A catastrophic pandemic in 1918 was New Zealand's worst ever natural disaster, killing more than 9000 people and ruining untold numbers of lives. Lessons learned from that outbreak underpin the country's pandemic response plan, and may save many lives today, a history expert says.

The first to die was a soldier. Robert Torrance, a 25-year-old from Dunedin, was taken to a military hospital in Rouen, France. He, like other soldiers, had a nasty case of the flu.

Torrance had been fit and healthy shortly before before his death on August 28, 1918. It only became clear, in retrospect, what had killed him: One day before he died, the second wave of a brutal influenza pandemic had struck the Northern Hemisphere, taking Torrance as its first New Zealand victim.

Within four months of his death, between one-third and one-half of all New Zealanders would have fallen sick from the same illness. Thousands would be dead, and some communities would never recover.

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The global influenza pandemic of 1918, sometimes called the Spanish flu, was the worst of its kind since the bubonic plague.

Despite New Zealand's relative isolation, the country as a whole was hit hard, and Māori in particular died at rates among the highest anywhere in the world.

Basic errors by the Government and local officials made the disaster much worse: A lack of planning, political squabbling, and a reluctance to disrupt the economy fuelled the spread of the virus which, six weeks after it began, had killed upwards of 9000 New Zealanders, including a shocking five percent of the Māori population.

Revisiting that pandemic, and the many failures that led to its spread, show many lessons can be drawn.

The Pandemic Plan, published in 2010 and now being used to address the coronavirus pandemic, was explicitly based on addressing the issues that emerged in 1918.

The world is a much different place a century later; but similarities between the two pandemics show just how easily things can spiral out of control.

ALEXANDER TURNBULL LIBRARY/SUPPLIED Volunteers doing washing for Plunket during the influenza outbreak in Christchurch.

THE SECOND WAVE

Aucklanders were the first to mysteriously fall sick.

It is unclear when the second wave of influenza arrived in New Zealand. The first wave had passed through late in September, but did not have a major impact, and appeared to be tailing off.

By the middle of October, people in Auckland started to fall sick. At first, it was a handful of cases a day. Then the cases got more frequent, and worse in severity.

Within a week, a handful of people every day were dying, either from the flu itself or from a secondary infection such as pneumonia. Antibiotics had not yet been discovered, meaning pneumonia could not be effectively treated.

The alarm was quickly sounded by doctors. A report in the New Zealand Herald on October 22, quoting doctors, said influenza should be declared a notifiable disease as soon as possible.

Doing so would allow aggressive action to contain the virus; But it would not happen for another two weeks.

It was increasingly clear there was a problem when nurses started falling sick. Dozens of nurses were too sick to work, and Auckland Hospital struggled to maintain staffing levels. At its height, more than 100 of the hospital's 180 nurses were too ill to work.

By October 29, the epidemic was fully unleashed throughout the city. Post office employees, railway workers and telephone exchange workers reported sick en masse, and basic public utilities struggled to function.

The hospital could not cope, and emergency hospitals were set up around the city. It wasn't enough: A specially set-up influenza ward at the hospital was filled up on the first day, nearly entirely by sick nurses.

ALEXANDER TURNBULL LIBRARY/SUPPLIED An influenza medicine depot in Christchurch in 1918.

In retrospect, it is clear that, at this point, the outbreak was killing large numbers of Aucklanders.

What began as a handful of deaths per day rose to 15 per day in early November, quickly peaking at 83 deaths on November 12, before falling off again. By the second week of December, it was mostly over; the virus had killed around 1100 Aucklanders, or 7.6 in every thousand Europeans (European and Maori death rates were recorded separately).

But even in the midst of the outbreak, outside of Auckland, it was unclear how serious the pandemic was, even to the Government.

Although there had been international reports of mass flu deaths in Europe, including among New Zealand soldiers on the Western Front, the Government had made little effort to prepare.

