Monday, April 27, 2009

The Wind of Death by David Killingray

During the space of a few months in 1918 and early 1919, when large areas of the world were involved in the greatest war ever fought, virulent influenza struck. No continent was spared the silent and frightening arrival of the disease which left in its wake not only the dead, widowed, and orphaned, but often economic dislocation and famine. The global death toll has been variously estimated but may have been more than 50 million people.

The flu pandemic of 1918-19 was the single largest demographic disaster of the twentieth century, and, almost certainly the single greatest short-term demographic catastrophe in Africa’s history’. Whatever its origin the disease spread with great rapidity around the world along the conduits of war and commerce.

Most victims did not die of the infection itself but from pneumonic complications that accompanied the disease. The incubation period was between 48-60 hours and victims suffered cynosure, coughed blood, and in fatal cases often died by drowning from an accumulation of fluid in their lungs. In some cases death was sudden with apparently healthy people succumbing to the disease. More mystifying was the universally high death rate among younger men aged 15-40 years, the population group usually deemed to be the fittest and most strong and thus best able to resist the infection.

The pandemic was characterized by a ‘W’ shaped mortality curve: deaths being highest among the predictable victims, very small children and the very old, but also among younger men, and to a lesser extent women in the same age group, especially those who were pregnant. A possible reason for this is that in confronting the infection, the more robust natural resistance system of younger and stronger people went into overdrive and simply collapsed leaving them vulnerable.

The various measures taken to prevent, arrest and cure the disease were of little avail. Inoculation was at best ineffective, at worst lethal. Masks worn widely in hospitals and public places appear, from recent research, to have had some efficacy. Probably the best treatment for an infected patient was go to bed, take regular doses of aspirin, and be properly nursed*, a degree of care available only to a very small number of victims.

In East Africa and neighboring parts of central Africa, African populations suffered from the disruptions of war with harsh labor demands, loss of cattle, famine, human and cattle disease, all of which left them weakened to the ravages of influenza. Influenza was democratic, killing rich and poor, black and white alike but hitting hardest the poor and malnourished and those who lived crammed into insanitary slums and crowded housing that were vulnerable to infection. High mortality occurred in the confined mine compounds of South Africa and Southern Rhodesia.

Thus to the already 100,000 or more deaths as a result of war (mostly carriers), need to be added a further150,000-190,000 (5.5 percent of the population) deaths from influenza, totaling more than a quarter of a million deaths in a period of just over four years. A recent tentative estimate of flu mortality in sub-Saharan Africa by Johnson and Mueller suggests a total figure of 2.375 million dead in the space of few months. But all such figures are tentative and the truth is that the total death toll in Africa during the influenza pandemic can never be accurately computed. What is certain is that the pandemic brought a crisis of mortality to Africa.

*see comment

1 comment:

  1. Proper nursing can be a problem even in the most modern and well-equiped hospitals, as recent studies have shown, especially in intensive care units and homes for the elderly, among private for-profit providers in particular.

    Reports suggest a break-down in commitment and professionalism in at least one of the hospitals treating the first victims of the flu in Mexico City. An atmosphere of incomprehension and fear developed, with some providers walking off the job. Administrative responses were, in some cases, threatening and coercive.

    In many areas of the world in 1918 nursing science was in its infancy and this must certainly have been the case in Africa.

    There can be no real doubt that the situation faced by health care providers in the teeming refugee camps and slums of the developing world, the impoverished neighborhods of places like Baghdad and the Gaza strip conditions are very similiar and equally as intractible as those faced by the early pioneers of modern nursing like Florence Nightengale.