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September had been a lovely time to get married in Flintshire. The last of the summer,

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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,

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laughing all together. Such a happy day.

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You could almost forget the war.

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But as Gladis held the photograph in our hand, slowly scanning all of those familiar faces, she noticed the paper began to tremble.

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How many of them weren't here anymore? How quickly had they gone once the flu had arrived?

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How soon had she been separated from her precious Fred? Just two months, two months of married life.

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And then it was gone. It was all so quick. It was all so cruel.

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Welcome to the 20th century.

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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.

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We're about to discuss, especially in the early coverage of our current COPD outbreak after the black death, the so-called Spanish flu.

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That's one of the most famous monikers of any pandemic. But does it deserve such notoriety?

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Let's find out. Our guide for today is Professor John Oxford, a world expert on influenza from Queen Mary, University of London.

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I began by asking John to tell us more about the strain of flu in question and whom it's effective.

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As strong as we can see, a single virus was moving around the world.

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I've also done genetic work, along with Jeffrey Tobin Burger in the States.

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It's a lead question where I suppose on genetics of the 1918 flu, he was the first one to get our sample.

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That's the clinical sample from a frozen Eskimos in the wet land.

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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.

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When the most important determinants of virulence and everything else that was not so long after that,

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we were also able to get samples by a group from the Royal London Hospital Archives and the pathology department.

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So we had two samples, one from a sock from a policeman and one from our housewife.

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And when we did the sequencing, he did sequencing, we found they're almost identical.

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So a virus moving around the world three thousand miles apart.

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What a couple here in London compared to Jeffrey Taubenberger, samples from New York,

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for example, or from the India Group and the northern parts of the United States.

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They're almost identical. Jeffries were from soldiers. Mine were from civilians.

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Yet the virus was the same. And the clinical picture in those groups was the same as well.

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The picture was not so different from Kobe. Now, in general, most people survived.

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Most people survived. Otherwise, it would be as you will get a hundred million deaths on our hands from 1918.

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Almost certainly. But the Christian population, the world was probably about two billion at that time.

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So when you look at the statistics, most people and they all got in the end, everyone got it.

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But most people survived. But the mortality struck in the 21, 22, 23, 24 year olds, young people.

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That's why the unique and awesome thing about the Spanish flu compared to any other flu.

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It didn't go for elderly people. In fact, I've seen the figures in the United Kingdom.

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I look at the recently hardly anyone over the age of 65 who's dying in 1918 flu or 1919 flu.

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They just weren't. But the mortality was in the 21 to the younger age group.

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Now, why is that? That's another reason why we wanted this clinical result.

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Was that interested in the genetic sequence of the virus? That's very important.

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But to look at kind of what was going on in the lung, how did they die?

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Why did this virus attack young people, not the elderly group? And we're still not actually sure of answers to those questions.

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I must say a hundred million deaths was an astounding number to comprehend.

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And I asked John to put that in the context of the history of disease outbreaks that humanity has faced.

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Well, I think it is pretty unique situation, you know,

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is when you look at the history of the world that 1918 brings the biggest outbreak the world had ever seen.

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More up to now, there's been no bigger aerobraking infectious disease.

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There's been no bigger calamity in the world. That 100 million people.

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I mean, it's almost inconceivable. The numbers, 100 million. But they are they are accurate as far as we can see.

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I mean, you can see that with the code. I tricky it is to get accurate figures.

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But in 1918, it was just the same was quite tricky.

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And it was particularly there was a big black hole in Africa. The number of people died there.

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And a big black hole in China as it happened. But still, the figures have climbed from 20 million.

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The earlier estimates, up to 100 million. We should know more.

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That's more or less accepted. You can't draw that.

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You can't grasp it. And I come across with anonymous graphs randomly.

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We have to do is concentrate on one. That's the way to do it.

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And then from that one, you work out everything about that one person.

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And then multiply it by the figure that you settle on. And then you can get the impact and the way I do it.

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When I started work on this virus, I was sent to a gym Cordle on television message, and I was the centre of photographs.

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It was a wedding photograph. I'm telling him, frankly, and it's of a couple who just got married in September.

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Sentence in this very small village in Flintshire in Wales.

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The pair of them. So it's a lovely black and white photograph of the pair.

