Showing posts from category: Medical history
The Fight against the Coronavirus Pandemic: Reflecting on the Numbers
The war against the coronavirus outbreak is indeed global, infecting to date 199 countries and territories and every continent with the possible exception of (largely and seasonally unpopulated) Antartica. Every day the apps on social media and the news broadcasts inform us of the rising tally of coronavirus cases and of the fatalities, but what we do know is that these totals do not convey a true picture of the populations affected by the virus. They are often an indicator only, a way of charting the trajectory of the elusive curve that every health service and provincial and national government strives to flatten.
Distribution of Covid-19 cases worldwide, 31-Mar-2020 (www.ecdc.europa.eu)
The complexity of the disease partly explains the inexactness. That being infected with coronavirus can be asymptomatic and remains recordable for those never tested, highlights this problem. On a country by country basis the uncertainty over numbers magnifies. Some countries (a lot in Africa for instance) have no or minimal records of testing, which is not the same as saying they have no coronavirus cases! The reason for this might lie in the fact these predominantly impoverished countries have not the wherewithal nor the infrastructure to test even significant numbers of the population, they simply can’t cope. Thus their true numbers are never ascertained. There are other countries in the world who are motivated by reasons other than capacity to report the incidence of infection and mortality, eg, a desire to mask the extent of the calamity for domestic or external purposes.
Geographical distribution of Covid-19 cases worldwide, 31-Mar-2020 (www.ecdc.europa.eu)
The media’s daily servings, the table of virus mortality and morbidity gives us the bare bones of the depth of the human catastrophe — Italy a disaster, Spain a disaster, China a disaster but seemingly over the hump, Iran shockingly bad, France shockingly bad, USA very bad but likely to become even more catastrophic, UK and Netherlands, both worsening, etc. But of equal curiosity is those countries positioned much lower on the ladder of gloom that stand out as demographic anomalies, their numbers almost too good to believe…indeed! Two such are Russia and India. Russia, a vast country with around 145 million people has fessed up to just 17 deaths⋇. On face value a result that would hearten the most pessimistic, but you have to wonder about the level of reportage? India, with 1.3 billion-plus people has so far recorded a mere 32 deaths⋇ (compared to Italy with 60 million people which has lost just shy of 11,600 lives⋇). With India, the lowness of the figure is overshadowed by the inevitability of magnification…the sheer mass of humanity confined within such an acute density of space means that for the substrata of Indians, the poorest classes, no matter how earnestly their prime minister entreats them, they simply cannot physically isolate themselves. The directive from on high to keep a “social distance” from others to ward off the virulent effect of the epidemic remains for the vast masses a pipe dream. That many, many of these unfortunate souls will not escape infection and worse—either recorded or unrecorded—remains inevitable.
At 26-Mar-2020 (Source: Newsweek Statista)
_______________________________________________________________________
⋇ as at 1515 hrs, Greenwich Mean-time, 31st March 2020, ‘Confirmed Cases and Deaths by Country, Territory, or Conveyance’, www.worldometers.info/
The COVID-19 Crisis: Are We Creating a Whole Generation of New Scofflaws?
Scofflaw: (n) as neologisms go, the word scofflaw has an interesting back story. It is a portmanteau word, derived by combining scoff + law. Scofflaw’s origin came about in 1923 when Massachusetts banker Delcevare King offered up a prize of $200 in gold to the American public for the best word which described “the lawless drinker”.. America being knee-deep in the era of Prohibition at the time and King being one of Prohibition’s greatest zealots. The winning entry (in fact ‘entries’, as two separate entrants submitted the same word), came from Henry Irving Dale and Kate L Butler (who herself was a Anti-Saloon Leaguer) who shared the prize. ‘Scofflaw’ beat a field of over 25,000 entries which included ‘boozocrat’ and ‘boozshevik’ (“DELCEVARE KING, BANKER, 89 DEAD; Prohibitionist’s Contest Led to Coining of ‘Scofflaw’ “, New York Times, 22-Mar-1964; “Ken Burns & Lynn Novick: Prohibition”, PBS, broadcast 2011, www.pbs.org). So, it’s original meaning was someone who drinks illegally (earning the opprobrium of prohibitionists like Mr King) or someone who mocks (scoffs) or ridicules anti-drinking laws. Over time scofflaw was extended to mean “a person who flouts the law, especially by failing to comply with a law that is difficult to enforce effectively”…in the US since the 1950s the word has largely been applied to individuals who habitually violate laws of a less serious, non-criminal nature, especially traffic violations (‘Scofflaw’ Wikipedia, http://en.m.wikipedia.org/; www.thefreedictionary.com/).
Prohibition: confiscating barrels of illegal grog in America (Source: Pinterest)
As part of the government mantra directed towards us home-front civilians in the war on coronavirus, we are asked by our leaders, entreated even, to practice safe social distancing. In the early days of the war against the invisible biological enemy we were told to immediately implement social distancing from others at all times. Later this was quantified and codified – 1.5 metres distance outdoors from others, no congregations of people of more than 500, indoors a four to one ratio, no more than 25 people in a room 100 square metres. And yet at the same time—this is where the mixed messaging starts to gain traction—we were told we can keep using public transport to go to work or school or uni or TAFE. So we pile onto crowded buses, trains and LRVs like the George Street ‘Snail’, at peak time. We shop in scarcity-hit supermarkets teeming with increasingly chaotic shoppers, we sit in class rooms and cafés and pubs and restaurants, or line up in the ever-lengthening queues of the recently unemployed outside Centrelink offices – in all instances numerically and spatially infringing the prescribed limits✱. We should all, even the politicians, shout as one – “I’m a violator!” All of us at some point have been or will be violators – by design or default!
