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Mark Humphries

Lesson from the 1918 pandemic: Focus on treatment, not prevention Add to ...

Swine flu has sparked fear worldwide and is likely to elicit outright panic this fall if, as most public-health experts expect, it launches a second attack. So, comparisons to the deadly 1918 influenza pandemic are inevitable.

Unlike the milder pandemics of 1957 and 1968, the so-called Spanish flu was caused by an H1N1 virus that is also responsible for the current outbreak. As now, the 1918 flu first appeared in late winter, then spread across the world in the spring and early summer, sickening many but killing relatively few. But in midsummer, the virus did what health officials now fear most: It mutated into a more deadly organism.

In late August, 1918, the new virus spread back across the Atlantic, afflicting hundreds of thousands of Canadians during October and November. Then, as now, young people between 15 and 35 were hardest hit. In only a few short months, the flu killed as many as 50,000 Canadians and as many as 50 million people worldwide. The 1918 flu is a terrifying reminder of influenza's deadly potential.

Yet, it is important to note that we live in a far different world today. Antiviral drugs and antibiotics can be used to treat influenza infections and secondary cases of pneumonia, the predominant cause of death in 1918. Many of those who died from Spanish flu were likely suffering from other long-term chronic illnesses such as tuberculosis. Today, we have ventilators and perhaps a vaccine that can protect the most vulnerable among us.

Nevertheless, our health resources are finite, and public-health officials must now decide how and where to allocate scarce drugs, health-care workers and technology. They must also determine whether we spend the next few weeks trying to prevent the disease from spreading or concede it's unstoppable. They might be wise to look to history for insight.

In 1918, Canadian municipal and provincial governments put their energies into preventing influenza from spreading from community to community rather than preparing to treat those who grew ill. As some are now demanding, schools were closed, public transportation was shut down, sporting events and religious services were cancelled and businesses shuttered. Albertans were required to wear masks, and spitting in the street was banned. Prince Edward Island even quarantined itself from the mainland.

Yet, even though the 1918 flu struck when air travel and mass car ownership were still years away, the disease managed to travel across the country in less than a week. When the pandemic was over, health officials agreed their efforts at prevention had not only been ineffective but also impossible to enforce. By focusing on stopping the disease rather than preparing to treat a massive influx of patients, Canadians were faced with overflowing hospital wards and a lack of trained health-care workers. This lack of preparedness meant scarce resources were unevenly distributed when preventive measures failed.

It was often minority groups that suffered the most. The 1918 flu hit First Nations communities particularly hard. A Department of Indian Affairs report compiled in 1919 put the death toll at 3,694 out of a total population of 106,000 aboriginal Canadians; the mortality rate in first nations communities was more than five times the national average.

Native communities in Western Canada were hardest hit: 6 per cent of aboriginal people in Alberta and Manitoba and 4.7 per cent in Saskatchewan died in the pandemic. At the time, officials ascribed the high mortality to the fact that "it was impossible to secure adequate medical attention for the Indians living in the more outlying parts [of the western provinces] a circumstance which existed in the majority of the white communities throughout the Dominion."

In preparing for a possible autumn wave of influenza, we should heed the lessons of the past. School closures and other restrictions on public business will do little to dull the blow and could harm Canada's economy at a difficult time. We should prepare our health-care infrastructure to meet a worst-case scenario, ensuring that all Canadians have access to the same standards of care. If history tells us anything, it is that First Nations and remote communities are most at risk. We should focus our efforts on protecting these communities and avoid the mistakes made 90 years ago.

Mark Humphries is assistant professor of history at Mount Royal College in Calgary.

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