Emma Espiner: When the pandemic strikes

Emma Espiner looks at how a pandemic like the 1918 influenza virus might play out in New Zealand in 2018

One of my favourite lecturers kills conversations at summer BBQs when people ask him what he does for a job. Infectious diseases are not what people want to talk about when they're gnawing on a hunk of charred flesh in someone else's backyard. One's taste for meaty goodness is rather dulled by the thought, and then you start wondering when the hot plate was last cleaned.

The passenger sitting next to me on a flight to Wellington this week grimaced when I announced (unasked) that I was off to a course about the influenza virus which killed almost 9000 New Zealanders in 1918 in less than two months. "Did you know that that's half of the amount of people who died in World War One over four years?!?" He did not. Nor was he keen to discuss the implications for disease spread in the age of commercialised air travel. He did avail himself of my hand sanitiser at snack time, however.

It’s been 100 years since the pandemic and that's as good a time as any to reflect on what went down.

I'm being a bit flippant here because it staggers me how little attention we pay this. There are seven public monuments to the 9000 dead compared to 49 in memory of the Boer War, in which we lost 230 soldiers. In the Pacific the story is even more bleak. Dr Ryan McLane told us that one in five people in Western Samoa died in part because of terrible decisions made by our country's representative, Colonel Robert Logan. Tonga's sole doctor was caught outside of a maritime quarantine line, unable to return until after the worst of the pandemic had passed. The Queen of Tonga was left alone in her residence, only 18 years old, with an infant and a deathly ill husband for a week. If that was her plight you can barely bring yourself to imagine what her subjects were faced with.

Where is the appetite for these incredible stories?

Geoffrey W. Rice, author of Black Flu 1918: The Story of New Zealand's Worst Public Health Disaster, thinks the trauma of the war losses was such that people 'shut the door' on the memory of the influenza deaths. This is not a unique local amnesia; Pale Rider by Laura Spinney traces the history of the 'forgotten pandemic' across the world. Even the name Spanish Flu is misleading — it did not originate in, nor have any special significance, in Spain. Rather, Spain was a neutral country during the war and so less inclined to conceal illness in its population for strategic military purposes.

The hospitals are generally overcome by acute cases. So it's up to you, me and the authorities to do what needs to be done.

But its relevance reaches beyond the importance of knowing our history. Last year Bill Gates warned of the imminent threat of a global pandemic, like the 1918 influenza, which could claim more than 30 million lives. And you know that when Bill Gates is on the kaupapa, things are serious and some serious money will be spent.

As a mum, a future doctor and a person with an unhealthy enthusiasm for dystopian fiction, I was really interested to understand how a pandemic could play out in New Zealand in 2018 compared to 1918. I was surprised by what I learned.

The biggest bang-for-your-buck interventions aren't going to be the vaccines. In fact, the consensus among the experts we heard from was, should we experience something similar to the 1918 influenza virus, the vaccine will arrive after the first wave of the pandemic. They're still important and useful because you can protect populations from subsequent waves of the virus. But the success of any response will largely be determined by us. The hospitals are generally overcome by acute cases. So it's up to you, me and the authorities to do what needs to be done – or community resilience as the speakers described it.

But we don’t know our neighbours any more, mutter mutter, social fabric decay, did I hear you say?

Jon Mitchell, an emergency management specialist, cautioned the audience about falsely characterising modern New Zealand as having less 'community' than the early 1900s. He knows what he's talking about, having been heavily involved in the post-quake response in Christchurch. He talked about the inter-generational sharing of responsibilities. The university students freely admitted they wouldn’t probably have three days of supplies for an emergency, but they knew they could barter their physical labour with their older neighbours for some of theirs.

Christchurch responded well to the 1918 influenza too – due to a combination of planning, chance and leadership. The planning was in the quality of housing stock – slum housing in Auckland and Wellington contributed to more deaths. The chance element was having the early warning about the pandemic from what had occurred in Auckland and the presence of hundreds of trained civilians with the ability to treat people in their homes. The leadership came from Drs Chesson and Fox who contradicted some of the Ministry of Health recommendations and acted swiftly and sensibly to save lives.

If it happened now, equity has to be front of mind for health and government officials. The 1918 influenza virus did not discriminate, affecting all parts of society, but the outcomes were worse for those who had the least.

My pre-schooler coughs into her elbow because that’s what they get taught now, but you often still see adults in public coughing into their hands and then smearing the nearest surface with their sneeze droplets.

And while these diseases might be colour-blind, our systems sometimes aren't. In Australia for example there are no good records for how Aboriginal and Torres Strait Islanders were affected by the pandemic. Why not? Because historical epidemiologists (scientists who count stuff) can only rely on the historical data available. They rely on census data and in 1918 indigenous Australians weren't counted, because they weren't considered to be human.

Here in New Zealand, Māori were seven times more likely to die after being infected with the influenza virus. Again, historians struggled to count them because an estimated 50 percent of Māori deaths were not reported. Ministry of Health efforts to provide Māori with the skills to provide home-based care for their sick whānau via pamphlets in Te Reo were 'slow and erratic' according to Rice. Some arrived after the pandemic, as people were burying their dead. Colonisation had stripped Māori of our land and food sources, accelerating disease spread through malnourishment and poor housing. Even Māori in urban centres were sometimes refused healthcare in hospitals.

So what can we do? Well, we need to end poverty, ethnic inequities resulting from colonisation and solve the housing crisis. That should be straightforward. No sweat.

After that, community preparedness is key, and our kids could be a really good source of health education. My pre-schooler coughs into her elbow because that’s what they get taught now, but you often still see adults in public coughing into their hands and then smearing the nearest surface with their sneeze droplets. Maybe even adopt mask wearing in public. It was the 1918 pandemic which influenced Japan to enforce the use of masks to prevent the spread of disease.

Workplace culture around sick leave also needs to change so that social distance can be maintained when people are sick to stop the spread of disease, and employers should support their staff to have access to the seasonal influenza vaccine. You might think you’re indispensable at work – but trust me you’re not.

Oh and be a good neighbour. You might not know your neighbour now, or you might be trying desperately to unsubscribe from Neighbourly for the 150th time after getting the umpteenth notification about Jan’s garage sale, but as a nation we’re pretty good at helping each other out when we need it. We did then and we would now.

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