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But within a month. Certainly within two months, the virus that arrived.

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That little spot. And killed the husband. It was a bit like Titanic.

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And I remember getting it more or us at the same time as Titanic, which is a film, after all.

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Not about a ship, but about love and being separated.

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This is a piece about separation because Fred Beth, a young man who was her husband, had married Gladys,

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but they were torn apart because he had the virus and exited, as it were, leaving her.

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Now they had the photographs. They had this black and white photographs. She married him another person and had a child.

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And it was that child who sent a photograph.

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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.

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And then her mother had the same photographs beside her bedside.

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And it was only past me when in this generation at these you that single couple,

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the impact and it's been called the forgotten flu and all that sort of stuff was locked and forgotten.

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And that's a perfect example. The impact of one person, one family.

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That's right. Now you most about 100 million. So then you can see the overall punch of it.

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And as you say, it's completely special because of the of the age group.

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Next, you say, well, why? And that's a question we've been asking.

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Why should a perfectly healthy twenty three year olds die when their grandkids, age 83, didn't and the virus is moving around?

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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.

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Remember, this is a pretty special web of fresh pressures. But what outbreaks of influenza had they already experienced?

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Licalsi, 21 year old, had not experienced probably any influenza, but the 83 year olds had experienced influenza going back to the 80s,

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90s, leading possibly back to 1840 where there were previous pandemics.

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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.

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They survived that outbreak come 1918. They still have some memory, some immune memory of the 1918 virus attacked them.

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Those immune cells came into action and protected them. After all that time.

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So the old people survive. Younger people did not survive. So we think that mass, this immune memory was was very important.

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It's pretty outstanding when you think that this is a long lived memory.

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But of course, it's you can have it for yellow fever and other viruses as well.

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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.

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As John was about to outline, it wasn't just the sheer number of deaths that was astonishing here,

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but how rapidly these fatalities occurred compared with other pandemics in our series.

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And that's how many people in 18 months the bubonic plague.

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Obviously, it's a nasty infection still. Yes. I mean, the Saints. They know it.

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They never had 100 million dying in a couple of years. You might have had millions died over a period of 30 years.

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I can accept that. But I don't think we should get too much dragged into Bluebonnet.

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I'm sure a picturesque, if you like to put it away, I suppose, with fluids like picturesque about it apart.

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And, you know, you just look normal, don't you, actually? Except for that, that in the Spanish flu,

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you didn't quite some of the young people didn't look quite normal by the time they

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were getting to the point of death because they had this heliotrope cyanosis.

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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

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infected or super infected and they're gasping for breath and that's why they're cyanotic.

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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,

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both of cyanotic, both with the blue lips, blue ears and this lavender colouration that will die tonight.

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So we'll have to make best available tomorrow. So you could do that sort of thing.

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But more or less. Otherwise, people died quietly. And I think a lot of people were shocked at the Kobe when it all comes.

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I suspect many people died at home and in the Spanish flu.

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Most people did die home. The hospital in Britain with Chock-a-block, with wounded soldiers.

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I mean, there are so many wounded soldiers that they couldn't all the hospitals were full.

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They were commandeering hotels and boarding houses all down the coast where I come from, Dorson, Hampshire, all those boemre to.

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Sandbags, well, those famous things you keep seeing and the paper, all the hotels were full of wounded soldiers.

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My mother was shot at that stage. She would go and see them. Young women would go visit these wounded soldiers.

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They never wanted them out. A lot of them say they're so badly wounded.

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But women were persuaded to go and look and say hello and bring them back to normal.

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So, you know, it was pretty horrendous thing. This Spanish flu, the effects mixing with the war as well.

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I think I wanted to cheque with John that we could set.

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The main timeline of this outbreak is taking place between the spring of 1918 and the winter of 1990.

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That's in the northern hemisphere. Yes, really? Really.

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I suppose if we if we took on my own work to look at earlier outbreaks,

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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.

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There was a kind of a preamble. You know, it's kind of built up a bit before it exploded.

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So but mainly, yes, mainly the three main thrust to the outbreak where most people died.

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And in fact, the ago died was, as you say, in the autumn of 1918 and the winter of 1919.

