Pandemic 1918

While dusting bookshelves, I came upon a paper by Prof. Francis A. Gealogo titled “The Philippines in the World of the Influenza Pandemic of 1918-1919” (Philippine Studies, Vol. 57,No. 2, June 2009). It is a must read in the time of COVID-19.

The professor said there is a dearth of serious in-depth studies of how the Pandemic of 1918-1919 affected the Philippines. “The specific problems and challenges faced by colonial public health programs at the height of the epidemic have not been examined,” he affirmed. Apparently, the “traditional assessments” tend to “ celebrate the supposed success of health programs in the American-occupied Philippines.”

History tells us that the influenza pandemic of 1918-1919 was the deadliest to hit humanity as it killed 50 million the world over, victimizing young adults from ages 20 to 34; women under 35 comprised 75 percent of female morbidity. The stats were truly appalling: the 1918 pandemic killed more people in a single year than the Black Death (bubonic plague) that hit Europe in the Middle Ages, and it claimed more lives in 25 weeks than AIDS in 25 years.

According to Prof. Gealogo’s sources, the 1918 pandemic incubated in the American Midwest and burst out in the spring ( March and April), spread to the south and on to military camps all over the USA. Troops of the American Expeditionary Forces probably carried this form of influenza to Europe, but ironically enough, as the pandemic waned in its place of origin, a more virulent form attacked port cities in France and from there spread to West Africa, South Asia, and other parts of the world. Prof. Gealogo said the pandemic attacked in waves, unlike other diseases; the first came in April-July, 1918, the second in October-November, and the third in February-March, 1919. The second wave was most devastating; it had the highest death rate. Is that a hint of what might occur if and when the “extended enhanced community quarantine” is lifted on 30 April 2020?

Curiously enough, the description of the 1918 pandemic reminds one of COVID-19 — round balls, with hundreds of spikes protruding all over the surface, much like pins in a pincushion. The spikes could be triangular (hemagglutinin) or mushroom-shaped (neuraminidase). The virus was transferable not only from human to human, but also from animal to human. The virus appeared in different forms in 1929, 1946, 1957, and 1968; it mutated.

The 1918 pandemic arrived through ports, travelled inland via railway systems, vessels sailing down rivers, lakes, and other waterways. Africa, South America, and some Caribbean islands were affected through their ports. Canada was attacked along its Atlantic coast and overland from the USA. Canada lost 30,000, including 108 doctors. Neither Southeast Asia, Australia, nor New Zealand were spared.

In the Philippines, the epidemic began in Manila, as observed by Dr. Francis Courtant a surgeon working at the St. Luke’s Hospital. The first victims were the longshoremen and laborers of Manila’s ports which indicated that the virus was brought in from other parts of the world. An early medical report by Dr. Eugenio Hernando (chief of the Provincial Division of Sanitary Services) stated that in 1918, from June to December, 70,513 died, with morbidity of 40 percent of the total population. The virus came in waves; the second in October was the most fatal. Dr. Hernando’s report stated that “the disease did not seem to be imported, since cases were occurring before any ships arrived from infected countries, although after the importation of cases, it assumed a more severe form…”

Exposed to global trade and commerce, Manila, Bataan, Bulacan, Rizal, Laguna, Tayabas, Pampanga, and Nueva Ecija were hit by the first wave. The extremely severe second wave hit Cebu, Iloilo, Pangasinan, Negros, Ambos Camarines, provinces also engaged in international trade. It was also observed that provinces exposed to the first wave seemed to have developed defenses against the deadlier second wave.

One can imagine the problems of combatting the pandemic after the turmoil of World War I. Although the Philippines was not directly involved, the Philippine Health Service lost a lot of personnel. The Director of Health, Dr. John Long, resigned in December, 1918, during the second pandemic wave. As a result, a Filipino doctor had to be appointed acting director on 1 January 1919. Seven American commissioned officers resigned, so did six presidents of municipal sanitary divisions, thus endangering the state of provincial health institutions. Even the clerical force was reduced to a skeleton force. “In the case of commissioned personnel, the absence of so large a percentage from the total available number caused a serious handicap in routine health work,” noted Prog. Gealogo. After all, commissioned officers were supposed to supervise the eradication of communicable diseases. All that had political repercussions. Poor Governor-General Francis B. Harrison! He was most unjustly blamed by his enemies for the collapse of Health Services. The most vicious of them all, Commissioner Dean C. Worcester, lamented that the Philippine General Hospital was “no longer a place fit for white patients.” He blamed Harrison’s damned Filipinization program!

While other countries were quick to conclude that the 1918 virus came from outside sources, Philippine officials willingly accepted its autochthonous origin and gave it a local name, “trancazo.” However, Prof. Gealogo pointed out that “…the triumphalism in the scientific and medical field [of the USA] was drowned by the admission that the measures adopted by health authorities in combatting the disease [in the Philippines] failed.” In 1920, the Philippine Health Service published a handbook, “Proposed Sanitary Code Prepared for General Use in the Philippine Islands.” Among other things, the isolation and institutionalization of the sick, the disinfection of the environment were all made compulsory. There were specific provisions to avoid pandemic outbreaks in the future.

Perhaps, the Inter-Agency Task Force (IATF) should now rush to the National Library to borrow a copy of that manual.