Interview with Laura Spinney: The flu that changed the world

Interview with Laura Spinney, science journalist and author of “Pale Rider: The Spanish Flu of 1918 and How it Changed the World”.

Laura Spinney.

L aura S pinney is a reputed science journalist who has written for a wide range of publications, including The Guardian , National Geographic , The Economist , Nature and New Scientist . A British journalist currently based in Paris, she is also the author of Pale Rider: The Spanish Flu of 1918 and How it Changed the World (Public Affairs, 2017). Pale Rider   cites estimates that up to 100 million people died between 1918 and 1920 when the world was ravaged by the deadly influenza virus which struck in three waves (of which the second was the deadliest), meaning that the Spanish flu had the highest death toll for any pandemic in recorded history.

This excellently researched book often reads like a detective thriller as the author retrospectively attempts to trace the origin of the influenza virus. Laura Spinney’s research shows three possible spaces from where the H1N1 virus could have emerged: Shansi (Shanxi) in China, Kansas in the United States or Etaples in France. She also demonstrates that while the flu was named after Spain, it could not have emerged from that country. Like all good journalistic narratives, the book uses the stories of individuals to embellish the larger story of how the flu travelled the world, leaving a trail of destruction in its wake.

Dipping into a wide range of historical and current resources that include medical records, scientific journals, newspapers, literature and art, Laura Spinney recreates the havoc of that dreaded period when a trifling cough and fever would often lead to a ghastly death. In an uncanny resemblance to the victims of COVID-19, the ones who recovered reported lingering fatigue for a long time. Certain aspects of Laura Spinney’s narrative resonate strongly with the prevailing situation in India. While a hundred years ago, the millions of Indians who were felled by the Spanish flu paid the price for the colonial British government’s indifference to issues of public health, the current generation of Indians have been let down by a callous Central government that belatedly woke up to the explosive second wave of COVID-19.

Towards the end of her book, Laura Spinney writes of the possible threat of a new and dangerous virus that could blight the world once again. She writes: “The danger is that a new strain appears in our midst, to which nobody alive has ever been exposed. Even then, it’s hard to predict what form a pandemic would take, because human beings have also moved on since 1918. The conditions that prevailed on the Western Front, and the massive displacement of people triggered by the First World War, are unlikely to be repeated. On the other hand, the globe is better connected. Transport, of humans and the germs that infect them, is faster, and we have fewer natural sanitary cordons in the form of geographic isolation.”

Pale Rider is an important book because the story of the Spanish flu is relevant as the world fights COVID-19. While there are crucial differences between the two pandemics, both mirror each other in the scale of their global spread. In a video interview with Frontline , Laura Spinney spoke on a wide range of issues regarding the Spanish flu with emphasis on its impact on India. Excerpts:

In your book, you have pointed out that the scale of deaths owing to the Spanish flu could have been between 50 and 100 million, which would mean that around 2.5 to 5 per cent of the global population fell prey to that deadly influenza virus. How did you calculate this figure?

These are obviously vague figures, and there is a simple reason for that, which is that there was no laboratory test for influenza at that time. Even in terms of clinical diagnosis, experts think that there was a massive problem of under-reporting which, by the way, is going to be a problem today with COVID-19 as well, but probably not on the same scale. So, essentially, the estimates were revised upwards over the 20th century and those are the numbers we work with now. You should probably emphasise the 50 million more, but 100 million deaths were a possibility.

Considering that such a large number of people died in a short period of three years between 1918 and 1920, why is there such limited attention paid to this catastrophe compared to, say, the deaths during the World Wars?

This is an important and difficult question and it’s the reason I wrote my book. I’m not sure that I can say I’ve answered it but I have a few theories about why pandemics seem to leave less of a trace in our collective memory than other kinds of disasters. I don’t think there’s one reason: one of the more practical reasons is simply the difficulty of counting the number of casualties. I think it is always easier to count the casualties from a war, but you have to understand that for most of the 20th century, people believed that the death toll of the Spanish flu (so- called “Spanish flu”, we should always say “1918 flu”) was in the ballpark of 20 million, so it was in the same kind of league as the death toll of the First World War, which is about 18 million. It’s only much later, towards the end of the 20th century, that the numbers were revised upwards to the one we work with now.

I also think there must be something inherent to a pandemic because the actual central event—the sickness and the death—happens behind closed doors in a private space. Maybe it also has to do with the fact that the disease was often misdiagnosed so it was given all sorts of other names, and the language around it is confusing. One could also say that at least in some parts of the world, it was just one trauma too far: They had already had four years of this terrible [First World] War. I think you’ll begin to see that the reasons for its eclipse in popular memory are complex.

You published “Pale Rider” in 2017. Reading your book now, your grim prognosis seems prescient. A “new strain” did emerge “in our midst” and because of advanced global connectivity and “fewer natural sanitary cordons”, the virus travelled quickly around the world. Others like David Quammen, who wrote “Spillover: Animal Infections and the Next Human Pandemic”, also made a similar prediction (See “ Pandemics are inevitable and costly ”, Frontline, April 24, 2020). How did the world become so complacent when there have been warnings that a pandemic was imminent?

It’s not difficult to make that kind of prediction because if you look back over the last 500 years, we have had, on average, three pandemics a century. Pandemics are not as infrequent as people think. It’s just that we seem to be forgetful of them. I don’t think any public health expert is really surprised that this pandemic [of COVID-19] came along now.

Having said that, it is still impossible today, in 2021, to predict exactly when the next pandemic will erupt, where it will emerge and what will be the pathogen causing it. In that sense, it always is a surprise. And how did the world become complacent? I don’t think the world was careless and complacent. We do learn lessons from past pandemics but perhaps we don’t learn the right lessons as fast as we should.

