missouri, schools and movie theatres were closed and public gatherings banned. Saint Louis went on to have a peak mortality rate that was only 12 percent of Philadelphia’s. 

South Africa was rated as the fifth hardest hit country with regards to the Spanish Flu (and last year we were ranked in the top ten of total Covid infections). According to local historian Howard Philips, in his book In a Time of Plague, Memories of the “Spanish” flu epidemic of 1918 in South Africa, our Spanish flu spread in two waves. 

The first was via the port of Durban where returning troops and auxiliaries disembarked, spreading it to the rest of Natal and the Witwatersrand.  The second was when two ships, also carrying demobilised troops, docked in Cape Town. 

From September to October 1918, 60 percent of the South African population contracted the virus, killing upwards of 200,000 nationwide in six weeks. Philips, using eyewitness accounts, writes that by 7 October the virus had engulfed Cape Town, with dead bodies lying uncovered on pavements from Sea Point into the CBD. An eyewitness, Stan Stone, remembered: 

“It was like a city of the dead, yes – it was awesome (horrible), it was quiet, you’d never hear a horse-and-cart, very, very, few motor cars, and, you know, you’d miss the horses’ hoofs going round and the rumbling of the wheels on these gravel roads. It was really, really bad, very bad…” 

That October, an infamous black south-easter – a chilly, spring wind that brings in dark clouds and squalls of horizontal of rain – raged through the streets of Cape Town. The worst affected in the city, in what came to be known as “Black October”, were the poor – especially its non-white citizens. Nontombi Mawu reported from Ndabeni:

“Somebody coming from somewhere fell dead in the street, but I know that in the houses there were 20 or 30 in one house. And in the morning when you come there early everybody’s dead. During the time … there were no dogs barking, there were no fowls crowing, no trains running, everything was at a standstill. Everything was quiet.”

Not unlike Covid, the Spanish Flu had a “longer version”, characterised by strange symptoms. An account by Edith Goring says that after the flu, apart from a general weakness that endured for weeks on end, it was also was very difficult to remember any simple thing, even for five minutes: 

“People whose temperature was very high for days on end, lost all their hair, two or three months later. Fortunately, it grew again.” 

Phillips notes that one of the outcomes of the flu was nearly one million children being orphaned nationwide, Cape Town experiencing a big increase in street children. Other social factors that arose were quackery (no WhatsApp then), witch hunts and religious fervour, leading to “prophets” and even the establishment of the Zionist church.

Reading through Phillip’s work, and the comments of those affected by the Spanish Flu, it indicates there are critical issues that will have to be addressed beyond the immediate urgencies. This is because most of the survivors of the Spanish Flu appeared to have displayed classic signs of Post-Traumatic Stress Disorder – depression , hopelessness and despair. 

Anna Heimbold remembers that after the flu had departed there was “a cloud, a dreadful depression over one all the time”. Popema Mhlungu talks of people just crying.

Some survivors spoke of associations that haunted them for the rest of their days, such as the smell of the fever. Many did not want to remember what had happened.

And as our government moves towards its ambitious programme of vaccinating 40 million people in 2021, healing will definitely not just be in the double jab of a syringe. We will be a broken nation, not only ravaged by the deadly aftermath of the disease and its socio-economic devastation, but by societal PTSD.

Despite the bleakness  now, there is a light in the dark vortex. Had it not been for modern medical science, the death rate from Covid would have been much higher. Vaccines were developed in record time – less than 12 months – when previously two years for vaccine development was the conventional minimum.

At the end of the bumpy Covid journey, many challenges will have to be faced: children without parents, hunger, homelessness, public health, employment, psychological trauma and the realisation that compassion, and not capitalism, will help solve our problems. 

The fact is, that like the Spanish Flu, Covid 19 will leave us. For in 1919, Ted Jones woke up one day and noticed that a white cloth had settled on Table Mountain. The south easter was blowing, but this time – thankfully – it was carrying away the cursed germs.