Two pandemics, 102 years apart: echoes of the 1918 Spanish flu pandemic

When the 1918 Spanish flu pandemic hit Canada, the country had to tackle some of the same conundrums we face today — such as how to find enough space for the sick, how to deal with shortages of doctors and how to help each other through a crisis. 

Canadians turned to some similar solutions, including turning hotels into hospitals and bringing doctors out of retirement to work on the front lines. 

The Sunday Edition's host Michael Enright spoke to Heather MacDougall, a historian of medicine, public health and health policy at the University of Waterloo, about the parallels between 1918 and 2020. 

Here are some highlights from her interview, edited for clarity and condensed.

What effect did the Spanish flu have on the daily life of ordinary Canadians, in both rural and urban Canada? 

[In rural Canada], life had to go on. Healthy neighbours kept an eye out on the farm down the road, and if by chance there was no smoke coming out of the chimney, they went down the road to see what was going on. The Peace River area in Alberta was in the process of being settled, and one man there did an 18-mile route on a daily basis to feed his neighbours' cows and horses, to chop wood, to melt snow for water for them. This was fairly standard across the country.

In the cities, things were slightly different in the sense that individual cities did indeed impose school closings, theatres, any collective gatherings. They requested that organizations that were going to stay open, industries that were going to have to continue to function, go to flex time so that not everyone had to get on public transit at the same time. There was a real push for people to bicycle to work to stay in the fresh air and avoid contagion. 

There was a sort of split feeling, I think, in the sense that because the war was continuing and we had to maintain the production of war materials, plus we still had to feed the population, people kept working unless they got sick. That was when you started to see ads in Canadian newspapers apologizing for delays in the delivery of bread and milk and coal.

This was generations before any kind of national health plan. How well did Canada's health care system of the time meet the surge of patients? 

The health care system did the best that it could under the circumstances. Many of the younger doctors and nurses were overseas with the Canadian Army Medical Corps at our base hospitals and field hospitals. The result of that was that many Canadian hospitals were very quickly overrun with patients, and they had to rely on retired doctors who came out in response to calls from their local and provincial authorities.

That is echoed in the current pandemic, because some provinces are talking about getting retired doctors and nurses back on the front lines. 

Yes, both Ontario and British Columbia have put out the calls and I think they are being responded to.

The healthcare workers — many of whom got sick themselves — how were they replaced? Was it all by retirees? 

No, it couldn't possibly have been, because there weren't that many doctors or nurses in the Canadian population at that point. Several interesting developments occurred, one of which was that medical and nursing students were assigned to assist doctors making house calls and to work in the hospitals. 

Cities like Toronto and Montreal basically commandeered hotels and they set up hospital facilities in these hotels. They were staffed both by retired and returning health care professionals, and what were called valiant volunteers.

The province of Ontario also set up a three-lecture nursing course for women who were either unemployed or willing to volunteer. That type of activity was conducted by the St. John Ambulance people across the country, through the voluntary aid detachments. These ladies had basically volunteered throughout the course of the war, and were willing to do home nursing care for people that were not family members. That's the other thing that was crucial throughout all this. Healthy family members looked after the sick, because there was clearly not going to be access to formal health care.

Did the deaths and the pandemic change the view of ordinary Canadians, as far as vaccination was concerned, or public health generally? 

I think one of the crucial things that happened was that since many middle- and upper-class women did indeed do volunteer work in the poorer sections of the cities in which they lived, they came to the rather stunning realization that not everyone had the social advantages that they did. This crossing of class barriers, I think, was part of what ultimately enabled Canada to bring in the old age pension in 1927, and then even more obviously during the Great Depression, to start getting very serious about employment insurance and of course a national health care system.

But in the immediate aftermath, in terms of vaccination, it was very ironic. The city of Toronto had done yeoman's work throughout the pandemic. And then there's a an outbreak of smallpox in 1919, a mild form that's initially misdiagnosed as chicken pox, and returned soldiers who were clustered in the east end of Toronto basically mounted an anti-vaccination movement when Charles Hastings, the medical officer, tried to impose mandatory vaccination. 

As one of the observers at the time pointed out, if a vaccine had been available in 1918, people would have lined up for such a preventive. Yet a proven preventive like the smallpox vaccine was opposed because, I think, by that point people were really fed up with government direction. 

Again, there is a small echo of that. There are people complaining about government overreach. 

It's very interesting, because we do live in a democracy, but I thought that one of the most telling statements made right at the beginning of the outbreak was that Canadians have rights, and they have responsibilities, and there are moments in time when the responsibilities have to take precedence over the rights. That's the fundamental conundrum of public health. The collectivity requires us to surrender some of our individual liberties, especially in a situation like the one that we're facing at the moment.

Click 'listen' above to hear the full interview.