September had been a lovely time to get married in Flintshire. The last of the summer,
he TEB sent a soft breeze dancing around the trees of Flint Castle and the rustling leaves chimed with the hum of their family and friends meeting,
laughing all together. Such a happy day.
You could almost forget the war.
But as Gladis held the photograph in our hand, slowly scanning all of those familiar faces, she noticed the paper began to tremble.
How many of them weren't here anymore? How quickly had they gone once the flu had arrived?
How soon had she been separated from her precious Fred? Just two months, two months of married life.
And then it was gone. It was all so quick. It was all so cruel.
Welcome to the 20th century.
Towards the end of the Great War and to the eighth episode of our history of pandemic season, you'll have heard a lot about the disease outbreak.
We're about to discuss, especially in the early coverage of our current COPD outbreak after the black death, the so-called Spanish flu.
That's one of the most famous monikers of any pandemic. But does it deserve such notoriety?
Let's find out. Our guide for today is Professor John Oxford, a world expert on influenza from Queen Mary, University of London.
I began by asking John to tell us more about the strain of flu in question and whom it's effective.
As strong as we can see, a single virus was moving around the world.
I've also done genetic work, along with Jeffrey Tobin Burger in the States.
It's a lead question where I suppose on genetics of the 1918 flu, he was the first one to get our sample.
That's the clinical sample from a frozen Eskimos in the wet land.
And take the sample into a sequence of the haemoglobin and the H.A. the little Toblerone spiked the sticks, sticks out from the virus.
When the most important determinants of virulence and everything else that was not so long after that,
we were also able to get samples by a group from the Royal London Hospital Archives and the pathology department.
So we had two samples, one from a sock from a policeman and one from our housewife.
And when we did the sequencing, he did sequencing, we found they're almost identical.
So a virus moving around the world three thousand miles apart.
What a couple here in London compared to Jeffrey Taubenberger, samples from New York,
for example, or from the India Group and the northern parts of the United States.
They're almost identical. Jeffries were from soldiers. Mine were from civilians.
Yet the virus was the same. And the clinical picture in those groups was the same as well.
The picture was not so different from Kobe. Now, in general, most people survived.
Most people survived. Otherwise, it would be as you will get a hundred million deaths on our hands from 1918.
Almost certainly. But the Christian population, the world was probably about two billion at that time.
So when you look at the statistics, most people and they all got in the end, everyone got it.
But most people survived. But the mortality struck in the 21, 22, 23, 24 year olds, young people.
That's why the unique and awesome thing about the Spanish flu compared to any other flu.
It didn't go for elderly people. In fact, I've seen the figures in the United Kingdom.
I look at the recently hardly anyone over the age of 65 who's dying in 1918 flu or 1919 flu.
They just weren't. But the mortality was in the 21 to the younger age group.
Now, why is that? That's another reason why we wanted this clinical result.
Was that interested in the genetic sequence of the virus? That's very important.
But to look at kind of what was going on in the lung, how did they die?
Why did this virus attack young people, not the elderly group? And we're still not actually sure of answers to those questions.
I must say a hundred million deaths was an astounding number to comprehend.
And I asked John to put that in the context of the history of disease outbreaks that humanity has faced.
Well, I think it is pretty unique situation, you know,
is when you look at the history of the world that 1918 brings the biggest outbreak the world had ever seen.
More up to now, there's been no bigger aerobraking infectious disease.
There's been no bigger calamity in the world. That 100 million people.
I mean, it's almost inconceivable. The numbers, 100 million. But they are they are accurate as far as we can see.
I mean, you can see that with the code. I tricky it is to get accurate figures.
But in 1918, it was just the same was quite tricky.
And it was particularly there was a big black hole in Africa. The number of people died there.
And a big black hole in China as it happened. But still, the figures have climbed from 20 million.
The earlier estimates, up to 100 million. We should know more.
That's more or less accepted. You can't draw that.
You can't grasp it. And I come across with anonymous graphs randomly.
We have to do is concentrate on one. That's the way to do it.
And then from that one, you work out everything about that one person.
And then multiply it by the figure that you settle on. And then you can get the impact and the way I do it.
When I started work on this virus, I was sent to a gym Cordle on television message, and I was the centre of photographs.
It was a wedding photograph. I'm telling him, frankly, and it's of a couple who just got married in September.
Sentence in this very small village in Flintshire in Wales.
The pair of them. So it's a lovely black and white photograph of the pair.
But within a month. Certainly within two months, the virus that arrived.
