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 devastatedother countries, had not yet breached Australias quarantine, Commonwealth andVictorian health authorities considered theoutbreak to be a local variety ofinfluenza prevalent in the last quarter of 1918. As a result, Victoria did notofficially notify the Commonwealth it was infected with pneumonic influenzauntil 28 January.

In the meantime, travellers from Melbourne had carried thedisease to New South Wales. On Saturday 25 January Sydneysiders awoke to readin their newspapers that a returned soldierfrom Melbourne was in hospital at Randwickwith suspected pneumonic influenza. The federal authorities responded by assuringthe public that the Melbourne outbreak was not Spanishflu. Acting PrimeMinister Watt felt the need to declare, ‘It certainly seemed to be an epidemic,but not the epidemic’. Unconvinced, NSW Premier William Holman requested that Victoriabe quarantined under the federal-state agreement signed in Melbourne in November1918. If the Commonwealth did not act, New South Wales would take its own course.

On the following Monday, after the soldiers diagnosis hadbeen confirmed, the NSW government notified the Commonwealth of the presence ofpneumonic influenza in its state inaccordance with clause 3 of the Novemberagreement, a provision designed to isolate an infected state from those thatwere uninfected. In addition, the next day the governor issued aproclamationunder the_Public Health Act 1902_ordering all libraries, schools,churches, theatres, public halls, and places of indoor public entertainment in metropolitanSydney to close and be kept closed until further order.

This proclamation was quickly followed by social distancingrequirements to be observed in places of assembly, a requirement to wear a facemask in public, and the closure of the citysracecourses. Later, licensedpremises were ordered shut. But it was already too late. Other infected personshad travelled from Melbourne at about the same time as the soldier and, overthe next few days, cases of pneumonic influenza presented across a number ofSydneys suburbs.

Making good its threat, NSW also imposed restrictions ontravel from Victoria. This was in contravention of the November agreement, asVictoria by then had been proclaimed an infectedstate. While the southernstate might have been the first to contravene the agreement by delaying notificationunder clause 3, NSW effectively put an end to the onlymechanismthen available for federal-interstate cooperation. Thereafter, each state wentits own way and the Commonwealth left them to it.

Generally, the Sydney restrictions were received withoutdemur, even from church authorities whose churches and schools (due to go backafter the summer holidays) were orderedclosed. In fact, church leaders, both Catholicand Protestant, welcomed the measures and recommended the public comply withthem. In obedience to the proclamation, and with theapproval of the Ministerfor Health, the churches put in place arrangements to hold their Sunday servicesin the open air.

However, the atmosphere of cooperation between church andstate soon evaporated. On Saturday the cabinet, on the advice of its expertadvisory body, the Consultative Medical Council(CMC), decided to prohibit bothindoor and outdoor church services. Curiously, hotel bars, restaurants and teahouses were permitted to remain open, though subject to social distancingrules, and no restrictions were placed on the free use of the beaches. Reportsof the cabinet meeting were published in that evenings newspapers andlarge-print governmentadvertisements notifying the changes appeared in theSunday papers.

Protestant churches for the most part complied with the newrestrictions. However, open-air masses went ahead at St Marys Cathedral and insome suburban parishes. The cathedraladministrator told the press that the last-minutenotice of the change was insufficient. He might have added it was of no legaleffect. The governor did not sign the necessary order untilthe followingFriday.

In the meantime, church leaders, the religious press andindividual churchgoers of all denominations registered strong protests,accusing the government of raising the flag of paganism inthe face of theimpending epidemic. They questioned the logic of allowing people to dine inrestaurants and to ride in crowded trains, trams and ferries to the throngedbeaches, wheremasks would be discarded, while prohibiting masked churchgoers,observing physical distancing, to assemble out of doors for worship.

Despite suggestions that some Catholic priests intended todefy the order and celebrate mass, Archbishop Kelly issued an instruction toobserve the prohibition, which was obeyed. So too,with the Protestantdenominations. During the week churchmen continued to lobby the government topermit religious services in the open air. At first the cabinet was not forturning, butunder sustained pressure it decided by the end of the week to liftthe prohibition, subject to certain conditions as to masking, duration andsocial distancing.

With open-air church services now permitted, the controversybetween church and state subsided. Other sections of the community, however, continuedto lobby the government to easerestrictions that affected them, particularly thehorseracing and liquor industries.

Such controversies aside, the governments prompt and strictapplication of restrictions proved successful. During February the number of hospitaladmissions in Sydney was just 139, anaverage of less than 5 per day, while thetotal deaths for the month across the state was 15. This was in stark contrastto Victoria, which had delayed for three weeks before introducing amorelimited range of restrictions. There the number of deaths in February was 489, inaddition 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 theorders prohibiting public assembly and those requiring the wearing of masks inpublic places, except that masks were still to beworn on public transport.Religious services could now also be held indoors.

So successful had the government been in its prompt actionto contain the spread of pneumonic influenza that it came under criticism fromvarious quarters, including the Laboropposition, which accused it of having overreactedand of imposing unnecessary economic and social burdens on the people. Thegovernment defended its actions by reference to themedical advice it hadreceived from the CMC, citing the endorsement of its strict social distancingmeasures by Professor David Welsh of the University of Sydney, a member of theCMC.

Welsh was the 1919 equivalent of todays 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 justas Swan has been criticised by sections of the media, so too did Welsh have hiscritics.In fact, he was expelled from the Sydney branch of the British MedicalAssociation for having acted unethically in writing signed articles ondiseases andtheir treatment in the lay press. The complainant accused Welshof a most reprehensible action to appear in the public press on matters ofbutlittle interest to the ill-informed members of the community, adding thatit was degrading to our profession.

Welsh well understood his and the governments 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.