The 1918 ‘trancazo’ epidemic

History tells us that the pandemic is not new. We have had others like it before. History also tells us that the present pandemic will end, though the big question is when?

The flu, or trancazo in Spanish and Tagalog, is something we have learned to live with. If not for the COVID-19 outbreak, many of us would not have heard of the 1918 influenza pandemic that killed an estimated 50 million people worldwide from February 1918 to April 1920. It is odd that classroom history is silent on the influenza pandemic when it killed more people than the First World War, whose beginning and end are recorded in our textbooks.

It’s a pity that libraries, museums, and archives have been closed for over a year now, because the Inter-Agency Task Force for the Management of Emerging Infectious Diseases classified them as “non-essential.” I really want to dig up Philippine newspapers from the 1918-1920 period to gather eyewitness accounts of the influenza pandemic when the Philippines was an American colony. One of the few eyewitness accounts available online, from the Journal of the American Medical Association, is by A. Francis Coutant, a doctor in St. Luke’s Hospital, Manila who gave an account of the beginnings of the pandemic in June 1918 when he noticed an increase in hospital admissions with flu patients.

Based on his notes and records from around 300 cases that came under his direct observation, Coutant concluded that the epidemic was short-lived and would be blown away by a well-timed typhoon. What he did not know, at the time of his writing, was that he had experienced and described the first and mildest of three waves of infection that would sweep over the Philippines from 1918 to 1920 and kill over 90,000 people.

Coutant observed that the first cases of the flu were from longshoremen and laborers in the waterfront, suggesting that the disease was imported from abroad. Some people claimed otherwise, pointing to Manila as the source of the flu because the outbreak came ahead of neighboring ports and countries. Coutant narrated that a United States Army transport from San Francisco had arrived in Manila with 30-40 cases on board and one death. Filipino cabin boys and mess attendants were severely affected, and since the disease did not discriminate based on cabin class, some First Class passengers caught it as well.

Around 70-80 percent of the first cases were longshoremen, dock workers, clerks, and people who worked in the port of Manila. Their absences resulted in the delay of some transpacific vessels. Five days from the time the flu cases were reported from the ports, the disease had spread to the commercial and residential areas of Manila. The flu did not choose by race, though Filipinos comprised the majority of the infected; the minority were Chinese, Japanese, Europeans, and Americans in that order. People called in sick, with one firm reporting that 80 percent of its Filipino employees were unable to work or were absent for at least two days, while absences among Europeans were significantly lower—on average, they were absent for a day.

The flu made some newspapers stop operations for a day, and the telephone service apologized for bad service after 90 percent of its workforce got infected. St. Luke’s Hospital averaged 90-96 patients during that time compared to its normal capacity of 70 patients. It was the greatest number of admissions recorded since the hospital opened. Ten days after the outbreak, majority of those infected were well enough to return to work, but the hospital continued to be crowded with flu patients for three more weeks until a typhoon swept the disease away.

Coutant wrote: “Clinically, most of the cases ran the typical course of influenza as described in textbooks, namely sharp onset, usually with sore throat or upper respiratory tract symptoms, sudden high fever and headache. With aching and stiffness all over the body. A pronouncedly slow pulse rare, in proportion to the temperature, was remarked to be the rule. This slow pulse, and the absence of a skin rash, together with the lightning-like spread of the epidemic, served to differentiate the disease from dengue fever, the only closely similar condition. The highest temperature recorded was 106.2F [41.22C]. The patient with this high fever did not suffer, however, nearly as much as many others, and it appeared that the severity of the attack did not depend on the temperature. The majority of the patients also withstood the pain very well, as is the usual thing among these peoples, but the toxemia developed was so great that it made those who were most severely stricken practically collapse. The faces of the patients as a whole, as one looked down the wards, were more miserable-looking during the days of the epidemic than at any other time in my experience.”

Anorexia, nausea, and vomiting were unusually common. A person admitted for hiccups had endured it continuously for 40 hours! Two people coughed up a small amount of blood but were clear of tuberculosis. Four passed a lot of blood from the rectum without having hemorrhoids or dysentery. The death rate was unusually high at 2 percent—the normal was 0.4-0.6 percent—and those who died in the hospital developed pneumonia-like symptoms.

From Manila, the flu traveled to port cities and areas of commerce connected by train and roadway, because there were no quarantine lockdowns. The highest deaths recorded were in November 1918 with 48,523, and December 1918 with 35,204.

Yes, if we look back, today’s face masks, disinfection, isolation, and quarantine are not new.

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