Bondi: defying the coronavirus warnings (Source: AAP)
Scofflaws and recusants of the world unite!And what of those other violators of social distancing in this time of pestilence, the beach-going masses whose capers—from Sydney all the way to Florida—the media have revelled in? The beach-goers at Bondi and other popular summer-time beaches who are either indifferent or wilfully tone-deaf to the authorities’ daily mantra of abstinence or are pleading ignorance of the messages on the grounds of being Generation X, Y, Z, Millennials, Xennials (or whatever term you prefer) and therefore invincible. We can add peripatetic domestic tourists currently roaming around the country to the list of sloth-minded transgressors. Whether the violators are blatantly snubbing their noses at society and authority or are forced by circumstance into breaking the government’s edicts, the trajectory of the crisis suggests that a new generation of scofflaws is in the making. These multitudes, theses new scofflaws or recusants, some with a very deliberate rationale of defiance, will undoubtably continue to breach government warnings and (now) rules on social distancing and contact as the crisis continues⊞, replacing the traditional notion we have of scofflaws – unrepentant recidivists who accumulate unpaid parking fines or debts, ignore summonses or graffiti public or private property.
Given the sheer impossibility of compelling all citizens to maintain social distances in public (considering the scale of the enterprise and the limitations of the enforcement agencies), it will probably come down to the will and commitment of governments and bureaucracies to enforce these rules. The stick is already out…the NSW police minister has announced that individuals breaching the social distancing guidelines will be instantly fined $1,000 or even jailed (this second option however is highly implausible in the present health climate which sees the country’s prisons under fire for crowding too many inmates in together!) (‘Breaking social distancing rules will lead to on-the-spot fines of $1,000’, ABC News, 25-Mar-2020, www.abcnews.com.au). Tough talk✬ but it remains to be seen how thoroughly this threat to act will be prosecuted or how practical it will be to implement. You can also expect the civil libertarians of the community to come out in earnest support of the Covid scofflaws, defending to the last adjective their right to freedom of movement. Watch this space.
Footnote: Of course the opposite could also happen – if recent reports of public reactions to self-isolation are an indication. We may witness a whole lot of people coming out of the woodwork, channeling their inner Oliver Cromwell and dobbing in their scofflaw neighbours to the local constabulary for breaching their two week home quarantine.
Postscript: Tips for occupying some of the 960 minutes a day of stay-at-home time you are awake
The more realistic and level-headed of us who are not still spending our days at the beach (yes there are scofflaws still trying to circumvent the barriers now in place at popular beaches) are hunkering down for the long haul during the pandemic. So if you are looking for some light reading material while in mandatory hibernation for the winter, there’s always that classic allegory of unrelentingly grim reality, Camus’ The Plague☌, or if you want something more apocalyptically contemporary, try The Road or Station Eleven.
_________________________________________________________________________________________
✱ even more unfathomably bizarre, after the latest round of war cabinet lockdowns, is the circumstance of hairdressers and barbers – they have been allowed to stay open and serve the public, whilst still observing the 1.5 m gap. How that will be expected happen remains a mystery to all except the inner workings of the war cabinet I surmise (robotic arms and 150cm-long scissors may be the answer!)
⊞ the best the government can hope for is to minimise the non-compliance of this cohort so that the numbers of them who are infected and the numbers that they infect are kept as low as possible
✬ certainly a considerably more substantial deterrent than the drop in the ocean £30 Boris has announced he’ll fine scofflaw Britons
☌ incidentally, sales of Camus’ book about a disease-infested 1940s Algerian town have soared during the pandemic (The Economist, April 2020)
The Government’s War on Coronavirus: The Great COVID-19 War from Ground Level
(Source: www.thesummitexpress.com)
A few years ago one of the incumbents of the revolving door that is the Australian prime ministership intoned: “these are the most exciting times to be alive”… well, for “exciting” substitute “worrying and challenging” and you have the status quo, 2020. We are getting bombarded daily, even hourly it seems, with mixed messages from news sources – it was okay to go to the football last Sunday and mingle with crowds of much more than the 500 limit but somehow it’s not okay to do this on Monday, the day after (what changed?!?); the medical experts warn us to keep a distance of one-and-a-half metres from anyone else, yet it’s fully expected that people will still travel on trains and buses which will generally make that an impossibility; the government tells us not to fly overseas but it’s still okay to fly within Australia (a lifeline to the national carrier?).
(Image: www.nature.com)
Every day media outlets offer up a doomsday book of horror stories…”London faces stricter lockdown after coronavirus advice ‘ignored’” |”Italy coronavirus deaths rise by record 475 in a day” |”All of us have to assume we have the virus’: COVID-19 infections rise past 300 in NSW” |”Yes, young people are falling seriously ill from Covid-19” |”Trump spent weeks downplaying the coronavirus. He’s now pretending that never happened” | “Stay home’. Grey nomads unwelcome as Top End coronavirus tensions grows’ | “Coronavirus UK: Boris to impose FOUR-MONTH quarantine for elderly under ‘wartime’ measures” | “China blaming US for coronavirus? It refuses to come clean about origin” | “Privacy fears as India hand stamps suspected coronavirus cases” | “Coronavirus: One dead every 10 minutes in Iran as government faces backlash over late response” | “Spring Breakers Pack Some Florida Beaches, Ignoring Social Distancing Warning Amid Coronavirus“ | “Italy overtakes China in coronavirus toll”. Panicked consumerism born of exaggerated fears of limited resources➀, foolhardy apathy as the young party on regardless in fatalistic Titanic style (‘Millennialmania’), doom and gloom, finger-pointing recriminations, the media has been full of it for two months…sorry, we don’t do calm, rational, measured responses here.
