The 1918 flu pandemic — Australia’s experience

The 1918 influenza pandemic was one of the worst natural disasters recorded in history. Known as the ‘Spanish’ flu because it was first reported by Spain, it infected ~500 million people, and killed as many as 100 million people worldwide, including healthy adults under the age of 40. When the disease hit Australia in 1919, maritime quarantine measures put in place helped to curb the death toll, but the social impact was significant.

This pandemic spread across the globe in three distinct waves; the first was in March 1918 and spread through the US, Europe and Asia over the next 6 months. The second wave spread across both the Northern and Southern hemispheres from September to November of 1918 and had about five times the death toll of the first wave. The third wave came in early 1919 and killed more people than the first, but it was not as severe as the second wave. More on the global impact of this pandemic can be found in my previous blog.

Australia was spared the ravages of other countries in this pandemic. Although the mortality rate that was the lowest on record—233 per 100,000 of the general Australian population, compared to 430 in England and 500 in the non-indigenous New Zealand population—there were ~15,000 recorded deaths. Indigenous populations were more severely affected. Among Aboriginals in Australia, some tribes were almost entirely wiped out. Infection rates were quite high, up to 40% of the general population, and 50% in Aboriginal communities.

Like most countries, Australia was not prepared to cope with this disaster, given that the war had disrupted social and economic life, and key medical personnel were abroad. During the first wave in March 1918, Australia remained free of infection, and the Australian Quarantine Service monitored the spread of the pandemic. After learning of outbreaks in New Zealand and South Africa, a first line defence was to implement maritime quarantine, which came into force on 17th October 1918. But the first infected ship arrived the very next day in Darwin. Over the next six months, ~50% of intercepted vessels were found to be carrying the infection.

A second line of defense was to establish a consistent response to handling and containing influenza outbreaks. A national influenza planning conference was held in November 1918 with all State and Commonwealth health authorities, and a thirteen-point plan was agreed upon, six of which involved interstate quarantine. It was agreed that the Federal government would be responsible for declaring infected States and enacting more stringent quarantine, while States would be responsible for local medical and emergency services as well as public awareness of the potential for outbreaks. These measures limited the entry of the virus into Australia, by which time the virulence had lessened.

The first severe case of ‘Spanish’ flu occurred in Melbourne in January 1919. Confusion about other milder cases led to a delay in confirming that there was indeed an outbreak in Victoria, and it was not until a case was diagnosed in New South Wales that the Victorian authorities officially notified the Director of Quarantine. The New South Wales government viewed Victoria’s delay as a breach of the national influenza planning agreements. Although both States were declared infected, New South Wales unilaterally closed their border with Victoria because the first diagnosed case was a soldier travelling by train from Melbourne. This led to a general breakdown in the Federal systems agreed upon in November 1918. Individual States then made their own decisions regarding border control and handling and containing outbreaks, and in February 1919, the Commonwealth withdrew temporarily from the November 1918 agreements.

The measures put in place did not prevent the spread of the disease, but slowed its movement. Although the cause of influenza was not known at the time, an experimental vaccine to treat pneumonia had been developed by Commonwealth Serum Laboratories (CSL). Once the New South Wales government closed its borders, the city of Sydney closed schools and some public places, and implemented the use of masks and vaccine programs. However, there were three waves of outbreaks in Sydney with many deaths. The first cases of the ‘Spanish’ flu in Queensland were recorded at the Kangaroo Point Hospital in Brisbane in May 1919, and by the end of June there were over 20,600 reported cases throughout the Sunshine State. The relative isolation of Perth and State border controls proved effective, as the ‘Spanish’ flu did not appear in Western Australia till June 1919.

