This is from “Clinical Infectious Diseases, Volume 31, Issue 6, December 2000“
A catastrophic epidemic that would severely tax society’s ability to care for the sick and dying and to contain disease is the scenario of greatest concern to medical, public health, and political leaders charged with developing a response to bioterrorism. Surveying the prominent issues that arose during Spanish flu’s fall peak in 1918 provides a number of lessons on how the suffering and social disruption caused by a large-scale lethal epidemic might be reduced. The following recommendations are meant to advance conversations among health professionals and policymakers about what constitutes an effective medical and public health reaction to a bioterrorist act and to inform planning for any large-scale infectious disease emergency (e.g., pandemic flu).”
The US lessons from the Spanish Flu which are applicable also to Australia:
BURIAL PRACTICES There was no preparedness for an enormous number of funerals and therefore social mores and customs were disregarded, adding to the burden of local communities and states and territories. Lack of ability to store corpses ready for burial together with a shortage of caskets, caused at least one state to hijack a consignment meant for another. Such situations resulted in the need for mass burials and home internment.
In Australia, by virtue of geography and luck, we avoided the need to consider drastic alternatives to traditional funerals. However, we still could have done better with many left unable to pay last respects to loved ones due to numbers restricted to 10 – including those officiating and arranging proceedings. No limit on numbers could have been implemented with temperatures taken at the door and all attending, required to wear masks. Further, services could be shortened without damaging the dignity of the occasion. Wakes would have to be postponed until restrictions lifted.
REPORTING AND UPDATES Poor disease reporting hampered the ability of health authorities to keep the public well-informed. This was mainly caused by state and municipal authorities being so overwhelmed by on-the-ground workloads that registering statistics got pushed back. This lack of community updates on current and projected trends only added to the already high levels of distress and uncertainty.
Reporting of updates has been like a thousand shrieking monkeys all giving slightly different messages in slightly different ways. There was no one port of call for information and each media outlet has employed their own “expert”. This is on top of local, state and federal health officials in almost daily briefings, with some updates over-riding updates made only hours before. The updates need to be streamlined, consistent and responsive to community concern. This has been especially apparent regarding the issue of reopening schools. It took ages for officials to even attempt to explain how schools were somehow magical places where no infection was possible, unlike for instance Parliament House. So long did a full explanation take, and so fraught with what sounded like magical thinking was that explanation, that many have remained sceptical.
PUBLIC HEALTH COMPLIANCE MEASURES Some community members embraced public health measures to control Spanish flu; others resisted orders seen as inconsistent, burdensome, or contrary to common sense or deeply held values and religious beliefs.
Resistance to public health measures can never be fully eradicated (and shouldn’t be, at least not by brute force). Better compliance depends a lot on delivery of the message. Here, initially, the message was dire, heavy-handed, almost threatening. Whilst some health professionals outside of the official messaging blitz got it beautifully right, such has not been the case with public officials, A better delivery, given with care and empathy, would have achieved greater compliance.
DISCRIMINATION & BLAME Social cohesion improved in many ways during the course of the Spanish Flu pandemic, but it also slid back in other areas, for example in pitting groups against each other in an effort to assign blame or to protect access to limited resources. Rumors circulated in the United States that German spies, some disguised as doctors and nurses, were spreading flu and that Bayer aspirin, a German product, was infected with flu germs. Baltimore hospitals, during Jim Crow segregation, were closed to blacks at their moment of dire need, and once the epidemic passed, an official defended the city’s poor public health record by attributing high mortality rates to the number of black residents.
These issues are more likely now than ever, given the platforms available in which hate and lies can be easily and widely spread. There is no short term solution without severe censorship. And there are genuine reasons why this should be avoided. The long-term solution is in education. Kids need to be taught to practice their own discrimination – insofar as choosing reliable sources of information. They also need to be taught how propaganda works, the reason it is used and how to spot it.
Since this report was published nearly 20 years ago, the world has experienced regional and global outbreaks of disease, including the return of Bubonic Plague in Madagascar and Swine Flu and SARS pandemics, all culminating in this years Covid-19 pandemic.
Western democracies, and as far as can be ascertained, most closed societies, despite knowing more pandemics would come, failed not only to build on existing preparedness, but actually cut funding, This happened in Australia under the Abbott government who cut funding to the CSIRO and its Australian Animal Health Laboratory in Geelong (now named The Australian Centre for Disease Preparedness).
On August 14, 2014, it was report in the Sydney Morning Herald that:
The CSIRO will cut the number of infectious disease researchers at its Australian Animal Health Laboratory in Geelong, the country’s only facility capable of working with live samples of some of the most deadly diseases, including Ebola and MERS.
As the world’s health authorities grapple to contain the largest outbreak of Ebola, infectious disease experts warned cuts to research would leave the country vulnerable to new and emerging diseases.
At the time of the cuts, the CSIRO did as you would expect and ran the government line that the cuts “would not effect the organisation’s response to emerging infectious diseases“. More independent voices begged to differ, including Nobel Prize winner, Peter Doherty who did not hold back:
Professor Doherty, jointly-awarded the 1996 Nobel Prize for physiology or medicine, said the laboratory should be prized for its rare capacity to work with large animals, using live samples of some of the world’s most dangerous viruses.
‘‘They are an absolutely unique facility in south-east Asia,’’ he said. ‘‘You can work on large animal models, be it a cow, a sheep, a goat or even a llama and you can do that under level four security conditions.’’
The former Australian of the Year noted that if Prime Minister Tony Abbott wanted to make his name as the infrastructure prime minister then, scientifically speaking, that included staffing federally funded outfits such as CSIRO.
Professor Doherty said given science was a global discipline, Australia’s ‘‘scientifically illiterate government’’ risked losing talent to other countries, such as Singapore, which were investing in research. If or when conditions in the sector improved, they may not be willing or able to return to Australia.
Meanwhile CSIRO staff association’s secretary Sam Popovski described the cuts as “particularly illogical and short-sighted.”
The cuts amounted to $111 million over four years with the shedding of 500 jobs throughout the entire organization.
At the same time as these cuts were taking effect in a scientific field in defense of certain future pandemics, the Abbott government was embarking on a $20 billion spend on submarines that will never be used in war-time defence of our shores. Defence of the nation after all, was not the real purpose of the spend; only the permanent cover story. The real purpose is in feeding what journalist Michael West has dubbed the Australia/US Defence and Intelligence Complex or AUSDIC which now unofficially runs our foreign policy and defence strategies out of a think tank known as the Australian Strategic Policy Institute (ASPI) . The primary purpose of this think tank is not to contribute to public debate about defence policy but to provide an alternative source of policy ideas for government. Ironically, China runs most of its programs via policy input through just such think tanks. The description given here of the APSI Charter comes from Hugh White, formerly Deputy Secretary, Department of Defence, and the inaugural Executive Director of ASPI.