That little spot. And killed the husband. It was a bit like Titanic.
And I remember getting it more or us at the same time as Titanic, which is a film, after all.
Not about a ship, but about love and being separated.
This is a piece about separation because Fred Beth, a young man who was her husband, had married Gladys,
but they were torn apart because he had the virus and exited, as it were, leaving her.
Now they had the photographs. They had this black and white photographs. She married him another person and had a child.
And it was that child who sent a photograph.
And she said it had been by her mother's bedside for her entire life, not her second husband, but photograph of the first husband for her entire life.
And then her mother had the same photographs beside her bedside.
And it was only past me when in this generation at these you that single couple,
the impact and it's been called the forgotten flu and all that sort of stuff was locked and forgotten.
And that's a perfect example. The impact of one person, one family.
That's right. Now you most about 100 million. So then you can see the overall punch of it.
And as you say, it's completely special because of the of the age group.
Next, you say, well, why? And that's a question we've been asking.
Why should a perfectly healthy twenty three year olds die when their grandkids, age 83, didn't and the virus is moving around?
Well, the answer seems to be in the past. That is, you look back and see what the history of Spain and what outbreaks of influenza.
Remember, this is a pretty special web of fresh pressures. But what outbreaks of influenza had they already experienced?
Licalsi, 21 year old, had not experienced probably any influenza, but the 83 year olds had experienced influenza going back to the 80s,
90s, leading possibly back to 1840 where there were previous pandemics.
So what we reckon is that they had were the old people were infected with previous pandemic viruses, other Asian 89 or maybe the eighteen sixties.
They survived that outbreak come 1918. They still have some memory, some immune memory of the 1918 virus attacked them.
Those immune cells came into action and protected them. After all that time.
So the old people survive. Younger people did not survive. So we think that mass, this immune memory was was very important.
It's pretty outstanding when you think that this is a long lived memory.
But of course, it's you can have it for yellow fever and other viruses as well.
Again, you can buy I think it shows the value of trying to disentangle a huge outbreak like 1918 to help us work on this cold for the future.
As John was about to outline, it wasn't just the sheer number of deaths that was astonishing here,
but how rapidly these fatalities occurred compared with other pandemics in our series.
And that's how many people in 18 months the bubonic plague.
Obviously, it's a nasty infection still. Yes. I mean, the Saints. They know it.
They never had 100 million dying in a couple of years. You might have had millions died over a period of 30 years.
I can accept that. But I don't think we should get too much dragged into Bluebonnet.
I'm sure a picturesque, if you like to put it away, I suppose, with fluids like picturesque about it apart.
And, you know, you just look normal, don't you, actually? Except for that, that in the Spanish flu,
you didn't quite some of the young people didn't look quite normal by the time they
were getting to the point of death because they had this heliotrope cyanosis.
And I accept that. I mean, there's enough evidence of that and that more this is that the telling us that the lungs are
infected or super infected and they're gasping for breath and that's why they're cyanotic.
They just can't get enough oxygen into the. So a system could go in the ward and look down the ward and say, look, there's two young men there,
both of cyanotic, both with the blue lips, blue ears and this lavender colouration that will die tonight.
So we'll have to make best available tomorrow. So you could do that sort of thing.
But more or less. Otherwise, people died quietly. And I think a lot of people were shocked at the Kobe when it all comes.
I suspect many people died at home and in the Spanish flu.
Most people did die home. The hospital in Britain with Chock-a-block, with wounded soldiers.
I mean, there are so many wounded soldiers that they couldn't all the hospitals were full.
They were commandeering hotels and boarding houses all down the coast where I come from, Dorson, Hampshire, all those boemre to.
Sandbags, well, those famous things you keep seeing and the paper, all the hotels were full of wounded soldiers.
My mother was shot at that stage. She would go and see them. Young women would go visit these wounded soldiers.
They never wanted them out. A lot of them say they're so badly wounded.
But women were persuaded to go and look and say hello and bring them back to normal.
So, you know, it was pretty horrendous thing. This Spanish flu, the effects mixing with the war as well.
I think I wanted to cheque with John that we could set.
The main timeline of this outbreak is taking place between the spring of 1918 and the winter of 1990.
That's in the northern hemisphere. Yes, really? Really.
I suppose if we if we took on my own work to look at earlier outbreaks,
then we weren't stretched back at the bit in 1917 because I think there's a growing feeling this thing didn't just occur in 1918.
