Could flu really kill thousands again?

As fears over a global pandemic only just begin to fade, Chris Bowlby compares our present situation to flu outbreaks of the past.

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Fear of a major influenza pandemic in recent months – and uncertainty about its consequences – has had the authorities and the media searching eagerly for evidence from the past. Optimists and pessimists take their historical pick: will swine flu be as devastating as, say, the flu outbreak beginning in 1918; or will it be relatively minor, like the outbreak in the 1960s?

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The problem, as historians of these events are discovering when asked to give their views, is that today’s urgent search for past comparisons has little time for the subtleties, such as the social context. Even if we can discover that, say, swine flu is related to what caused earlier pandemics, the effect of a virus, and the way society responds, depends on much more than the biology of the virus itself. Mark Honigsbaum, author of Living with Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918, makes the immediate point that “no two pandemics are alike”.

In purely scientific terms, if more pessimistic forecasts turn out to be true, swine flu may pose a comparable health challenge to the 1918 virus, which killed more than 200, 000 Britons. And yet the way we’d face such a challenge would be vastly different.

As Honigsbaum points out, in 1918 there was no National Health Service, nor was there a welfare state or a broader expectation that government would leap into action. With a world war still being fought as the outbreak began, the threat of flu seemed relatively insignificant. No one was going to propose bringing doctors back from the front to treat flu victims, nor could the movement of vital workers such as those in the munitions industry be disrupted by attempts to halt the spread of infection.

Although some with medical responsibilities in particular places – Manchester, for example – took measures such as closing schools and urging people to avoid crowded gatherings, in general the authorities simply urged people to cope as best they could. Harking back to a much older idea of disease – that it was linked to an individual’s state of mind – slogans like “fear is the mother of infection” were used. British citizens were urged to remain steadfast in the face of flu germs, just as they had against the threat of German invasion.

Another major contrast with the present day was the absence of intense media coverage and speculation, pressing the authorities to act. A war-time sense of patriotic restraint in 1918 encouraged self-censorship among journalists, and there were other things on people’s minds.

Interestingly, though, Mark Honigsbaum points to an earlier pandemic when media interest did seem more akin to what we see today. The ‘Russian flu’, which began in the winter of 1889–90, affected all levels of society: “postmen and train drivers got it, but so did the prime minister and the Prince of Wales”.

This pandemic became a “sensational event”, a great talking point in society. The young Winston Churchill even wrote a poem about it. And it coincided with a new era of media competition – cheaper mass market newspapers, with access to telegraphed reports, eager to follow the latest international spread of flu like the 24/7 news cycle and boom in internet coverage we see sustaining today’s health scares. Then as now, says Honigsbaum, “we can see the media amplifying people’s anxieties about this mysterious new disease”.

The absence of intensive media coverage of the 1918 pandemic, however, has made it harder for historians like Honigsbaum to reconstruct the social and cultural responses and suggest how it affected society as a whole. Although it caused so many deaths, it left few traces in collective memory, perhaps because society was absorbed in the greater challenge of coming to terms with the Great War’s enormous consequences.

So those searching for current lessons from past pandemics need to bear in mind that the memory of a particular event may not reflect the actual effect it had at the time. And history suggests too that the way we react to any current pandemic will be influenced not only by hard facts, or how the authorities respond, but also by how the pandemic is perceived in the media and the popular mind.

Chris Bowlby is a presenter on BBC radio, specialising in history.

This feature was first published in the December 2009 issue of BBC History Magazine.

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This series is produced with History & Policy. You can find out more about them and read their papers at www.historyandpolicy.org.