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Opinionista

Spanish flu to Covid-19: If we cannot learn from history, we are condemned to repeat its mistakes

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Bonang Mohale is chancellor of the University of the Free State, former president of Business Unity South Africa (BUSA), professor of practice at the Johannesburg Business School (JBS) in the College of Business and Economics and chairperson of The Bidvest Group, ArcelorMittal and SBV Services. He is a member of the Community of Chairpersons (CoC) of the World Economic Forum and author of two bestselling books, Lift As You Rise and Behold The Turtle. He has been included in Reputation Poll International’s (RPI) 2023 list of the “100 Most Reputable Africans”. He is the recipient of the 2023 ME-Vision Academy’s “Exclusive Recognition in Successful Leadership” award.

It has reached the stage where almost all of us know someone who has died from Covid-19. We cannot afford to relax our vigilance, as the US city of Philadelphia learnt to its great cost during the Spanish flu pandemic in 1918.

In late September 1918, Philadelphia prematurely ended its quarantine from the February 1918-April 1920 Spanish flu pandemic to throw a parade to boost morale for the war effort. About 200,000 people lined the streets. Within 72 hours, every bed in Philadelphia’s 31 hospitals was filled and the city ended up with 4,500 people dying from the pandemic or its complications within days.

This was an unusually deadly influenza pandemic caused by the H1N1 influenza A virus that infected 500 million people – about a third of the world’s population at the time – in four successive waves. In the spring of 1918, just as the human-made horrors of World War 1 were finally starting to wind down, Mother Nature unleashed the deadliest strain of influenza in modern history. The virus infected as many as 40% of the global population over the next 18 months. Of these, an estimated 20 million to 50 million died – more than the roughly 17 million people killed during WW1.

The pandemic’s grasp stretched from the US and Europe to South Africa and the remote reaches of Greenland and the Pacific islands. Its victims included President Woodrow Wilson, who contracted it while negotiating the Treaty of Versailles in early 1919. As the pandemic reached epic proportions in the spring of 1919, it became commonly known as the Spanish flu or Spanish Lady in the US and Europe. Many assumed this was because the sickness had originated on the Iberian Peninsula, but the nickname was the result of a widespread misunderstanding. 

Spain was one of only a few major European countries to remain neutral during WW1. Unlike in the Allied and Central Powers nations, where wartime censors suppressed news of the flu to avoid affecting morale, the Spanish media were free to report on it in gory detail. News of the sickness first made headlines in Madrid in late May 1918, and coverage only increased after King Alfonso XIII came down with a nasty case a week later.

Since nations undergoing a media blackout could only read in-depth accounts from Spanish news sources, they naturally assumed the country was the pandemic’s ground zero. The Spanish, meanwhile, believed the virus had spread to them from France, so they took to calling it the French flu.

While it’s unlikely that the Spanish flu originated in Spain, scientists are still unsure of its source. France, China and Britain have all been suggested as the potential birthplace of the virus, as has the US, where the first known case was reported at a military base in Kansas on 11 March 1918. Researchers have also conducted extensive studies on the remains of victims, but have yet to discover why the strain that ravaged the world in 1918 was so lethal.

Those who cannot learn from history are condemned to repeat its mistakes. The current Covid-19 pandemic mutation variant seems to have up to 70% transmissibility (more contagious), affecting higher socioeconomic groups/levels, though with up to 25% less mortality now that frontline staff know how to treat it much more effectively.

Back home, data from the Department of Health, University of the Witwatersrand, the National Coronavirus Command Council and medical schemes seem to confirm that deaths are probably understated by up to 100% when looking at “excess mortality”. Estimates are that up to 40% of the adult population could already be infected.

It is unfortunate that the second wave coincided with, and was aided by, our major annual holidays in December, with the majority of our people going back home to be with their loved ones, mostly to villages, and those who can afford it, going on holiday to Cape Town, Plettenberg Bay, Knysna and Hermanus in the Western Cape, and Ballito, Umhlanga and elsewhere in KwaZulu-Natal.

Unfortunately, the same people had to go back to work in major cities in the middle of January, thereby being exposed at least twice. The annual migration from neighbouring countries, with our highly porous borders and high levels of corruption, can only exacerbate a dire situation. January has already presented the highest Covid-19 admissions, giving us one of the highest daily infection tracking in the world.

Major areas of concern remain KwaZulu-Natal, the Eastern Cape and Gauteng. Limpopo could still be better prepared and better equipped. The biggest concern must surely be the perception that vaccines will be the silver bullet. Our only salvation and best defence for some time will still be working from home, self-quarantine, physical distancing, wearing masks, and regularly washing hands with running water and soap.

The president has set us a herd immunity national target of 67%. That’s 40 million people at 100,000 per day! Our social partners – government, business, labour and the Solidarity Fund specifically – having gained access to the Covax facility, are, like most countries, going about it in an integrated, coordinated, moral and ethical manner.

For effectiveness and efficiency, and mindful of the massive and coordinated personal protective equipment looting, central procurement will certainly help. There are four approved vaccines globally and, depending on the type, foreign exchange, cost per unit and logistics to land/manufacture locally, it could cost us between R2-billion and R18-billion. Considering about 16.4% of South Africans belonged to medical aids in 2018, medical schemes have a maximum liability of about R7-billion, representing about 2% of all premiums.

It is in the country’s enlightened self-interest to take care of those most at risk first – frontline workers, essential workers, people in old age homes, teachers, people in descending order of age (>75 years, >65 years, and so on) and people with comorbidities – to stand the slightest chance of ultimately defeating this unusually deadly virus and maintaining a modicum of hope. DM

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"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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  • Glyn Morgan says:

    Cape Town’s two suburbs, Langa and Pinelands, were both built to reduce crowding in the central city after the Spanish Flu. Read Prof. Howard Philip’s book.

  • Martyn Payne says:

    Spanish flu is not comparable. Many times the multiple CFR of Covid and killed a completely different demographic. It would a pleasant change to read opinions based on facts rather than unsubstantiated generalisations.

  • Belinda Roxburgh says:

    Learning from the past year would be useful too. Is it possible that masks are actually doing more harm than good? (Psychologically, economically, environmentally as well as facilitating viral spread?) People feel invincible behind masks and take unnecessary risks spending too long in crowded places? Is it possible that all day breathing through a mask could have an effect on the normal defences of the upper and lower respiratory system?
    Is it possible that preventing healthy young people from mingling in a normal fashion is not only hindering the rate at which herd immunity will be attained but also lowering the general immunity of the vast young population in our country? Oversanitising, mask wearing and stopping school and sports surely does not a healthy immune system make? Add these factors to increased screen time and more anxiety I suspect that our reaction to Covid may be responsible for serious long term effects on our youth (and elderly for that matter)- time will tell..

    My personal observation is that since March 2020, most people are more stressed, depressed, poorer, less fit and many have put on a lot of weight (those that are fortunate enough to afford food) – all of which only serve to make them more susceptible to Covid-19 as well as a myriad of other physical and mental health issues including addiction and suicide. My hope is that we will learn from this past year and respond to the next pandemic in a more wholistic, kinder way.

    • Bernhard Kirschner says:

      Don’t forget closing beaches kept many out of the sun with many medical experts now agreeing that Vit D deficiency exacerbates Covod-19 sickness and mortality, especially since those with darker skins are more likely to suffer Vit D deficiency.

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