A corona red world, March 2020 (Credit: www.abcnews.go.com)
It’s a climate ready-made for rumour-mongering and this is not confined to the West…China is rife with rumours ‘explaining’ the epidemic’s origin starting with the fiction of it’s supposed transmission from bats in January. The rumours soon became more fanciful and more conspiratorial, ranging from coronavirus being deliberately released to cull excess numbers of pensioners in society to it being a bio-weapon brought to Wuhan by the US Army to it being the consequence of the zodiac signs being out of harmony in the Year of the Rat!
The pandemic has caused divisiveness. Not just between rival countries trying to shift the blame and score political points, but at a grass roots level. We’ve seen the spectacle of shoppers in supermarkets fighting over the providence of a single pack of toilet roll➁.We’ve got incorrigible prepper-minded hoarders boasting online of their Fort Knox-sized storage bunkers of stockpiled household essentials, counter-balanced by the shopper-shaming of overzealous buyers queueing up with 150 rolls of toilet paper in their trolly (human behaviouralists tell us that buying ridiculous quantities of toilet rolls gives us reassurance, a warm and fuzzy feeling in a time of fear). The supermarkets, one of the very few sectors doing spectacularly well out of the crisis, have responded (too late) with partial war rationing to head off the panic buyers. War rationing seems apt as democratic governments across the world channel their inner Churchill and rush to set up “war cabinets” to deal with the extraordinary and unprecedented situation.
Deserted departure lounges 🔺
Whole industries grind to a halt, workers laid off with mortgages and bills that won’t disappear, while those of us investing in the stock market have taken an instant massive hit and the Aussie dollar plunges ever lower. Border closures, tourism industry bottoming out, small businesses going to the wall, nightlife, restaurants, bars, cafes, shows, movies, public events, etc…all nix! The hackneyed T-shirt slogan “Keep calm and carry on” is now “Keep calm, stay home and don’t go anywhere”. Lockdowns, compulsory home quarantine for targetted groups of the population, Pacific cruising virus-traps, a safe and effective vaccine for the virus still up to 18 months away. Talk in the UK of prioritising “herd immunity” uncomfortably evokes the spectre of eugenics. Some have called for the euthanasia of family pets, which is drawing a long bow even if you accept the possibility (far from definitively proven at this stage) that the virus was transmitted to humans by pangolins (scaly ant-eaters) in a Wuhan wet market. What next, euthanasia vans going round the suburbs to collect the weak and elderly? Reality at the moment looks increasingly like an unbelievable dystopian novel or movie! Welcome to the scary new world of indefinite uncertainty.
Thanks to COVID-19 we’re learning a slew of new buzzwords, for a start social distancing and elbow bump (sounds and looks dorky but it’ll catch on, trust me), and us non-statisticians in the community are already tired of hearing TV expert commentators rabbiting on about the merits of “flattening the curve”. I am waiting to hear (and am surprised not to have heard it yet) the adjective “Orwellian” uttered in the current crisis.
Bay County beach, Fla. (Ya Photo: WJHG/WECP)
I don’t know anyone who envies the governments or the frontline health care sector at the moment, but the government responses do have their critics? To take the scenario I am most familiar with, Australia…on the credit side the mortality rate is low (so far) though the morbidity rate is climbing fast and winter and the flu season are on the near horizon. However, under the government’s partisan “war cabinet” a coordinated approach to the crisis seems to be missing. We are looking for more systematic and less chaotic here! One example, the distribution of scarce essential goods depleted by panic buying is held up by a failure to get councils involved so they can free up the delivery schedule. Some medical and communications experts have asked where the government’s public awareness campaign is? Unlike some other countries, we are bereft of the myriad of community billboards and the television and social media advertisements which can raise awareness in the public of the disease. Overcoming ignorance is a first step to diminishing fear and apathy.
As with something this truly extraordinary, of such novel complexity and uncertainty, despite (or perhaps because of) the deluge of information, more questions than answers remain…should we lockdown cities or not? What are we not doing here to stem the crisis that appears to be working overseas? Face masks, yes/no?➂ Test for virus or not test? Can I be infected, recover and be infected a second time? What’s the shelf life of an infected surface? What do I do if I’m at high-risk and social distancing is not a viable option? Should we let the grandparents babysit our pre-schoolers any more? And then of course there’s the greatest imponderable of all, when is this whole nightmarish scenario going to end?
No issues with social distancing here (Photo: AP)
All the punter at ground zero can do is listen to the official medical advice➃, make sure we inform ourselves about Coronavirus 101 and get the basics down pat. This means identifying the likely symptoms—persistent cough, sore throat, runny nose, headache, (and more seriously) fever, shortness of breath, difficulty in breathing—all the usual suspects. Understand that coronavirus can be either symptomatic or asymptomatic, that it can be mild as well as severe, and that lethality generally (but not universally) hinges on considerations of age and serious pre-existing health conditions. Learn how to avoid contagion, what to do with the lethal weapons which are our hands – washing and drying them the correct way, eschewing the convention of shaking hands with people and start guesstimating our own personal space in public➄, sneezing into your elbow, not your hands, cleaning and disinfecting surfaces and door handles, using hand sanitisers, etc. Thus armed against ignorance, and hopefully the pandemic too, we will bunker down for the long haul, tough it out and try (very hard) not to add to the growing count of national virus statistics.
⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕
➀ and thus creating a self-fulfilling prophecy ➁ almost as unedifying was the sight of Aldi staff hurling blocks of toilet paper into the air so that demonic shoppers could jostle and wrestle each other for the prized commodity (classy look!) ➂ surgical masks have become a bit of an “us and them” issue, adding to the emerging divisive atmosphere…the war cabinet’s medical experts (in line with WHO’s recommendations) have pooh-poohed the wearing of masks for the general populace as not beneficial and unnecessary, saying they only need to be worn by people diagnosed with the disease. Given that the Chinese community in Australia tend to wear the masks sometimes for cultural reasons as much as protection, this leaves them open to wild and inaccurate assumptions about their health status as a group ➃ this will probably require a judgement call as some of the medical advice has been contradictory ➄ the latest edict in the social distancing caper from the war cabinet limits indoor gatherings of 25 in a space of 100sq m (one person to every 4sq m). I can’t wait to see police officers turning up in clubs and pubs armed with measuring tapes
⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎⍎
PS. All the big business houses and major financial institutions have started sending out “touchy-feely, look we really are human” messages, along the lines of we’re here to help “our people” get through COVID-19 … excuse me while I go and bolt down my raging cynicism to the floor.
The 1918 Spanish Flu: History’s Most Deadly Pandemic
The ongoing fight to contain the outbreak of COVID-19, the Coranavirus—now entering a new stage of transforming itself into a global epidemic—gives rise to recollection of another virus that swept the world just over one hundred years ago, the so-called Spanish Flu✺. For most of the rest of the 20th century, the Spanish Flu (sometimes known as La Grippe) was largely neglected by researchers and mainstream historians, and study confined to actuaries, specialist epidemiologists and virologists and medical historians [Laura Spinney, Pale Rider: The Spanish Flu of 1918 and How it Changed the World, (2017)].
(Credit: CNN International)
Why did such a devastating pandemic fly under the radar for so long? The timing of the outbreak goes a good way to explain this. After having suffered four long years of a unique world war, people tended to treat the Spanish Flu as a footnote to the Great War conflagration. Moreover, the war, concentrated in Europe and the Middle East, had a limited geographical focus for people, contrasting with the pneumonic influenza outbreak which was truly global [The Spanish Flu Pandemic’, (L Spinney), History Today, 67(4), April 2017]. As catastrophic events go, the two stand in stark contrast. With today’s scientific and medical advances experts estimate that the Spanish Flu killed at least 50 million people worldwide, some estimates put it as high as 100 million [NP Johnson & J Mueller 2002;76: 105-115 (‘Updating the accounts: Global mortality of the 1918-1920 “Spanish” Flu pandemic’, Bull Hist Med)]. Estimates of World War I casualties—military and civilian–—sit somewhere in the range of 20 to 22 million deaths [‘WW1 Casualties’, (WW1 Facts), http://ww1facts.net]⌖. By the late 20th century and early 2000s outbreaks of new viruses like SARS, Asian Bird Flu, Swine Flu, etc, spurred mainstream historians◙ to look afresh at the great global influenza of 1918-20.
An abnormal spike in morbidity and mortality The Spanish Flu was truly global, like the Coronavirus its lethal reach touched every continent except Antartica, both are novel (new) respiratory illnesses. Similarities have been noted between the responses to the two outbreaks, eg, the issuing of instructions or recommendations by the authorities for the public to wear masks, avoid shaking hands (part of social distancing), good hygiene, quarantine, an alarmist overreaction by the media [‘Coronavirus response may draw from Spanish flu pandemic of 100 years ago’, ABC News, (Matt Bamford), 05-Mar-2020, www.amp.abc.net.au]. The great flu of 1918’s morbidity and mortality rates were frighteningly high and far-reaching…one in three people on earth were affected by it✪. Between 2.5 and 5% of the world’s population perished, including India a mind-boggling 17M-plus, Dutch East Indies 1.5M, US (up to) 675,000◍, Britain 250,000, France 400,000, Persia (Iran) (up to) 2.4M, Japan 390,000-plus, Ghana (at least) 100,000, Brazil 300,000, USSR (unknown, but conservatively, greater than 500,000)⊞.
While densely crowded communities were thought the biggest risk of mass infection, the Flu caused human devastation even in remote, isolated corners of the world, eg, in Oceania, Samoa bereft of immunity, lost 22% of its population in two months, the Fijian islands lost 14% in a 16-day period⌀. The kill rate was something around 2.5% cf. a ‘normal’ flu outbreak a rate of no more than 0.1% would be expected [‘The Spanish Flu Pandemic’, (Spinney, History Today ; ‘The Spanish Flu’, Wikipedia, http://en.m.wikipedia.org/].
(Source: National Library of Australia)
If the Spanish Flu didn’t originate in Spain, where did it originate? No one knows for sure is the short answer…but there has been much speculation on the topic. At the time of the epidemic a popular notion was that the Flu started in China, but China experienced low rates of infection compared to other regions of the world. The explanation for this perhaps lay in that China was subjected to an initial, mild flu season which gave its citizens an acquired immunity to the disease when the more severe strain of the virus hit them.