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So it's worth spending a moment on the earlier outbreaks of this disease.

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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,

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actually. And before then, it was called epidemic catarrh or epidemic.

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This particular it was not called flu until 1918, 1919.

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So there were things described in the medical literature. Well, I wish with all time all my students are searching the medical literature.

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Germany, France, England, America to look for pre outbreaks, what are called Herold's outbreaks.

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Kind of an outbreak that could've warned us that something bad was coming.

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And there were some of these outbreaks, but it was very difficult.

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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.

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I mean, you have to understand circumstances here. This is total commitment to winning this war total.

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Everything else went by the by the board. We had to win it. So all the effort we, for example, over half,

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three quarters of the doctors and medical staff being there were not including in England and France servicing the war.

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And the same with hospitals said one hundred seventy five thousand beds in France to deal with wounded soldiers.

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Everything was there in France and there were three in the end, three million soldiers, young people moving around and not very good circumstances.

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And then on top of that, the Western Front is farmland. Total farmland was the first war to be fought like that.

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And I think farmland. And that's why there's so much contamination with Clostridium gas gangrene,

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so important infection on the Western Front just because of the cows and horses around.

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But also it was a migrating area is an air of loss of where the migrating birds coming from Siberia moved across the eastern,

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tipping the Norfolk down across France down to stop some parts.

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Those countries across the Mediterranean into Africa, huge migration.

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And we know now the migration of these ducks and geese.

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Waterbirds is very important for the spread initially and spread to these new pandemic strains.

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Then you've got the farmlands, the wars being fought on time.

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That's only twelve miles and it's 50 miles from the front where soldiers are being mangled daily.

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People are carrying on, doing their farms, you know, listening to see when you think of it now.

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But they were. And even more so on the great encampments of the British army up and down the Western Front, great hospital.

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The Catterns, they they had ducks and geese in the camp.

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And these camps are not Boy Scout camps is accounts of hundred thousand young people.

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A hundred thousand young people in 24 hospitals in one town.

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The vast you've to appreciate the energy that gone into fighting this war to end all wars.

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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,

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domesticated birds, large numbers of young people under stress.

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There they were on the western front. So it is a pretty unique circumstance and even worse, I suppose, when the whole war ended.

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You had all these millions of young people going home and they came from the whole world.

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They didn't just come from Suffolk and Norfolk. They came from Australia, South Africa.

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And they got on those boats in the British Navy. Help me to go.

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They didn't want to be delayed.

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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.

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So he got off the boat and went up the railway lines.

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Normally when they get on the sidelines home to their parents, their little farms, they tip, they cheque the barge with them.

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And the biggest outbreak in South Africa, resample, was that was the railway line outbreak where they did just that.

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And their parents, when their sons arrived and called in all the neighbours neighbouring farms,

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and they came in on their horses and buggies to about twelve miles in the sort of area.

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And that was an excellent read, led to an explosive outbreak. So that was happening all over the world.

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So, you know, there were all these circumstances. And in a sense,

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I think now the war engendered the virus and changed the circumstances where it could

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begin to spread and spread widely around the world after which we committed to this war.

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We threw everything at it through my father aspect, as it were.

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Everything was thrown back. And the survivors, they came out.

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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.

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No, those modern things. 1918 was not fit for anyone to come back here.

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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.

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The war had also impacted on any preparation which might have been prompted by those earlier outbreaks.

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Well, because everything in 1917, whatever topic you talk about religion or art or whatever,

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is dominated by the war since the first global war and that consumed every once energy just dominated everything.

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So people who should have been on the lookout. I suppose public health, who whoever politicians there were totally preoccupied with the war.

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In fact, my own personal feeling is that the to the pandemic and the war are closely intertwined.

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They're almost inseparable, almost to the extent that perhaps if they had not been a First World War,

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they may not have been the 1918 Spanish influenza. So that's how closely they were intertwined.

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That's an opinion endorsed by our medical expert, Professor Brian Angus.

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But I suspect that the reason that was quite so deadly was, as you say, because of the circumstances.

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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.

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So so I think it was probably a combination of quite a quite a nasty virus that it evolved.

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No immunity in the population. Again, probably because the virus had evolved that most people hadn't seen it.

