Losing patients:  While the  flu affected many parts of the world, the mortality rate in SA was higher than that of the US and some European countries. Picture: YOUTUBE
Losing patients: While the flu affected many parts of the world, the mortality rate in SA was higher than that of the US and some European countries. Picture: YOUTUBE

For years, epidemiologists puzzled over a South African medical mystery that involved two cities and a deadly plague. Johannesburg got off lightly when the disease swept across the Rand nearly 100 years ago, but 500km away in Kimberley, the population was hit hard.

As the centenary of the pandemic that left hundreds of thousands dead nears, scientists believe they have the answer to this mystery — it had much to do with luck.

In 1918, just as the First World War was drawing to an end, a deadly flu swept the globe. As it devastated the countries and communities, the pandemic became known by different names. To the amaXhosa, it was umbathalala, while the West referred to it as the Spanish flu.

When it disappeared months later, the virus had killed more people than the Black Death and left its mark on how future generations dealt with pandemics. Soon scientists will mark the centenary of the outbreak of the Spanish flu. Medical conferences have been planned and books are being written. SA’s medical mystery has a special place.

"The mortality rate in SA was roughly 4%, about 300,000 dead. If you consider that it was under 1% for the US or some countries in Western Europe, then you can see that it is much worse," says Laura Spinney, who has just released a book entitled Pale Rider: The Spanish Flu of 1918 and How it Changed the World.

The mining compounds of Johannesburg and Kimberley should have been ideal breeding grounds for the pathogen. Men lived in crowded hostels and worked underground in damp, hot conditions. Soldiers carried the disease from France, returning to SA in cramped troop ships and rail carriages.

According to historian Prof Howard Phillips, Kimberley lost about 4,700 citizens — 8.86% of its population. Johannesburg had a mortality rate of 0.9% of its population. The meticulous record-keeping of mining houses helped epidemiologist Dennis Shanks find a likely reason for this disparity. In the records, he found evidence of a milder flu-like illness that arrived in Durban in July 1918. This infection headed north to the Rand, following the rail tracks.

"There were three waves of the epidemic. The first was mild but highly infectious, the second was lethal," says Phillips.

To Joburgers in the winter of 1918, the virus would have caused the usual sniffles experienced during the annual flu season. In September, the second wave struck. It arrived in Cape Town on the troop ships Jaroslav and Veronej.

"It arrived on the Rand a week before it got to Kimberley," says Spinney.

"When the flu reached the Rand, a lot of people fell sick, but the vast majority of them recovered. So, the authorities breathed a big sigh of relief and they thought Kimberley would be okay. But they watched with horror as about a quarter of the working population of Kimberley died."

Death often came quickly. Spinney describes in her book how those infected would watch their hands and toes turn blue. Days later, they turned black and the blackness crept up their arms and legs. Hair and teeth fell out and nurses described how the sick gave off a smell "like that of musty straw". Death was usually caused by pneumonia.

Shanks believes the milder form of the disease that first hit Joburg immunised the residents against the second wave.

Spinney estimates that 500,000 children were orphaned in SA. In her book, she tells the sad story of a "coloured flu remnant" who was tried for theft in Cape Town. Describing the accused, the prosecutor said: "He has no home and does not know what has become of his parents. He does not know his age or his proper name, and has no surname, so far as he knows."

In 1919, the government set up the first department of public health. There was emphasis on providing housing for the poor, although along racially segregated lines.

"The suburb of Pinelands was laid out in 1919 and was designed as a garden city to provide housing for families that the flu had shown up to be desperate," says Phillips.

In Johannesburg, the authorities began demolishing slums and separating black from white.

"They were seen as a threat to white health," explains Phillips.

The third wave arrived in 1919, but the flu had lost its edge and wasn’t as deadly. It did, however, kill SA’s first prime minister, Louis Botha.

Phillips says a characteristic of the Spanish flu was that pregnant woman who were infected often miscarried. By October 1918, the virus swept through the Transkei, claiming the lives of tens of thousands of people. However, Nelson Mandela arrived in the world three months ahead of the pandemic and survived.

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