Image of A historic mass hospital ward with patients being tended by medical staff

Influenza - 1918/19 and now

Take two authors and add one virologist to talk about pandemic flu and what do you get? A fascinating discussion about the 1918 Spanish flu outbreak and an insight into modern day preparations for a future pandemic.

Run by our Intellectual Forum, the event - Influenza - 1918/19 and Now – brought together Catharine Arnold, the current Sheriff of Nottingham and author of Pandemic 1918: The Story of the Deadliest Influenza in History; Laura Spinney, novelist, science journalist and author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World; and Jesus College virologist David Pattinson

A century ago, influenza swept the globe. Lasting from March 1918 to March 1920, the Spanish Flu infected one in three of the global population. It was 25 times more lethal than an average flu outbreak, claiming 50 to 100 million lives – more than the Great War.

Laura Spinney explained that the only treatment that made a difference during the pandemic was good nursing - keeping patients hydrated and warm. Many deaths were also caused by overdoses of aspirin, the taking of which had been recommended to reduce inflammation and fever.

With 20 to 40 year olds disproportionately affected, many children were orphaned and demographics across the world were affected for decades. While more men than women fell ill, pregnant woman were particularly susceptible, with high incidences of miscarriage and death.

No part of the world was spared; 18million died in India, outbreaks took hold in the Pacific Islands and scores of orphans were left behind in remote Alaskan communities, as reported recently by the BBC

Laura shared the sobering fact that the World Bank has predicted that a modern flu pandemic is likely to kill 33 million people in just its first six months, knocking five percent off global economic output and triggering a worldwide recession. Concluding, she suggested that there is almost no public memory of the pandemic, which may drive a seemingly lower interest than necessary in pandemic preparedness.

The World Bank has predicted that a modern flu pandemic is likely to kill 33 million people in just its first six months, knocking five percent off global economic output and triggering a worldwide recession.

Catherine Arnold began her talk by sharing that her grandparents were killed in the Spanish flu pandemic.  She read excerpts from her book - which examines the social history and impact of the period through personal correspondence, news reports and more.

Outlining that the connection with Spain was nothing to do with the origination of the virus, Catherine explained that the press in neutral Spain was free and unfettered to report news both from home and abroad. In many parts of the world, press restrictions focused on not reducing wartime morale even further by reporting on a deadly illness.

In the UK, Spanish flu first spread to the North and Scotland, but London carried on as normal, allowing the pandemic to blaze through the capital as crowds mixed in theatres, galleries and shops. The death of prominent socialite Rose Selfridge garnered attention and raised awareness, but it was the poor that suffered most.

An effective quarantine scheme for Manchester, instigated by Dr James Niven, meant that the city initially largely avoided the flu - until his advice was ignored about the dangers of holding public celebrations, with tragic consequences.

The third and final speaker was David Pattinson, a graduate virologist here at Jesus College, working on flu prediction techniques with the World Health Organisation.

David outlined how the influenza virus mostly lives in water birds, but can affect other species - humans, horses, pigs, dogs and bats - by jumping to a new host. It is believed the 1918/19 flu was a fusion between a bird and human virus, creating a particularly virulent strain. Pandemics are caused by these ‘host shift’ events. Once a pandemic flu dies out, influenza moves back to seasonal and epidemic strains.

Influenza was only recognised as a virus in 1933. David explained how the virus acts like a mousetrap, locking on to a host cell and using it to spread. Coughing and sneezing is an incredibly effective way for the flu virus to spread, with air travel and increasing globalisation spreading strains of the virus faster than ever.

Pressure points for an upcoming pandemic as opposed to 1918/19 include a quadrupled global population, ageing populations and worldwide travel. Preparedness, better healthcare, vaccines and anti-virals are all defences.

A lively question and answer session followed our speakers’ presentations. Asked why flu viruses are given geographically referenced names rather than less emotive coded classifications, David Pattinson advised that researchers simply need an internationally agreed label for researchers to use. Naming convention doesn’t reflect origination of a virus.

In a UK government list of critical incidents, a flu outbreak similar to 1918/19 is most feared due to the huge impact it would have on infrastructure and daily life.

Asked about public preparedness for a future flu pandemic, Laura Spinney explained that in a UK government list of critical incidents, a flu outbreak similar to 1918/19 is most feared due to the huge impact it would have on infrastructure and daily life. During the Spanish flu outbreak, coffin making and grave digging couldn’t keep up with demand. In Nottinghamshire, a swimming pool was drained to store bodies; steam machines dug mass graves in the US and Indian rivers became clogged with partially cremated remains.

Discussing theories of why the Spanish flu was so virulent, Laura outlined a theory that the first flu a person catches imprints an immune system response which is triggered by subsequent flu infections. Twenty to 40 year olds in 1918 may have been first exposed to the Russian flu strain – H3N8 - which spread in the 1890s. The Spanish flu was H1N1, meaning that the immune system response of 20-40 year olds was sub-adequate.

A radical solution posed by one attendee was to reduce or remove all human contact with swine and poultry, possibly by implementing greater use of robotics and artificial intelligence in farming. David agreed that removing all contact would remove the risk of a host shift event, but would require a huge culture shift across the world, particularly parts of South East Asia where poultry farming and markets are often close to people’s homes. Laura added that in 1918, both swine and horse flu pandemics were also raging, with the most threatening reservoir likely to have been horses – used at the time for transport, farming and the military.

Concluding the event, the final question from the floor asked whether the Spanish flu brought about an early end to World War One. Possibly, said Catherine Arnold, with Germany postponing their planned spring offensive and with so many soldiers ill or killed on both sides. Men living together closely in trenches, already under physical stress and with limited access to healthcare no doubt exacerbated the spread of the pandemic – both in the trenches and as they returned home.

Talking after the event, Intellectual Forum Director, Dr Julian Huppert said: “This was a really fascinating event, bringing together history and science. I know I learned a huge amount, but it also left me wondering why such a huge event, which affected so many people, is remembered so little. As a result, people don’t seem to take flu seriously enough. Discussions like this are key, both to remember the past, and to prepare for the future.”