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And then a very vulnerable population, although, you know, when we see vulnerability to flu, it tends to be being old and being obese.

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And those certainly weren't the characteristics of people in the First World War.

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So. So it's like malnutrition certainly can can can cause problems.

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And again, a lot of people. Were one of the classic things we talk about infectious diseases is that if you have flu,

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you then afterwards look for infection with a cold starts off as areas,

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which is a thing that causes of skin lesions and causes possible causes, infections, the bloodstream.

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And that is one of the things that tends to happen. You get flu, you damage to the lung.

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Then you get a secondary bacterial infection on top of it. And again, at that time, there were no antibiotics.

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So you would have quite a high death rate from 70. Back to you.

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Infection as well. You know, taken against if you dissect it, open even more than that.

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And you mentioned nutrition that normally the soldiers, when one were well nourished,

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was again all the effort of France, Germany, and if the were to were so had to nourish up the soldiers.

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So they were well nourished. If there was any deprivation in the country of food, it was not soldiers.

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It was on the homefront, on the homefront.

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And particularly in Germany, for example, because we blockaded Germany, the food normally be imported by sea to Germany.

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And we ruled that we totally blockaded it. So there was no court.

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So the starvation started in Germany. There was no starvation in England.

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I don't think people were that well nourished on the homefront in England.

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But soldiers were okay. Soldiers had other problems to deal with.

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But there were a very unique mixture of circumstances which were Basken like influenza being spread by aerosol droplets can take advantage of.

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This would also be a relevant place to discuss the name by which we now know this outbreak,

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the Spanish flu, and how the war led to the use of such an unfair title.

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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.

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You know, for the first time, some of these politicians have been antagonistic about the origin of virus.

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We won't name the competition, but it goes round calling this. Delivered all that something.

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And blaming them. Now, the most famous American textbook about 1980s is that is that America's forgotten pandemic?

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And in that book, they extol the whole theory that that virus, the 1918 virus, didn't that didn't arise in Spain.

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It arose in the United States. In Kansas. Well, I mean, I don't believe that you believe that.

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I don't believe that most Americans do. So why are they busy? Right.

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Talking about the virus. It cause the biggest pandemic in the world.

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1918. Well, we'll call the Americans who still more accurately call it the Spanish flu anyway.

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So this is sort a tangle you get into if you're not careful.

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If you start getting nationalistic and say with HIV, you know, you can stop blaming a country or what are you going to do?

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So you have to be very careful with it. On the other hand, I think with flu particularly,

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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.

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So we've got to look at it quite carefully. And I feel now we've got a lot of evidence to support that.

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This virus certainly didn't arrives in Spain.

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And the reason why it was all over the newspapers, everyone swallowed this was that Spain wasn't in more Spanish.

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Newspapers are being published. Weekly isn't as usual, daily as usual.

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The king was in fact, the prime minister was infected in Spain.

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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.

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They were they looked see what's going on in Spain. And of course, you invaded with to shake that off.

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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,

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that either is totally a scam spat out. But so Spain is out of the question as far as we could work concerned.

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That leaves the theory of Kansas and Dorothy and the yellow brick road.

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We've seen almost equally preposterous, I think, as a Spanish one or the China one.

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The China. I'm just saying half the population.

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What do you say to a citizen in charges who say it's a possibility, but there's not any solid evidence?

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If you look at the literature of what there is of anything emerging in China.

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There were not the statistics average trying to find them.

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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.

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Second waves. And I ask John to tell me more about the pattern of waves during this pandemic.

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So the first wave was from half the preceding Herrod waves in these camps and in 1917.

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But the big wave was in the autumn of 1918 and by Christmas.

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And I think it had gone through. It's worse than I think people began to think, well, thank God for that.

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So it's, you know, it's going to get better. But by February 1919, never come back again.

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Or more likely, it's never gone away. Never gone away.

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For reasons best known to herself, it had circumstances to spread again.

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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,

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those who had not been mopped up, as it were, three or four months to go, were picked up again in 1919.

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And when you come to think of it, there was waves to follow was just wait one, two waves.

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It's like when you throw a pebble in a pond, you get you get serious waves and you get a big one.

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Then you get a little a little of a little girl. Ten waves. That was what happened in nineteen eighteen.

