COVID-19: How can we avoid a repeat of Spanish Flu History of 1918?

Civil society need to be part of the solution

Excerpt From: Catharine Arnold. “Pandemic 1918”. 

Biksham Gujja

In beautiful Prague city, the Czechs republic ‘s capital, a massive party has been held on 30th June 2020. This party is to give coronavirus a “symbolic farewell”. The city’s historic Charles Bridge, on Vltava river, was transformed into massive dinner party  venue with 600 meters long table, with music, dance and all the other things of a nice sunny summer European party will have.  Czechs with 10 million people have reported 1200 cases and 350 deaths. Even on the day party is going on one person died and 149 new cases are reported. 

Almost everyone on planet earth would like to be part of such party to mark the end of the virus.  But, is it realistic to believe what Czechs want to belive?  or it is nowhere near that reality.  WHO, the official global body monitoring the Pandemic, just few days ago warned that Pandemic is not even close to being over and warned that  the worst is yet to come. Which one is real, Czechs or WHO. It is not difficult for many countries which one is close to reality.

Across the Atlantic,  in USA, at the Senate hearing, the country’s top expert on Virus, Dr. Faucci, delivered a warning statement that  it would not be surprising if daily infections in USA would go up to 100,000. On 30th June, USA reported 46,042 new cases. It is important to note, it took nearly 40 days of first reported case in USA to reach 100,000 cases. China where the whole thing originated had just over 80,000 cases. The maximum number of cases in any day in  China never exceeded more than 4000. So USA, just one country alone reporting ten times higher than a single day China reported.  USA, the most powerful country in the world, with its economic, military and political power came to its knees due to this invisible tiny Virus, which was dismissed by its president in not long ago. Never before in history, USA was faced such extraordinary situation. The Corona virus is the most powerful weapon any nation ever faced in recent history.

The western Europe,  somehow, wriggled out it, at least for now. After massive death toll and infections, just now slowly  limping back to “new normal”.  Still economy shattered, the fears are lingering but for the boarders are being re-opened. Health experts are monitoring and cautioning  every day that the second wave could come. Still some infections are going on every day in all the countries,  but significantly reduced numbers and health infrastructure is more or less intact and ready if and when second wave comes. At least that is the confidence they are exhibiting for the public consumption. Czechs song and dance party in Prague need to be seen in that broader context.

Global situation

As on 1st July, globally more than 1.1 crore people have been infected and about 5.20 lakh people have died. The only good news, if one want to look in this pandemic is that, more people, about 60 lakh have got the virus and recovered. Globally just over 8% of people who got, might meet the death.  Every day more than 200,000 new cases are being reported with daily deaths of more than 5000 a day. This is more than all the deaths in China, where the virus originated.  

Situation in India

India, by the time this is published, most probably, the total cases may reach more than 6 lakhs and country might surpass Russia to be in third place only after USA and Brazil. The deaths might still be under 20,000. This itself is not bad, looking at the other countries. But there is an issue with India, our testing is far below that what it should be and our reporting of death, if not deliberately, is far fewer than what is happening in the country. For example, India has so far tested 88 lakh tests out that 6 lakhs were positive. This works out about 640 tests per lakh of population. Whereas USA and Russia which are showing more cases than India tested 10, 322 and 13, 400 people per each one lakh of population. That means they tested 16 to 20 times more tests. So if India has done that many tests within its population, once can imagine the actual cases in our population. It is not far from reality  to say that, India, probably, is on top of the list had it tested even half of USA and Russia has tested. Testing itself will not cure, that will help in prevent others to get it, so that news as are not too fast to disrupt the health system.. Well, surely we have our own problems of resources and logistics as many as other countries, but surely we can accelerate the testing, in order to prevent its rapid spreading. So once again, India should now consider that it is having more cases than any country, in realistic sense and start dealing that way. 

Still our numbers both the virus infections and deaths are low when compared to population basis. For example, getting back to Czechs who celebrating, our numbers both the cases and deaths are just around one third.  Fortunately, our death rates are certainly low. Even if one considers the deaths reported are far lower than what the actual situation on the ground, still numbers are low. But that might not be the situation in coming weeks and months. The worry is that these numbers are rapidly going up and our public health system might come under too much stress to point of breakdown, that has to be avoided.