There was a kind of a preamble. You know, it's kind of built up a bit before it exploded.
So but mainly, yes, mainly the three main thrust to the outbreak where most people died.
And in fact, the ago died was, as you say, in the autumn of 1918 and the winter of 1919.
So it's worth spending a moment on the earlier outbreaks of this disease.
And what we might be able to learn from those were the outbreaks that wasn't caught flu because flu was not a word that came into big use until 1918,
actually. And before then, it was called epidemic catarrh or epidemic.
This particular it was not called flu until 1918, 1919.
So there were things described in the medical literature. Well, I wish with all time all my students are searching the medical literature.
Germany, France, England, America to look for pre outbreaks, what are called Herold's outbreaks.
Kind of an outbreak that could've warned us that something bad was coming.
And there were some of these outbreaks, but it was very difficult.
I think with again, with the war on and with when some of these outbreaks occurred in the great army camps, then it was even more difficult.
I mean, you have to understand circumstances here. This is total commitment to winning this war total.
Everything else went by the by the board. We had to win it. So all the effort we, for example, over half,
three quarters of the doctors and medical staff being there were not including in England and France servicing the war.
And the same with hospitals said one hundred seventy five thousand beds in France to deal with wounded soldiers.
Everything was there in France and there were three in the end, three million soldiers, young people moving around and not very good circumstances.
And then on top of that, the Western Front is farmland. Total farmland was the first war to be fought like that.
And I think farmland. And that's why there's so much contamination with Clostridium gas gangrene,
so important infection on the Western Front just because of the cows and horses around.
But also it was a migrating area is an air of loss of where the migrating birds coming from Siberia moved across the eastern,
tipping the Norfolk down across France down to stop some parts.
Those countries across the Mediterranean into Africa, huge migration.
And we know now the migration of these ducks and geese.
Waterbirds is very important for the spread initially and spread to these new pandemic strains.
Then you've got the farmlands, the wars being fought on time.
That's only twelve miles and it's 50 miles from the front where soldiers are being mangled daily.
People are carrying on, doing their farms, you know, listening to see when you think of it now.
But they were. And even more so on the great encampments of the British army up and down the Western Front, great hospital.
The Catterns, they they had ducks and geese in the camp.
And these camps are not Boy Scout camps is accounts of hundred thousand young people.
A hundred thousand young people in 24 hospitals in one town.
The vast you've to appreciate the energy that gone into fighting this war to end all wars.
Everything had been thrown at it. All the circumstances we now realise can lead to the emergence of an influenza virus that is migratory birds,
domesticated birds, large numbers of young people under stress.
There they were on the western front. So it is a pretty unique circumstance and even worse, I suppose, when the whole war ended.
You had all these millions of young people going home and they came from the whole world.
They didn't just come from Suffolk and Norfolk. They came from Australia, South Africa.
And they got on those boats in the British Navy. Help me to go.
They didn't want to be delayed.
And when they got to where they were going, like South Africa from smallpox, they didn't want to be stuck on the boat by the.
So he got off the boat and went up the railway lines.
Normally when they get on the sidelines home to their parents, their little farms, they tip, they cheque the barge with them.
And the biggest outbreak in South Africa, resample, was that was the railway line outbreak where they did just that.
And their parents, when their sons arrived and called in all the neighbours neighbouring farms,
and they came in on their horses and buggies to about twelve miles in the sort of area.
And that was an excellent read, led to an explosive outbreak. So that was happening all over the world.
So, you know, there were all these circumstances. And in a sense,
I think now the war engendered the virus and changed the circumstances where it could
begin to spread and spread widely around the world after which we committed to this war.
We threw everything at it through my father aspect, as it were.
Everything was thrown back. And the survivors, they came out.
My father didn't come back to England for heroes. There was not fit for heroes, not to 1948 when they introduced a national health service.
No, those modern things. 1918 was not fit for anyone to come back here.
So they had to come back. They came back and they just had to face the settlers. On top of everything else, they faced that.
The war had also impacted on any preparation which might have been prompted by those earlier outbreaks.
Well, because everything in 1917, whatever topic you talk about religion or art or whatever,
is dominated by the war since the first global war and that consumed every once energy just dominated everything.
So people who should have been on the lookout. I suppose public health, who whoever politicians there were totally preoccupied with the war.
In fact, my own personal feeling is that the to the pandemic and the war are closely intertwined.
They're almost inseparable, almost to the extent that perhaps if they had not been a First World War,
they may not have been the 1918 Spanish influenza. So that's how closely they were intertwined.
