After residing in relative historical obscurity for a century, the tragic story of the so-called[1] Spanish flu is getting told. As COVID-19 spreads around the globe, the pandemic that claimed millions of victims between 1918 and 1920 has become a reference point for how bad things could get with the latest pandemic. Thanks to Allan Marble, Nova Scotians can read about how the earlier flu affected this province. His 2018 lecture on the impact of the Spanish Influenza pandemic on Nova Scotia has been posted by the Royal Nova Scotia Historical Society.

The Spanish flu numbers are harrowing – 40-50 million deaths worldwide, as many as 55,000 in Canada with the virus striking hardest among young people between 15 and 40 years of age. If, perish the thought, this country’s Spanish flu death rate of 4.58 per thousand were to prevail with COVID-19, nearly 173,600 Canadians would succumb to the virus.

No one has yet forecast anything as dire for COVID-19. Canada’s Public Health Agency has estimated that if we maintain strong controls and keep the infection rate to five per cent of the population, the pandemic will claim 22,000 lives, a rate of 0.58 per thousand. On the other hand, according to the health agency, doing nothing could have cost could cost 300,000 lives, a rate of 7.92 per thousand – much worse than Spanish flu.

There are some intriguing parallels between what went on a century ago and what’s happening today. For instance, although the 1918 carriers were primarily soldiers coming back from war, in both pandemics the virus was spread by returning travellers. In both cases there is also a tendency to downplay the virus at its onset. In October 1918, one month after the first deaths were recorded in Nova Scotia, the province’s public health officer announced there were no cases in Halifax. Two days later, there were 64 reported in the city. Likewise, at the end of January, 2020, Canada’s chief public health officer described the coronavirus risk to Canadians as low.

Marble’s research also highlights the link between isolation from others and limiting the impact of the disease. Nova Scotia had the lowest death rate from Spanish flu of any province, 3.18 per thousand, well below rates in excess of seven per thousand in both Alberta and British Columbia.

Marble attributes the province’s relative good fortune partially to the age profile – Nova Scotia had fewer citizens in the most vulnerable age bracket. But the main factor was willingness to obey orders to remain isolated from others, a compliance stemming from public respect for the heroic work of health care professionals following the Halifax Explosion months earlier. By contrast, “health officials in western Canada were unable to control both the general public and the returning soldiers at train stations throughout Saskatchewan, Alberta and British Columbia.”

Rushing back to normal

Despite shutdowns of businesses, schools, churches and other public buildings and the population’s relative willingness, in today’s parlance, to stay the blazes home, 2,265 Nova Scotians died from the flu, more than perished in the Halifax Explosion. At the pandemic’s peak, between October and December of 1918 there were 1,335 deaths in Nova Scotia. This included 30 in the tiny Richmond County fishing village of Petit-de-Grat. There were 14 deaths in Digby, a town of 1,265, producing a death rate of 10.8 per thousand for that town. Middleton had a death rate of 9.7, Stellarton 8.5.

The deadly impact of the pandemic notwithstanding, Nova Scotians – or at least the newspapers of the day – seemed anxious to move on. Daily life returned to normal and attention shifted to new problems, such as a looming recession. From June, 1919 (a month when only five deaths were recorded) to Jan. 1, 1920 Marble found no mention in Nova Scotia newspapers of the influenza.

“Public health officials, physicians, nurses and the general public probably assumed that the disease had disappeared from the province,” Marble writes. But it had not. By looking at death certificates he discovered that another wave began in late January of 1920, killing 280 Nova Scotians over the next four months. That resurgence of the Spanish flu virus is another parallel with COVID-19, already making a second appearance in places like Singapore.

Allan Marble points out that the Spanish flu epidemic had a positive impact on public health infrastructure. Provinces beefed up their capabilities and Ottawa established a federal department of health for the first time. In our day, the SARS outbreak in 2003 led to the establishment of the Public Health Agency to improve Canada’s ability to prevent and respond to infectious disease.

But these moves took place behind the scenes. Just as in 1919-20, there remains a tendency to let epidemics and pandemics disappear from the political radar until another one comes along and ignites a round of recriminations about failing to heed the lessons of the past. That’s happening now at the federal level, where officials are being criticized for a lack of preparedness for COVID-19. So far that kind of criticism has not happened in Nova Scotia, but the response in this province to the 2009 H1N1 swine flu pandemic illustrates how quickly such events drop from the political agenda.

H1N1 experience

Although Nova Scotia recorded Canada’s first cases in the country of H1N1 in April of 2009, the outbreak was not considered serious enough to interfere with a provincial election campaign that spring. But when the second wave of the pandemic arrived in the fall it was a bigger deal. By that time, Canada was ready with a mass vaccination campaign. The opposition parties in Nova Scotia tried to score political points against the new NDP government when the program hit a few bumps in this province.

When those problems were ironed out, political interest in H1N1 declined, despite the fact that the pandemic had, by some measures, a greater impact on Nova Scotians than COVID-19 has to this point. From April 2009 to January 2010 there were 1,334 lab confirmed cases of the virus, resulting in 291 hospitalizations. Fifty patients ended up requiring intensive care, and there were seven deaths, according to a December, 2010 report co-authored by Chief Public Health Officer, Robert Strang. The pandemic also led to the largest immunization program in the province’s history, with over 500,000 vaccinations.

Dr. Strang’s report left a few questions – for example, could any of those deaths or hospitalizations been prevented and if so, how? But the report attracted little or no attention at the time. There was a report in 2013  by the Auditor-General on public health and preparedness. It did not deal specifically with the H1N1 response, but was critical of the slow pace at which officials were moving to improve health surveillance to better protect against disease outbreaks.

The Auditor’s report was reviewed by the Public Accounts committee, but in the years since there has been no follow up by that committee. And if public health and epidemic preparedness has been part of the non-stop political and media discourse about health care it has been drowned out by talk of emergency rooms, family doctors, surgery wait times, nursing homes, drug costs and (mea culpa) federal transfers.

The impulse to move on too quickly from pandemics is a global problem. The World Bank and the World Health Organization recently released a report on pandemic preparedness, decrying the cycle of panic when pandemics appear, followed by neglect when they pass. “We ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides.”

Given the human, economic and political cost of COVID-19 this time should be different. At the very least, the crisis ought to position pandemics in the first division of perils, joining the likes of climate change, inequality and nuclear war among threats to humanity. It should happen, but history suggests it may not.



[1] Spain got a bad rap because there’s no evidence the virus originated there. It’s just that because their country was neutral in World War I, Spanish newspapers were free to report on the devastation the outbreak was visiting on their country. Newspapers in warring nations were subject to censorship filtering out news that would hurt morale on the home front.