There were various degrees of maritime quarantine enforced, depending on the extent of infection on a vessel. If a ship arrived with a single infected individual, everyone on board was inoculated and forced to wear a mask for the quarantine period, which could be up to fourteen days. This did not bode well with returning troops, as family reunions and victory parades were delayed, causing a sense of rejection and divisiveness to fester among troops. As expected, there were instances of some troops breaking quarantine. One significant break occurred in South Australia, leading to a court martial in March 1919, a charge of inciting mutiny, and sixty days detention. A more spectacular example of breaking with quarantine occurred in New South Wales in February 1919, when 1000 men broke out of their snake-infested campsite at North Head where their ship had landed. The North Head quarantine station is now the longest operating quarantine station in Australia with a rich history dating back to the 1800’s.

Once the Commonwealth efforts had broken down, each State then implemented interstate travel regulations in an attempt at self-preservation, and imposed restrictions as they saw fit. Over the next six months, further ‘mayhem’ ensued as a result, with considerable disruptions in commerce and tourism between States, the impounding of the Trans-Australian railway which had opened one year prior, as well as political fallout for the Nationalist Government.

Although these disputes had no positive impact on the control of the disease, at least 25% of the New South Wales population were inoculated against pneumonia by the end of 1919. There were few trained doctors around at the time because many were still on overseas service. Given that little was known about the cause of this pandemic and the fact that available trained doctors could not suggest anything substantive, people turned to their own methods of diagnosis and treatment. Quack remedies came from all quarters, including some in the medical establishment, many of whom were seen to be arguing in the press about the nature, causes and treatment of the disease. Advertisers saw opportunities to claim preventive powers in their products, and pipe-smoking motor cyclists with false teeth could expect maximum protection!!

As the epidemic progressed, hospitals were overwhelmed with patients. Additional staff was employed at well-earned wage increases, and by the time the first wave had abated, citizens committees were organized to do volunteer work ranging from the equivalent of ‘meals on wheels’ and accommodating children whose mothers were hospitalized. These Good Samaritan efforts were not without negative consequences, both in terms of contracting illnesses and violence at the hands of distraught relatives of those in their care.

Many lessons can be learnt from Australia’s experience with this pandemic, particularly for outbreaks for which there are no existing medical remedies or measures to contain the disease. Cooperation between Federal and State governments in imposing quarantine measures is of paramount importance in controlling the spread of disease. Public health preparedness and the awareness and appreciation of the impact of such a disaster on the health care system will also be important, as will the role of the media in reporting any outbreaks in a manner that does not incite chaos and fear. Medical journals later accused daily new papers of ‘fanning the flame of panic’ by attention-grabbing headlines, including words like ‘plague’ and ‘black death’ and raising alarms that muted any appeals for calm and measured responses.

1918 also saw many other notable historical events that cannot be overlooked in terms of their impact on the pandemic. World War I was not yet over and there were concerns that the turmoil of the previous years, combined with the quarantine restrictions at home, would lead to further disquiet among returning troops. The Bolshevik revolution in Russia was well in progress at the time, and threatened to spread revolution all over the world. While conservative governments feared ‘copycat’ uprisings taking hold in the name of social revolution, reporters saw opportunity to link epidemics of disease with epidemics of social disorder under the name of ‘Bolshevism’.

As the Australian winter wears on and flu season progresses, it is worth remembering what we have learnt from our past experiences. Guidelines implemented to safeguard public health and focus resources where they are most needed will only be as good as the individual responses in heeding these restrictions. We are further along the curve of public health awareness and access to reputable information about disease control and the value of coordinated responses. Let us harness what we have learnt from our past, and not regress to a time when the ‘every man/State for himself/itself’ principle reigned supreme.

References:

P. Curson and K. McCracken. An Australian perspective of the 1918–1919 influenza pandemic. http://www.phrp.com.au/wp-content/uploads/2014/10/NB06025.pdf

H. McQueen. The ‘Spanish’ Influenza Pandemic in Australila, 1912-1919. In ‘Social Policy in Australia’. Cassell Australia Ltd. 1976. http://honesthistory.net.au/wp/wp-content/uploads/SpanishFlu-1919.pdf

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