It is fascinating how language can buckle under the strain of what it has to bear. “A very depressing time,” Sister Katherine McPhee noted in a letter home in 1918. She was writing from a casualty clearing station just behind the front, as flu-ridden soldiers arrived, blue about the lips and gasping as the virus destroyed their lungs and set about making them some of the first fatalities of a pandemic that would infect a third of the world’s people and kill 50 million of them. By June, Dr James Niven in Manchester noted that the children in his city “are simply dropping at their desks” and advised that schools and Sunday schools be shut to prevent further spread of infection. Officials refused. “It is difficult to understand the perversity of those who withstand this request,” he wrote. One of the nurses on the USS Leviathan, hundreds of whose 9,000 troops fell ill and died as they journeyed the eight days to France, and whose decks were awash with effluvia, wrote: “The odour is terrible in the infirmary.” Perhaps understatement was a way of trying to immunise against the horror.

The stated justification for last night’s documentary The Flu That Killed 50 Million (BBC2), about the Spanish flu pandemic, which began just as the first world war ended and claimed 10 times more victims in a few months than four years of the most vicious fighting yet recorded by man had done, was that the horror could rise again. Pandemic remains at the top of the UK’s risk register – although there have been more than a few crossings out and reinstatements over the past few years, since the US president started dismantling various accords and goading unstable nuclear powers over social media in the early morning hours – and the suggestion was that we could learn from history rather than repeat it.

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It was a premise that didn’t really stack up. What the 1918 catastrophe had to teach us about incidence, transmission, precaution and so on has long been absorbed. Since then, the world has changed so much, in all the ways that most matter when it comes to dealing with a sweeping epidemic – medically, socially, communicatively – that there is not much more to be gleaned from it, at least in practical terms. As virologist Prof Mary Barclay from Imperial College London pointed out, even the most cutting-edge researchers at the time knew almost nothing about viruses. The methodologies and technologies for finding out about the little blighters – a thousand times smaller than bacteria – simply didn’t exist. Past trying and testing had proved masks and isolation to be “good things”, but not necessarily why.

Just when it begins to feel like an almost unimaginably ancient past, recognisable landmarks appear out of the mist of sprayed sputum and the welter of blood, fever, sweat and tears. The dedication of doctors such as Niven and Dr Basil Hood, whose records show him doing 15 or 16 rounds a day as he tried to keep the increasingly overwhelmed St Marylebone Infirmary going (“the staff are dropping like ninepins”), persists – surely – today. As does the intransigence of officialdom, blessed by its eternal ignorance of ground-level suffering and the arrogance that enables it to dismiss the calls of experts. Niven got 30,000 leaflets and 500 posters issued in Manchester, but the most senior public health official at the time, Sir Arthur Newsholme, decided against distributing the precautionary advice amassed for him in order that munitions and public transport could keep serving “the relentless needs of warfare”.

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Then, of course, there is the ruthlessness of nature itself. The first wave of the disease broke over an exhausted, beleaguered populace and then it withdrew. Just as the survivors were beginning to pick themselves up, it returned in even greater strength, killing more quickly and more violently, with people drowning ever more swiftly in their own blood as their lungs were laid waste.

Between 50 and 100 million deaths later, the virus burned itself out. (The only country that was spared was Australia, which had time to throw a cordon round itself and quarantine all incoming boats and passengers, a course of action that would not be repeatable in today’s shrunken world.) The only good thing about a 3% mortality rate in a fast-acting virus is that it eventually becomes unsustainable. You kill your hosts too quickly to replicate.

If and when it happens again, modern medicine will probably manage to keep things down to a 1% mortality rate. God and officialdom willing, of course. Whether we the public can muster the stoicism displayed by the letter writers and diarists of 1918, I don’t know. It will, after all, be a very depressing time.



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