As the number of swine flu patients in Wales continues to soar, David Williamson looks at the parallels – and the differences – with previous pandemics, and speaks to survivors of the Asian and Hong Kong flu outbreaks

DISTANT memories of the devastation which influenza wreaked across Wales less than a century ago may be a reason why the mere spectre of swine flu is enough to make many of us shiver.

The so-called Spanish flu pandemic of 1918-19 killed many more people than the battles of World War I. Between 40 and 50 million are thought to have died worldwide, with at least 10,000 perishing in Wales.

This apocalyptic moment demonstrated that a virus pays no heed to the borders for which men were prepared to go to war.

The true cost to Wales is detailed in work by retired doctor Edward Davies of Cerrigydrudion in Conwy.

He has studied records which show Caernarfonshire had the highest death rate in the whole of Wales and England, with 6.7 people in every 1,000 falling victim to the pandemic. Flintshire ranked fourth in this grim league table of death.

Soup kitchens had to be opened in Caernarfon and Llanberis to care for families that had been struck with the virus. And 80 Canadian soldiers, among 17,000 troops waiting to go home, were among those who died at Bodelwyddan, Denbighshire.

At the time, newspaper Herald Cymraeg reported: “We live in terrible days, fearing every minute of the day that we will hear of the death of neighbours and friends.”

Dr Roland Salmon, director of the communicable disease surveillance centre of the National Public Health Service for Wales, said the high death rate linked to the Spanish flu has never been satisfactorily explained.

In many ways, society was in a fundamentally weaker condition than modern Wales.

He said: “These were the last years of the Great War. The British had a naval blockade over the central powers and it was remarkably effective. Meanwhile, the German submarines were preventing food reaching France and Britain.”

Food scarcity had an automatic effect on nutrition. To make matters worse, millions of people were living in the ideal environment for a disease to be communicated.

He said: “There were these huge agglomerations of people in the Army which were perfect conditions for the transmission of the virus. These are circumstances we wouldn’t expect to be replicated in the next few months.”

Furthermore, flu-related fatalities often come when infection has crept in. Today’s antibiotics can quickly deal with a multitude of complications.

There are memories of more recent flu outbreaks, such as in 1957-58, when 37,500 died in the UK over two winters, and the 1968-70 “Hong Kong” virus which led to the deaths of 78,000 people in Britain.

However, other instances of widespread flu have been largely forgotten.

There were 29,169 deaths in a 1989 epidemic – including 1,627 in Wales.

Dr Salmon said: “The comforting thing about that is very few people have a marked recollection of 1989 as a year of Biblical carnage.”

The spectacle of the Berlin Wall collapsing was not eclipsed by terror at the latest flu strain. Similarly, Dr Salmon urges people to keep the latest outbreak in proportion.

He said: “The message we try and get across is not necessarily that this is mild or severe, but that this is flu and it behaves like flu does, so most people’s experience will be reasonably benign.”

He considers the reporting of swine flu “rather frenzied” but believes the Government’s efforts are worth while.

“I think this is a reasonable threat to prepare for and I think the preparations we’ve got will stand us in good stead,” he said.

Mark Honigsbaum, author of Living With ’Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918, said the establishment refused to treat the Spanish flu outbreak as a crisis.

He said: “There was not anything like the same response [as today] because there was no NHS, there was no Minister of Health, and it was decided it was in the best interests of the country to simply ignore the threat because the war took precedence and it was important to keep up morale.”

However, individual medical officers in cities often decided to give their own guidance as the disaster mounted.

He said: “Many of them took it upon themselves to issue advice to the public which was very, very, very similar to the advice the Government’s putting out in its leaflets. It’s uncanny how similar.”

Mr Honigsbaum does not sense that hysteria has seeped into modern Britain.

“I think there is a difference between how the media project risk and threats, and how people actually react in practice,” he said. “My feeling about the British is, actually, there have been scary headlines for several months and most people’s response is quite common-sensical.”

However, were men and women to start showing the symptoms which hit the victims of Spanish flu, panic could spread at a faster rate than in any prior epidemic.

He said: “If it was to mutate and lots of people were turning blue and choking, as they did in 1918, I think the potential today for that to be much scarier is much larger. It would not be something that’s taking place in isolated communities behind closed doors.

“In 1918, doctors witnessed this but it wasn’t something witnessed widely.”

Despite the tragedies that influenza brought to families as it ripped through Britain, the trauma did not spur strong demands for social change.

Mr Honigsbaum said: “Within individual families, if you lost a beloved aunt, father, sister or mother, it was passed on in the memory of families so it left a trace in that respect.

“But did it have lasting social impacts? The answer is, surprisingly, no.”

It was not until 1948 that the National Health Service was born. And it took the arrival of antibiotics as part of a revolution in modern medicine for the fear of premature deaths through sickness to largely recede from the public consciousness.

Worries about crime and addiction have replaced the dread of TB and pneumonia in our society. But throughout much of the world, the threat of malaria and water- born disease remains a real and present source of fear. According to Unicef, more than 5,000 children a day die from diarrhoeal diseases.

The drama of this swine flu pandemic has brought an anxiety to developed countries that a virus may strike and disrupt our plans. This gives us a reminder of the monumental power of nature to destroy and terrify.

Swansea cultural historian Peter Stead believes caution should take hold as society recognises it is not invulnerable to viruses.

He said: “I’ve got a feeling in the future we are going to have to be far more careful than we were in the past. Standards have slipped. The whole thing about washing hands and using handkerchiefs is going to come back.”

Mr Stead believes that the way technology has enabled the media to display magnified images of the virus has personalised the threat.

He said “[These] red jellyfish that look like science fiction things from outer space – that makes it all the more terrifying.”

When measured against the scale of history, bacteria and not humans are the true survivors.

Mr Stead said: “Viruses and bacteria are the strongest things. They are always going to be here, they are going to see us off.”