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Tyee Books

Sick Politics

What flu epidemics tell us about social justice and mass amnesia.

By Crawford Kilian 30 Jul 2008 |

Tyee contributing editor Crawford Kilian blogs about avian flu at H5N1.

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Pandemic lessons: nothing to sneeze at.

Influenza 1918: Disease, Death, and Struggle in Winnipeg
By Esyllt W. Jones
University of Toronto Press (2007)

SARS in Context: Memory, History, Policy
Edited by Jacalyn Duffin and Arthur Sweetman
McGill-Queen's University Press (2006)

The Thin White Line: A History of the 2012 Avian Flu Pandemic in Canada
By Craig DiLouie
Future Shock Books (2008)

Stress exposes the truth about individuals and societies, and it's often an unpleasant truth we'd rather not face.

Disease is of course a major stressor, and pandemics stress societies more than most other peacetime disasters. Maybe that's why we try to forget them as quickly as possible.

But it's in our own interest to be reminded. Three recent books give us a panoramic reminder, from 1918 to 2003 to the near future.

Dealing with pandemic on upper-class terms

Historian Esyllt Jones looks at the Spanish flu and its political context just a few months before the Winnipeg General Strike of 1919. The two events were strongly related.

Using "discourse analysis," Jones shows us how Winnipeggers understood the pandemic and articulated their response. That discourse shows a very different Canada from ours. Public discussion of the flu was dominated by upper-class Anglo-Canadians and their values.

The large populations of immigrants and workers in the North End reacted too, but Winnipeg's elite ignored them. Only the elite got publicity and recognition.

Almost a century later, we've forgotten the suspicion and contempt that once faced non-Anglo immigrants to Canada. Novelists sneered at them as "mongrels." Anti-Semitism was widespread and socially acceptable.

So when working-class Jews and Ukrainians struggled to save their own from sickness and death, they did it by themselves through their ethnic organizations. And by themselves they raised the money to care for the widows and orphans the pandemic left behind.

Winnipeg's health-care system in 1918 looked a lot like what today's conservatives want to restore: you'd get care as soon as you showed you could pay for it. The working-class North End suffered more disease, and got worse care, than the affluent parts of the city.

Women as sole caregivers

The flu death of a working male was a disaster for his family. A "Mothers' Assistance Program" was advanced for its time, but didn't apply to widows with only one child, or who weren't yet citizens.

Another part of 1918 discourse was the assumption that caregiving was strictly a woman's job -- whether in the home or the hospital. Most caregivers were unpaid volunteers. A man who lost his wife was a truly sad case unless he had female relatives willing to look after his kids. Many widowers put their surviving children in orphanages.

Class tension had been an issue for years. The pandemic -- fought from the top down by the Anglo-Canadian elite, on its own terms -- made it worse. Jones makes it clear that the Spanish flu wasn't the only factor resulting in the General Strike, but it helped.

SARS inflicted far fewer casualties, but it challenged the public-health system that we now take for granted.

In some ways, the system itself made things worse. Ontario's provincial coroner James Young recalls the night when he and colleagues realized that the disease was probably all over Toronto because patients were routinely moved from one hospital to another. That was good practice in general, but not when a new and unknown disease had arrived.

Improvising the response to SARS

Canada's biggest city had to improvise a response, with a cluster of experts running a war room -- and sometimes themselves being quarantined. When the first wave of cases eased, everyone relaxed. Then SARS II erupted, and everyone had to improvise again.

Medical historian Heather A. MacDougall reviews Toronto's responses to disease outbreaks from cholera to SARS. She concludes that federal, provincial and local authorities have chronically failed to co-ordinate their efforts -- the old top-down attitude again.

In the aftermath of SARS, two economists in the Ministry of Finance looked at the economic impact of earlier epidemics and SARS. Surprisingly, the impact was very mild.

Despite killing thousands of working-age young adults, Spanish flu barely registered on Canada's GDP. And despite Ontario's loss of tourism during SARS, the provincial economy ticked right along. Other SARS regions, like China, Hong Kong, and Vietnam, actually grew during 2003.

Jones notes the disappearance of influenza from the Winnipeg media after the pandemic. People didn't want to think about it. Something similar happened in Toronto, which is why SARS in Context mentions "memory" in its subtitle. If we don't recall the lessons of the past, we are likely to learn them again the hard way.

That's also the underlying message of Craig DiLouie's The Thin White Line, which purports to be a history of the next Canadian pandemic. Like the SARS book, it offers "nonfiction" accounts of the spread of the pandemic, with reminiscences by nurses, firefighters, soldiers and others.

DiLouie has done his homework, and his narrative of the medical response to the pandemic is plausible. Less persuasive is his basic scenario, in which the Chinese government covers up an outbreak in Guangdong until it's spread around the world.

Yes, China suppressed news of SARS, and suffered a severe loss of face. But the recent response to the Sichuan earthquake suggests the Chinese now understand that public confrontation with disaster is both wise and good politics.

Does pandemic mean panic?

We also learn about "panics" in which desperate Vancouverites fight each other while looting supermarkets, and troops patrol the streets. Pandemic-caused shortages might trigger some looting, as in New Orleans after Katrina. But such civil violence is rare after disasters, except in middle-class nightmares.

Both together and individually, these books demand that we think hard about an uncomfortable idea. We've already forgotten about the years when diphtheria and typhoid and polio terrified us. We think about the current HIV/AIDS pandemic as little as possible.

But the best response to a pandemic is to prepare for it long in advance, from the ground up, with a strong and flexible public-health system. Winnipeg and Toronto responded with improvised, top-down solutions.

Perhaps the economic cost of the next pandemic will be minimal. But the cost of top-down improvisation will be the needless loss of human lives.