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The national Medical Officer of Health, Dr Joseph Frengley, finally decided to leave Wellington for Auckland in early November to see what was happening for himself.

He immediately realised it was a disaster. He asked the Minister of Health, George 'Rickety' Russell, to join him in Auckland. Ads were placed in newspapers around the country pleading for nurses to come to Auckland to help.

While this was happening, the virus was rapidly, and silently, spreading.

TE KUITI HISTORICAL SOCIETY Nurses and doctors at a "native hospital" for treating influenza patients in Te Kuiti.

The failures in 1918 were numerous, and, for the most part, have not been repeated with the response to coronavirus.

That's the verdict of Dr Geoff Rice, an Emeritus Professor of History at the University of Canterbury, who has extensively studied the 1918 pandemic's effect on New Zealand.

In his book, Black November, he recounts how the pandemic hit the country unaware, with brutal consequences.

"New Zealand has done well to keep its confirmed cases [of Covid-19] as low as 12, with no deaths and no signs of community spread," he said on Tuesday.

"Our Pandemic Plan has worked well, and the government has done all the right things to contain this threat. This is in great contrast to 1918, when we had no plan, no antibiotics and a Health Department that was pathetically understaffed and hopelessly complacent."

Whereas the coronavirus has not yet spread widely in New Zealand, the influenza virus spread rapidly.

GEOFF RICE A graph of influenza deaths per day, showing how quickly they spiked.

By the end of October, Christchurch had its first case; a day later, Wellington had its first. By mid-November, at the pandemic's peak, it was established in nearly all parts of the country — from rural Southland to Whangarei — just weeks after it first appeared in Auckland.

Two factors were integral to its quick spread, Rice says: Soldiers returning from WWI, who boarded trains to return to their homes across New Zealand, and large community gatherings that celebrated the end of the war.

Unlike today's focus on social distancing and limiting mass gatherings, people flooded the streets in the midst of the influenza pandemic to celebrate the Armistice.

It happened twice: First, on November 8, when an inaccurate report declared the war over, then again on November 12, when the war actually ended. On both occasions, people flooded the streets to celebrate, undoubtedly spreading the virus further.

ALEXANDER TURNBULL LIBRARY/SUPPLIED A mass public gathering to celebrate the WWI armistice in Christchurch, which occurred at the height of the pandemic.

BLACK NOVEMBER

The quickness and the severity of the outbreak ground the country to a halt, crashing the health system

In recent weeks, the term "flatten the curve" – in reference to this graph – has been used to show the importance of spacing out new infections over time, so as not to overwhelm the health system.

The influenza pandemic showed what happens when the curve is not flattened.

By early November, Auckland Hospital was overflowing. At the time, the city had approximately 100 doctors, serving a population of 133,000 - the second highest ratio in the country, behind Dunedin. Figures from before WWI suggested the country had 4000 hospital beds, around 0.4 for every 1000 people.

Some doctors, however, were overseas on the front-line — as many as one-third. Hospital beds were likely taken up by returned soldiers.

Today, Auckland has 543 doctors per 100,000 people, around five-fold the number in 1918. The country as a whole has around 2.8 hospital beds per 1000 people, seven times the 1918 number.

At the time, it was nowhere near enough, and the system could not cope. Not only were the number of doctors and nurses critically short, there was a lack of people to do other basic tasks: Washing the bedding used by sick people, looking after children, and handling the bodies.

There were so many bodies, in such a short space of time, that it was unclear what to do with them. In Auckland, Victoria Park was turned into an open-air morgue: Many of the victims are now buried at Waikumete cemetery in West Auckland.

Due to the lack of experienced medical staff, it was up to volunteers to run the temporary hospitals, which were usually in school and community halls.

This likely caused numerous deaths, Rice says: "Inexperienced volunteers often had no idea how to nurse serious pneumonias."

Although Auckland was brutally affected, the worst-hit city of all was Wellington. It was largely because for the better part of a week, no one was in charge.

