What Difference Does a Century Make? Pandemic Responses to Influenza and COVID-19

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Overnight, it seemed, daily life in Quebec was transformed.  When, beginning on Thursday, March 12th, Premier François Legault, Minister of Health and Social Services Danielle McCann, and Dr Horacio Arruda, Quebec’s Director of Public Health, announced a sweeping series of measures in order to limit the transmission of coronavirus in the province, residents of Quebec realized that their government was embarking upon an aggressive public-health campaign.  Large gatherings were henceforth forbidden; public and private institutions – daycares, schools, universities, ice rinks, swimming pools, community centres, libraries, then bars, movie theatres and commercial gyms – were closed.  In subsequent days, a public health emergency was declared in the province and further restrictions were adopted.  Key municipal governments were also highly visible as Quebec stepped up its campaign against COVID-19.  Valérie Plante, the Mayor of Montreal, was present at daily press conferences: critical of federal inactivity at airports across the country, she dispatched an information squad to Montreal’s Pierre-Elliott-Trudeau airport in order to inform incoming passengers of the public-health measures that they were strongly encouraged to adopt, notably voluntary isolation for a period of 14 days.  Unable to offer an effective scientific treatment or vaccine against COVID-19, public-health authorities recommended frequent hand-washing and issued directives for people to practice self-isolation and social distancing, that is, to work from home when possible, to keep their children and teens at home, and to avoid socializing.  Citizens over the age of 70, in particular, were urged to stay home for their own protection; visits to hospitals and long-term care facilities were abruptly cancelled.

Just over a century earlier, Montreal’s municipal board of health and Quebec’s Conseil d’hygiène de la province de Québec (CHPQ) had issued similar directives in the context of the influenza pandemic that reached Canada in the fall of 1918.  Then, too, their advice was relatively basic: avoid crowds; cough or sneeze into a handkerchief; refrain from spitting in public places; get lots of fresh air and sunshine; take to bed when feeling under the weather; isolate the ill; disinfect the lodgings of those who recovered.  Then, too, there was little in the way of effective medical treatments for influenza. In a province mobilized for war and wartime production (munitions, explosives, tanks, uniforms, and tents) since the summer of 1914, and starkly divided over military conscription, pandemic influenza was the latest in a series of dramatic events to both mobilize and divide Quebecers.  Religious authorities, initially reluctant to close churches, ceded to the demands of public-health authorities.  Military authorities continued, however, to hunt down and mobilize conscripts and defaulters.

Across Canada, during the flu pandemic of 1918-1919, there appeared little dissension over public health restrictions, although there was concern about, and sometimes resistance to, their economic and social impacts. Workers in Winnipeg, for example, who were affected by the municipal government closure of places of leisure (bars, movie theatres, concert halls), advocated for wage replacement, petitioning City Hall. Wives and mothers whose husbands were out of work wrote sometimes desperate pleas on behalf of their families, which fell on deaf ears. In a city where most people continued to go to work in offices, factories, and stores, those who lost their livelihoods due to targeted closures felt a sense of injustice. Callous civic officials responded by saying that everyone had to do their bit.

In 1918, isolation or quarantine almost certainly meant the loss of the salary provided by the male breadwinner, if there was one, or by the adolescent boys and girls who often constituted a secondary source of wages for their family.  The impact of the influenza pandemic on people’s attempts to make a living was clear in the letters sent to the mayor of Montreal, the municipal board of health, and local newspapers throughout the rainy fall of 1918.  Amid letters proposing ways to improve public health, suggestions that streetcars be disinfected and cinemas closed, we find letters from shopkeepers reacting to municipal restrictions on opening hours and requesting that their small businesses be allowed to stay open longer hours, despite the pandemic.

While public health officials had considerable legislative power in 1918-1919, for the most part measures taken were not directly coercive, even if officials were frequently indifferent to the peril they posed to livelihoods. Today’s threats of arrest or imprisonment for violation of public health edicts, heard in some parts of the country (such as B.C.), seem extraordinary, viewed through a historical lens. In the pandemic’s aftermath, public trust and cooperation were seen by a humbled generation of health practitioners as necessary pillars in an uncertain future.

It remains unclear how the balance between consent and coercion will evolve during the COVID-19 outbreak. Initially, Quebecers appear to have readily followed the recommendations of Legault, McCann, and Arruda to self-isolate and socially distance.  Legault, a Premier whose approval ratings have fluctuated considerably in the year-and-a-half since he was elected, is garnering nothing but praise, from political allies and opponents alike, for his statesmanlike behaviour; a public-opinion poll conducted on March 18th revealed an approval rating of 85% for his management of the crisis.  Arruda, a public-health physician and experienced civil servant known for his ability to deliver accurate information in an accessible and convincing manner, is now the subject of a Facebook page called “Horacio, notre héros” (“Horacio, our hero”). Quebecers appear more than willing to follow public-health directives and self-isolate; perhaps the echoes of 1918-1919, particularly loud in recent years, have mentally prepared us for the arrival of another pandemic.

Certainly, for many sectors of the population, staying at home is easier in 2020 than it was a century ago.  Technology, including e-mail and the Internet, makes some forms of paid work possible at home.  Social media gives some sense of connectedness to family, friends, and the outside world, even in the absence of physical contact.  Constant media updates on the number of coronavirus cases and deaths around the globe remind us, if any reminder is needed, of the huge stakes of isolation.

And yet, public health communiqués seem, as so much public health advice has been for over a century, tone deaf to the limitations of people who have precarious employment, who are living paycheque to paycheque, of single parents, the mentally or physically ill, or those who lack savings or family supports that might make compliance possible – or even humane. When a million Canadians apply for emergency employment insurance within days of the program’s announcement, the depths of social inequality and economic insecurity in our society are visible to all of us.

Pandemics simply do not affect everyone equally. It is a truism in infectious disease history that disease outbreaks expose social division and fissures in the social order. It is also important to note that they frequently deepen and clarify those fissures. Public health policy must attend to this history, and ensure that all residents believe that measures are just, and that these measures fairly consider the needs of the majority, not only those of the privileged.

Feature Image Credit: “Men Wearing Masks During the Spanish Influenza Epidemic,” 1918, Library and Archives Canada / PA-025025
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Magda Fahrni & Esyllt Jones

Magda Fahrni is Professeure agrégée, Département d'histoire, Université du Québec à Montréal. Esyllt Jones is Professor of History at the University of Manitoba. They are the editors of Epidemic Encounters: Influenza, Society, and Culture in Canada, 1918-20 (UBC Press, 2012).


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