That's an opinion endorsed by our medical expert, Professor Brian Angus.
But I suspect that the reason that was quite so deadly was, as you say, because of the circumstances.
And as I mentioned before, you know, it's interesting. Infectious diseases tend to find the weak spot and then then move in to that weak spot.
So so I think it was probably a combination of quite a quite a nasty virus that it evolved.
No immunity in the population. Again, probably because the virus had evolved that most people hadn't seen it.
And then a very vulnerable population, although, you know, when we see vulnerability to flu, it tends to be being old and being obese.
And those certainly weren't the characteristics of people in the First World War.
So. So it's like malnutrition certainly can can can cause problems.
And again, a lot of people. Were one of the classic things we talk about infectious diseases is that if you have flu,
you then afterwards look for infection with a cold starts off as areas,
which is a thing that causes of skin lesions and causes possible causes, infections, the bloodstream.
And that is one of the things that tends to happen. You get flu, you damage to the lung.
Then you get a secondary bacterial infection on top of it. And again, at that time, there were no antibiotics.
So you would have quite a high death rate from 70. Back to you.
Infection as well. You know, taken against if you dissect it, open even more than that.
And you mentioned nutrition that normally the soldiers, when one were well nourished,
was again all the effort of France, Germany, and if the were to were so had to nourish up the soldiers.
So they were well nourished. If there was any deprivation in the country of food, it was not soldiers.
It was on the homefront, on the homefront.
And particularly in Germany, for example, because we blockaded Germany, the food normally be imported by sea to Germany.
And we ruled that we totally blockaded it. So there was no court.
So the starvation started in Germany. There was no starvation in England.
I don't think people were that well nourished on the homefront in England.
But soldiers were okay. Soldiers had other problems to deal with.
But there were a very unique mixture of circumstances which were Basken like influenza being spread by aerosol droplets can take advantage of.
This would also be a relevant place to discuss the name by which we now know this outbreak,
the Spanish flu, and how the war led to the use of such an unfair title.
It isn't it isn't fair. And it's a very topical thing to look at because after all, look at it even to look at the curve with nineteen, if you like.
You know, for the first time, some of these politicians have been antagonistic about the origin of virus.
We won't name the competition, but it goes round calling this. Delivered all that something.
And blaming them. Now, the most famous American textbook about 1980s is that is that America's forgotten pandemic?
And in that book, they extol the whole theory that that virus, the 1918 virus, didn't that didn't arise in Spain.
It arose in the United States. In Kansas. Well, I mean, I don't believe that you believe that.
I don't believe that most Americans do. So why are they busy? Right.
Talking about the virus. It cause the biggest pandemic in the world.
1918. Well, we'll call the Americans who still more accurately call it the Spanish flu anyway.
So this is sort a tangle you get into if you're not careful.
If you start getting nationalistic and say with HIV, you know, you can stop blaming a country or what are you going to do?
So you have to be very careful with it. On the other hand, I think with flu particularly,
I felt that we had to try and sort it out because we're not looking necessarily at where wise of the 1918, but we could look at the circumstances.
So we've got to look at it quite carefully. And I feel now we've got a lot of evidence to support that.
This virus certainly didn't arrives in Spain.
And the reason why it was all over the newspapers, everyone swallowed this was that Spain wasn't in more Spanish.
Newspapers are being published. Weekly isn't as usual, daily as usual.
The king was in fact, the prime minister was infected in Spain.
It was all over the newspapers, of course, and the rest of the world where the news was heavily censored, particularly in the warring nations.
They were they looked see what's going on in Spain. And of course, you invaded with to shake that off.
The idea of starting in Spain just because of a Spanish report when not no one believes at least the Spaniards virologists left from Spain,
that either is totally a scam spat out. But so Spain is out of the question as far as we could work concerned.
That leaves the theory of Kansas and Dorothy and the yellow brick road.
We've seen almost equally preposterous, I think, as a Spanish one or the China one.
The China. I'm just saying half the population.
What do you say to a citizen in charges who say it's a possibility, but there's not any solid evidence?
If you look at the literature of what there is of anything emerging in China.
There were not the statistics average trying to find them.
And I don't think based on them, we'd mentioned Kovik a couple of times, which brought to mind another topic very relevant to us today.
Second waves. And I ask John to tell me more about the pattern of waves during this pandemic.
So the first wave was from half the preceding Herrod waves in these camps and in 1917.
But the big wave was in the autumn of 1918 and by Christmas.