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There were big wave my attention to be late 1990 those wave nineteen twenty twenty one to be taken up through the 20s.

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There were enough problems with this virus up into the 20s and in the sense it

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continued causing problems throughout the world to the 30s and through the 40s,

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and it was not hit on the head to 1957 and it was 70 hit on the head by another influenza virus.

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It came displaced it. That the Asian flu of 1957 called H two and N2 or C H1N1, a different haemagglutinin during it.

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There are not cross immune to talk. So you had a virus displacing the H1N1 and the new one coming in.

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So there are plenty of waves of no surprise about waves.

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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.

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Not really. Not not about my way of thinking. But let's put it another way.

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The quarantine, when it was properly imposed, which was in the South Seas.

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If it was properly chosen by the Americans for a new colony, that they did everything, it wouldn't allow mail in to total.

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And so there is that colony. They wouldn't let any people in the inland apremilast.

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And we didn't then crack on had the Australians delayed the entry into Australia by a pretty strict quarantine.

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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.

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But that just delayed it. So I didn't think that did much good.

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But you know what young people are like? They didn't want to be held in quarantine.

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So I think the quarantine was broke. The gain in the game was extremely difficult to contain with the whole thing.

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So, you know, certainly we know the quarantine has been successful in the past, in the 16th and 17th century against particular diseases.

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This is particularly difficult to use here. I think with respiratory infection, we know it could not, could not be cannot be under percent.

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So, yes, you've got nothing else if you're desperate, if you're not in a scientific society.

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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.

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But one would want to be putting one's bets on the use of quarantine in the future.

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This is a more scientific situation, surely, when we're looking for new specific antiviral drugs and vaccines.

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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.

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Ageing. They didn't wait in 1918 to say, well,

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can I get permission from 101 people now that you've got the situation in the camps

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where I've studied the good dog show makes that local pathologist makes a vaccine.

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That they've tried to work out because he didn't know there was a virus causing disease.

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They could see that the soldiers were dying of the bacterial infections.

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And you those are there. Good bacteriologists. I mean, Fleming was working there in these camps as well.

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You showed you. That was Dr. Fleming. He cut his bacterial gene.

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They knew how these soldiers were dying and most of them were dying of infection with staphylococcus streptococcus and pneumonia bugs,

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you know, bacteria. So we made sense. They did know about the virus, which triggered the whole loss.

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And then they put those bacteria to move deeper into the respiratory tract. But they thought, well, it's the dying of these bacteria.

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Let's make a vaccine with them. And so some of the first vaccines made were made with staphylococcus streptococcus pneumonia.

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And there were recently successful.

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They made them in doses of 30 and 40000, more or less under their own initiative and into some of the president trials.

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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.

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But that was the individuals by the time the war ended. All this was disbanded and the initiative blew out.

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You just melted away. I think that was a particularly critical time.

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Reorganising the way that health was handled in England was just being reorganised,

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which is not the best time to do it in the middle of a pandemic, as we've seen with this example.

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But it's an initiative flattened and so they never got round to immunising any strong I in England, any local civilian population.

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Another topic we read about a lot today is the ability of a virus to mutate.

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So I asked John whether we're aware of any mutation in this particular influenza strain.

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And I then discussed with Brian. How we studied this today. No, no, we're not.

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This is a good question, because there's a virus that mutates, which shows you look at it to say, why should it?

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It was doing very well. Thank you. You know, why did it need to make sure they're not done with these viruses?

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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.

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And so you got four American soldiers and all that time apart were space apart.

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I think they were the ones we picked up, landed, did have one mutation.

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The other receptor binding site where we're getting a bit technical.

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But overall, overall, the forest started off and it finished, but studying optimum looks at 1917 samples.

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But once we got going in 1918, it didn't seem to change at all as it moved around and caused that devastation.

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I mean, it does seem to be because people have reconstructed it. Of course, in the lab, which was very controversial,

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there was a big debate in the scientific community about whether they should reconstructed it escapes.

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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

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how pathogenic they can become so that you can prepare for them in the future.

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So the avian flu is, for example, are very good.

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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.

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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.

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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.

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And so in the lab, people are looking at how you make flu more deadly, which it seems seems an odd thing to do.

