JEFF KILDEA. Lessons to be learned from the Spanish flu pandemic of 1919 – Part 1

May 8, 2020

COVID-19 is the worst pandemic Australia has faced since the visit of the ‘Spanish Lady’ just over a century ago. What lessons can we learn from that earlier experience?

In a remarkable coincidence, the first reports of the presence in Australia of ‘Spanish flu’ and of COVID-19 both occurred on Saturday 25 January – exactly 101 years apart. It is likely, however, that in both instances the disease was present in the community before being officially reported. This was undoubtedly so in 1919 when the first case was admitted to hospital in Melbourne on 9 January, though not then diagnosed as ‘Spanish flu’. Ten days later there were 50 to 100 cases.

Confident that pneumonic influenza, which had devastated other countries, had not yet breached Australia’s quarantine, Commonwealth and Victorian health authorities considered the outbreak to be a local variety of influenza prevalent in the last quarter of 1918. As a result, Victoria did not officially notify the Commonwealth it was infected with pneumonic influenza until 28 January.

In the meantime, travellers from Melbourne had carried the disease to New South Wales. On Saturday 25 January Sydneysiders awoke to read in their newspapers that a returned soldier from Melbourne was in hospital at Randwick with suspected pneumonic influenza. The federal authorities responded by assuring the public that the Melbourne outbreak was not Spanish flu. Acting Prime Minister Watt felt the need to declare, ‘It certainly seemed to be an epidemic, but not the epidemic’. Unconvinced, NSW Premier William Holman requested that Victoria be quarantined under the federal-state agreement signed in Melbourne in November 1918. If the Commonwealth did not act, New South Wales would take its own course.

On the following Monday, after the soldier’s diagnosis had been confirmed, the NSW government notified the Commonwealth of the presence of pneumonic influenza in its state in accordance with clause 3 of the November agreement, a provision designed to isolate an infected state from those that were uninfected. In addition, the next day the governor issued a proclamation under the Public Health Act 1902 ordering all libraries, schools, churches, theatres, public halls, and places of indoor public entertainment in metropolitan Sydney to close and be kept closed until further order.

This proclamation was quickly followed by social distancing requirements to be observed in places of assembly, a requirement to wear a face mask in public, and the closure of the city’s racecourses. Later, licensed premises were ordered shut. But it was already too late. Other infected persons had travelled from Melbourne at about the same time as the soldier and, over the next few days, cases of pneumonic influenza presented across a number of Sydney’s suburbs.

Making good its threat, NSW also imposed restrictions on travel from Victoria. This was in contravention of the November agreement, as Victoria by then had been proclaimed an infected state. While the southern state might have been the first to contravene the agreement by delaying notification under clause 3, NSW effectively put an end to the only mechanism then available for federal-interstate cooperation. Thereafter, each state went its own way and the Commonwealth left them to it.

Generally, the Sydney restrictions were received without demur, even from church authorities whose churches and schools (due to go back after the summer holidays) were ordered closed. In fact, church leaders, both Catholic and Protestant, welcomed the measures and recommended the public comply with them. In obedience to the proclamation, and with the approval of the Minister for Health, the churches put in place arrangements to hold their Sunday services in the open air.

However, the atmosphere of cooperation between church and state soon evaporated. On Saturday the cabinet, on the advice of its expert advisory body, the Consultative Medical Council (CMC), decided to prohibit both indoor and outdoor church services. Curiously, hotel bars, restaurants and tea houses were permitted to remain open, though subject to social distancing rules, and no restrictions were placed on the free use of the beaches. Reports of the cabinet meeting were published in that evening’s newspapers and large-print government advertisements notifying the changes appeared in the Sunday papers.

Protestant churches for the most part complied with the new restrictions. However, open-air masses went ahead at St Mary’s Cathedral and in some suburban parishes. The cathedral administrator told the press that the last-minute notice of the change was insufficient. He might have added it was of no legal effect. The governor did not sign the necessary order until the following Friday.

In the meantime, church leaders, the religious press and individual churchgoers of all denominations registered strong protests, accusing the government of raising ‘the flag of paganism’ in the face of the impending epidemic. They questioned the logic of allowing people to dine in restaurants and to ride in crowded trains, trams and ferries to the thronged beaches, where masks would be discarded, while prohibiting masked churchgoers, observing physical distancing, to assemble out of doors for worship.

Despite suggestions that some Catholic priests intended to defy the order and celebrate mass, Archbishop Kelly issued an instruction to observe the prohibition, which was obeyed. So too, with the Protestant denominations. During the week churchmen continued to lobby the government to permit religious services in the open air. At first the cabinet was not for turning, but under sustained pressure it decided by the end of the week to lift the prohibition, subject to certain conditions as to masking, duration and social distancing.

With open-air church services now permitted, the controversy between church and state subsided. Other sections of the community, however, continued to lobby the government to ease restrictions that affected them, particularly the horseracing and liquor industries.

Such controversies aside, the government’s prompt and strict application of restrictions proved successful. During February the number of hospital admissions in Sydney was just 139, an average of less than 5 per day, while the total deaths for the month across the state was 15. This was in stark contrast to Victoria, which had delayed for three weeks before introducing a more limited range of restrictions. There the number of deaths in February was 489, in addition to 56 in January.

In the third week of February, the NSW Minister for Health told the press that the measures taken had had a remarkable effect in limiting the epidemic and that overseas experience was that the disease declined after three weeks. With NSW in its fourth week of the epidemic, he said he was ‘very hopeful that the worst is over’.

A week later, the government, as expected, revoked the orders prohibiting public assembly and those requiring the wearing of masks in public places, except that masks were still to be worn on public transport. Religious services could now also be held indoors.

So successful had the government been in its prompt action to contain the spread of pneumonic influenza that it came under criticism from various quarters, including the Labor opposition, which accused it of having overreacted and of imposing unnecessary economic and social burdens on the people. The government defended its actions by reference to the medical advice it had received from the CMC, citing the endorsement of its strict social distancing measures by Professor David Welsh of the University of Sydney, a member of the CMC.

Welsh was the 1919 equivalent of today’s Dr Norman Swan. In the early days of the epidemic, he provided clear and concise information to the public about the epidemic through articles in the Sydney Sun. And just as Swan has been criticised by sections of the media, so too did Welsh have his critics. In fact, he was expelled from the Sydney branch of the British Medical Association for having ‘acted unethically in writing signed articles on diseases and their treatment in the lay press’. The complainant accused Welsh of ‘a most reprehensible action … to appear in the public press on matters … of but little interest to the ill-informed members of the community’, adding that it was ‘degrading to our profession’.

Welsh well understood his and the government’s predicament, declaring:

It is the irony of the situation that, whatever happens, all who have taken a part in trying to control the epidemic will be blamed. If they cannot be blamed for failure, they will be blamed for the means they have taken to achieve success.

But talk of success in dealing with the epidemic was premature, as will be seen in Part 2.

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