And I think it had gone through. It's worse than I think people began to think, well, thank God for that.
So it's, you know, it's going to get better. But by February 1919, never come back again.
Or more likely, it's never gone away. Never gone away.
For reasons best known to herself, it had circumstances to spread again.
And the more times he began working in the same groups in the younger age groups, not in the older groups and in the younger age groups,
those who had not been mopped up, as it were, three or four months to go, were picked up again in 1919.
And when you come to think of it, there was waves to follow was just wait one, two waves.
It's like when you throw a pebble in a pond, you get you get serious waves and you get a big one.
Then you get a little a little of a little girl. Ten waves. That was what happened in nineteen eighteen.
There were big wave my attention to be late 1990 those wave nineteen twenty twenty one to be taken up through the 20s.
There were enough problems with this virus up into the 20s and in the sense it
continued causing problems throughout the world to the 30s and through the 40s,
and it was not hit on the head to 1957 and it was 70 hit on the head by another influenza virus.
It came displaced it. That the Asian flu of 1957 called H two and N2 or C H1N1, a different haemagglutinin during it.
There are not cross immune to talk. So you had a virus displacing the H1N1 and the new one coming in.
So there are plenty of waves of no surprise about waves.
I was also interested in how far other techniques that we've become so familiar with, such as a nationwide lockdown were applied at this time.
Not really. Not not about my way of thinking. But let's put it another way.
The quarantine, when it was properly imposed, which was in the South Seas.
If it was properly chosen by the Americans for a new colony, that they did everything, it wouldn't allow mail in to total.
And so there is that colony. They wouldn't let any people in the inland apremilast.
And we didn't then crack on had the Australians delayed the entry into Australia by a pretty strict quarantine.
I've been to the quarantine station myself there, several star stations around Big Strong in Sydney, for example, and you would die there quenching.
But that just delayed it. So I didn't think that did much good.
But you know what young people are like? They didn't want to be held in quarantine.
So I think the quarantine was broke. The gain in the game was extremely difficult to contain with the whole thing.
So, you know, certainly we know the quarantine has been successful in the past, in the 16th and 17th century against particular diseases.
This is particularly difficult to use here. I think with respiratory infection, we know it could not, could not be cannot be under percent.
So, yes, you've got nothing else if you're desperate, if you're not in a scientific society.
And they also do, then the quarantine is important. And you can see whether it has it has contributed here to the cold 19 is contributed.
But one would want to be putting one's bets on the use of quarantine in the future.
This is a more scientific situation, surely, when we're looking for new specific antiviral drugs and vaccines.
But they were in 1918. I could say that. And at the same always thrills me is the individual initiatives that were carried out in nineteen.
Ageing. They didn't wait in 1918 to say, well,
can I get permission from 101 people now that you've got the situation in the camps
where I've studied the good dog show makes that local pathologist makes a vaccine.
That they've tried to work out because he didn't know there was a virus causing disease.
They could see that the soldiers were dying of the bacterial infections.
And you those are there. Good bacteriologists. I mean, Fleming was working there in these camps as well.
You showed you. That was Dr. Fleming. He cut his bacterial gene.
They knew how these soldiers were dying and most of them were dying of infection with staphylococcus streptococcus and pneumonia bugs,
you know, bacteria. So we made sense. They did know about the virus, which triggered the whole loss.
And then they put those bacteria to move deeper into the respiratory tract. But they thought, well, it's the dying of these bacteria.
Let's make a vaccine with them. And so some of the first vaccines made were made with staphylococcus streptococcus pneumonia.
And there were recently successful.
They made them in doses of 30 and 40000, more or less under their own initiative and into some of the president trials.
I mean, you know, tried them out in the Army and in the New Zealand Army and in the British army as well with some success.
But that was the individuals by the time the war ended. All this was disbanded and the initiative blew out.
You just melted away. I think that was a particularly critical time.
Reorganising the way that health was handled in England was just being reorganised,
which is not the best time to do it in the middle of a pandemic, as we've seen with this example.
But it's an initiative flattened and so they never got round to immunising any strong I in England, any local civilian population.
Another topic we read about a lot today is the ability of a virus to mutate.
So I asked John whether we're aware of any mutation in this particular influenza strain.
And I then discussed with Brian. How we studied this today. No, no, we're not.
This is a good question, because there's a virus that mutates, which shows you look at it to say, why should it?
It was doing very well. Thank you. You know, why did it need to make sure they're not done with these viruses?
