A history of pandemics: How Alberta dealt with public health threats 100 years apart

As the COVID-19 pandemic challenges public health systems around the world, experts say the last time Alberta dealt with a public health crisis of this nature was more than a century ago.

Between 1918 and 1920, the Spanish flu, a previously unknown strain of influenza, hit Canada in multiple waves.

It didn't target just the very young or very old, it killed people in the prime of life. 

As estimated by centres for disease control and prevention, the flu infected about one-third of the world's population, killing at least 50 million people worldwide and roughly 55,000 Canadians.

Mark Humphries, author of The Last Plague: Spanish Influenza and the Politics of Public Health in Canada, has noticed measures taken in Canada at the time are similar to those being used now.

In 1918, Alberta and most other provinces advised people to avoid public gatherings. Just like today, schools, many businesses and some church services shut down as a result.

Along with this social distancing, ads in local newspapers instructed people how to make their own face masks to wear outside, Humphries said.

But whether these measures were effective is a another story.

"We see the efforts to try and link the non-pharmaceutical interventions we're taking today to what happened in 1918, and to use that to support what we're doing today," Humphries said. 

"As an historian, I can say the evidence is still largely out on how effective those things were in 1918."

In many ways, life continued on normally in 1918, Humphries said.

He attributed this partially to how much more common infectious diseases were in the early 1900s, as diseases now vaccinated for such as mumps, whooping cough and measles made regular appearances.

"There was a major war effort; factory production was not shut down; business largely continued and there was never an attempt to shut down life across the board that we're seeing today," Humphries said.

One result of the Spanish flu was how the high death rate changed the way Canadians think about public health and the government's role in managing it.

It led to the creation of the federal health department in 1919, while convincing Canadians public health is a concern for all, not just the sick and the poor, Humphries said.

Shirley Lowe, former Edmonton historian laureate, said modern Canadians are unfamiliar with pandemics and are convinced that health problems can be easily solved.

"I think we've just gotten a little arrogant over the last while. We think we can just swallow a pill or get a needle and it will fix us. And I think this has shown us that we're just not that clever," Lowe said.

Craig Jenne, an infectious disease specialist at the University of Calgary, said modern public health tools like antibiotics, intensive care units and ventilators have helped ensure modern pandemics, like H1N1, a disease similar to the Spanish flu, keeps fatality rates low.

But viruses spread around the world more quickly now, Jenne said.

"In the modern world, diseases are really never more than 20 hours away from any corner of the Earth."

One major problem in 1918 was that the Spanish flu created too many patients for hospitals to accommodate, similar to the situation in countries like Italy and Spain.

Canada is trying to avoid this same fate through social distancing guidelines aimed slowing the rate the infection, flattening the curve so to speak.

Making these historical comparisons is critical, Jenne said.

Canadians need to be reminded these pandemics require preparation and recall what slowed their spread in the past, but also to recognize Canada has weathered through them in the past, he said.

"Things are not bleak. If we all work together, we will absolutely get through this.

"Once we get through COVID-19, there may be something else down the road and we just have to be prepared for it. We do get smarter; we do get better able to deal with these things."

For now, Jenne said it's been positive to see people following voluntary measures like social distancing, without enforcement.

The question for Jenne is how long the measures will last.

"Coronavirus is not a sprint, this is going to be a marathon," he said. "It's going to take several months before we have a vaccine or a therapy, so we have to be in this for the long haul."