Report: it was an outbreak which silenced entire communities and towns and caused thousands of deaths

The 1918-1919 flu pandemic (the "Spanish flu") killed upwards of 50 million worldwide and possibly even as many as 100 million. Coming at the end of the First World War, this pandemic caused huge upheaval in Ireland and throughout the world.

Dr Ida Milne is a historian of disease and author of Stacking the Coffins, Influenza, war and revolution in Ireland 1918-1919 (Manchester University Press). She joined Myles Dungan on RTE Radio 1's History Show to talk about life in Ireland during the outbreak and to make some comparisons with the current coronavirus outbreak. Here are some edited excerpts from the discussion

How many got the flu and how many died?

"According to the registry, 20,057 died from flu in Ireland and I have added in about 3,000 pneumonia deaths to that. I think it's quite conservative because doctors were far too busy treating the ill to be that worried about registering the dead. I estimated that there's probably about 800,000 cases on the island if the case fatality rate is 2.5%."

How did it affect the country?

"What it did was silence entire communities and towns. You might see two or 3,000 sick in a town like say Dundalk or a thousand in a town like New Ross all under medical care at the same time. You'd see things like businesses shut down not because they were instructed to do so, but because the staff were just gone sick. You'd see the Irish Times writing things like the better sort of client is sending out for their messages just now rather than risking themselves.

From Cambridge University, how the Spanish flu provides a warning from history

The businesses mostly close down for maybe three or four weeks, or they'd be at half pressure for three or four weeks as the staff are sick and as people are not going out and not buying things. Partly, that's because they're sick and partly, it's because they're self quarantining, they're staying at home. I've come across quite a few people who've told me, for example, that they weren't allowed to go out. I've interviewed people who said they weren't allowed by their parents to go out to celebrate the end of the war in November 1918 which was at the peak weeks of the flu. A week later, you can see spikes in the number of deaths.

What was the official reaction?

"Right from the very beginning, secrecy is built in into the 1918 flu and then people always think that something is being hidden. The way governments can combat that is by being very open and making sure that they pass on good information. They can deal with panic by making sure that information is really simple to understand

"In 1918, the local government board for Ireland issued this notice that you really needed a PhD to be able to read - it was full of long words and difficult concepts about disease. Whereas Dublin Corporation and Sir Charles Cameron, who was a marvellous communicator, issued really simple notices like when you get the disease, go to bed and stay there until you are well better. A lot of people got ill from getting out of bed too quickly. 

From the Smithsonian Channel, why the 1918 Spanish flu probably didn't originate in Spain

"One unusual feature of the 1918 flu, which thankfully doesn't seem to be happening now, is that very strong, young, previously healthy athletes and people aged 25 to 35 caught it. It's one of the things that makes it particularly sad because it's also the age group for parents of young children. A lot of children were orphaned."

Was there any attempt to introduce quarantines?

"Australia did try it quite successfully. They managed to delay it coming in by keeping people in ships off the shores before checking them for temperatures and stuff like that. It's really surprising that we didn't as an Island nation try to do that. I think the reason for that is that we were very important for Americans in the war. They were using our shores and our bases to operate defences against the u-boats and to operate the convoys system to bring ships in and out safely from the war arena.

Some of the eye witnesses in the hospitals say oxygen wasn't used until it was too late

"The amazing thing about the 1918 flu is that it spread to just about every place in the world despite air travel. There were some islands I think in the Pacific that didn't get it, but, but it spread in a very short time very, very quickly." 

How did people deal with the illness?

"It's the pre-antibiotic area so there's nothing to treat the secondary bacteria infections, which were a big factor with the flu because the pneumonia took a lot of the deaths. There is nothing. People don't have a knowledge of things like paracetamol and they don't have home medications in the same way that we do nowadays. Whiskey would have been a major treatment. Some of the eye witnesses in the hospitals say oxygen wasn't used until it was too late. 

READ: What history tells us about health panics

"This is a flu that actually began in summer and that's why people find it so surprising that it was influenza. They thought at first it was a plague. They thought it was some dreadful disease that came out of the war and they were talking about a dread disease. It arrived here in May-June, 1918 but had been in America slightly earlier than that. Summer didn't seem to affect it all that much."

You can hear the discussion in full below