Daily Times

Since 26 February, when the first two cases of Covid-19 were officially reported in Pakistan, without scientific evidence social media is flooded with information which may negatively influence public perception and administrative effort. With limited data and rudimentary scientific knowledge about Covid-19, drawing conclusions about mortality rate or predicting growth pattern need extreme care to avoid fatal mistakes. The world is right now in the midst of crisis and at this moment no one knows real nature of this pandemic. In a situation characterized by several limitations – information asymmetries, knowledge constraints, and capacity issues – history may offer some help in drawing some analogies and extracting some clues to base our response.

We don’t know today how history will remember Covid-19 but the destruction caused by the Spanish Influenza earned it titles like the ‘mother of all pandemics’ and the ‘greatest medical holocaust in history’ which swept across the whole world in a few months. In the Subcontinent, the death toll was highest in the world. K. Davis in The Population in India and Pakistan has estimated that the mortality due to influenza of 1918 was around 20 million in the Indian subcontinent. According to Demography (Vol 49), mortality in India accounted for 38 per cent of total global deaths. If we trace back what happened back in 1918, we may find something of value to shape our response today.

Without a clear knowledge of origin – either US Mid-West or France or China – scientists still lack a complete picture of the conditions that bred that pandemic. In the Subcontinent, the Spanish Influenza is believed to have coincided with the return movement of Indian troops after participation in World War I at European and Middle Eastern fronts. Major Norman White, Chief Sanitary Commissioner of India, in his preliminary report addressed to Government of India in February 1919 has given an account of the Spanish Influenza in India with help of data collected till 30th November 1918. According to his report, the initial cases were reported in May 1918 on a ship which arrived at Bombay from Mesopotamia (present day Middle Eastern region comprising Iraq, Kuwait and Syria). By the end of June, some cases were observed in Calcutta and Madras. In July it appeared in Karachi, Quetta, Abbottabad, Punjab and the United Provinces. According to another 1919 report (Public Health Reports 1896 – 1970, Vol 34), during July and August epidemic remained mild in Punjab. In September, the geographic spread increased but death rates remained low. In October, the character of disease entirely changed and Punjab began to experience the worst epidemic in its history.

If Spanish Influenza could remain benign for a few months before striking with monstrous intensity in 1918, the reported low mortality in Pakistan during the early phase of Covid-19, in the absence of scientific rationale, must be seen with caution and suspicion

In The Proceedings of the Indian History Congress, Ruby Bala writes about Punjab, ‘From 15 October to 8 November 1918, the description of the province resembled a cremation ground or a cemetery, as so many pyres were lit and so many were buried that it seemed as death was dancing everywhere in the province’. District wise Influenza mortality statistics of Punjab during those few weeks in 1918 present an apocalyptic scenario: 35128 deaths in Lahore, 33825 in Sialkot, 27751 in Multan, 21912 in Shahpur, 16371 in DG Khan, 14648 in Rawalpindi and almost same situation in all other districts. Within a month, Punjab lost 4.77 percent of its population as at least 962,937 persons died. Mortality rate in Punjab was 42.2 deaths per 1000 persons. In the North-West Frontier Province, 82000 people died because of pandemic and mortality rate was 40 per 1000 persons. Not a single district was spared by the pandemic in entire north western Subcontinent.

The rapid outburst of Spanish Influenza was considered to be correlated with movement of people as its initial occurrence was reported in home-coming Indian battalions, post office and railway employees and general travellers. The incidence of disease was relatively less intense in areas situated far off from the railway lines and in remote villages not connected with roads. The areas which were more isolated remained relatively less affected. But in general, despite early onset of disease in urban areas and garrison towns, the rural areas were the ultimate victims of disease. Majority of those who died were poor and they lived in villages.

From May to August 1918, despite continued geographic spread of the Spanish Influenza mortality rate was quite low. This is what demands caution today. If Spanish Influenza could remain benign for a few months before striking with monstrous intensity in 1918, the reported low mortality in Pakistan during the early phase of Covid-19, in the absence of scientific rationale, must be seen with caution and suspicion. Complacency well before the full grasp of chemistry of Coronavirus may prove harmful. If in case of Spanish Flu, mobility of people and spread of pandemic were correlated, the same is now an established fact about Covid-19. Social isolation could have saved millions in 1918 and still remains an economically harsh but perhaps a Hobson’s choice. If poor sanitary conditions and poverty in 1918 made rural areas an easy prey of disease, the persistence of almost same conditions today places rural population at a higher risk. This makes villages as vulnerable today as they were in 1918 particularly when these days wheat harvest has already started in the plains of Pakistan.

History of 1918 pandemic can be taken as a gentle warning before making premature judgements about pattern of spread and local mortality rate. We must pay heed to what history tells about value of social distancing in combating pandemic. The last but obviously not the least take away point from history is to focus on rural areas with as much urgency as visible in case of cities.

The writer is a development policy analyst