The 1918 flu pandemic cut a swathe across New Zealand, killing thousands of people in just a few weeks. In the final part of a two-part feature, health reporter Mike Houlahan asks experts if such a deadly disease could strike again.
After the deaths came the recriminations.
Health Minister George Russell’s conduct during the critical few months was much-maligned, and stern questions were asked about why the Health Department had not reacted sooner to a disease which newspaper reports clearly showed was winding its way from the northern hemisphere to New Zealand.
The inquiry’s findings saw a range of regulations enshrined to, hopefully, ensure the country would be ready for a similar event in the future.
Those laws survived for 70 years, a testament to the quality of their draftsmanship, former University of Otago public health lecturer Warwick Brunton said.
"The law they drafted was good, and the provisions they put in place of similar event happening were good ... sometimes you need to take actions in the best interests of public health which impinge on personal liberties."
In recent years health planning laws have been overhauled, but the lessons of the influenza pandemic have not been forgotten.
There is a national pandemic plan, and each district health board has its own emergency plan setting out what will happen in a major public health event.
Internationally, in the 1920s the League of Nations set up its own health committee — a forerunner to today’s World Health Organisation.
The WHO runs a global flu surveillance and response system, which New Zealand plays a part in and pays close attention to — for example, its advice helps determine what strains will be protected against in each year’s flu vaccine.
A vaccine is a tool health officials in 1918 did not have available to them. It was one of many precautions which could have alleviated much of the agony of the pandemic.
"In 1918 influenza viruses had not even been discovered. That didn’t happen until 1930," Otago and Southland Medical Officer of Health Dr Marion Poore said.
"We now know a great deal more about the virus, the fact that it mutates and changes on a regular basis, and we have much better treatments for people who get seriously ill with influenza.
"We are also much better organised in terms of having a plan and a response approach."
Influenza is seasonal and annual, with a range of severity from very mild illness to death.
A pandemic influenza is a new disease and — as in 1918 — its world-wide spread can sometimes be rapid.
In 2006 New Zealand — confronted with dire predictions of the damage bird flu might wreak — passed new pandemic preparedness legislation.
Thankfully, the Ministry of Health did not need to order the number of bodybags it said it would require if the outbreak was as severe as in 1918.
Nor did councils have to tangle with resource management laws which might have stalled the setting up of graveyards.
However gruesome such discussions might be, they need to be had, Dr Poore said.
"It’s not whether it’s going to happen again, it’s when — there will be another pandemic," she said.
Dr Brunton agreed, and noted that things like the flu vaccine should not breed complacency.
"The vaccine is all very well, but how would that help a country like Bangladesh, or Kiribati?" he asked.
"Bacteriologists and virologists have to keep one step ahead of disease."
Despite those scientific advances, much of the public health advice in our modern pandemic plans would have been very familiar to those wrestling with the disease in 1918 — stay away from people if you are sick, stay in bed until you are well, use handkerchiefs and tissues correctly ... Then, as now, getting the message out to the public — and having them act on it — was an issue, Dr Poore said.
"One of the key challenges with all this is communication," she said.
"Communication is incredibly challenging in that situation: we would receive lots of requests for information but might not necessarily have a proper picture of what is going on ... and with faster and better communication comes the challenge of accuracy of information."
New Zealand’s pandemic flu response plan focuses on minimising the impact of disease on individuals and communities, enabling life to function as normally as possible, and to minimise the impact on the economy.
The Ministry of Health is the lead agency, but all of Government is expected to play a part.
District health boards will lead at ground level, and Dr Poore and her colleagues have their own plans if facilities like Dunedin Hospital come under serious strain.
In 1918 the city’s main hospital came very close to not functioning — at the pandemic’s peak four of its five surgeons and 82 of its 116 nurses were incapacitated with the disease.
Things were worse at the nearby Seacliff asylum, where so many staff were ill patients were entrusted with running the facility for a few days.
"That is always a risk with a new virus that nobody has any immunity to, and the health workforce is at risk at the very beginning stage of a pandemic," Dr Poore said.
"The workforce is very much dependent on good infection prevention and control methods: that’s about wearing appropriate personal protection equipment, excellent hand hygiene, good environmental cleaning, looking after patients in appropriately air-controlled environments — a range of techniques not necessarily known or understood 100 years ago."