If you look at it that way. Mr. Grey. Well, I mean, but the virus isolated in it was almost identical to the Jeffrey German begger zoomed in.
And so you got four American soldiers and all that time apart were space apart.
I think they were the ones we picked up, landed, did have one mutation.
The other receptor binding site where we're getting a bit technical.
But overall, overall, the forest started off and it finished, but studying optimum looks at 1917 samples.
But once we got going in 1918, it didn't seem to change at all as it moved around and caused that devastation.
I mean, it does seem to be because people have reconstructed it. Of course, in the lab, which was very controversial,
there was a big debate in the scientific community about whether they should reconstructed it escapes.
And they had to have a panel to debate it. And the argument is that you should you should push these flu strains to see
how pathogenic they can become so that you can prepare for them in the future.
So the avian flu is, for example, are very good.
The receptors, the avian flus use in humans tend to be in the nose and in chickens tend to be in the lungs and nose.
So we tend to have less of these receptors in our lungs, which means that we get much less severe disease than than the chickens.
But it is possible that there will be a mutation that allows those things to be much more infectious to humans and to cause severe disease.
And so in the lab, people are looking at how you make flu more deadly, which it seems seems an odd thing to do.
But of course, you want you want to be ready for it if it if it comes.
And so by changing the way that some of these flu viruses use human receptors or poultry receptors or ferret heftiest print ferrets are used,
that what is is great potent. And it does look when they reproduce the Spanish flu sequences,
that it was quite a pathogenic flu given the huge volume of conversation in the media about the so-called Spanish flu pandemic,
particularly at the start of the Kovil pandemic. I wanted to devote some time to discussing what humanity did and didn't learn from that experience.
John started by outlining why the political and social environment at the time wasn't conducive to such learning.
I think we could have learnt a lot. But those two men, those in DeLay, I think was too much to do.
I think they will were so much recovering from World War and then the Spanish thing on top of it, that everyone was pretty exhausted.
And then the health system was unable to cope with at that stage.
And then I faced off from Britain. It wasn't so long before the general strike.
Huge political events arrived on the scene. And I think that delayed our response.
Really, Italy certainly delayed anyone saying, well, let's make some preparations.
Those responses, like should we make some preparations for another pandemic, didn't really begin to happen until the nineteen seventies.
And I remember being with Joe Smith, who was director of the Collingdale Laboratories,
began to produce a pandemic report about what the government should do.
Remember that six of us helped along with that. But that was not until the 1970s, I think.
So not enough, I think was learnt. There were things were left, but they weren't applied in in our society or indeed in any other society.
Quickly enough. And indeed, strangely, I remember talking to a very famous neurologist of the London hospital, you know, way past his retirement.
And I said, what was it like then? You were you you you're right.
You experienced the pandemic. Oh, yes. You said yes. I was a student at the London hospital and dance.
And that's. Well, what what do you do? What do you do? Well, what was your expertise? I didn't even notice it.
I didn't even notice it. So busy being a medical student. I didn't even notice the pandemic.
So you see, again, you had to change it in context, cheque you with death.
You know, you might have 100 million people, but they're dying of it over a period.
And there's plenty of other people left.
Say, an average GP, you might not have had more than a couple of people die in the practise or three or four, Jozo, people dying like flies.
They were not most people carrying on their lives and struggling along.
So you have to get a perspective. Ninety nine percent of people survive that pandemic.
They did. So, you know, a lot of survivors are around. However, John wanted to point out a couple of.
National lessons to learn and parallels with today's kuvin experience, starting with the slow reaction of some cities, states and countries.
But this is pretty amazing. First of all, in the 21st century, what we're trying to do, we're not doing much better than they did a hundred years ago.
That rather depresses me sometimes.
But what the biggest lesson from the great Spanish flu so-called outbreak was that if you want to prevent it with all these measures,
social measure the masks and wear these, you have to react quickly.
Social distancing the great cities of America, 80 of them.
I think they vary somewhat dilly dallied. The mask said, I don't like the idea of masks.
The president said, I don't like the idea of social justice noticing that.
But those rights. These are the things that we can do and we are going to do them in this city
of ours and we're going to throw them at this flowers all at the same time.
Some of them said we'll do one. If that doesn't work, we do another one. That is a welder. Not those who through the these these methods at the virus.
They had some success. That's the biggest single piece of positive information.
I think that came from that outbreak that would have helped us today if we take any notice of it, whereas most of us here dillydally ran.
