Dr Harleen Kaur, Dr A S Bhatia
As Stalin is supposed to have observed, a single death is a tragedy, a million deaths is a statistic. Nirala, a leading figure in modern Indian literature wore the wrath of 1918 pandemic that struck the world as whole and India, wrote in his memoir, A Life Misspent. “I travelled to the riverbank in Dalmau and waited, The Ganga was swollen with dead bodies. At my in laws house, I learned that my wife had passed away.” Many other members of the Nirala’s family too died. 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 workers died, Most of my relative were dead now. My cousin’s eldest son was fifteen years old, my young daughter a year old. In which direction I turned I saw darkness.” These tragedies were not just a coincidence of personal tragedies visited upon the poet, they were connected.” The newspapers had informed us about the ravages of the epidemic,” Nirala wrote.
No organized medical services were available then and the concept of public health and sanitation was not given that importance. The history of western medicine in India dates back to 1600, when the first Medical officers arrived in India along with British East India Company’s first fleet as ship’s surgeon. In 1757, The East India Company established its rule in India, which led to the development of civil and military services. A medical department was established in Bengal as far as back as 1764. The Montgomery-Chelmsford Constitutional reforms of 1919 led to the transfer of public health, sanitation and vital statistics to the provinces. This was the first step in the decentralization of health administration in India. In 1920-21, Municipality and local Board Acts were passed containing legal provisions for the advancement of public health in provinces.
The past history has shown that the devastation caused by epidemics exacerbated social tensions and had contributed to violence. The first significant flu pandemic, Russian Flu, started in Siberia and traveled to Moscow and moved to Europe, North America and Africa. By the end of 1890, 360,000 had died.
Since then mankind has faced many flu epidemics and some worth to mention are Spanish Flu(1918-1919), Asian Flu (1957-1958), Hong Kong Flu (1968-1970), Swine Flu (2009-2010), SARS (2002-2003), Ebola (2014-2016), MERS ( 2015), and now the much talked about COVID -19.
The 1918-19 influenza pandemic affected about one third of world’s population and killed more people in absolute numbers than any other disease outbreak in human history and it is estimated that more than 50 million people lost their life. The world’s population was only 28 percent of today’s population, so by adjusting for population, a comparable toll today would be 175 to 350 million. Another alarming fact about 1918 influenza pandemic is that nearly half of the deaths in 1918 pandemic were young adults aged 20 – 40 . Why this age group suffered such extreme mortality is not fully understood and is the unique feature of 1918 pandemic.
Avery important thing to note is that the 1918 pandemic came in three waves, it began mildly with a spring wave presenting as febrile illness only. Soon it was followed by second pandemic wave which swept around the world and this time it was not only virulent and lethal, but extraordinarily violent. Second wave of Flu pandemic was followed by third wave in 1919 and also 1920. It is worth noting that the 1889-1890 pandemic also came in waves, but the third wave seemed to be more lethal. The 1918 virus also targeted the young adults. In South African cities, people between the age of 20 and 40 accounted for 60 percent of deaths. In Chicago the deaths among those aged 20 -40 nearly quintupled deaths of those aged 41-60. In united states the single greatest number of deaths occurred in aged 25-29, the second greatest in those aged 30-34 , and the third in those aged 20-24.The single group most likely to suffer, if infected was the pregnant women with mortality rate ranged from 23 to 71 percent.
The United States, National and local government and public health authorities badly mishandled the epidemic Spanish Flu. Every country at that time was engaged in World War I and in order to avoid hurting the morale of the people did not mention the outbreak, But Spain was not at war and its press wrote about the outbreak, so the pandemic became known as Spanish Flu. The government authorities continued to give reassurances to the people that there is nothing to worry about Spanish Flu. One example is Chicago Public Health Commissioner who said, He would do nothing to interfere with the morale of the community. It’s our duty to keep the people away from fear. Worry kills more people than Epidemic” one leading news paper even wrote, there is no cause of panic or alarm”
As the people heard these assurances, they could see neighbors, friends, relative and spouses, ultimately dying horrible deaths. The horrific disconnect between reassurances and the reality destroyed the credibility of the government. People felt they had no one to turn to, no one to rely on, and no one to trust.
Mankind has gained much experience in handling pandemics after the three major flu pandemics of 1918, 1957, and 1968. As our past experience has shown that total isolation, cutting a community off from outside world is the only intervention to break the spread of pandemics. And are to be applied rigidly and if these isolation/quarantine measures are applied carelessly these will fail measurably. It has also been learned from the past experience that as the epidemic proceed in a given city, medical care gets disintegrated. Doctors and Nurses and other paramedical staff gets over worked and sick themselves, and victims possibly even a majority of victims may receive no care at all late in an epidemic.
One lesson learnt from this experience is that the combination of callous attitude and disregard for truth can have dangerous consequences. It is very important to retain credibility in handling such crisis.
The good news about these flu pandemics is that these give significant warning signs of their arrival. In 1918, a pandemic herald wave occurred 6 months or more before the majority of mortality impact the following fall. Further in both 1957 and 1968 pandemics, much of the total impact occurred as a series of smaller Twisters in the first several seasons after its emergence, before the total population had been affected. Pandemic mortality impact is not always tornado like, or sudden Storm, followed by return to clear skies. Instead mortality rates can remain elevated for several years.
Contrary to what the Government of United States did in 1918, the Government of India is trying its best to control the epidemic. Many states have closed the schools, Mall, Cinema halls, Gym, and all other places of public gathering including many religious places of the country and suspension of public transport. Repeated directions are being issued in various print and other medias about the measures to be taken to prevent the spread of COVID -19. Public transport is being suspended, strict vigilance at airports, cancellation of visas of all people coming from affected countries, and many more stringent ways being put into force by the state as well as central agencies, are bound to bring fruitful results. The regulatory authorities of union territory of Jammu and Kashmir have been very active since the day one and with all districts being monitored on day to day basis.
Now the question is, is it the sole responsibility of government to contain the spread of epidemic? The answer is Big No. It is the responsibility of all responsible citizen of this country to behave responsibly. All have to follow the instructions issued by regulatory bodies in letter and spirit and religiously and help the sincere efforts of the health authorities in controlling the spread. A very sad news heard while penning down this article was about a corona patient committing suicide in Safdar Jang Hospital New Delhi. As medical personnel dealing with diseases affecting human life for last more than twenty five years, we would emphasize that there is no need to press the panic button but at the same time everyone needs to come out of fool’s paradise that I will not be affected; my child will not be affected. Remember you could be the next victim if you donot take the things seriously and follow the instructions issued by regulatory agencies and the price you have to pay may be unbearable.
The authors are Associate Professor in the Department of Microbiology Government medical college Jammu and is heading the front line team to collect samples from suspected cases of Corona virus (COVID -19) patients; professor and head department of Biochemistry, Government Medical College Jammu.)
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