Again, coming back to this forgetfulness thing, perhaps we should have learned more lessons from SARS, Ebola and AIDS; from the more recent flu pandemics in 1957, 1968 and 2009. Surely, we could argue that we didn’t take enough action to make our health care systems more robust. You can make those kinds of arguments and they’re perfectly reasonable and it also depends on what country you’re in when you make those arguments, but I don’t think it’s fair to say that we completely ignored the problem. We have tried; we have taken some steps. It’s just that perhaps we haven’t gone as far as we could have.

India bore the brunt of the Spanish flu in terms of the sheer number of deaths that took place. You have pointed out that up to 18 million Indians could have lost their lives to influenza or its complications. Why was the death toll so high in India?

You’re right that in terms of absolute numbers of deaths, India was the epicentre of that pandemic as it is at the moment at the centre of the COVID-19 pandemic. However, it did not have the highest death rate in relative terms. There were other places in the world that had higher relative death rates.

One answer for the high number of deaths in India is the very big size of the Indian population with respect to the global population, both then and now, but then it is also true that in that pandemic, as in all pandemics including COVID-19, there is always a socio-economic effect. Poorer countries tend to be hit harder than wealthier countries. Within countries, the poorer tend to be worse hit than the rich. The reasons for this include access to health care, underlying nutrition, socio-economic factors like having to go out to work when others can stay at home, and so on. There are many reasons that feed into this defect and I’m afraid that we’re going to see it again this time. In the early months of the COVID-19 pandemic, it seemed as if the rich world was going to be hit hardest when they had something like 80 per cent of the burden of deaths with 15 per cent of the global population. Now the tables have turned and it’s likely the developing world will bear the brunt of it again. That, unfortunately, is the lesson from India.

What impact did this staggeringly high loss of lives have for India in the next few years?

I suppose I should start with the caveat that my book was not about India, but I did argue in my book that it [the Spanish flu] had a social and political impact. This is controversial and not everybody agrees with me.

As in the rest of the world, it was clear in India that the poor people, the poorer castes, who had less access to food, health care and so on, were the ones that were hit hardest and I think this fuelled a certain amount of resentment particularly against the British whose provision of health care was obviously lacking and even more so because of the [First World] War effort. Even the doctors that were there were serving at the [war] front.

I built a detailed case in my book that the impact of the pandemic fed and build a grassroots movement behind Gandhi, who at that time did not have grassroots support. He was being seen in some sort of elite circles as a future leader of the independence movement but he did not bring millions of people out in his support until after the pandemic.

I think that had a lot to do, at least in some parts of India, with the kind of networks that were organised at the grassroots level to bring flu relief to the worst-off, and these networks fed into the independence movement once the pandemic had passed. That’s my theory.

I’ve raised the question in a provocative manner and it needs to be researched further by someone more capable than me.

In your book, when you discuss the situation in India during the time of the Spanish flu, I could not help but be struck by the reference to how “Rivers became clogged with corpses because there wasn’t enough wood to cremate them.”

You must be aware that hundreds of corpses have been seen floating down the Ganga as COVID-19 ravages the hinterland of north India. Did you ever think that you would hear of such shocking incidents that are repeating after a hundred years?

I’ve quoted the Hindi poet Nirala, who lost his wife and daughter to the Spanish flu, in my book. For him, the universe was a cruel place and there was no place in it for sentimentality. In 1921, he wrote a poem called “Beggar”, which arguably captured the mood not only of Indian writers at that time but of writers all over the world. It included the following lines:

“When their lips shrivel up from starving

what recompense

from the generous Lord of destinies?

Well, they can drink their tears.”

This poem could have been written today. I mean it’s extraordinary but that’s what happens when systems are overrun and that includes the system for the disposal of the dead and it could happen anywhere. In other parts of the world in 1918, like New York, there was a shortage of coffins. In Rio de Janeiro in Brazil, people left the dead with the feet propped up on the windows so that the dead bodies could be taken away.

Having researched extensively on the Spanish flu and living through the COVID-19 pandemic, how would you compare the two in terms of the impact they have had on the world?

As we speak, the death toll of COVID-19 is somewhere over three million. That is the official toll and is certainly an underestimate. We don’t know what the real death toll of COVID-19 will be for some time. There were three more flu pandemics between the 1918 flu and COVID-19: the Asian flu in 1957, which is supposed to have killed around two million people; the 1968 Hong Kong flu, which supposedly killed four million; and the swine flu pandemic of 2009.

I wonder why we are not making comparisons with 1957 and 1968 rather than the really big one which happened in 1918 because the global population today is four times what it was in 1918, so this [COVID-19 death toll] is a much smaller blip on the landscape than that [Spanish flu death toll]. It [COVID-19] may turn out to be the biggest one in a century, as a big pandemic comes along roughly every century.

COVID-19 is on course for outdoing 1957 and 1968 as far as the death toll is concerned, but will it get close to the league that the 1918 flu was in? I have my doubts and there are lots of reasons for that. An important one is that the 1918 flu erupted into an extraordinarily bizarre world, a world that was at war, and that has something to do with why it was so bad.

It’s not the happiest world at the moment, but we don’t have a World War at least, and I don’t think the impact of COVID-19 will measure up to the Spanish flu in its death toll. Of course, there are all sorts of other differences and similarities we could talk about, but I think that like with the 1918 flu, we mustn’t underestimate the long-term consequences that COVID will have, the most obvious being “long COVID” (people who recover but have lingering symptoms that we are just beginning to recognise).

The pandemic itself is going to have massive social and economic consequences, but even when it’s over, when the kind of acute phase is over, we will have to deal with the aftermath, which will be “long COVID” and people who may be handicapped in a diverse number of ways. So it is going to have a very long tail in terms of its socio-economic impact.