John also had a warning about longer term neurological effects, which has echoes in the conversations about long kuvin today.
The vast, of course, was respiratory. We knew that people died of superinfection.
Bacteria, which is not seems to be happening now. The culprit, simply bigger immune reaction.
But there was something something started. But we know we didn't know how to 1918.
That is, I think that the virus is moving into the brain in some people.
It was caught in urological vaccine, a few. And of course, when you get a big outbreak, you begin to pick up rare complications.
So neurological complications have been described. Not very often flu before, but they're being picked up more often in 1918.
And then things quieted down for a year.
But neurologist working in in Austria and Vienna, it began to notice people with Parkinson's, young people with Parkinson's disease.
Now it's a shaky Polski Parkinson's. And on it, a young person.
Yes, he was picking up a young person and more and more. So he has been described in his name as one economist.
And it's been described as VONNE economy overseas.
And later on, those people who began to show symptoms of it amongst them didn't recover and were kept in hospitals.
And in the end, about five million people suffered VONNE economies. And they're still being kept in hospitals the 1960s.
So it's a warning, I think that things are not over sometimes with these infections that you think is.
All right. You've got you've had your Kogod you had your Spanish flu.
You've had this idea that everything's fine, you've survived, but sometimes it can come back and kick you nastily.
So that's one thing to be aware of. And I think we'll begin to see it with the cold, you know?
You know, it's not over. If you've just recovered from it, in fact, it's going to take a long time to recover from it.
And there might be then long, very long term. I mean, the big outbreak with the gone economy oche disease.
The the peak of it was 1925 and by that time to five million people who died of it.
So it was not small. And that's what I worry about.
I think with the current 19, it's something else is going to happen from people they think they've recovered.
But even a respiratory virus can penetrate. And we know this virus with 19 can penetrate quite widely in the body.
It needs to penetrate like that. We think the Spanish flu did in the mid brain area.
And it can be there for some years before some probably clinical problems began to appear to conclude today's discussion.
I wanted to end on a question that had been bothering me since the beginning.
That is despite recent attention why this devastating disease has been relatively forgotten compared to the war which ran concurrently to it,
especially given their respective death camps. John had a very interesting story to tell in response about a nurse called Phyllis and
the central now largely overlooked role that women played in tackling the outbreak.
But first, Dr. Class Cashell, whom we met in our cholera episode, wanted to challenge the premise of my question.
So the Spanish flu was never forgotten by the public health establishment.
The Spanish flu is a key driver of the public health figures shaping post-World War One International Disease Control.
That experience the failure of classic bacteriology to contain it leads to a fundamental reordering on how we think about microbiological disease.
The status of epidemiology, etc. in the entire period. And that then informs the design of international health institutions like the W.H.
We still rely on. So I think in terms of the history of science and the history of the public health system was never forgotten.
The people with the generational memory of the Spanish flu end up designing the post-war post,
Second World War post-World War One, the international health order.
And that disease is in their minds that that kind of phenomenon of rapidly spreading pandemics.
And it leads to the fact that the WTO, even one year before it's even formally founded,
starts developing an international influenza surveillance system, starts debating doing that.
So it is that I think we need too easily. And I come back to an earlier point.
Tell ourselves moralising stories about create heroes are lessons not learnt from history.
I think we should rather ask ourselves why the collective shouting about the Spanish
flu wasn't given the same attention as collective shouting about other health threats.
And I think that is then a very interesting question, because after 1945, the world is a very different place.
With the advent of antibiotics for bacterial pathogens, widespread decline of infectious diseases, new viral vaccines that are developed.
That is, I think, a much more powerful way of explaining why the Spanish flu is perhaps not as deeply
lodged in the public memory as it may well have been in the immediate years afterwards.
I mean, additional factors of the end of World War One, which is obviously huge event.
The fact that large initial first reports about the influenza spreading was censored in many countries,
leading to the famous description of it as the Spanish flu. And I think perhaps most importantly,
the fact that the Spanish flu could not be explained with contemporary bacteriological knowledge of how pandemic should look like.
Remember, bacteriology, in a way, is springs up in relation to these massive bacteriological pandemics of the 19th century,
cholera and the plague pandemic and the repertoire of these microbe hunter self-styled micro parties is useless in this.
In this. In this context.
So you know that the learning effect that separates it, that this disease is experienced as a crisis, as something that unfolds.
Yes, you can use classic hygiene methods, but there was no viral theory to explain anything after 1945.
