SPANISH FLU TOO SPARED KERALA

Its Duration in Malabar Was Long

We now know that Covid-19 has not been destructive in Kerala. Influenza epidemic of 1918-1919, better known as the Spanish flu of 1918, also almost spared Kerala. The census report of Travancore then is silent on the influenza deaths. But it took its toll in the neighbouring state of Madras. The 1921 census report of Travancore, South India, says:

“Influenza, to which about 6 millions of people succumbed in places outside Travancore, affected the state only ligfhtly and was not attended with high mortality”.

The report is silent on the death toll. The fever deaths during 1920-21 was 17,377 and 15,210 in 1921-22. The duration of the pandemic was very long in Malabar.The mortality rate there was 10-20% per annum, per 1000 people.

The Tirunelveli district of Madras, adjoining Travancore was devastated. It, which had a population of 19 lakh in 1921, had 12,798 fever deaths, mailnly due to the flu.

The highly infectious Spanish flu had swept through the ashram in Gujarat where 48-year-old Gandhi was living, four years after he had returned from South Africa. He rested, stuck to a liquid diet during “this protracted and first long illness” of his life. When news of his illness spread, a local newspaper wrote: “Gandhi’s life does not belong to him – it belongs to India”.

Outside, the deadly flu, which slunk in through a ship of returning soldiers that docked in Bombay (now Mumbai) in June 1918, ravaged India.

The influenza killed between 17 and 18 million Indians, (Close to 2 Crore) more than all the casualties in World War One.

India bore a considerable burden of death – it lost 6% of its people. More women – relatively undernourished, cooped up in unhygienic and ill-ventilated dwellings, and nursing the sick – died than men. The pandemic is believed to have infected a third of the world’s population and claimed between 50 and 100 million lives. To make matters worse, a failed monsoon led to a drought and famine-like conditions, leaving people underfed and weak, and pushed them into the cities, stoking the rapid spread of the disease.

A Spanish flu camp in India,1918

The outbreak in Bombay, an overcrowded city, was the source of the infection’s spread back then.

By early July in 1918, 230 people were dying of the disease every day, up nearly three times from the end of June. “The chief symptoms are high temperature and pains in the back and the complaint lasts three days,” The Times of India reported, adding that “nearly every house in Bombay has some of its inmates down with fever”. Workers stayed away from offices and factories. More Indian adults and children were infected than resident Europeans. The newspapers advised people to not spend time outside and stay at home. “The main remedy,” wrote The Times of India, “is to go to bed and not worry”. People were reminded the disease spread “mainly through human contact by means of infected secretions from the nose and mouths”.

“To avoid an attack one should keep away from all places where there is overcrowding and consequent risk of infection such as fairs, festivals, theatres, schools, public lecture halls, cinemas, entertainment parties, crowded railway carriages etc,” wrote the paper. People were advised to sleep in the open rather than in badly ventilated rooms, have nourishing food and get exercise.

“Above all,” The Times of India added, “do not worry too much about the disease”.

Colonial authorities differed over the source of infection. Health official Turner believed that the people on the docked ship had brought the fever to Bombay, but the government insisted that the crew had caught the flu in the city itself.. Hospital sweepers in Bombay, according to Laura Spinney, author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World, stayed away from British soldiers recovering from the flu. “The sweepers had memories of the British response to the plague outbreak which killed eight million Indians between 1886 and 1914.”

“The colonial authorities also paid the price for the long indifference to indigenous health, since they were absolutely unequipped to deal with the disaster,” says Ms Spinney. “Also, there was a shortage of doctors as many were away on the war front.”

Eventually NGOs and volunteers joined the response. They set up dispensaries, removed corpses, arranged cremations, opened small hospitals, treated patients, raised money and ran centres to distribute clothes and medicine. Citizens formed anti-influenza committees. “Never before, perhaps, in the history of India, have the educated and more fortunately placed members of the community, come forward in large numbers to help their poorer brethren in time of distress,” a government report said.

IN 1918, misfortune befell the 22-year-old poet Suryakant Tripathi, better known as Nirala or “the strange one.” “I travelled to the riverbank in Dalmau and waited,” he wrote in his memoir, A Life Misspent. “The Ganga was swollen with dead bodies. At my in-laws’ house, I learned that my wife had passed away.” Many other members of Nirala’s family died too. There was not enough wood to cremate them. “This was the strangest time in my life,” he recalled later. “My family disappeared in the blink of an eye. All our sharecroppers and labourers died, the four who worked for my cousin, as well as the two who worked for me. My cousin’s eldest son was fifteen years old, my young daughter a year old. In whichever direction I turned, I saw darkness.” These deaths were not just a coincidence of personal tragedies visited upon the poet, they were connected: “The newspapers had informed usabout the ravages of the epidemic,” Nirala wrote.

Though other countries lost a higher fraction of their populations—Western Samoa (now Samoa) lost 22 percent, for example, compared to 6 percent in India—because of the larger size of the Indian population, that 6 percent translated into a staggering slew of death. Asia as a whole experienced some of the highest flu-related death rates in those years, but the story of how the disease ravaged the continent is relatively unknown. The 1918 flu pandemic has been called the “forgotten” pandemic, and ironically the continent that seems to have forgotten it most thoroughly is the one that bore the brunt of it.As Stalin is supposed to have observed, a single death is a tragedy, a million deaths is a statistic.

