Story of a Pandemic

First official Infectious Reads blog post! I thought I’d start by introducing you to a beautifully constructed little novel by William Maxwell. ‘They Came Like Swallows‘, first published in the 1930s, has autobiographical undertones from Maxwell’s own childhood, growing up in the American Midwest at the close of the First World War in 1918.

The First World War has barely ended when a new trouble spreads innocuously into the lives of the Morison family. We experience the Spanish influenza pandemic through the eyes of eight-year old Bunny, described as angel-like, a delicate, bullied child; thirteen-year old Robert with his toy soldiers; and their seemingly stern father James, whose worlds revolve around the mother of the family, the newly pregnant Elizabeth. At first a distant threat, noted with polite interest, ‘flu cases start to break out closer and closer to home: Chicago, St Louis, then Bunny’s school. Suddenly, the Morisons are presented with the stark reality of how fragile they are, as they each catch the highly infectious disease, and face the unthinkable, that the Spanish influenza may tear their family unit apart forever.

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A time of horrors, this subtly written book presents the personal sufferings of people gripped by one of the most lethal pandemics in history. Maxwell’s own first-hand experience of losing his mother to the pandemic is explored quietly with themes of love, loss and grief interwoven with historical context.

Without spoiling the events of this delicate story – I’ll leave you to discover it yourselves – it is fascinating to see how Maxwell describes the illness; its symptoms, spread and in particular the public health response to its spread. No 24 hour news channels, trending Facebook feeds, Twitter storms to warn the world of the arrival of the Spanish ‘Flu! No: James Morison reads out a newspaper public service announcement to the family over dinner.

‘Spanish influenza’ resembles a very contagious kind of ‘cold’ accompanied by fever, pains in the head, eyes, back, or other parts of the body, and a feeling of severe sickness.  The Morisons hear that most cases recover rapidly within 3-4 days, but that some develop ‘pneumonia, or inflammation of the ear, or meningitis, and many of these complicated cases die’.

Maxwell’s descriptions are on point, including the specific complications which caused such a high death toll from a usually nasty, but rarely so deadly, virus. So, too, do the descriptions of Bunny being “adrift utterly in his own sickness” with his “eyes glittering with fever” conjure up the image of a child in the grip of the ‘flu: I can picture him, shivering and wrapped up in blankets as his mother Elizabeth and aunt Irene try to comfort him.

Why so deadly? The Spanish influenza was caused by the influenza A virus, in fact by the same strain that caused the swine flu pandemic in 2009: H1N1. Sure, the ‘flu still causes a number of deaths each year, particularly in older, or health-compromised people. But why so much deadlier than our usual ‘flu season’? Well, the ‘flu virus changes over time, and each year different strains emerge as the dominant strains. This is the reason why ‘flu vaccines are given annually, to cover the most problematic strains of that particular year.

In 1918, before ‘flu vaccines, before antibiotics to cover bacterial complications of influenza infections, and at a time when the health systems of the world were weakened by the demands of war, the influenza strain that emerged was much deadlier than usual. In total, an estimated 20-40 million people died, MORE than during the War itself. Strangely, a lot more young people succumbed to this strain of ‘flu than usual – we’re talking teenagers, young adults to mid-thirties. It’s thought that the Spanish ‘Flu triggered the immune system in a way that made it over-react, with deadly consequences from the excess effects to those with stronger immune systems. Another high-risk group were pregnant women: even if the mother survived, there were high numbers of babies who succumbed in the womb.

Where did it come from? The virus strain probably originated from China, and spread along trade routes; although according to Bunny’s Uncle Wilfred, the Spanish ‘Flu was brought in on German submarines. Whilst it was not actually used as a bioweapon, the ships coming to and from Europe and the US undoubtedly contributed to the spread of the virus, in addition to the celebrating crowds around Armistice Day. A perfect virus breeding ground…

‘They Came Like Swallows’ is sadly an accurate representation of the scale of devastation caused by the Spanish ‘Flu pandemic, made more real in the knowledge that it probably reflects true aspects of Maxwell’s own childhood. As ‘Flu Season’ gets underway here in Australia – the time of year when infectious diseases cause coughs and sneezes – I will be thinking of Bunny and Robert, thankful of some of the defences we have against similar pandemics, and mindful of how vulnerable we still are to this little virus.

Got a comment or question? Have you read ‘They Came Like Swallows’? Get in touch here!

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