These things are put into place, but there is a declining awareness in the West. And I talked about this in the context of laboratory systems, too,
of the need to protect at the local level against infectious disease and the threat.
Infectious diseases pose. Remember the 20th century?
We see the transition from infectious diseases as a major cause of death to lifestyle, associated diseases,
cancer, etc. Heart disease are becoming the major cause of death in high income country contexts.
And so I think that is probably more of an explanation of why these things are forgotten.
I know we could also ask why are the cholera pandemics forgotten?
Even though cholera is still in contrast in the Spanish flu, cholera was a very visible phenomenon of 1960s, 1950s health reporting.
And then from the 1980s, 1990s onwards. Right again.
So, again, I think I think it's much better to rather than ask lessons learnt or lessons forgotten.
There rarely are simple lessons.
It's to ask why politica marketplaces didn't allocate more resources to these warnings because the warnings were being met continuously.
You can read public health reports going back to the 50s and you will be references to the Spanish flu as an event.
You've got the whole the whole weight of society with these wars.
There always remember. There was certainly stook about Waterloo. Yes.
Whereas people talk about podia, they say was polio. It's just this society is the way that orientated than war mongering.
There's always been a part of them walked down the street area, every statute bloke standing on his legs apart.
If some say this general was unstable and all rather than chaises, Survivor is great.
Status was arrived during the battle of our arse.
So the whole it tells you all the time how important men are and it tells you how important soldiers are.
Really don't see many scientists stuck up on a pedestal.
And while I'm not sure, one actually don't see many women who save lives coming back to the first.
Risk their own lives. She may statues to that fearless burdens.
The will and we're doomed in our first exclamations because she was buried in a coffin.
She volunteered for the Western Front against the parents wishes and she became a BFD like bureaucrat and a volunteer nurse.
Should Middletown's. She'd never seen a. You know, she won't.
And she was thrown into that cataclysmic affair, handing soldiers of the Western Front.
And then when the war ended, she embarked on a train coming back.
She was not feeling so well. She had aches and pains. She had slight slushy temperature, coughing.
She knew she had the Spanish flu. She got to Charing Cross station where they all came in.
And rather than go home to a mother who she felt she could, in fact, she tried to battle it out in a small flat that she rented.
Near near where her mother lived. And she did not survive. So her death was witnessed by a stranger.
The doctor came along and gave the certificate. Spanish flu, double pneumonia exit, Phyllis.
All those years later, when we identified her grave and we knew she was in a coffin and we asked permission of the relatives who wish we could, Exuma.
They said, well, we know well, she would like volunteering for the Western Front.
If she were here now, we ask her if you volunteer to have you use your land for scientific reasons.
She would say yes. Yes, that's what she was.
I always think of her action and I would like to see more commemoration for the role of nurses and women who housewives in that pandemic.
I think women play a huge contribution in nursing people. They usually do.
So many people feel their contributions are almost like an estimate.
Now, I'd like to see more of it. Acknowledge and I'm so proud of our window at the hospital, in the church, just behind the hospital,
which is the Spanish flu commemorative window based on the page where we come from.
Who are we? Where are we going? Well, we know we can probably cut my road infection.
The question of who are we? Phyllis can answer that and these other people can answer that.
Sometimes we don't find out who we are until we're faced with huge issues like the threat of death from the virus.
Where are we going? Well, hopefully we're going to a more scientific world than Goke as world.
Sometimes I wonder whether we are.
Next time on Future Makers, we arrive in the 1980s, a decade that really resonates in my own memory with the Falklands War.
The Chernobyl disaster and the fall of the Berlin Wall. Not to mention marriage and the birth of our first two children.
But for all this, while I was a post graduate in 1981,
I remember friends telling me of a growing panic about the emergence of a never seen before infection, which seemed to be overwhelming.
Previously healthy young men's immune systems, the HIV virus and the acquired immunodeficiency syndrome it causes would go on to create one of the
most devastating epidemics that humanity has experienced and one for which we still have no cure.
We'll hear from some of those who worked on it from the very beginning in the next episode of our history of pandemic season.
Until then, I'm Peter Milliken, and you've been listening to Future Makers.
Future Makers is produced in-house at the University of Oxford.
Our voice artist at the beginning of this episode was under Wilson. The show was hosted by Peter Milliken from Hartford College.
The series original soundtrack was written and composed by Richard Watts, and the show was produced by Ben Howard, The Me, Steve Prichard.
We thank you very much for listening and hope you've enjoyed the series on the history of Pandemic's.