The Last Plague

It’s anyone’s guess whether what Canadians experienced during the last pandemic will repeat today, but if you are like me and want to learn more about pandemics outside of what Netflix and other streaming services have to offer, I recommend you read Mark Osborne Humphries’s 2012 book, “The Last Plague: Spanish Influenza and the Politics of Public Health in Canada.”

The Spanish Flu, as it was misnamed, spread across the globe in three waves. The first was in the spring of 1918, next in the fall, and the third in the winter. The first phase was responsible for few deaths, but the virus mutated during the summer and killed 100 million people worldwide in the fall and during phase two when, “it tended to kill young, otherwise healthy adults”. By the winter of 1919, the virus was less deadly and virulent and was gone by the summer.

Before the ‘Spanish Flu,’ there was cholera in 1832 which crossed the Atlantic along the trade routes. The first line of defense was quarantine and the second was urban sanitary reforms. During the cholera epidemic, Canada fared better than major hubs like New York in part because our medical professionals had more success in persuading government officials to institute a program of urban sanitary reforms — likely due to a higher concentration of power by our healthcare community. This was done within a framework in which public health interventions and restrictions on individual freedoms remained the exception rather than the norm.

During the next cholera epidemic in 1854, cases were traced back to drinking water tainted by faeces, which led to the construction of sewers, protection of water supplies, and garbage pick-up. Even with these measures, cholera still made its mark again in 1866.

By 1892 Canada had passed maritime quarantine regulations forcing inspections before landfall on every ship coming from a cholera-infected port, with all passengers required to prove they were vaccinated for smallpox or be inoculated before entering Canada.

By 1918, “civilian public health officials remained confident that maritime quarantine would be sufficient to protect from any overseas threat. But that year, a particularly virulent H1N1 strain of influenza emerged, causing the most devastating influenza pandemic in history”.

Spanish influenza was brought to Quebec in September 1918 by a group of 600 American sailors. Although they were promptly quarantined, sufficient contact was made with others in the cramped garrison for it to spread quickly among soldiers and civilians alike.

Recent research suggests that otherwise healthy young adults developed more severe symptoms and ultimately died in disproportionate numbers from cytokine storms–that is, from an overreaction of the immune system as it rapidly cascaded out of control. It was the strength of their body’s immune response that ultimately may have killed them.”

But not every jurisdiction had the same experience. Cities that instituted quarantines, signs on doors, and bans on public gatherings early during the second wave suffered less. For example, New York — despite being one of the densest populations in North America — experienced the lowest death rate on the eastern seaboard by sending the sick to isolation hospitals, quarantining their contacts in their homes, and placing signs on their doors.

The flu came into Canada via the American border which was at the time not regarded as a significant source of infection. Once in Canada, the Canadian military spread the flu across the country with the mobilization of the Siberian Expeditionary Force. As sick soldiers from eastern Canada were taken off trains in Winnipeg, Regina, Calgary, and Vancouver, flu spread across the country in a matter of hours.

When the novel influenza virus attacked their immune systems a hundred and two years ago, it was able to replicate itself freely and spread among people who lacked natural immunity. More recently, the H5N1 avian influenza virus killed nearly 60% of the approximately 500 people worldwide infected between 2003 and 2010. “For a virus like H5N1 to pose a serious risk of causing a pandemic, it would have to become more efficient at transmitting itself from one person to another.” As a virus sweeps around the world, it often attacks in waves, sometimes circling the globe several times for years before it out-competes other flu strains to become the dominant virus. Pandemics end when the human population gains immunity to the new strain.

An interesting book to read, especially given our current situation. The author also canvasses the politics of pandemic responses which I have not covered here. Suffice to say that while some may wish for politics and health to never mix, history has repeated the lesson that politics tends to follow pandemics as day follows night.

Norm Letnick is MLA for Kelowna-Lake Country, and a frequent contributor to The Daily Courier.