Once and Future Flu

NATHAN: The impact of this disease was felt across the globe. Spanish flu didn’t respect national boundaries and would travel with soldiers headed home on boats and trains along the connective tissue of the modern world of 1918. Today’s world is connected in ways undreamed of at the beginning of the 20th century. And today’s doctors and public health officials are acutely conscious of pandemic threats in a world bridged by international air travel, subway systems, conferences, and pop concerts.

BRIAN: Earlier in the show, we heard from virologist John Oxford. He spoke to us from London. And I asked him about the international impact of the Spanish flu.

JOHN OXFORD: The deaths varied quite a lot in different countries. In some countries, for example in Labrador, nearly 100% of people in some of the villages died. And yet, in one place on this planet actually organized by the United States that is in Samoa, there was a complete quarantine. And as far as I know, no one died.

BRIAN: Unbelievable. What was it about this particular flu that caused so many deaths? Was it the strain of the flu virus or something else?

JOHN OXFORD: It’s probably a combination of things. I mean groups in the states have resurrected the virus. They’ve tested it in little animal models, in mice, in cell culture. It does look slightly more virulent, maybe five times. But I don’t think that really explains the deaths in 1918. And then you come onto the most recent possibility, which has always been in the background, that it sort of depends on our immune history. What was the history of an old person? How many strains had they been infected with before 1918? Had they been infected with anything at all?

So you’ve got that combination. You’ve got what the past immune history, the past infection history has been. On top of that, you’ve got a virus which is perhaps a little bit more virulent than a common old garden one. But on top of that again, you’ve got one other factor that, of course, 1918 was very much a bacteriological world. There were bacteria all over the place pre-antibiotic. So we know now that that must have made– that was another factor that comes into it.

BRIAN: How to explain the global reach of this pandemic? I understand it made it as far as the Arctic Circle.

JOHN OXFORD: There the war, I think, has a lot to answer for. Well, all the troops, including American troops, in Europe by the autumn of 1918, British troops and colonial troops from all the colonies. And in November 1918, certainly the whole thing finishes and they all want to go home. There was a huge movement of young men, 18, 19, 20-year-olds. They were some of them carrying the influenza. And the boat comes into South Africa. They go home at the railway lines. The railway lines were quite important in carrying this virus, as a transport mechanism in 1918.

They go to the furthermost spots in South Africa. Their parents, that we can call their friends in from a range of about 10 miles. They come in by horse and cart to celebrate the young men coming home and they all catch it. So it’s a question of people movement. And there were a lot of people moving, probably more than had ever been moved before, probably 10, 15 million young people on the move. And that had a lot to do with it, I think.

BRIAN: Well, you mentioned the war as a crucial factor in transmitting this disease. Obviously, the war killed tens of millions of people. How do the casualties from World War I compare to the totals from the influenza pandemic?

JOHN OXFORD: Well, very much. They were very much smaller. I mean it’s bad enough, isn’t it, to have 10 million, as you say 12 million young men dying because of the war. But I feel myself now, that whoever was responsible for that– and I myself put it at the feet of politicians. It was their job to try and stop all this. That is their job. And they failed. So not only did that result in 10 million or more young people dying in that conflagration, but I think myself if it had not been for that war, the pandemic would not have arisen. So I think now those responsible are responsible for 10 plus 50 million, 60 million. So it tells in modern terms, you can start things off with these war things, but you never know when they’re going to end.

BRIAN: And were there things that could be done to help?

JOHN OXFORD: The doctors and nurses tried and tried and tried. And in the group of doctors and nurses I’m particularly involved in looking back on– I mean I read their papers in The Lancet. It’s as though they’re talking to you now. Right in the middle of those battles when they were within 10 miles of the western front day and night, all they got were explosions going off and shells and everything else, they were trying to look after these first patients coming in with what was the first kind of wave, the early wave of the Spanish flu.

They even set up– to try to help these soldiers, they even set up tents. And they had aromatic compounds and oils in those tents, so it’s kind of a steam tent. And that I find so admiring. I mean those [INAUDIBLE] were risking their lives. They were pretty close to the western front, all this going on, and they were making these tents of canvas and steam so they could persuade these ill soldiers to get up and sit in there and get some relief from it. So I think they were really into it. But all they could do in reality was that sort of thing, the nursing care, a lot of care, and try and bring their temperatures down with aspirin. And there’s not much else they could– if their heart began to fail, they had belladonnas and had [INAUDIBLE] so they could tackle that a little bit. But overall, again and again, you feel how helpless they felt at the time.

BRIAN: Well, whether it’s that strain or not, what are your thoughts about the possibility for another global pandemic on the scale of the Spanish flu?

JOHN OXFORD: Well, I think all virologists, when we look at the past, there have been been pretty, not regular exactly, but they’ve been they’re coming out at us. And remember the theory is that they’re spread– these pandemic viruses come from the great migrating geese and ducks and swans of this world. And they’ve got all of the viruses, the mutating influenza virus. All of them are in those migrations not normally causing any problems. So they go on their business around the world on the big migration routes, come into contact with domesticated ducks and creatures and turkeys. And then they’re pressurized, the domesticated ones, because [INAUDIBLE] like factory farming. And there you begin to get the symptoms if they catch it from a migrator and then push on the symptoms and the virus on to their keepers.

So we know which way the virus comes now. We didn’t know that before. So it’s [INAUDIBLE] to say, well, that’s not going to happen again because it happened in– we know from recent history– in 1845, there was a big outbreak that was almost certainly flu. 1889, so called Russian influenza was kind of big one. The 1918, 1957, 1968, 1976, and then 2009. So they’re coming after us. And there’s every reason. Given the global population increasing and everyone on the move, there’s every reason to anticipate and plan from the next one.

NATHAN: John Oxford is a virologist at the Royal London Hospital.

BRIAN: That’s going to do it for us today. But you can keep the conversation going online. Let us know what you thought of the episode or ask us questions about history. You’ll find us at backstoryradio.org. Or send an email to backstory@virginia.edu. We’re also on Facebook, Tumblr, and Twitter @BackStoryRadio. Whatever you do, don’t be a stranger.