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But of course, you want you want to be ready for it if it if it comes.

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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,

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that what is is great potent. And it does look when they reproduce the Spanish flu sequences,

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that it was quite a pathogenic flu given the huge volume of conversation in the media about the so-called Spanish flu pandemic,

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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.

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John started by outlining why the political and social environment at the time wasn't conducive to such learning.

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I think we could have learnt a lot. But those two men, those in DeLay, I think was too much to do.

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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.

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And then the health system was unable to cope with at that stage.

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And then I faced off from Britain. It wasn't so long before the general strike.

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Huge political events arrived on the scene. And I think that delayed our response.

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Really, Italy certainly delayed anyone saying, well, let's make some preparations.

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Those responses, like should we make some preparations for another pandemic, didn't really begin to happen until the nineteen seventies.

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And I remember being with Joe Smith, who was director of the Collingdale Laboratories,

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began to produce a pandemic report about what the government should do.

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Remember that six of us helped along with that. But that was not until the 1970s, I think.

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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.

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Quickly enough. And indeed, strangely, I remember talking to a very famous neurologist of the London hospital, you know, way past his retirement.

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And I said, what was it like then? You were you you you're right.

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You experienced the pandemic. Oh, yes. You said yes. I was a student at the London hospital and dance.

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And that's. Well, what what do you do? What do you do? Well, what was your expertise? I didn't even notice it.

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I didn't even notice it. So busy being a medical student. I didn't even notice the pandemic.

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So you see, again, you had to change it in context, cheque you with death.

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You know, you might have 100 million people, but they're dying of it over a period.

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And there's plenty of other people left.

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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.

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They were not most people carrying on their lives and struggling along.

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So you have to get a perspective. Ninety nine percent of people survive that pandemic.

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They did. So, you know, a lot of survivors are around. However, John wanted to point out a couple of.

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National lessons to learn and parallels with today's kuvin experience, starting with the slow reaction of some cities, states and countries.

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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.

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That rather depresses me sometimes.

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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,

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social measure the masks and wear these, you have to react quickly.

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Social distancing the great cities of America, 80 of them.

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I think they vary somewhat dilly dallied. The mask said, I don't like the idea of masks.

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The president said, I don't like the idea of social justice noticing that.

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But those rights. These are the things that we can do and we are going to do them in this city

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of ours and we're going to throw them at this flowers all at the same time.

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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.

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They had some success. That's the biggest single piece of positive information.

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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.

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John also had a warning about longer term neurological effects, which has echoes in the conversations about long kuvin today.

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The vast, of course, was respiratory. We knew that people died of superinfection.

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Bacteria, which is not seems to be happening now. The culprit, simply bigger immune reaction.

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But there was something something started. But we know we didn't know how to 1918.

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That is, I think that the virus is moving into the brain in some people.

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It was caught in urological vaccine, a few. And of course, when you get a big outbreak, you begin to pick up rare complications.

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So neurological complications have been described. Not very often flu before, but they're being picked up more often in 1918.

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And then things quieted down for a year.

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But neurologist working in in Austria and Vienna, it began to notice people with Parkinson's, young people with Parkinson's disease.

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Now it's a shaky Polski Parkinson's. And on it, a young person.

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Yes, he was picking up a young person and more and more. So he has been described in his name as one economist.

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And it's been described as VONNE economy overseas.

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And later on, those people who began to show symptoms of it amongst them didn't recover and were kept in hospitals.

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And in the end, about five million people suffered VONNE economies. And they're still being kept in hospitals the 1960s.

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So it's a warning, I think that things are not over sometimes with these infections that you think is.

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All right. You've got you've had your Kogod you had your Spanish flu.

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You've had this idea that everything's fine, you've survived, but sometimes it can come back and kick you nastily.

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So that's one thing to be aware of. And I think we'll begin to see it with the cold, you know?

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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.

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And there might be then long, very long term. I mean, the big outbreak with the gone economy oche disease.

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The the peak of it was 1925 and by that time to five million people who died of it.

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So it was not small. And that's what I worry about.

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I think with the current 19, it's something else is going to happen from people they think they've recovered.

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But even a respiratory virus can penetrate. And we know this virus with 19 can penetrate quite widely in the body.

