Deadly encounters: are we prepared?

Six months before the end of the First World War a new and deadly form of influenza emerged and swept across the world. Over the next 12 months more than 500 million people would catch the flu and probably between 50 and 60 million would die.

It was without doubt the deadliest and most destructive pandemic to affect our world since the Black Death. Australia managed to avoid the pandemic until early in 1919 but over the next seven months more than 1.8 million Australians caught the flu and 15,000 died. It was the greatest public health disaster in Australia's history and it affected all aspects of Australian life.

After sweeping through Europe the pandemic reached South Africa in September in 1918 and New Zealand in October. In both these countries it caused an appalling mortality. In South Africa at least 139,471 people died in four months of which 11,726 were Europeans and in New Zealand there were nearly 9,000 deaths in a little over two months in a total population of only 1.16 million. For some countries the pandemic was even more deadly. In Western Samoa, for example, 90% of the population were infected and 23% died in just a few months.

Towards the end of 1918 Australia, conscious of the pandemic raging in Europe and nearby, made provision to quarantine all ships arriving at Australian ports where cases of influenza had occurred on the voyage. From late October 1918 until late January 1919 infected vessels continued to arrive at Sydney and Melbourne many from Europe with returning servicemen. Most vessels were placed in formal quarantine.

Over this period 326 persons were quarantined at the North Head Quarantine Station in Sydney of which 49 died. A number of returned soldiers who had landed in Melbourne made their way to Sydney in January 1919 carrying the flu with them. One in particular was admitted to the Military General Hospital at Randwick on January 23^rd. Two days later, three of the medical staff who had attended him went down with the flu. It was the beginning of what was to be Australia's greatest social and public health disaster.

From February until late August every aspect of Australian society struggled under the impact of the flu. The Commonwealth Government and all the States fought over who should be responsible for pandemic control and how to institute it. States fought other states and many closed their interstate borders.

The medical profession was totally unprepared and ill-equipped to deal with a viral infection and most simply believed that they were dealing with a bacterial disease. Quarantine, isolation, masks, disinfectant sprays, and popular and quack medicines ruled the day. Thousands tried to flee Australia's cities while tens of thousands locked themselves away in their homes and avoided any contact with neighbours or others.

Social distancing and isolation became the order of the day and fear and panic ruled. Essential services, shops and businesses closed due to lack of staff and State Governments had to convert schools, race courses and other public buildings into temporary hospitals. Within seven months more than 34% of all Australians had succumbed to the flu and 3% died from it.

But could it happen again? What lessons have we learnt over the last 100 years and how well prepared are we if it did happen?

There is little doubt that it will happen again and it is not so much a question of "if" as "when". Both the WHO and the CDC believe that we are overdue for another pandemic of influenza and that it is just a matter of time. SARS, Avian Flu and Swine Flu were mere forerunners of what might soon take place. Interestingly more new influenza strains have been identified over the last 20 years than in the entire 20th century.

But are we ready and what have we learned from our past experience?

Well, in the first place there is no doubt that our attempt to overcome infectious disease over the last 100 years has failed. Smallpox is probably the only real triumph of medical science.