ROB ROSE: Coronavirus: avoiding a repeat of SA’s 1918 flu debacle
During the 1918 flu epidemic, the government dithered and 4.3% of SA died. Swift action on Covid-19 may lead to a different outcome
On October 27 1918, the Sunday Times ran an editorial titled "Flu — or what?" It was the height of "Black October", one month after the Spanish flu arrived in SA. At the time, no-one was quite sure why people were dying. It’s sobering today to read the real-time reporting in the newspapers of the day, at a time when SA is facing another global pandemic a century later.
Back then, there was no health minister explaining cases or causes, no wall-to-wall TV coverage, no Twitter. Hysteria was the order of the day. Schools closed, farmers bolted their gates shut, people boycotted the "bioscope" for fear of germs, and tea rooms closed "because there wasn’t enough trade to pay for the electric light used".
The newspapers, unable to explain events, indulged in gallows humour. "The average Joburg man did not run away from the germs — he fought them courageously. Retiring to bed with a bottle of brandy, and an adequate supply of ammoniated quinine and aspirin, and a pile of the latest novels, he challenged the flu to a 10 rounds contest," one reported. Superstition, bonkers "cures" and fake news were everywhere: wearing "vinegar-saturated masks" was touted as a remedy, as was consuming piles of lemons.
Opportunists piled in. One man wrote to the newspaper, saying: "I feel sure that [Wood’s Wine] saved my life." Coincidentally, on the same page an advert proclaimed: "Wood’s Wine creates new blood, rich in strength-giving power … Pneumonic influenza cannot injure you if you take Wood’s Wine." At the same time, Commando Brandy marketed itself as "the best cure for Spanish flu". Even Castle was advertising itself as "the beer that flu cannot stand". (The flu isn’t alone: it’s a distaste that has stood the test of time.)
Yet the Sunday Times warned that "this is not the time to make light of the epidemic. We fear that underestimating the gravity of the disease has already produced fatal results in many cases in which recovery would have followed."
The panic, fear and wild myth-making is common to both the Spanish flu and Covid-19
Still, many did underestimate it — which is why more than 50-million people across the globe died in a year.
Howard Phillips, an emeritus professor of history at the University of Cape Town, is the pre-eminent expert on SA’s 1918 flu epidemic. During the 1970s he spoke to 127 survivors, and later drew on this for a 535-page thesis.
"It was a seminal event, which added distinctive and novel features to SA life … at a stroke, it radically altered the composition of the [country’s] population with regard to size, age-structure and ratio between the sexes," he wrote.
It seems unlikely that Covid-19 will come anywhere near replicating the horror of 1918, which made SA the fifth worst-hit country on the globe. The numbers are staggering: in two months, 300,000 South Africans died — 4.3% of the country’s population of 6.8-million. And they died quickly: between October 9 and 10, for example, 203 deaths were reported. By the end of the outbreak, 4.2% of Port Elizabeth’s population had died, 3.4% of Cape Town residents, and 7.5% of the people living in Kimberley.
Covid-19 is, of course, different to the Spanish flu virus. For one thing, Spanish flu targeted younger people, and left the elderly alone — in contrast to the current virus. But the panic, fear and wild myth-making is common to both.
In 1918, this was more forgivable. Back then, as the New York Times pointed out, “doctors knew viruses existed but had never seen one”. This time, Chinese scientists worked out Covid-19’s genetic sequence within days.
Speaking to the FM this week, Phillips points out that within two months of SA’s 1918 outbreak, the epidemic had faded. By November, it was gone. That sounds comforting to a country facing Covid-19. But it shouldn’t be.
"In 1918, one of the reasons it didn’t last long is it swept through the country at such a rate that within weeks, many people had either contracted it and died, or recovered and built up short-term immunity. Covid-19 is spreading rapidly but we’re still at the beginning. We don’t know what will happen — or if it will mutate," he says.
And while the Spanish flu may have disappeared pretty quickly, it left a crippled economic landscape. "The mining industry was seriously disrupted, as was agriculture, with some serious knock-on consequences," says Phillips. "Many black families in rural areas had no crops to harvest, since no-one had planted anything during the epidemic. The hunger and famine led many young men to volunteer to become migrant workers on the mines."
His 2018 book In a Time of Plague recounts how devastating it was for survivors — like the Slabbert family in Reitz, a small town in the Free State, which lost six sons within days. Even months after the virus died, one Cape newspaper reported "long processions of people in black garments who throng the Maitland trains on Sunday to visit the lines and lines of new graves at the cemeteries".
Part of the reason for the immense body trail was that the government dithered. In fact, it was only because of the excoriating criticism over its handling of this disaster that, six months later, SA set up its first ministry of health.
Today, a century later, President Cyril Ramaphosa has shown admirable initiative by shutting borders, closing schools and displaying remarkable intent.
So what does Phillips think the odds are of SA getting on top of Covid-19, given the lessons of 1918? His answer is carefully hedged. "Well, if the figures we’re getting from China are reliable, it does seem possible to contain it from being a runaway epidemic. That could be a source of solace for us — but only if we believe the numbers."
In the aftermath of 1918, SA pledged to never repeat the mistakes made at the time. Today, Ramaphosa has acted with far greater urgency in locking down the country. Now let’s hope it makes a difference.