Lessons from past pandemics

Submitted by AWL on 25 March, 2020 - 8:12 Author: Martin Thomas

The nearest historical precedent to the Covid-19 pandemic is the “Spanish flu” which swept the world between March 1918 and March 1920, in three successive and distinct waves.

On the best estimates, made decades later because no one counted well at the time, that strain of flu infected about one-third of the world’s whole population and killed between 50 and 100 million, possibly more than World War 1 and World War 2 combined.

The deaths peaked sharply in the second wave, between mid-September and mid-December 1918. Most strains of flu disproportionately kill the elderly and the very young. “Spanish flu” also disproportionately killed people between the ages of 20 and 40. Like Covid-19, though it seems less so, it killed males more than females.

As Laura Spinney remarks in her history of the “Spanish flu”, “there is no cenotaph, no monument [for it] in London, Moscow, or Washington DC”. It is oddly absent from general political histories.

The November Revolution in Germany in 1918, in which workers’ councils rapidly spread across the country and took a large part of effective power before handing it back to a Social-Democrat-led bourgeois government, happened when the “Spanish flu” was at its worst. Yet political histories of the time, and the writings at the time by Rosa Luxemburg and others, scarcely mention it. Equally, Victor Serge’s book on Year One of the Russian Revolution does not mention it, although the Bolsheviks’ chief organiser, Yakov Sverdlov, was among the many who died from the flu in Russia then.

In the big European countries more died from the war than died of the flu. In the USA, more died of flu. The biggest toll was in India. The disease was brought there by troopships returning from the war, but the British colonial administration did nothing to check it or even to count the deaths, estimated by later researchers at 18 million.

The revolutionary left campaigned against the World War whose troopships, aggregations of soldiers in the trenches, and contingents of returned prisoners of war seem to have been the main incubation-points and carriers of the disease. They campaigned against the poverty, malnutrition, and insanitary housing which made tens of millions less likely to recover from the flu than the better-off. And they campaigned for Indian independence.

By the end of the “Spanish flu” epidemic the world’s first “NHS” (though a primitive and patchy one) was being built, by our comrades, the Bolsheviks, in Russia, and with an emphasis on public health and the prevention of epidemics.

In bourgeois West European states, the epidemic was followed by governments setting up health ministries. In Britain, the patchy social-insurance system for GP care initiated in 1911 was extended after the epidemic, and working-class self-help contributory schemes gave more and more working-class people access to treatment in a growing network of hospitals.

But while millions explicitly set themselves to try to prevent another imperialist war like World War 1, fewer explicitly set the goal of preventing or being able to stall future epidemics. Even the Bolsheviks knew little beyond generalities about how.

The epidemic, in mass awareness, had been just another of the plagues which had been sweeping society for hundreds of years. And the mass awareness was patchy.

It was called “Spanish flu” not because it originated in Spain, or hit Spain especially hard, but because Spain, neutral in World War 1, openly reported on the epidemic. The US, British, French, and German governments hushed it up for fear of damaging their war efforts.

The first known case was in a military camp in Kansas, USA. The virus spread from there to different military camps and to the troopships. The US military commanders said they must keep the troopships sailing, and only toyed with the idea of reducing overcrowding on them.

Scientific medicine had begun to emerge, but only begun. Doctors thought, rightly, that the flu was caused by some tiny organism being transmitted from person to person through such mechanisms as coughs and sneezes. There was a widely-accepted, but false, theory that the flu was due to certain bacteria. A vaccine was developed on the basis of that false theory, used patchily in the USA, and proclaimed effective, though in fact it wasn’t.

Beyond that, face-masks were recommended and sometimes mandated (though probably they had little effect). There were lockdowns in US cities somewhat like the current ones, with theatres, bars, and so on shut, and sometimes schools. In those days before widespread electronic communications, there was of course no “working from home”.

New York never shut its schools, and came through the epidemic somewhat better than other US cities. One reason seems to have been that conditions in schools were healthier than in the tenements where most working-class children lived. Another, that in school infected children had a better chance of being identified and offered treatment than in the tenements.

“As usual”, reports Alfred Crosby in his book on the epidemic in the USA, “the poor tended to suffer more”. Statistics for San Francisco, for example, showed that Italian immigrants did much worse than American-born people. The Chinese population showed no spike in death rates from flu and the pneumonia which often followed it. “A patent impossibility”, comments Crosby. “The deaths were not reported as such or, possibly, not reported at all”. As with the deaths in the mass of the population in India.

In Japanese-ruled Korea, at least the deaths were counted: Koreans died at twice the rate of Japanese settlers.

The odd and unexplained exception is that African-Americans, on average, suffered less in the epidemic than white citizens of the USA.

The “Spanish flu” spread worldwide with an unprecedented speed and reach because of the mass movements of people, often in cramped and unhealthy conditions, for the war.

Previous epidemics had for some time been more localised. Russia, in 1891-2, had a cholera epidemic, following a famine, which killed maybe 300,000 people.

There, the political dimensions were clearer. The Tsarist regime became much discredited, even among large sections of the landowning class and bourgeoisie, for its indifference and ineptitude.

The pioneer Russian Marxist Georgi Plekhanov, in exile in Geneva, wrote a pamphlet, The Tasks of the Socialists in the Famine, which shaped the thinking of such figures as the young Vladimir Lenin, then just edging into political activity. The pamphlet gives a classic explanation of what socialists do, and coined the later-much-discussed distinction between “agitation” and “propaganda”.

