As the issue of repatriation of foreign nationals from China grabs the headlines in South Africa and elsewhere on the continent in the wake of the spread of COVID-19, there are some important lessons that can still be drawn from events 102 years ago in 1918 when an earlier epidemic, of so-called Spanish flu, arrived in the country.
This was the most devastating pandemic of modern times, killing more than 50 million people around the world (or 3%-4% of the globe’s population) in just over a year.
South Africa was one of the five worst-hit parts of the world. About 300,000 South Africans died within six weeks. That represented 6% of the entire population. After it had finally ebbed, a doctor reflected in the South African Medical Record in January 1919:
It has truly been an irreparable calamity which has fallen on South Africa.
Certainly the world is a very different place in 2020, not least in the speed of international travel compared to that in the steamship-era of 1918. Yet, the ways in which viruses behave and humans respond have not changed so much. That’s why there are still important lessons to be learnt from the catastrophe of 1918. This is particularly true when it comes to quarantining people infected with the virus, and their contacts.
The Spanish flu episode highlights some elementary mistakes made back then which must be avoided at all costs today to prevent another public health disaster.
Elementary mistakes
Towards the end of World War I, in September 1918, two troopships arrived in Cape Town from England carrying over 2,000 black South African Labour Corps soldiers. They were being repatriated after spending over a year behind the lines on the battlefields of France and Belgium where, as non-combatants (the South African government of the day did not allow black people to bear arms), they had provided ancillary support for the white soldiers in the frontline.
Their voyage included a coaling stopover in Freetown, Sierra Leone, where Spanish flu was already raging. Within days of their departure from there, cases of influenza began to appear aboard both ships. When the first of them docked in Table Bay, 13 of the soldiers were still laid up.
The corps’ medical officer insisted that the influenza on board was similar to ordinary influenza. Nevertheless, as a precautionary measure, the state’s local medical officer had the sick troops placed in isolation at 7 Military Hospital in Woodstock. The rest of the men were put under quarantine at a military camp at Rosebank. There they where all medically examined thrice in 72 hours for signs of influenza before they could be demobilised.
But these examinations were rather cursory. And three days later all were allowed to board trains for their homes across the country. It is clear that the enforcement of the quarantine at the camp was cursory too. A local journalist wrote in the Cape Argus, the Cape Town newspaper, on 9 October 1918 about how some of the impatient soldiers were seen on the
prowl in shoals about the Peninsula, notably in District Six.
Within a day of the soldiers having left the camp on trains for home, influenza cases began to appear in a host of sites. These ranged from the staff at the camp and 7 Military Hospital and members of the transport unit which had ferried the returned soldiers from the harbour to fishermen and stevedores working in the docks.
But by then the trains were well on their way, carrying the newly-discharged soldiers all over South Africa. Even before they disembarked, some had begun to show symptoms of influenza. From as remote a district as Tsolo in the deep rural Transkei, the local magistrate was soon reporting that, since the arrival of a batch of soldiers
sickness has become rife … in village and country and people are being brought in to local doctor by wagon and sledge loads. (Phillips, ‘Plague, Pox and Pandemics’, p. 79)
Spanish flu had arrived, becoming more lethal by the day.
Inexorably infecting the entire country, railway station by railway station, it engulfed the whole of South Africa within weeks, during what contemporaries called ‘Black October’. It had been allowed to run everywhere at once, like spilt quicksilver fulminated one magazine.
Lessons
One hundred and two years later South Africa’s departments of defence and health should heed the lesson of 1918 about the need to ensure that precautionary measures are rigorously implemented to the letter. If not, by the end of this year the Cape Times may be echoing what it wrote in the midst of ‘Black October’ on 15 October 1918, that the Department of Public Health had
lamentably failed in rising promptly and effectively to the emergency … Instead of showing itself the provident and well-prepared authority that we have a right to expect … it showed a lack of imagination and initiative that were wholly deplorable.
Howard Phillips, Emeritus Professor of History, University of Cape Town.
COVID-19 is a global pandemic that caused President Cyril Ramaphosa to declare a national disaster in South Africa on 15 March and implement a national lockdown from 26 March.
UCT is taking the threat of infection in our university community extremely seriously, and this page will be updated regularly with the latest COVID-19 information.
Getting credible, evidence-based, accessible information and recommendations relating to COVID-19
The Department of Medicine at the University of Cape Town and Groote Schuur Hospital, are producing educational video material for use on digital platforms and in multiple languages. The information contained in these videos is authenticated and endorsed by the team of experts based in the Department of Medicine. Many of the recommendations are based on current best evidence and are aligned to provincial, national and international guidelines. For more information on UCT’s Department of Medicine, please visit the website.
To watch more videos like these, visit the Department of Medicine’s YouTube channel.
As the COVID-19 crisis drags on and evolves, civil society groups are responding to growing and diversifying needs – just when access to resources is becoming more insecure, writes UCT’s Prof Ralph Hamann.
03 Jul 2020 - 6 min read RepublishedThe Covid-19 crisis has reinforced the global consequences of fragmented, inadequate and inequitable healthcare systems and the damage caused by hesitant and poorly communicated responses.
24 Jun 2020 - >10 min read OpinionOur scientists must not practise in isolation, but be encouraged to be creative and increase our knowledge of the needs of developing economies, write Professor Mamokgethi Phakeng, vice-chancellor of UCT, and Professor Thokozani Majozi from the University of the Witwatersrand.
09 Jun 2020 - 6 min read RepublishedSouth Africa has been recognised globally for its success in flattening the curve, which came as a result of President Ramaphosa responding quickly to the crisis, writes Prof Alan Hirsch.
28 Apr 2020 - 6 min read RepublishedIn an email to the UCT community, Vice-Chancellor Professor Mamokgethi Phakeng said:
“COVID-19, caused by the virus SARS-CoV-2, is a rapidly changing epidemic. [...] Information [...] will be updated as and when new information becomes available.”
We are continuing to monitor the situation and we will be updating the UCT community regularly – as and when there are further updates. If you are concerned or need more information, students can contact the Student Wellness Service on 021 650 5620 or 021 650 1271 (after hours), while staff can contact 021 650 5685.