🔺 Red Cross volunteers: caring for the sick during the Spanish Flu fell overwhelmingly on women (volunteers and professional nurses) who bore the brunt of the work at quarantine stations and camps, as well as exposing themselves to great personal risk
Influenza-ravaged Ft Riley soldiers in hospital camp 🔻 
The military, mobility and zoonosis Another theory attributes the Spanish Flu’s beginnings to the movements of the combatants in WWI. Virologist John Oxford favours the village of Étaples in France as the centre of the 1918 influenza infection. From a hospital camp here, 10,000 troops passed through every day…with their immune systems weakened by malnourishment and the stresses of battle and chemical attacks they were susceptible to the disease which was probably transmitted via a piggery and poultry on the same site. Once contracted, it’s dissemination was likely facilitated by mass transportation of troops by train.
Another view that has gained wide currency locates the Flu’s genesis in America’s Midwest. In recent times, historians led by Alfred W Crosby have supported the view that the epidemic started not in Europe but in a US Army base in Kansas in 1917 (America’s Forgotten Pandemic). According to adherents of this theory soldiers training at Fort Riley for combat in Europe contracted the H1N1 influenza virus which had mutated from pigs. The infected troops, they contend, then spread the virus via the war on the Western Front. Whether or not the virus started with WWI fighting men in France or in the US, it is undeniable that the soldiers moving around in trains and sailors in ships were agents of the Flu’s rapid dissemination [‘Spanish Flu’, History Today, (Upd. 05-Feb-2020), www.historytoday.com]. A recent, alternative origin view by molecular pathologist Jeffrey Taubenberger rejects the porcine transference explanation. Based on tests he did on exhumed victim tissue, Taubenberger contends that the epidemic was the result of bird-to-human transmission [‘Spanish flu: the killer that still stalks us, 100 years on’, (Mark Honigsbaum), The Guardian, 09-Sep-2018, www.theguardian.com].
(Image credit: Guia turístico)
Demographics: differential age groups The pattern of Coronavirus mortality points to the disease being most virulent and most fatal to elderly people (the seventies to the nineties age group). This accords with most flu season deaths, although unlike seasonal flu outbreaks Coronavirus contagion has (thus far) had minimal impact on children, in particular the under-fives (Honigsbaum). But the pattern of Spanish Flu was markedly different, the records show a targeting of young adults, eg, in the US 99% of fatalities in 1918-19 were people under 65, with nearly 50% in the 20 to 40 age bracket (‘Spanish Flu’, Wiki). Statistics from other countries on the 1918 outbreak conform to a similar trend.
🔺 Conveying the health message to the public (Source: www.shelflife.cooklib.org)
The Flu in a series of varyingly virulent waves The first wave of the Flu in early 1918 was relatively mild. This was followed by a second, killer wave in August. This mutated strain was especially virulent in three disparate places on the globe, Brest in France, Freetown in Sierra Leone and Boston in the US. There were myriad victims, some died (quickly) because they had not been exposed to the first, milder wave which prevented them from building up immunity to this more powerful strain [‘Four lessons the Spanish flu can teach us about coronavirus’ (Hannah Devlin), The Guardian, 04-Mar-2020, www.msn.com]. The second wave was a global pathogen sui generis. The bulk of the deaths occurred in a 13-week period (September to December). The lethality of the disease, and especially the speed with which it progressed, was the scariest part✧.
2nd wave curve in the US, 1918: note the different mortality peaks during Oct-Dec 1918 for St Louis (imposed a stringent lockdown) vs Philadelphia (much less restrictive approach)
(Source: Proceedings of the National Academy of Sciences, 2007)
The symptoms of this murderously effective strain were unusual and extreme, eg, haemorrhaging from mucous membranes, bleeding from the eyes, ears and orifices, etc. The extreme severity of the symptoms were thought to be caused by cytokine storms (overreaction of the body’s immune system) (‘Spanish Flu’, Wiki) [‘Spanish Flu’, History, 12-Oct-2010, www.history.com]. The third and last strain of the Flu, in 1919, was markedly milder by comparison to the second, but still more intense than the first.
Many parallels exist between the 1918 flu outbreak and the present pandemic – of a positive nature, the widespread advocacy of wearing masks to limit the spread of disease and mandatory lockdowns. Plenty of negative parallels too – the disregarding of science and medical expertise on how to tackle the outbreak; countries engaging in playing the “blame game” against each other rather then co-operating on a united approach to the pandemic. There was especially, but not only in the US, a repetition by some of the denial at the national leadership level to square up to the pandemic and give it the complete seriousness it demanded.
✥ ⌯ ✥ ⌯ ✥
In 1919 in the middle of the flu crisis, Irish poet WB Yeats wrote in a poem the line for which he is perhaps best remembered: “Things fall apart; the centre cannot hold; mere anarchy is loosed upon the world…”
✥ ⌯ ✥ ⌯ ✥
Footnote: The health authorities’ inability to check the juggernaut of the 1918 virus was exacerbated by misdiagnosis – at it’s onset the Spanish Flu was widely believed to be a bacterium like the Black Death, not a virus. Misreading the symptoms, the influenza outbreak was variously and erroneously diagnosed as dengue, cholera or typhoid (Spinney, ‘History Today’; ‘Spanish Flu’, History).
