Laura Spinney is a science journalist. She published La Grande Tueuse, how the Spanish flu changed the world , by Albin Michel.
FIGAROVOX.- The President of the Republic said that this coronavirus crisis was the most serious health crisis in France for a century, referring to the Spanish flu of 1919. Does the comparison seem justified to you?
Laura SPINNEY.- It is difficult for the moment to compare an epidemic in progress to a bygone epidemic, especially since the statistics of the Spanish flu are very disputed, because it was difficult at the time to count. During the 1918 epidemic, 50 to 100 million people died. The Case Fatality Rate CFR is estimated to be 2.5%. It is estimated to be 25 times more dangerous than a typical flu. It is not yet known what is the CFR for the current pandemic, probably around 1%. What is comparable is that it is a new pathogen with a very high attack rate. The Spanish flu had the particularity of very severely affecting people in the prime of their life between 20 and 40 years of age, which made it so disastrous. The coronavirus seems to inevitably affect people over the age of 60, but here too it changes very quickly and there is a lack of perspective.
Many accuse globalization of being responsible for the rapid spread of the virus in a borderless world. During the Spanish flu era, how and how long did it take for the virus to spread?
Between March 1918 and July 1921, the Spanish flu spread in three waves: a first, moderate, which looked like a seasonal flu, a second very virulent where most of the deaths occurred, from mid-September to mid-December 1918, and a less virulent third wave. Most of the deaths occurred in three months. At the time there was already a form of globalization, even if it was much slower. War was one of the determining factors in the severity of the pandemic. Indeed, there was a lot of displacement: the soldiers who returned to their homes, but also the displaced, the refugees who were numerous. The jubilation scenes of the Liberation accelerated the spread of the virus. The immune systems were weakened by deprivation. Some scientists believe that the conditions of war have contributed greatly to the virulence of the virus. Normally, a new strain of influenza moderates its virulence over time, because the virus has no interest in killing the host that hosts it. Thus, the seasonal flu that we know started with pandemic flu that "calmed down". But the Spanish flu has encountered exceptional circumstances: in the trenches of northern France, men trapped in trenches, weakened, with lungs sometimes compromised by gases. All of this has contributed to the virus maintaining exceptional virulence for a long time.
It was exactly the same recommendations 100 years ago!How did governments react at the time? Were they effective?
First, the belligerent countries tried to hide the epidemic so as not to harm the morale of the populations. This is also why it was called "Spanish flu", when we do not know where it came from: Spain being neutral during the conflict, there was no censorship, and the Spanish press spoke about it first. Then governments were forced to act. What is interesting is that they then implemented exactly the same measures as today for the coronavirus: social distancing measures, the only effective despite the vaccine. Quarantine, insulation, masks, hand washing: these were exactly the same recommendations 100 years ago! With the same debates. For example, in a large Parisian newspaper, an expert from the Pasteur Institute was asked about the usefulness of disinfecting public spaces in Paris, and he replied that it was ineffective! We have the same reactions as our ancestors when faced with an unknown pathology.
Have there been any cases of panic?
Yes, there was fear everywhere, like today. But in New York City, for example, where the population was already used to the health interventions of the authorities for the collective good, the population obeyed the instructions rather well. In Rio de Janeiro, there was widespread panic because the government was ill-prepared. In belligerent countries, the population, exhausted and resigned after four years of war, relativized the scourge, or on the contrary saw it as the mystical confirmation of an apocalypse, of a divine punishment. There were many conspiracy theories: it was thought that the flu was due to the miasmas rising from the battlefields of Flanders, or in the United States, that it was the German submarines that had deposited it on the American beaches. The “fake news” does not date from today!
What social consequences has the Spanish flu had?
The economic consequences of the Spanish flu are incalculable, especially since they are closely mixed with those of the war. It has likely slowed the progress of affected societies for several years, if not decades. The epidemic sometimes had unexpected consequences. We have a very Western memory of this flu, but it is in the Third World countries that it killed the most: 18 million in India alone where it most certainly prepared minds for independence. The flu also had what is called a "harvest effect": by eliminating the weakest individuals, it left a smaller but healthier population. Survivors had a stronger immune system. The biological capacity for human reproduction had improved and more children were born ”life expectancy, especially for men, has increased.
Our current health systems are largely the product of the 1918 pandemic.At the time, the Spanish flu allowed prodigious advances in science. Can we expect the same thing today?
Indeed, our current health systems are largely the products of the pandemic of 1918: it was at this point that we realized the need for socialized medicine, to respond to epidemics that cannot be treated individually. This deeply stimulated virology and epidemiology, which were then embryonic sciences, and contributed to the foundation of the first global health agencies, but also to surveillance tools. The current coronavirus pandemic shows us that our health systems are probably underfunded for the current aging of the population. It will necessarily lead us to make them evolve.
Should we be resigned to the regular appearance of pandemics?
There are pandemics regularly. Three for the twentieth century: the Spanish flu (50-100 million), the Asian flu in 1957 (2 million dead), the Hong Kong flu in 1968 (4 million dead). Indeed very often new strains of influenza appear, but we can in principle prevent the passage from animals to humans, for example by regulating the markets for live animals ( wet markets ), where it is most likely started the coronavirus. We closed these live animal markets after the SARS crisis in 2002 but it did not work and created black markets because too many people depended on it. But these markets are only a tiny part of the problem: we will have to rethink our entire food system, because it is in particular the cradle of these new infections more and more frequent.