What history tells us about health panics

Opinion: other epidemics have shown that we need transparency and clear information from health authorities

Adults in huddles, worriedly discussing a mystery disease the newspapers have been warning is on the way. Children eavesdropping, sensing the fear that is being hidden from them, become curious listeners, and search the newspapers for clues. The coronavirus in 2020? No, a "mystery plague" in the early summer of 1918, as the Great War lumbered towards its end.

We know now that this "dread disease" - as some of the newspapers called it - was the 1918-1919 influenza pandemic, one of 15 influenza pandemics on record since the 1500s and the biggest killing influenza epidemic the world had known. The death toll was upwards of 50 million according to the World Health Organisation, and possibly even as big as 100 million. Bigger than the Black Death, which decimated Europe’s population, and caused a drastic decline in the economy. It comes from a different family of viral diseases to Covid-19, which is a corona virus, alongside the scary SARS, MERS, and Covid-19…and the common cold.

As a historian, I have spent the last 15 years studying the social, economic, medical and political history of the 1918-19 influenza pandemic in Ireland. It is a gripping story, of a society silenced as the disease passed through towns and townlands, with commerce, court cases and normal life disrupted, events cancelled, and community soup kitchens set up to feed the ill. Of families suffering terrible losses, of orphaned children and ongoing physical, economic and emotional damage.

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From RTÉ Radio 1's History Show, Ida Milne and Howard Philips look back at the 1918 influenza pandemic

While the coronavirus is not that disease - and we hope public health, medical science and medicine have advanced to a stage where that level of death and destruction could not happen again - there are many echoes and many lessons that can inform the present situation.

One of those is fear or panic, and the need to manage it carefully. Panic is often seen as a key component of social responses to new epidemic diseases, particularly as they first emerge, and then as infection increases rapidly. Doctors cautioned against it in 1918, just as they are doing in the current crisis.

The risk of panic is counterbalanced with the risk of the infection. In 1918, the medical profession told journalists that they were trying to "control influenza hysteria, a danger in itself". One doctor advised that there was nothing very serious in the disease if precautionary measures were taken, and if people took to their bed as soon as they got symptoms. "In some of the country districts people are becoming greatly alarmed at the spread of the disease ... there is a danger that the people may become panic stricken by even unexaggerated accounts of the ravages of the epidemic and thus help on the disease."

From RTÉ Radio 1's Today with Sean O'Rourke, a discussion on concerns around the coronavirus outbreak with Kingston Mills (Prof of Experimental Immunology, Trinity College Dublin), Dr. Sarah Doyle (HSE Consultant in Public Health), Fionn Davenport (travel writer), Paul Bell (Health Division Organiser SITU), Ian Renton (Regional Director, The Jockey Club, Cheltenham) and Dr Ida Milne (historian at Carlow College)

The media tend also to be blamed for spreading panic during a major epidemic. The president of the Royal Academy of Medicine in Ireland, George Peacocke, reprimanded the newspapers in November 1918, at the height of the second wave of the influenza pandemic in Ireland, for making the public "unduly alarmed by the writings of the press." He didn't seem to note any irony in that he was speaking at an exceptionally rare extraordinary general meeting of RAMI, where similarly alarmed medical doctors were desperately pooling their thoughts on treatments for a disease that was defying contemporary medical knowledge. It was a disease which punctured their confidence in bacteriology, which seemed to be at last making serious inroads into reducing the massive infectious disease burden.

But for the most part, then and now, media interests behave responsibly and provide a vital role in epidemics, bringing information to the people, in a way that public health cannot. Radio and television broadcasts are accessible to those with reading difficulties, or without access to computers and therefore to websites providing information. Journalists know how to communicate in soundbites, with clear expression that most people can understand and absorb. This is something the medical profession has traditionally found difficult. In 1918, the Local Government Board for Ireland’s public notices on the influenza epidemic were anything but clear and concise.

Poor information also creates panic and people can think there is something that is being hidden. Somehow medicine has to tread a fine line between recognising this, and protecting the identity of sufferers. In Carlow College this week, my students were concerned that the first two Republic of Ireland cases are "in the east". Rumour had gone around that it was in a neighbouring town, and they were experiencing unnecessary anxiety, that could have been quelled with a more local description than "east of the country". Epidemic fear needs to be carefully managed, to build trust between the public and health authorities. The public needs transparency from epidemic management teams, particularly as fears will increase as the numbers of ill escalate rapidly in the coming days.

From RTÉ Radio 1's Today with Sean O'Rourke show, an interview with Mark Honigsbaum about his book The Pandemic Century - One Hundred Years of Panic, Hysteria and Hubris

But does panic actually have a merit that its critics do not recognise? While the word panic itself suggests an irrational response, the panic we have seen in recent days could also be described as rational: cautious planning, or even responsible behaviour. Stockpiling a few weeks' supply of prescription medicines, and paracetamol or ibuprofen, hand sanitisers and tissues, toilet paper and disinfectant, and dry foods or UHT milk means people will not have to go out if the disease emerges in their locality, or if they are in one of the risk categories. It may save people from infection, or even slow down the passage of the disease through our community, lessening the pressure on medical services.

Increasing panic as the disease becomes more widespread will also mean that a complacent public that has been listening and reading the media stories, but still sees the crisis as something that does not apply to them, will reconsider. If panic persuades people to wash their hands, and take other precautions, it will be a major aide to the control of the disease. We should harness panic as a rational public health tool rather than an irrational hindrance.

Dr Ida Milne is a historian of disease, a lecturer on European history at Carlow College and a visiting research fellow at TCD School of History and Humanities. She is a former Irish Research Council awardee

The views expressed here are those of the author and do not represent or reflect the views of RTÉ

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