Now that the Australian coronavirus ‘curve’ seems to be flattening1, we run the risk of becoming complacent, or even worse, having disgraceful ignoramuses like Alan Jones2, assorted other Murdoch hacks3, and those from the Institute of Public Affairs4 (IPA), putting the government under pressure to weaken social distancing, to open up businesses, and to allow mass gatherings, or contact sports to recommence. If this happens, all the prevention measures undertaken, if belatedly, will be undone, and it may lead to a significant second wave of infection and death.
For a comparison, it may be wise to look back at what happened during the previous pandemic of 1918-1919. While I suspect many people, like me, simply assumed that the histogram of confirmed cases and deaths in any pandemic would rise from the initial recorded infections, reach a peak of cases and deaths, and then tail off until it was gone; this wasn’t the case in 1919.
While the source of the ‘Spanish Flu’* is uncertain, one of the main hypotheses is that it started in Kansas (US) in early 1918 and is suspected to have been a virus ‘native’ to birds that jumped species, perhaps to pigs and then to humans. It was first mentioned in medical reports in the US in April 1918. It has been suggested that it was American soldiers which brought the virus to the western front as hundreds of thousands of them arrived by May 19185,6.
The Australian Quarantine Service monitored the spread of the pandemic and implemented maritime quarantine on 17 October 1918 after learning of outbreaks of the illness in New Zealand and South Africa. This quarantining was done before the first cases appeared in Australia. Over the next six months the service intercepted 323 vessels, 174 of which carried the infection. Of the 81,510 people who were checked, 1102 were infected.
The federal government’s second line of defence was to establish a consistent response in handling and containing any outbreaks in Australia. It held a national influenza planning conference in Melbourne on 26–27 November 1918, at which state health ministers, the directors-general of their health departments and British Medical Association representatives met with Commonwealth personnel. Again, this was before any cases had been recorded in Australia. The conference agreed that the federal government would take responsibility for proclaiming which states were infected along with organising maritime and land quarantine, including closing state borders. The states would arrange emergency hospitals, vaccination depots, ambulance services, medical staff and public awareness measures7.
The first case of the Spanish Flu was recorded in Melbourne, on 9 or 10 January, 1919. It was likely the first cases came to Australia with soldiers returning from the western front, many of whom broke quarantine. Early cases were so mild, however, that there was initial confusion as to whether the virus was the Spanish Flu, or simply a continuation of the seasonal flu virus from the previous winter. This uncertainty delayed the confirmation of an outbreak from Victorian health authorities, which allowed the infection to spread to New South Wales and South Australia by the end of January 1919. New South Wales was the first state to officially proclaim an outbreak of pneumonic influenza (as it was called in Australia) on 27 January 1919, with Victoria following suit the next day7,8.
In an attempt to contain the outbreak, Australian authorities instigated a combination of strategies. Schools, theatres, dance halls, churches, pubs and other places of public congregation were shut, streets were sprayed, special isolation depots were established and people were compelled to wear masks in public. Movement by public transport was restricted and state borders were closed, with quarantine camps established at border crossings9. These precautions were introduced in early February10.
The first cases of COVID-19 were identified in late January in Australia. The number of new cases rapidly increased through March11. So, as far as pandemics go, we are a little behind where we were on the same date in 1919. In 1919, the first wave of the Spanish Flu reached its maximum in the middle of April with about 1,000 hospital admissions and 300 deaths per week. It then declined to about 300 admissions and 40 deaths per week in late May, before increasing dramatically again with as much as 1,300 admissions and 500 deaths per week, before trailing off just as quickly with admissions being less than 30 per week for the last four months of 1919. By the end of 1919, it was all over in Australia, and as many as 15,000 people had died, but in some other parts of the world the pandemic dragged on until December 202010.
Why were there two waves of infection and death in Australia in 1919? Nobody seems to know for certain. This is perhaps due to the fact that at the time nobody knew that it was caused by a virus. That was only found out over a decade after the pandemic had ended. Even stranger was the fact that in the UK and the US, and maybe other places, there were three waves of infection. Again, nobody really knows why this was so, although there are suggestions that it was a combination of (i) changes in seasons, (ii) opening and closing of schools, and (iii) changes in human behaviour in response to the virus, with the last of these being the most important12.
Countries previously praised for their success containing the initial coronavirus outbreak, such as Singapore and Japan, are now bracing for what some scientists fear will be a second wave of infection and death. The director-general of the International Vaccine Institute in Korea, Jerome Kim, warns that while some countries were considering relaxing measures to deal with the virus, the threat was far from over and remained unpredictable. Despite Japan being so successful in containing the first wave of infection over the first three months of the year, it has now declared a state of emergency, because it is experiencing a sharp increase in the number of new infections. Similarly, Singapore’s Government has instituted a second series of protective measures, including shutting down all workplaces, schools and non-essential services, due to an increase in locally transmitted infections13. This may be the key to what will happen next in Australia. While the first wave of infection in Australia in 1919 was thought to be from soldiers returning home from the World War 17, the second wave may have been caused by local ‘community’ transmission.
With the coronavirus, the first wave of infection in Australia was caused mostly by people coming from overseas, initially from China and other countries in east and southeast Asia, and then from the US. When the daily confirmed cases were at their maximum near the end of March, in both New South Wales and Victoria, the overseas transmissions were also at their maximum. With the shutting down of international travel, this source of infection has declined dramatically, and is now less than 10 admissions per day in both states. However, with that, the proportion of cases from known or unknown local transmission has increased. While still providing a fairly small number of daily cases, that number has not decreased significantly, unlike those from overseas infection14.
This may be the main source of the next wave of infection. Australia needs to be very careful before even considering relaxing restrictions. If any rash decisions are made in this regard, many people may die. In 1919, the second wave of infection killed many more people than the first wave. A government that gives in to the likes of Jones, Murdoch hacks and the IPA, and relaxes restrictions may be responsible for many deaths, and it will demonstrate, again, that the government is more concerned with the profits of its donors rather than the lives of Australians.
*Spanish Flu obtained its name from the fact that it was first reported widely in Spain, because that country was neutral in the First World War, and there was no censorship of the press, unlike that in France, UK, Germany and other combatant countries. As a consequence, the Spanish press reported the outbreak widely.
- Crosby, A.W., 2003. America’s Forgotten Pandemic: The Influenza of 1918 (2nd edition). Cambridge University Press, 337p.
- McCracken, K. & Curson, P., 2003. Flu Downunder: A demographic and geographic analysis of the 1919 epidemic in Sydney, Australia. In Phillips, H. & Killingray, D. (editors). The Spanish influenza pandemic of 1918-19: New perspectives. London, Routledge, 121–2.