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It needs to penetrate like that. We think the Spanish flu did in the mid brain area.

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And it can be there for some years before some probably clinical problems began to appear to conclude today's discussion.

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I wanted to end on a question that had been bothering me since the beginning.

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That is despite recent attention why this devastating disease has been relatively forgotten compared to the war which ran concurrently to it,

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especially given their respective death camps. John had a very interesting story to tell in response about a nurse called Phyllis and

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the central now largely overlooked role that women played in tackling the outbreak.

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But first, Dr. Class Cashell, whom we met in our cholera episode, wanted to challenge the premise of my question.

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So the Spanish flu was never forgotten by the public health establishment.

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The Spanish flu is a key driver of the public health figures shaping post-World War One International Disease Control.

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That experience the failure of classic bacteriology to contain it leads to a fundamental reordering on how we think about microbiological disease.

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The status of epidemiology, etc. in the entire period. And that then informs the design of international health institutions like the W.H.

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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.

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The people with the generational memory of the Spanish flu end up designing the post-war post,

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Second World War post-World War One, the international health order.

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And that disease is in their minds that that kind of phenomenon of rapidly spreading pandemics.

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And it leads to the fact that the WTO, even one year before it's even formally founded,

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starts developing an international influenza surveillance system, starts debating doing that.

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So it is that I think we need too easily. And I come back to an earlier point.

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Tell ourselves moralising stories about create heroes are lessons not learnt from history.

399
00:39:40,420 --> 00:39:45,850
I think we should rather ask ourselves why the collective shouting about the Spanish

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flu wasn't given the same attention as collective shouting about other health threats.

401
00:39:51,010 --> 00:39:57,370
And I think that is then a very interesting question, because after 1945, the world is a very different place.

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With the advent of antibiotics for bacterial pathogens, widespread decline of infectious diseases, new viral vaccines that are developed.

403
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That is, I think, a much more powerful way of explaining why the Spanish flu is perhaps not as deeply

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lodged in the public memory as it may well have been in the immediate years afterwards.

405
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I mean, additional factors of the end of World War One, which is obviously huge event.

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The fact that large initial first reports about the influenza spreading was censored in many countries,

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leading to the famous description of it as the Spanish flu. And I think perhaps most importantly,

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the fact that the Spanish flu could not be explained with contemporary bacteriological knowledge of how pandemic should look like.

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Remember, bacteriology, in a way, is springs up in relation to these massive bacteriological pandemics of the 19th century,

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cholera and the plague pandemic and the repertoire of these microbe hunter self-styled micro parties is useless in this.

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In this. In this context.

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So you know that the learning effect that separates it, that this disease is experienced as a crisis, as something that unfolds.

413
00:41:03,340 --> 00:41:09,460
Yes, you can use classic hygiene methods, but there was no viral theory to explain anything after 1945.

414
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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,

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of the need to protect at the local level against infectious disease and the threat.

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Infectious diseases pose. Remember the 20th century?

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We see the transition from infectious diseases as a major cause of death to lifestyle, associated diseases,

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cancer, etc. Heart disease are becoming the major cause of death in high income country contexts.

419
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And so I think that is probably more of an explanation of why these things are forgotten.

420
00:41:40,860 --> 00:41:44,680
I know we could also ask why are the cholera pandemics forgotten?

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Even though cholera is still in contrast in the Spanish flu, cholera was a very visible phenomenon of 1960s, 1950s health reporting.

422
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And then from the 1980s, 1990s onwards. Right again.

423
00:41:57,070 --> 00:42:03,300
So, again, I think I think it's much better to rather than ask lessons learnt or lessons forgotten.

424
00:42:03,300 --> 00:42:04,630
There rarely are simple lessons.

425
00:42:04,630 --> 00:42:13,030
It's to ask why politica marketplaces didn't allocate more resources to these warnings because the warnings were being met continuously.

426
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You can read public health reports going back to the 50s and you will be references to the Spanish flu as an event.

427
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You've got the whole the whole weight of society with these wars.

428
00:42:25,870 --> 00:42:31,120
There always remember. There was certainly stook about Waterloo. Yes.

429
00:42:31,120 --> 00:42:38,440
Whereas people talk about podia, they say was polio. It's just this society is the way that orientated than war mongering.

