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The few places that escaped the Spanish Flu — lessons from Samoa

Posted By Jo Nova On February 7, 2020 @ 5:34 am In Global Warming,Health,Microbiology | Comments Disabled

A fateful decision that led to many deaths

Samoa

The Samoan Islands, 1896 | Wikimedia

Western Samoa and American Samoa are side by side islands in the Pacific. When the Spanish Flu arrived in 1918, one would instigate a quarantine while the other had a trading community that did not want to stop trade. American Samoa survived the Spanish Flu without a death. Western Samoa kept trading and lost a quarter of the population.

Influenza 1918: the Samoan experience

John Ryan McLane

In 1918 the Samoan archipelago was split between American Samoa (a United States territory) and Western Samoa (previously a German colony but under New Zealand governance from 1914). The 1918 influenza pandemic killed a quarter of Western Samoans, while leaving American Samoa unscathed.

The dangers of ship-borne disease were well known, and exclusion of many diseases, especially plague, had been implemented since the imposition of colonial governance nineteen years before.

On 30 October 1918 the Union Steamship Company’s Talune left Auckland for its run through Polynesia… The new, more lethal influenza variant had arrived in Auckland with the spring, and several crew members were ill.

Western Samoa was a German colony that had three times as many foreign ships visiting as American Samoa which was a semi-neglected military base. Western Samoa had been handed over to New Zealand management.  But when the Talune arrived the sailors that were sick hid their illness (captains orders). The Governor of Western Samoa,  Colonel Logan, hadn’t been warned of the new Flu, the traders didn’t want a quarantine, and Logan decided to wait for orders. American Samoa was a military base, and it was easy to set up quarantine.

To officials in Washington, American Samoa was a naval station with an incidental indigenous population. There was scant need for traders to maintain a permanent presence in the colony and no effort to attract settlers. This facilitated the American Governor’s use of quarantine: the absence of a trader community allowed General Poyer to impose measures without resistance, and the small number of ships visiting Pago Pago made such an effort manageable. When descriptions of the flu reached Poyer, he acted decisively. Quarantine was established, and implemented under the leadership of traditional chiefs. With modifications, the quarantine in American Samoa continued, with no fatal cases of influenza reported, until late 1921.

In contrast, Western Samoa suffered the highest known mortality of any state during the 1918-1921 pandemic. At least 24 percent of the population died, and most who died were between 18-50 years of age. Half of the most productive age cohort of Western Samoa, and the chiefly and religious elites, died. Western Samoa collapsed.

It was a “bungle that amounts to a crime”. The rampant influenza in New Zealand should have been noted in the ships “bill of health”. It was a reportable disease by the time the ship arrived in Western Samoa.

Even though the virus will arrive eventurally, despite the best efforts, the delay by quarantine is very useful. It’s a general rule of infectious diseases that viruses often mutate and become more infectious but less deadly with time. Natural selection naturally selects the more “fertile” virus, not the one that kills the host in 24 hours before they can spread it to Aunt Martha and her six kids.

In the places that escaped the Spanish Flu, by Richard Gray

 … there may be some benefit to keeping the virus out for as long as is possible. American Samoa implemented a five-day quarantine for all boats that kept influenza from its shores until 1920. When it finally did arrive, the virus appears to have lost much of its sting and there were no deaths attributed to influenza in a population of more than 8,000. The main island of Samoa to the northwest, however, lost around a fifth of its population to the pandemic.

 Gray looked at all the pockets in the US that escaped the worst of the Flu:

“These communities basically shut themselves down,” explains Howard Markel, an epidemiological historian at the University of Michigan who was one of the authors of the study. “No one came in and no one came out. Schools were closed and there were no public gatherings. We came up with the term ‘protective sequestration’, where a defined and healthy group of people are shielded from the risk of infection from outsiders.”

The people of Gunnison managed this by erecting guarded barricades on the main highways in and out of the surrounding county. Railway passengers were forced to submit to two days of quarantine upon arrival.

Tasmania had a quarantine too

A similar story unfolded on the on the Australian island of Tasmania, which implemented strict quarantine measures for boats arriving on its shores that required all passengers and crew to be isolated for seven days. When the infection penetrated the island in August 1919, medical officers reported that it was a milder infection than that on the mainland. The death rate on Tasmania was one of the lowest recorded worldwide.

Villagers in Barrow and Wainwright in north Alaska posted armed guards around their villages and travel between settlements was prohibited. When scientists tested people living in a number of remote settlements in north Alaska, they found they too were free of antibodies, suggesting they had never been exposed.

It appears that many of these villages were given advanced warning of the oncoming virus as it spread across Alaska by dog sled teams that raced ahead of the infection to alert villages. It was an incredible gamble – mail delivery teams and seal hunters moving through the region were already spreading the virus from settlement to settlement – but one that paid off.

Delaying an infection has other benefits too. It can help spread the peak, thus making resources more available.  There are around 2,000 ICU beds in toto in Australia, that’s about 1 bed per 12,000 people. The high Ro infections (which rise and fall the fastest) will be bad news if they are also nastier germs and a high proportion of people need an ICU bed. The system gets overwhelmed.

Remember those exponential curves are so unforgiving. If CoronaVirus has a 6 day doubling period, without any quarantine China is potentially only three months away from having 300 million cases. Officially some 12% or so get the severe form. In the Lancet study 29% got acute respiratory distress syndrome.

Watching those CoV numbers (not the Chinese ones so much as all the other nations.) The good news is that in the Western world the numbers don’t seem to be growing rapidly. We are only 5 days in from stopping the flights, but that’s getting close to the average incubation period. The few new cases in Australia and the US still seem to have come direct from China or through a close relative.

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