(Photo: State Archives & Records, NSW)
PostScript: The upside of a global catastrophe The Spanish Flu in it’s vast human decimation rammed home lessons for post-WWI governments and health practitioners in its wake. Being helpless to prevent or halt the virus once in full swing, the vital need to develop vaccines to counter pandemics was subsequently understood. Advanced countries started to restructure their public health systems to try to cope (such as the United States’ NIH – National Institutes of Health, which emerged about 10 years after the Spanish Flu) [‘The great influenza The epic story of the deadliest plague in history‘ (JM Barry), Reviewed by Peter Palese, (JCI), www.ncbi.nim.nih.gov]. And of course the 1918 flu virus had other, indirect, outcomes…it led to universal healthcare, alternative medicine, intensive care facilities and a modern preoccupation with the benefits of healthy exercise under clean, clear skies (‘Pale Rider’).
⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴
✺ the name is a misnomer. The Spanish association came about thus: with the Great War still raging other combatant European nations such as France and Germany had imposed censorship restrictions on the reportage of the flu outbreak, whereas Spain being neutral in the war did not. When the Spanish press freely reported a serious eruption of the Flu, people outside the country unquestioningly assumed that the influenza came from Spain
⌖ to further break that down, more American troops died from the Spanish Flu than in combat during WWI (‘Pale Rider‘)
⊞ the numbers cited tend to be approximations given the paucity of adequate record-keeping at the time
◙ part of a new multidisciplinary approach to the subject including economists, sociologists and psychologists
◍ consequently life expectancy for Americans dropped by 12 years in 1918, and for the first time since Britain commenced recording data, the death-rate in 1919 exceeded the birth-rate (Honigsbaum)
✪ Pandemic: pan ⤑ all ║ demos ⤑ the people (not literally but fairly close)
⌀ although isolation did prove beneficial in some instances, such as in Australia where the virus didn’t arrive until 1919 and entry was closely monitored with a maritime quarantine program. As a result Australia’s death-rate of 2.7 per 1000 of population was one of the lowest recorded [‘Influenza pandemic’, National Museum of Australia, www.nma.gov.au]
✧ Philadelphia alone experienced 4,597 influenza deaths in a single week
Eyes on the Prize: Callan Park, a Modern Saga of Development Vs Conservation
In 1976 the NSW state government consolidated the two mental health care facilities in Lilyfield, Callan Park Mental Hospital and Broughton Hall Psychiatric Clinic, into one body, called Rozelle Hospital (the word ‘Psychiatric’ was quietly excised from the name). Drug and alcohol and psycho-geriatric services were added to the psychiatric care and rehabilitation roles of the hospital.
A watershed moment in mental health with profound and long-lasting repercussions for Rozelle Hospital occurred seven years later in 1983. The Richmond Report recommended a policy of de-institutionalisation, moving patients of mental hospitals back into the community. From the 1960s, with overcrowding in state mental hospitals rife, there had been isolated attempts to deinstitutionalise starting to happen but the Report advocated that the government accelerate the process on a more systematic basis.
Stairs to a safe haven?New specialised mental health wards were eventually opened, such as in Western Sydney hospitals Nepean and Liverpool. But the cost of caring for the former patients, providing them with the services and housing they needed once released, has not been adequately met by the authorities. As a consequence, the state’s prisons have returned in practice to a traditional role they had filled in past centuries, acting as de facto psychiatric institutions. Government research points to a high percentage of prisoners (90% female and 78% male) experiencing a psychiatric disorder in the year preceding their incarceration [R Pollard, ‘Out of Mind’, Sydney Morning Herald, February 12, 2005].
Derelict “Social Club” for the patients
The fallout from the policy to deinstitutionalise continues to be felt in the community. NSW Health’s 2007 ‘Tracking Tragedy’ report identified that there had been some 113 suicides by former psychiatric patients plus a number of patients who had committed homicides upon release [‘Final Government Response to Tracking Tragedy 2007’ (3rd Report)].
“Harbour Bridge” monument to Ward B patients or to war?By the early ’90s the Kirkbride Block was being phased out as a psychiatric institution (the nearby wards however were retained for patient relocation) and a deal was struck with Sydney University (USyd) to lease it from 1996 as the site of its College of the Arts (SCA). The University then injected 19 million dollars into upgrading the facilities to make it suitable as a tertiary education campus. At the same time the nearby Garryowen House was repaired to become the new home of the NSW Writers Centre.
Uncertainty about the Government’s future plans for Callan Park led concerned citizens to form the Friends of Callan Park (FOCP) in 1998. Their concerns were well-founded as the Carr Labor Government in 2001-2002 produced a draft Master Plan for the land which included the sale of significant chunks of the site for residential development and the shift of psychiatric services to Concord – all formulated without having consulted local residents (this followed an earlier clandestine arrangement made by Carr to provide land in the Park gratis for a Catholic retirement village). FOCP and Leichhardt Council mobilised community support against the Government’s plan, resulting in a huge backlash from residents of the municipality.