Hostile biographers of Lenin tell the story as one of Lenin being indifferent to the suffering in the famine and epidemic, and concerned only for how it would increase popular revolt. The truth? Lenin agreed with Plekhanov criticising socialists who buried themselves in relief efforts organised at local level by the liberal nobility, as many did.

Plekhanov’s arguments bore fruit in the next years. The Russian Marxist and workers’ movements first became a big force in the mid-1890s.

Only shortly before that 1891-2 famine and epidemic there had been a new strain of flu, originating in Russia in 1889 and spreading to kill maybe a million worldwide, including the great mathematician Sofya Kovalevskya.

In the 1930s and 40s, the different variants of flu and other viruses began to be identified through electron microscopes, and the first vaccines against polio and flu were developed. Together with the development of antibiotics (first, penicillin, from 1942), plus a piecemeal but real development in many countries of more sanitary working-class housing and at least of public health insurance schemes (if not NHSs), that gave medicine new confidence against the infectious diseases which had periodically ravaged humanity since, probably, the beginnings of agriculture.

When I was a child, in the early 1950s, my small home town, like others, had two hospitals: the general hospital, and a special one for tuberculosis patients. Now, at least in richer countries, and usually, most people die of cancer or of cardiovascular problems rather than infectious diseases.

But bacteria can mutate to become resistant to antibiotics. Viruses can jump species barriers (vast numbers of viruses are endemic in different species of animals, as in bats, probably, for Covid-19), or mutate dramatically when already established in humans. Climate change, which disrupts habitats and creates new intermingling of species, and mass global travel, accelerate the risk.

In 1968-9 a new strain of flu (“Hong Kong flu”) infected over 500 million worldwide and killed between one and four million.

In 1981 the AIDS pandemic was first identified. It now seems that the viruses leading to it, HIV-1 and HIV-2, had been in circulation for decades: people can live with the virus for a long time before developing AIDS.

Between 30 and 40 million people have died from AIDS, mostly in Africa, and 40 million are still living with HIV.

No vaccine has yet been found, though research is continuing. It took time to develop the medications which now make HIV infection not a death sentence.

Those who suffered worst were partly the poorest, as with most epidemics — drug companies were slow to make medications available affordably in Africa — plus partly those who are not necessarily poor, but victims of prejudice.

Homophobia made many people (and governments) see AIDS as a “gay plague” and thus possibly not much risk to “sound” citizens, or maybe even a divine punishment for sins. The Catholic Church denounced the use of condoms for safe sex.

Splinters on the left, or claiming to be left-wing, became (small) impediments too. The Revolutionary Communist Party, a group now mutated into the Institute of Ideas and Spiked Online, said: “The principal threat to homosexuals in Britain today is not from AIDS, but from the safe sex campaign… divisive moralism and phoney public health propaganda of the establishment”.

In 2002-3 an epidemic of SARS (a virus similar to Covid-19) claimed 800 deaths in 8,000 cases, mainly in China, Hong Kong, Taiwan, Singapore, and Canada. It is more deadly than Covid-19, but is transmitted less speedily. One reason why Hong Kong, Taiwan, and Singapore seem to have contained Covid-19 more successfully than other countries is that their experience with SARS was powerful enough to override the usual capitalist mode of dealing only with what gives “market signals” today, not future threats.

But the epidemic abated quickly enough that work on vaccines and treatments languished after 2004. Some say that if that work had pressed on, it could have produced results capable of quick adaptation to a vaccine for Covid-19.

In 2009-10 “swine flu” infected about one billion people, but killed a smaller proportion (about 300,000 to 400,000: about 70 million people die worldwide each year).

The most recent of the virus epidemics foreshadowing Covid-19 was Ebola, which had had localised outbreaks since the 1970s, but erupted into a full-scale epidemic in West Africa in 2013-6, killing about 11,000. Ebola kills up to 90% of those infected. A vaccine has now been developed.

Donald Trump, then only a property developer, called for US missionaries in West Africa who had contracted Ebola not to be allowed back to the USA for treatment. In West Africa, the obstacles to containing Ebola were lack of medical resources and sanitary living conditions, but also, according to Mark Honigsbaum’s history of 20th century pandemics, popular suspicion of anything coming from governments or from “the West”. Doctors had their cars stoned and their hospitals besieged by mobs.

The history yields several lessons:

It highlights the need to check climate change, and possibly the need to take more care over quarantines, even if that slows down international travel somewhat.

It mandates health systems governed by provision for future as well as current needs and risks, and not primarily by “market signals” (even “market signals” which mediate public rather than individual payment for care).

It shows that more equal societies, with better housing for the poorest, can deal with epidemics better.

Societies with greater democracy and social solidarity do better. In them, governments will be less disposed to neglect, or even cover up, epidemics — to think that they can be let run, so as not to disrupt “business” (or war), because they will primarily affect “lower” or stigmatised sectors of the population; and individuals will better follow public health advice.

It looks as if a police state, as in China or Singapore, can “work” up to a point to check epidemics, with its ability to enforce isolation and extend surveillance so as to track all contacts of infected people.

The police state, however, comes with all its other sides, such as those in China which made the government at first penalise the doctors raising the alarm rather than fight the epidemic.

Democratic social solidarity is better. It is possible, but it must be won by a fight also against the “reactionary anti-capitalists” of the “anti-vaxxer” conspiracy-theory type.

And 1891-2 and 1918 suggest that if socialists organise well in the crisis, then after it our message of democratic social solidarity can gain ground to change things for good.

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