Then, India had the largest number of deaths in any single country (10-20 million) as well as highest percentage of excess deaths (4.39%) in the world The estimated total global death toll was 50-100 million. A modelling exercise later showed that if an influenza pandemic with a similar severity were to happen in 2004, the world is likely to have around 62 million deaths. And sadly, India again would top the countries with maximum deaths (approximately 14.8 million).It is from this destructive prophecy,India is recovering.

Report from Health Officer, Delhi, on outbreak in Calcutta

 When the first pandemic struck in 1918, our knowledge on influenza was a clean slate, in fact, some believed that the pandemic was caused by a bacteria - Bacillus influenza. There were no vaccines, no antivirals and no antibiotics to treat the superadded infections. Every year, on an average, 3-5 million cases of seasonal flu and 290,000-650,000 deaths are reported globally. In high-income countries, deaths occur in elderly (65 and older) while in the low and middle income countries like India, 99 per cent of deaths are in children under five with influenza-related lower respiratory tract infections. However, the low and middle income countries hardly use the vaccine. In 2015, of the 486 million doses distributed to 201 countries, 95 per cent were shared among the Americas, Europe and western Pacific WHO regions and only five per cent were distributed among South-east Asia, eastern Mediterranean and Africa WHO regions. When a country does not buy and use the vaccine in ‘peace time’, it gets a low priority even if it were to pay for the vaccine when a pandemic strikes as happened during the 2009 pandemic.

The pandemic came in three waves. The first two — in spring 1918 followed by threr second and deadliest wave from September 1918 to January 1919.-coincided with the final period of World War 1.The third wave ran from Februar 1919 till the end of the year with some countries witnessing a fourt wave too,in 1920.The pandemic ended after enough people developed immunity,what we call herd immunity.Vaccine took another 25 years;the first approved batches of flu vaccine were given to soldiers in 1945,as World War 2 was ending.

The outbreak in Bombay, an overcrowded city, was the source of the infection's spread back then too.A ship carrying Indian troops reached the shores of Bombay on the 29th day of May in 1918. It remained anchored to the city’s docks for about 48 hours. The world was on its last leg of the First World War, so the Bombay ports were usually busy with the movement of troops and goods back and forth from England. The ship, thus, remained an inconspicuous visitor on its waters among the humdrum of activity around it. However, the city was not prepared for some unusual cargo that had come unbeknown to anyone on the ship: lethal strains of the H1N1 influenza virus right from the trenches on the Western front.

On June 10, seven police sepoys, one of whom was posted at the docks, were hospitalised with what appeared to be influenza. They were India’s first cases of the highly infectious Spanish flu that was rapidly sweeping across the world at the time. Bombay was soon crippled by the virus and railway lines carried it to different corners of the country.From the hilltops of Shimla to the isolated villages of Bihar, no part of the country remained unaffected. The speed and extent of the fatalities were overwhelming. In Bombay, 768 people died in a single day on the 6th of October in 1918.

A 1918-1919 image of Spanish flu treatment

Even Gandhi, who was gaining recognition among intellectual circles as a future leader, came down with the flu in its second wave. “All interest in living had ceased,” he later wrote in his autobiography. For a variety of reasons, the second wave proved particularly fatal for India. While the mortality rate for the epidemic stood at 4.7 per 1,000 people in Britain, India’s mortality rate climbed to 20.6 per 1,000 people. The country’s poor healthcare infrastructure had a key role to play in creating the disparity. But the arrival of the flu also coincided with a drought in 1918, which led to a famine in large parts of the country. Since, hunger weakens the immune system of the body, it made large segments of the population vulnerable to the virus. The colonial regime made matters worse. Despite the famine and the epidemic, Indian-grown food continued to supply the war efforts on the British front lines. Doctors were also away for the war.

Over 61 lower caste Hindus died per 1,000 in the community while merely 18.9 caste Hindus (sic) per 1,000 from the community lost their lives. The same figure for Europeans living in India at the time stood at 8.3. Since the lower caste Hindus were mostly engaged as sweepers and scavengers, it made them highly vulnerable to the spread of the virus.

According to an article in Psychology Today, before the European Plague swept across the region, “the Jews most often took the blame for spreading the Bubonic Plague and were accused of poisoning wells or trying to infect others directly.”

“Many Jews were murdered based solely on rumour and innuendo. Entire villages were wiped out in retaliation,” the article adds.

Till today, ‘The Great Flu Pandemic of 1918-1919’ is still referred to as Spanish Flu even though it didn’t originate there.The Spanish got tagged with the killer flu because Spain was the first country to report the disease publicly, not because it originated there.

Even though swine flu does not transmit by pigs, "some countries banned pork imports or slaughtered pigs after the 2009 outbreak” all because the flu's name appeared to convey that it is spread by pigs.Once, such a country was Egypt, which ignored the UN's advice and ordered the slaughter of all its 3 to 4 lakh pigs. According to Reuters, the culling of pigs placed the already marginalised Christians at a disadvantage, fuelling sectarian tensions in the mainly Muslim country.

© Ramachandran