Embarrassed, the state government backed down, ditched the Master Plan and enacted the 2002 Callan Park (Special Provisions) Act which guaranteed that the entire site would remain in public hands to be used strictly for health and education purposes only [‘Callan Park – a Tribute to the Local Community’, (FOCP), www.callanpark.com]
Later, Labor planning minister Sartor (again covertly) offered the the central core of the whole site (an area of 35HA) to Sydney University whose expansion plans for the SCA site envisaged increasing the student numbers to 20,000 and providing for up to 7,000 places in residential accommodation. USyd received a 99 year lease from the Government on the 35HA land. The University was planning to move the Sydney Conservatorium of Music from its present location in the city onto the Lilyfield site (the Conservatorium itself was very lukewarm about this proposal, as it turned out). This over-the-top development would have required 16 new buildings (some up to 4 storeys high!) to be built, which would have been a breach of the 2002 Act. Again, after a backlash and significant pushback from the public, the Government backed down [Sydney Morning Herald, October 21, 2002; Inner West Courier, November 6, 2007] (see also PostScript].
Recently USyd has been murmuring about the prospect of pulling out of the Rozelle campus, citing financial difficulties as the reason. It has already flagged its intention to move the Fine Arts School to the main Camperdown site [‘Sydney University abandons art school at Callan Park’, Sydney Morning Herald, November 25, 2015]. The uncertainty about Callan Park’s future has prompted critics like FOCP to suggest that the Baird Government may follow the same path as Labor did in trying to sell off part of the site for commercial gain. FOCP has accused the Government of taking a “demolition by neglect” approach to Callan Park, this will be a fait accompli, they contend, especially if USyd leaves Rozelle as the buildings will no longer be maintained and inevitably fall into disrepair [‘Callan Park in danger of being “demolished by neglect”, (23-04-15), www.altmedia.net.au].
New uses for old buildings
The next signpost in the Callan Park story occurred in May 2008 when the Government moved the psychiatric patients out of Broughton Hall and relocated them at a new, purpose-built psychiatric unit at Concord Hospital, six kilometres down the Parramatta River. The Friends of Callan Park had campaigned to retain the psychiatric facility, the late Dr Jean Lennane advocated that, rather than closing down Callan Park, the bed numbers needed to be increased as deinstitutionalisation had led to an increase in homelessness among the mentally ill, or had seen them end up ‘warehoused’ in gaols, or tragically, dead, after being turned out. FOCP also called for an extension of outdoor recreational activities available to the patients, eg, establishment of a city farm on the grounds with the patients tending the animals as part of their therapuetic regime.
Leichhardt Council also voiced its disapproval of the Government’s plans for Callan Park. Despite the chorus of opposition, the NSW Government went ahead with the closures. The Council persisted with its criticisms and the NSW Government in late 2008 granted the Council care, control and management of 40 hectares of Callan Park (roughly two-thirds of the area) under a 99 year lease (previously the “physical fabric” of Callan Park as a whole had been managed by the Sydney Harbour Foreshore Authority (SHFA) on behalf of the Government)
[http://callanparkyourplan.com.au/]
Sensing the need to be more proactive, Leichhardt Council prepared its own “Master Plan” for Callan Park, which, in a poll conducted by the Council, elicited 87% approval from municipality residents. The plan provides for greater use of the land for a broad cross-section of the community, with new sporting fields and skate parks and other activities.
The land and structures of Callan Park continue to be owned by the NSW Government now under the agency of the NSW Office of Environment and Heritage (although the SHFA website still confusingly lists Callan Park on its website as one of the “places we manage” [www.shfa.nsw.gov.au]). Some of the wards and halls (those remaining ones not riddled with asbestos) get rented out for film and television shoots from time to time, one building permanently houses a film production unit (building Callan 201) whose management harbours its own designs to expand further into the Park and create an international film production hub (again which would be a flagrant breach of the 2002 Act if it was ever allowed to happen)[‘Premiere plan for Callan Park film hub’, (20-06-13) www.altmedia.net.au]. Other current tenants of Callan Park include the Ambulance Service and a host of NGOs, eg, AfterCare, WHOS, SIDSKIDS and Foundation House.
With Sydney University’s future campus expansion plans looking elsewhere (closer to the city, North Eveleigh has been mooted as the spot to expand into) [University of Sydney, Campus 2020 Masterplan], Leichhardt Council seems to be running most of the debate currently. Very recently, the Council approved (over opposition from the Greens and Liberals) a motion to use the complex site to house some of the 7,000 Syrian refugees due to be settled in Sydney next year, ‘Leichhardt Council approves plan to resettle refugees at former mental hospital’, ABC News, 09-12-15, www.mobile.abc.net.au]. This produced a predictable if minor furore from some quarters of the community, demonstrating that land use in the area known locally as “The Lungs of Leichhardt” continues to be a divisive and hotly contested issue within the community.
PostScript: North Eveleigh trade-off Frank Sartor’s biography❈ shed more light on the machinations: according to him the NSW Keneally Government secretly planned to compensate Sydney University for the ‘loss’ of Kirkbride by offering it the North Eveleigh site in Redfern for the new location for SCA. The deal fell through though because the North Eveleigh site was valued at about A$100 million, whereas USyd was only prepared to pay $30 million for it [‘Sartor: Keneally discusses plan for North Eveleigh with Sydney Uni’, Redwatch, [www.redwatch.org.au].