While Prague is celebrating, probably pre-maturely, in India media is reporting the early signs of  the breakdown of health  system. Two specific incidents reported on 1st July are very disturbing a) A young man posting his dying message from a hospital to his father, which is heart breaking.  He pointed out that there is no ventilator for him and he is not able to breath. He reported to have died just 10 minutes after he posted that video to his father who is outside of hospital.  B) The reports of 18 dead bodies tossed into a pit  with photograph flashed on front pages of newspapers in Karnataka. A video is reported to be going around social media. These are just examples, but nationwide several reports are coming in about the inadequate medical facilities to deal with existing situation. Doctors are stressed, the equipment is not there and people are scared to go to hospital. These are early signs of system come to breaking point, while the rich and famous, if they have money can go to private hospitals if not for better treatment at least better facilities and dignity.

There is already panic in the air. There is talk of second lockdown, if not nationwide, a limited. This is enough to send the shockwaves. The memory of exodos only seen during partition was seen across the nation. The migrant workers walking thousands of kilometres have deeply scarred our national conscious. If similar or even lesser exodus happens from cities to villages by the workers, the system  might lead to complete breakdown leading degradation to social,  family, moral and religious values which are deeply binding us now. When societies face such unknown and unpredictable crisis, like this, the human values will collapse. That could happen very fast.

Are we as nation and people, prepared to deal with anything remotely close to what had happened in 1918?. This may not happen, but still are we in position to even understand what the worst scenario may look like?

What happened in 1918: Will history repeat?

Certainly let us hope and be confident that it will not repeat. But  we at least need to  know what actually happened in similar situation in 1918. Most of us,  not just in India, but globally do know even remotely the magnetite of destruction caused by similar virus a century ago. The 1918 influenza was the deadliest natural disaster in human history. The following passage from a book summarises.

“While the war still raged, along came an outbreak of the H1N1 influenza virus that would inflict higher casualties than the war itself, from Europe to Africa, from the Pacific to the Arctic, from India to Norway. Ten to 20 per cent of those infected died, a third of the world’s population. As many as 25 million are believed to have perished during the first twenty-five weeks of the epidemic, leading historians to refer to Spanish flu as the greatest medical holocaust in history, killing more than the Black Death. In India, 17 million are estimated to have died, 13.88 million of these in British India. In Africa, 2 per cent of the entire population was wiped out,”

Further

““During the devastating second wave of the epidemic, which began in the summer of 1918, victims collapsed in the streets, haemorrhaging from lungs and nose. Their skin turned dark blue with the characteristic ‘heliotrope cyanosis’ caused by oxygen failure as their lungs filled with pus, and they gasped for breath from ‘air-hunger’, like landed fish.”

Excerpt From: Catharine Arnold. “Pandemic 1918”. 

Then it did not spare even rich and famous. It is not the first time British PM, a shocking similarity of 2020, in 1918, then British PM David Lloyd George  got the influenza when he went to  Manchester on 11th September for a facilitation. That was kept it as secret. He recovered enough to travel back London after ten days on 21st September. 

This is where one has to be careful in reading dreadful comparisons and parallels of the century ago incidents. Similar virus, the Spanish influenza struck the world in 1918. India paid heavy price. The most of the following passages are from two books 

a) “PANDEMIC 1918” by Catharine Arnold published in 2018,

 b) The Spanish Influenza Pandemic of 1918–19, ed. Howard Phillips and David Killingray, Routledge Studies in the Social History of Medicine, Abingdon, Oxon: Routledge, 2003, Chapter on ‘Coping with the Influenza Pandemic: The Bombay Experience’ by  Mridula Ramanna,

Very few of us know that Gandhi our father of nation got it. His own daughter in law and her young son died to influenzas. Gandhi himself wrote to his son Harilal from hospital that his heart is at peace and so “I do not find going at all difficult” Gandhi ji was 49 then. Praja Bandhu magazine wrote “Mr Gandhi’s life does not belong to him – it belongs to India” in order to pressure doctors to do all in order to provide care and support to Gandhi ji. 