430
00:42:38,440 --> 00:42:46,350
There's always been a part of them walked down the street area, every statute bloke standing on his legs apart.

431
00:42:46,350 --> 00:42:54,040
If some say this general was unstable and all rather than chaises, Survivor is great.

432
00:42:54,040 --> 00:42:58,000
Status was arrived during the battle of our arse.

433
00:42:58,000 --> 00:43:03,910
So the whole it tells you all the time how important men are and it tells you how important soldiers are.

434
00:43:03,910 --> 00:43:06,990
Really don't see many scientists stuck up on a pedestal.

435
00:43:06,990 --> 00:43:13,540
And while I'm not sure, one actually don't see many women who save lives coming back to the first.

436
00:43:13,540 --> 00:43:18,750
Risk their own lives. She may statues to that fearless burdens.

437
00:43:18,750 --> 00:43:24,370
The will and we're doomed in our first exclamations because she was buried in a coffin.

438
00:43:24,370 --> 00:43:31,990
She volunteered for the Western Front against the parents wishes and she became a BFD like bureaucrat and a volunteer nurse.

439
00:43:31,990 --> 00:43:35,830
Should Middletown's. She'd never seen a. You know, she won't.

440
00:43:35,830 --> 00:43:41,920
And she was thrown into that cataclysmic affair, handing soldiers of the Western Front.

441
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And then when the war ended, she embarked on a train coming back.

442
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She was not feeling so well. She had aches and pains. She had slight slushy temperature, coughing.

443
00:43:52,570 --> 00:43:59,140
She knew she had the Spanish flu. She got to Charing Cross station where they all came in.

444
00:43:59,140 --> 00:44:08,740
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.

445
00:44:08,740 --> 00:44:14,210
Near near where her mother lived. And she did not survive. So her death was witnessed by a stranger.

446
00:44:14,210 --> 00:44:20,890
The doctor came along and gave the certificate. Spanish flu, double pneumonia exit, Phyllis.

447
00:44:20,890 --> 00:44:30,550
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.

448
00:44:30,550 --> 00:44:35,980
They said, well, we know well, she would like volunteering for the Western Front.

449
00:44:35,980 --> 00:44:42,580
If she were here now, we ask her if you volunteer to have you use your land for scientific reasons.

450
00:44:42,580 --> 00:44:46,000
She would say yes. Yes, that's what she was.

451
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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.

452
00:44:55,120 --> 00:44:59,560
I think women play a huge contribution in nursing people. They usually do.

453
00:44:59,560 --> 00:45:04,890
So many people feel their contributions are almost like an estimate.

454
00:45:04,890 --> 00:45:12,640
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,

455
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which is the Spanish flu commemorative window based on the page where we come from.

456
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Who are we? Where are we going? Well, we know we can probably cut my road infection.

457
00:45:22,720 --> 00:45:28,300
The question of who are we? Phyllis can answer that and these other people can answer that.

458
00:45:28,300 --> 00:45:34,510
Sometimes we don't find out who we are until we're faced with huge issues like the threat of death from the virus.

459
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Where are we going? Well, hopefully we're going to a more scientific world than Goke as world.

460
00:45:38,890 --> 00:45:42,880
Sometimes I wonder whether we are.

461
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Next time on Future Makers, we arrive in the 1980s, a decade that really resonates in my own memory with the Falklands War.

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The Chernobyl disaster and the fall of the Berlin Wall. Not to mention marriage and the birth of our first two children.

463
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But for all this, while I was a post graduate in 1981,

464
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I remember friends telling me of a growing panic about the emergence of a never seen before infection, which seemed to be overwhelming.

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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

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most devastating epidemics that humanity has experienced and one for which we still have no cure.

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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.

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Until then, I'm Peter Milliken, and you've been listening to Future Makers.

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Future Makers is produced in-house at the University of Oxford.

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Our voice artist at the beginning of this episode was under Wilson. The show was hosted by Peter Milliken from Hartford College.

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The series original soundtrack was written and composed by Richard Watts, and the show was produced by Ben Howard, The Me, Steve Prichard.

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We thank you very much for listening and hope you've enjoyed the series on the history of Pandemic's.