In Times Of Covid-19, What Can India Learn From The Spanish Flu That Killed 18 Million Indians?

The Spanish flu killed between 17 and 18 million Indians, more than all the deaths in World War One. More women – mostly malnourished holed-up up in dirty and ill-ventilated dwellings died, while the men nursing them also became the victims. 

The Spanish flu is first believed to have affected the World War I soldiers of the United States, Britain, France and Germany. However due to strict censorship and to keep the morale of the fighting soldiers high, the countries engaged in World War I did not communicate about the disease to their people.

In this case, the Spanish flu was not Spanish because Spain happened to be the one major nations that didn’t actively censor news of the pandemic, such as the infection of King Alfonso XIII, because it was not at war.

Over the centuries, the blame-game was started. Syphilis was called the French pox if you weren’t French. During the plague outbreaks of the Middle Ages, Jews were very often blamed for poisoning the water in the wells and expelled, and all sorts of other awful things happened to them.

And today, with the coronavirus, the blame is attributed to the Chinese.

The Covid-19 outbreak comes more than a century after the Spanish influenza pandemic of 1918, which had killed between 50 and 100 million people in the world and around 17 to 18 million people in India alone.

The World Health Organization (WHO) has declared the novel coronavirus or COVID-19 outbreak a global pandemic. With more than 30,000 deaths and over 600,000 positive cases, the virus has now spread to 175 countries.

Underprepared medical system

During 1918, when the Spanish Flu struck, India was woefully underprepared to take on such a pandemic and the indifferent and lackadaisical attitude of the British only made the matters worst.

However, in 2020, the Indian Government has shown quick response but the ground realities remain similar to what they were almost a century back.

According to the government, India has about 1 doctor per 1,500 citizens which is in sharp contrast with the recommendation of the World Health Organization (WHO) which has recommended 1 doctor per 1,000 residents.

However, in rural areas, where maximum Indians live and rely entirely on government hospitals, the ratio is 1 doctor for more than 10,000 people. If the coronavirus spreads to the rural areas, it could be disastrous for the country just like the Spanish Flu.

India also has 2.3 intensive care beds per 100,000 people which compared which China and the United States is short as they have 3.6 and 35 per 100,000 people. As for ventilators, the government doesn’t publish numbers. But experts quoted in Indian media estimate there are between 30,000 and 40,000 ventilators nationwide.

Second Wave

The first wave of the Spanish Flu seemed to have only affected the elderly and children and is eerily similar to coronavirus outbreak which is also severe amongst people with weak immune systems and with people above 80—years of age.

Researcher David Arnold, in his paper titled ‘Death and the Modern Empire: The 1918-19 Influenza Epidemic in India’, has written that the second wave was more fatal, killing adults between the ages of 20 and 40.

“In one day alone, 6 October 1918, there were 768 registered deaths from influenza in Bombay city, more deaths than at the height of the plague epidemic in the 1890s and 1900s,” Arnold wrote. The disease later swept across India, spreading to Punjab and the United Provinces (now Uttar Pradesh).

This is an important point to remember for the world and especially for India because experts are worried about the possible resurgence of the coronavirus as China where the virus first appeared is beginning to ease the restrictions in the country in order to bring back normalcy.

Coronavirus & Spanish Flu

In India, when the Spanish Flu struck, people realized how abysmally poor the British authorities had provided for the health care of the indigenous population.

As a result, the people who attended to patients were freedom fighters, activists and grassroot workers who had united to overcome caste barriers and work together for independence. Once the pandemic passed, emotions against the British ran higher than before and people now rallied behind Gandhi that propelled India towards independence.

Covid-19 pandemic too has once again united the nation, albeit for a different cause. People thronged to their balconies and cheered recently to show solidarity with India’s essential service providers.

Spanish flu caused widespread suffering and disrupted the economy and the infrastructure. Coronavirus is currently having the same impact with shops and offices shut and the economy in a downward spiral and growth forecast reduced to 2.5 per cent as against 5.2 per cent.

However, with the lockdown due to coronavirus, there is some good news too. The data from SAFAR and the Central Pollution Control Board (CPCB) showed air in many cities with relatively safer levels of pollutants. The air quality in Delhi was at a satisfactory level, according to the System of Air Quality Weather Forecasting and Research (SAFAR).

The air quality in other metro cities also improved with a large number of vehicles remaining off the roads and shops closed due to the nationwide lockdown enforced to contain the novel coronavirus outbreak.

A video of a Spotted Deer running across an empty street in Dehradun went viral on social media after the 21-day national lockdown was implemented. Animals, in fact, have also been spotted every other day across cities such as the Nilgai that walked freely on a road in Noida. Perhaps there is a silver lining after all.

Difference between Spanish Flu and Covid-19

The coronavirus is not mutating significantly as it circulates through the human population, according to scientists who are closely studying the novel pathogen’s genetic code. That relative stability suggests the virus is less likely to become less dangerous as it spreads, and represents encouraging news for researchers hoping to create a long-lasting vaccine.

All viruses evolve over time, accumulating mutations as they replicate imperfectly inside a host’s cells in tremendous numbers and then spread through a population, with some of those mutations persisting through natural selection.

Peter Thielen, a molecular geneticist at the Johns Hopkins University Applied Physics Laboratory who has been studying the virus alongside Stanley Perlman of the University of Iowa and Benjamin Neuman of Texas A&M University at Texarkana, both of whom were on the international committee that named the coronavirus, told The Washington Post that scientists have found only about four to 10 genetic differences between the strains that have infected people in the United States and the original virus that spread in Wuhan out of 1,000 different samples which was a relatively small number of mutations for having passed through a large number of people.

 “Just one pretty bad strain for everybody so far. If it’s still around in a year, by that point we might have some diversity,” Neuman said.

They told that the Flu is different from coronaviruses in the sense that— the flu virus genome is broken up into several segments, each of which codes for a gene. “When two flu viruses are in the same cell, they can swap some segments, potentially creating a new combination instantly — this is how the H1N1 swine flu originated,” Neuman said.

Why self-isolation is important?

An account given by the Sanitary Commissioner of Punjab is quoted here which said: “A recruit suffering from symptoms of influenza arrived at Narkanda and stayed a night with the Khansama of the hotel. Three days later the Khansama and his wife went down with influenza and soon passed it on to a blacksmith living nearby, who in a matter of few days passed it on to his family.

The postal peons who served as a disseminating agency contracted the disease after visiting Khansama’s house and two of them died of it.” But before falling ill, the postal peons spread the disease and in a short time, the Hindustan Tibet Road was thoroughly infected.

So how the outbreak was eventually tamed after it had passed through the length and breadth of India? There are at least three possible causes, Prof Chandra, Director of the Asian Studies Center at Michigan State University, told The Indian Express.

• The people of Calcutta took preventive steps and began practising social distancing after they came to know about Spanish Flu and were better prepared than the people of Bombay and Madras who were unable to take any action because the disease caught people at the early locations.
• The virus evolved as it spread across India, becoming milder in the process.
• Differences in climate across India helped to stop the spread of influenza as a flu virus tends to not do as well in warm and moist conditions as compared to cooler, drier conditions.

Takeaway

As another pandemic is upon India, the importance of a quick initial response cannot be overstated. Like 1918 pandemic, locations close to the virus’s entry point will have a small amount of time to deal with the virulent pathogen while locations that are away from the entry point will have a longer span of time to deal with the virus.

There is another important takeaway for India from the Spanish Flu. If it is indeed found to be true that the Spanish Flu reduced in its potency as it progressed because of awareness and the social distancing and other measures that people undertook then there is a very important need to be extra vigilant about hygiene and social distancing.