Every few of us know these historical facts. It is important to re-call some of the facts written about this deadly influenza and what it has done to our country a century ago. It is also important that, history should not repeat due to negligence and complacency. Very few of Indians even aware that one estimate put that,  then 6% of population, close to 2 crores of people died in that influenza. Shockingly there are parallels which are spine chilling. Some of them are:

  • The first patient died in February 1918 in Haskell County, rural Kansas, USA. The Dr. Loring Miner, who treater her thought it was “knock me down fever”, a local slang for common cold which normally go away in two three days. That every fever, actually knocked the world killing at least 30 million people, some estimate even 100 million over year. Most of the deaths happened in 24 weeks.
  • April 1918 from USA it reached France with US solders then part of world one.
  • First wave of Influenza reached Bombay (now Mumbai) on 10 th June. J.A Turner, the colonial health officer of Bombay mentioned that “believed that the outbreak had originated with the crew of a ship that had docked in Bombay at the end of May (1918)” but whereas the Colonial Government blamed it on poor sanitation of Indians.
  • The death rate  in Bombay climbed to 239 by 3rd July 1918. Times of India wrote “nearly every house in Bombay has some of its inmates down with fever and every office is bewailing the absence of clerks”
  • Within four weeks in June a total of 1600 people died in Bombay and  ‘at least a million working days, an incalculable amount of discomfort, expense and inconvenience’. The epidemic was confined to those working indoors, in offices and factories. The sickness rate in offices and mills was Europeans 25 per cent, Indians 33 per cent, and children 55 per cent.” Children were part of the workforce then in colonial time. Turner, the medical officer of Bombay reported to have said  ‘like a thief in the night, its onset rapid, and insidious”
  • Mahatma Gandhi survived but nation paid heavy price. We know little of our history, Gandhi Got and survived but not his daughter in law and her young son. “Another famous leader almost perished at the hands of the Spanish Lady on 2 October 1918. Following the death of his daughter-in-law and her young son from influenza, the forty-nine-year-old Mahatma Gandhi began to show symptoms of the disease. Spanish flu also raged in the Sabarmati Ashram, Ahmedabad, where Gandhi had retreated for meditation and prayer. By the time Gandhi had been admitted to hospital in Bombay awaiting an operation for boils and suffering from dysentery, he was refusing all treatment. Unlike the majority of patients, Gandhi had resigned himself to his imminent death.”
  • Gandhi  survived the Spanish influenza and he wrote ““Even after we feel that we have recovered, we must continue to take complete rest in bed and have only easily digestible liquid food. So early as on the third day after the fever has subsided many persons resume their work and their usual diet. The result is a relapse and quite often a fatal relapse”
  • “The Associated Press reported that the Hooghly River was ‘choked with bodies’, and ‘streets and lanes of India’s cities are littered with the dead. Hospitals are so choked, it is impossible to remove the dead to make room for the dying. Burning ghats and burial grounds are literally piled with corpses”
  • The Government of India then report stated “Typically of Spanish flu, the disease was fatal among the ten to forty age group, and more women died than men. In total, around 17 million people died of Spanish flu between June and December 1918. Bombay suffered terribly. Between 10 September and 10 November 1918, the total mortality was 20,258. This was made worse by the failure of the south-west monsoon and resultant crop failure. As a consequence, Bombay had to cope with an influx of migrants from districts suffering from ‘scarcity and dearness of food’. In Ahmedabad, 3,527 died, the highest mortality being among the lower castes, who were both ‘poor and underprivileged”

These are really shocking, it is difficult to believe that this happened in India. But it was global like what is going on. It did not spare any country. 

Is virus done with humans in 2020?. Probably not yet. It is summer, hope the summer of 1918 is not going to repeat even in tiny  way. But we need to be cautious, what that means?. At least we need to be aware and do whatever we can do, whatever little to protect us and protect others. This is not the time for political mileages or pointing the figures. We can’t change fundamentals of our governance or politics. As civil society, we all need to at least prepare in small way, in tiny way to make difference. No matter how much we are critical of what is going on, probably, it is not going to help. Similarly no matter how much look back into history, it might not help. History should be helping to deal with current situation than scaring or de-moralising. But we need to at least be aware, what the worst possible scenario might be. This is to do our  own small contribution in reducing the pain and suffering of fellow human beings. Communities need get together to protect, support and comfort each other. In India it is very important, no matter what our critism may be, it is highly unlikely that our institutions will significantly improve in short notice. We need to give support to our medical staff, we need to encourage them in what they are doing. This is not the time to be critical of their shortcomings. The big question is can each one of us do something. Probably we can.