•••••••••••••••••••••••••••••••••••••••••••••••••••••••
❈ FE Sartor, The Fog on the Hill – How NSW Labor Lost its Way, (2011)
Callan Park 1900-1965: A Stop-gap Era of Tinkering around the Edges and a Delaying of Genuine Reform
The 61HA expanse of the ParkAfter the Kirkbride complex at Callan Park started as a hospital for the mentally ill in the 1880s, patients held at Gladesville Asylum and other psychiatric institutions in Sydney were routinely redirected to it. Kirkbride had been carefully planned by the hospital’s collaborators, architect Barnet and superintendent Manning, and purpose-built from the start to hold a maximum of 666 patients. But such was the demand for its services that the hospital’s patient population had reached close to 1,000 within three years of its opening (1888), and continued to grow unchecked. By 1960 Kirkbride contained something close to 2,000 patients resident there and in the adjoining auxillary wards.
Unfortunately, political support for care of the insane from around the turn of the 20th century started to diminish, with predictable adverse consequences for mental institutions generally. Without a much-needed injection of capital expenditure from government—a reflection of public apathy about the plight of mentally ill at the time—the essential new building infrastructure required to keep pace with the increasing demands of psychiatric care was stifled. Hospitals like Callan Park, with fewer resources and too many patients, were forced to resort to medical treatments (surgical, chemical and mechanical interventions) to cope with the sheer numbers [M Lewis, Managing Madness. A Social History of Insanity 1788-1980]. The financial stringency occasioned by the Depression and World War was a further blow to hopes for increased funding for mental health.
During the first half of the century there were the occasional, tentative inquiry into the deteriorating conditions in state psychiatric institutions, but these, like the 1948 Public Service Board enquiry, never really went anywhere. In terms of the overcrowding at Callan Park, measures that were at best only stop-gap were employed from time to time, eg, additions to the existing buildings at Kirkbride and Garryowen … which were architecturally out of step with the original Barnet and Manning designs [Peter Reynolds and Ken Leong, “Callan Park Mental Hospital”, Dictionary of Sydney, 2008, http://dictionaryofsydney.org/entry/callan_park_mental_hospital, viewed 07 December 2015].
There were some positive signs, finally, in 1955 with the Stoller Report which forced the Commonwealth Government to provide funds for mental health care in Australia. 1958 marked a watershed year for mental health with the passage of the NSW Mental Health Act, the first significant legislation in the field of institutional psychiatry for 60 years (replacing the 1898 Lunacy Act). The 1958 Act, in an long-overdue enlightened step, legislated that insanity should no longer be viewed as a criminal offence. It also made provisions for welfare officers to do follow-up visits of patients after their release. A further consequence of the Act was the construction of North Ryde Psychiatric Centre, the first such NSW institution in 35 years!
Within three years of the new act a Royal Commission on Callan Park was undertaken (in 1961), the first detailed investigation into mental health in NSW for 60 years. The Royal Commission was in part triggered by revelations of staff delinquency and dereliction of duty made by Dr Harry Bailey (newly appointed medical superintendent of Callan Park) in early 1960. The reformist-minded but over-zealous Bailey impetuously went over his superior’s head in presenting a report directly to the head of the PSB. Bailey’s act of ‘whistle-blowing’ concerned allegations of staff cruelty to and neglect of patients, and the discovery that staff were withholding food and groceries from patients with the purpose of profiting from these stolen supplies.
Bailey’s action provoked a revolt amongst the workers with staff members of the Nurses Association and the Hospital Employees Union taking industrial action. Bailey, who was later universally reviled for his central role in the horrific Chelmsford Hospital “Deep Sleep Therapy” scandal, was ‘scapegoated’ and pressured by the government into resigning the following year. But, with the newspapers demanding answers, the health minister was forced to initiate a Royal Commission into Callan Park, which confirmed many of Bailey’s charges but found others to be grossly exaggerated [“A history of medical administration in N.S.W. 1788-1973] Public Health Administration: Chief Medical Officer – Director General of Public Health, (2003),http://www0.health.nsw.gov.au/resources/aboutus/history/pdf/pt2cmo.pdf; Stephen Garton, ‘Bailey, Harry Richard (1922–1985)’, Australian Dictionary of Biography, National Centre of Biography, Australian National University, http://adb.anu.edu.au/biography/bailey-harry-richard-12162/text21793, published first in hardcopy 2007, accessed online 12 December 2015].
The Commission’s predictable findings brought to the attention of the public what was commonly known by anyone who had regularly visited the facility. Callan Park (Kirkbride Block) was too large, too overcrowded, with low standards of accommodation. The orientation at Kirkbride was custodial rather than rehabilitative, there was evidence found of cruelty, neglect and corruption … Callan Park had, as it is standard to say today of such matters, failed in its “duty of care”, it had become “a byword for all that was bad in mental health care” [Tanner Architects, Callan Park Rozelle Volume I, Conservation Management Plan, www.callanparkyourplan.com.au].
One of the specific findings of the Royal Commission into the Callan Park complex identified a group of male nurses and attendants who were bashing, starving, verbally abusing patients, as well as neglecting their state of cleanliness. Sadistic nurses were a recurring feature of Callan Park, going back to the institution’s infancy, ex-patients had testified as to the cruelty meted out by these “mechanical, inhumane creatures” [“Sydney’s shameful asylums: The silent houses of pain where inmates were chained and sadists reigned”, The Daily Telegraph (Sydney), 3 March 2015].
The incidences of illegalities and misdemeanours unearthed by the Royal Commission hinted at the deep, structural problems that had plagued Callan Park since its early days. Bailey’s actions in exposing malpractice at Callan Park, though injudicious in method (Bailey secretly taped a conversation he had with NSW health minister Sheahan), ensured that the institution’s activities stayed in the public’s mind and in the media’s gaze in the years after 1961.
