Between 1918-19 Spanish flu and COVID-19, not much has changed

While reading the book The Spanish Influenza Pandemic of 1918-19, New Perspectives — specifically, a chapter titled Coping with the Influenza Pandemic, 1918-1919: The Bombay Experience by Mridula Ramanna — one is stuck by the similarity of response by the then British government in tackling the Spanish flu and the manner with which the present governments are responding to the novel coronavirus disease (COVID-19) pandemic.

A staggering 17-18 million died from the Spanish flu in the Indian sub-continent.

Ramanna, a medical historian, shares a fascinating account of the responses — both official and non-official — to the influenza pandemic in 1918-19.

She refers to historical documents and archival sources — including reports prepared by the then British government and government / health officials in Bombay (now known as Mumbai) — and accounts left by voluntary agencies and private medical practitioners as well as newspaper reports.

The sickness was first observed on June 19, 1918 when seven police sepoys, one of whom was working in the docks, was admitted to hospital for a non-malarial fever, with the city’s health officer JA Turner tracing day-to-day progress of the illness.

The British Government’s role was lacking: Other than collecting statistics, it recommended prompt isolation of the infected, opening of poorly ventilated dwellings and encouraged people to sleep in the open.

All hospitals and dispensaries expanded their premises to treat patients. Out of a total 233,346 indoor and outdoor patients, 220,000 were recorded as having the disease, while the rest were either treated by private practitioners or not at all.

The British government issued memorandums (now called notifications) that recommended education of the public, with instructions to “keep fit, avoid infection, (follow) healthy living” and suggested the closure of schools, colleges and cinemas.

The wearing of face masks and the use of disinfecting sprays and gargles was also recommended.

The government permitted the provisional government to exercise powers under the Epidemic Diseases Act, 1897 to formulate necessary rules to control and prevent a future outbreak of influenza.

The present government has also relied on this 123-year-old outdated colonial legislation to issue ordinances by the states. A reading of the article shows not much has changed. A quote from newspaper The Gujarati wanted to know “what were highly paid government experts doing to help people in their distress”.

The contention was thatthe wide social gulf that existed between the people at large and high government officials, prevented the latter from realising the sufferings of the former.

The Times of India daily castigated the failure of the health department, despite lakhs of rupees spent on it. Concern was also expressed about the suppression of information about the disease.

It clearly brought out the confusion and inconsistency seen to have marked the response of the authorities during the 1918-19 pandemic.

The chapter points the differences of opinion over the source of the epidemic, with charges being traded between Turner, and Lt Col Hutchinson, the sanitary commissioner of Bombay.

When the district magistrate of Bijapur wanted to release sick prisoners from a jail that was short staffed, the British government would have none of it. The Karachi municipality closed all cinemas and theatres for three months, while in Bombay, 13 cinema halls and 11 theatres remained open.

This is similar to the 4,000 notifications and government orders issued by the Union government and the states to handle the current situation. The script remains the same. Only the actors have changed.

The response to indigenous medicine systems — including ayurveda and unani — by government authorities is similar to the present situation.

It was observed that the ‘doctor’ practitioner of western medicine was expensive and unreliable in times of emergency.

When it was suggested that Indian medicine which was cheap and could be dispensed by school masters, postmasters and village officers, the Provisional government opposed it and put down indigenous systems citing the Bombay Medical Act of 1912 that upheld allopathy as the dominant medicine system.

The chapter points out voluntary efforts and gives a detailed account of the organisations in Bombay and the work they carried out. While the government’s response was inadequate, there was collaboration between health officials and voluntary associations in raising funds, distributing medicines, setting up temporary hospitals and propagating vaccines when made available.

Separate hospitals and wards were set up based on caste and religious communities. Like Jains had their hospitals in Girgaum, Marwaris did at Kalbadevi, Bohras at Null bazar, Pathare Prabhus at Chowpatty, etc.

They ensured rules regarding pollution were not violated. The 1918-19 pandemic took a heavy toll in Bombay and even today, Mumbai accounts for the highest number of infections and deaths due to COVID-19. The reasons were similar: People lived in crowded spaces, there was a lack of health facilities, personnel and equipment to provide treatment.

When a century is not good enough to understand and strengthen the public health system, policies and outlook towards development of its citizens, the ill-effects of such a crisis will be reinforcing rather than reversing.

One can see the similarity of the response of the British government and the present government. Perhaps most governments — elected or imposed — act in a similar manner.

Observing and dealing with the government, one gets a feeling that the British never left India and continue their influence through the steel frame, rules and notifications.

One wonders how the history of the COVID-19 pandemic will be written by medical historians and the roles played during the tragedy.

A pandemic is an epidemiological force that shapes the social landscape. Individual tragedy and collective resilience shape the policy narrative within the subcontinent profoundly.

Suppression of civil liberties, unfair treatment of migrants, loss of jobs, insecurity and uncertainty: The aftermath of COVID-19 will not just impact people’s lives and livelihoods but also widen already prevailing socio-cultural distress and resentment leading to a spur in untoward instances nationwide.

The fallout of the 1918-19 pandemic pushed people to demand India’s independence from British rule and created new leaders. The heavy toll of the current pandemic on the lower socio-economic groups will, in all likelihood, perpetuate existing inequities.

If early data is anything to go by, the uprooting of migrants, widening incomes and failing small and medium businesses will compound the employment crisis.

The outcome of COVID-19 will be beyond the impact of the pandemic itself and may weaken economic and social structures.

A clear lesson from the 1918-19 pandemic is resuscitating public health services, bringing comprehensive public health legislation, changing existing public health leadership, reigning in the private health sector, strengthening basic research and making health governance accountable.

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