What can civil society do?

This is all description of problem. Lot of us are doing on daily basis for last four months in India. But the question we need to ask ourselves, is there anything can be done, in the even of if not same, similar situation arises. Hopefully not, but can modern India prepare itself for such repeat of history. As on today, it appears, the virus is not over yet, at least in India. It is just beginning. There is nothing wrong to prepare for the worst scenario. Obviously, the Governments with its huge machinery, resources and mandate need to prepare. But media, civil society and Independent experts can suggest practical and doable measures. Here suggest is the emphasis. So far, it appear, there is no mechanism for any dialogue or discussion in order to take inputs from out side of Government system. Quickly Governments, particularly state Governments may establish such mechanism to at least listen to some of the views outside of their Government machinery. 

Specific simple and doable things.

Civil society initiatives

There are thousands of people who really want to do something to help the situation. But there is no specific way they can channel their time and skills to make small difference. Civil society can do a lot and some of the simple ideas are presented here. They are just ideas and it is worth considering  and similar things or even better things can also be suggested. If each one of us are part of at least one thing, just one thing, the situation might be less agonising. We all may be watching videos and posting messages, but question is can we do something? Within our own time, means some simple things.. Probably we can do something. First we need to agree on problem which we can something about.

Some of us can think of some of these simple, but pertinent issues faced on daily basis by many people in Telangana.

Problem or issue no.1.

Most of the people are not aware what to do in case they suspect that they or their loved ones or friends have COVID-10. What should they do, what is the first step.

Problem/ Issue no. 2.

If someone managed to join a Hospital want to talk to someone for consolation or comfort, is it possible for him to call someone from Hospital bed. This is not for medical advice or complains, just comforting.

Problem/ Issue no. 3.

Someone tested positive, but do not have symptoms, what should that person do, how to get isolated, how to prevent spreading virus, what measures to be take. In addition to advise the person might get from medical staff, is it possible to reach out to someone for comfort, second view on informal basis?

These issues look very simple, but these are the most critical one for someone who is in that situation. Surely, people who can do better and more important things they can do it. I am sure many are doing. But those who with limited time and resources can participate in such simple things which will be very useful to many people on daily basis facing such issues.

The Process

Some young techie reading this article can set up a online help line or WA help line, the persons who need can call and get assistance. Setting up is relatively easy, but what is required able to continue  the service, for that a dedicated voluntaries are required. There will be thousands of people who might register to to help provided, they are guided what they can do and can’t do. Also the volunteers need help when they want in order to serve better. I do not have clear picture of how to set up such systems but sure some people do know about it. They need to take initiative to set up the process.

If young and talented readers who has skills and some computer resources may be able to set up the facility. In order to do that, some of them may come together and work out the details before starting it. The group may discuss a) first find out may be there are such facilities already set up by others, instead of re-inventing the wheel, maybe we can join them b) what is that required to set up such group, if it is not existing c) what are the limitations d) how many volunteers are required, what type e) how to co-ordinate effectively etc.

If a state-wide service is not possible may be small area can be serviced, sticking to that small area and servicing better then expanding after it is success and if the demand is exceeding the capacity.. 

Set up zoom group to discuss all the issues of such groups before starting. This process can be completed in less than a week or even less.

During the process some other better and even more useful ideas may emerge.

Let us do our bit. Let’s not end up commentators on the videos which are being circulated. Let us be part of the solution. Virus is not going to away. Governments have their own limitations, instead of critical of their efforts every day and get de-moralised, let us be part of the solution in very tiny and small way. We can’t solve all the problems, but we can do small solution to a big problem.

Let civil society prepare  itself to play a role in meeting this public health challenge. 

gujjab@gmail.com

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