When the outbreak began in Wellington, around 10 days after it started in Auckland, among the first wave of people to fall sick were the city's medical health officer, the port health officer, the hospital superintendent, and its head matron, all of whom would have played a key role in the response.

This became a major lesson in New Zealand's pandemic planning: Make sure that groups of people, not individuals, have responsibility.

Much like Auckland, Wellington was critically short of medical staff. Outside of its main hospital, it had just six doctors to deal with many hundreds of patients in the numerous temporary influenza clinics around the city.

The city's mayor, John Luke, had been pressing the Government for an aggressive response since the Auckland outbreak had begun, including travel restrictions into Wellington.

He had limited power to act, and was at the mercy of central Government, which was desperately short-staffed and dealing with a national crisis it had not prepared for.

It wasn't until November 6 - at which point the virus was established in much of the country and had already killed dozens of people - that influenza was classed as a notifiable disease, weeks after doctors had first urged it to happen. It allowed local officials to make decisions such as restricting the opening hours of bars and restaurants and closing schools.

In many cases, that happened; And so for a couple of weeks, the country was quiet.

"The whole country virtually shut down in the middle weeks of November," Rice says.

"Shops and offices, factories and mines, pubs and schools were closed and many people were at home in bed with the flu or nursing their families."

ALEXANDER TURNBULL LIBRARY/SUPPLIED People using a public inhalation chamber in Christchurch.

Throughout the six week pandemic, information was hard to come by.

It was because newspapers were forbidden by the Government from publishing death statistics, an attempt to prevent panic that may have in fact caused it.

Theories were abound about how many were dead, and rumours colonised the information gap.

"In the absence of facts, rumours magnified the flu deaths, from tens to hundreds of thousands," Rice says.

"When the figures for cemetery burials were finally published some people were surprised that they were far less than had been feared."

The efforts to contain panic also extended to trying to maintain a business-as-usual atmosphere. When the Mayor of Greymouth said he planned to close the town, Russell, the Minister of Health, angrily urged him not to.

"As I have the whole Dominion under review I am urging all towns not to put up their shutters but to carry on," he wrote in a letter.

"If Greymouth follows your advice the people will be depressed and more liable to catch the disease... Face the trouble with determination and carry on."

Another issue for small towns was the lack of substantial hospital services. Several towns, including Reefton and Gore, turned the grandstand at the local racecourse into an influenza hospital.

Some towns, particularly those dominated by Māori, lost extraordinary numbers of people due in part to the lack of medical services. In one example, Kaitieke County in the King Country had a death rate of nearly 23 per cent among its Māori population.

The pandemic was over just six weeks after it started.

Because it moved so fast and so thoroughly, herd immunity quickly developed. The third and fourth influenza strains had little effect on New Zealand.

The total death toll, for a long time, was unclear. Records of Māori deaths were particularly poor. Rice's work, based on analysing death certificates, has estimated the toll at just over 9000.

New Zealand's response could have been much different, and more effective, Rice says.

He points to how Australia responded to the influenza outbreak: It quickly set-up a maritime quarantine in mid-October, which all but stopped the virus entering the country. Its death rate was 2.7 in every 1000, less than half of New Zealand's European death rate of 5.6 per 1000 and much less than the Māori death rate of 45 per 1000.

There were New Zealand example of effective action, too, which could have been emulated.

One of the few areas to escape influenza deaths was Coromandel: The local health officer acted aggressively, quarantining every ship that stopped by, including the regular steamship from Auckland. Checkpoints were set up on roads into the district, where every person had their temperature taken; those who were though to be sick were turned away. In Te Araroa on the East Cape, locals manned with shotguns stopped anyone entering, which also limited the spread of the virus.

The lesson was simple: Aggressive action to quarantine visitors and keep the virus from spreading - which New Zealand is doing - is an effective response.

What is less effective is letting the virus spread, hoping that herd immunity will kick in, which is essentially what happened in New Zealand in 1918.

"Our government's decision to 'go hard and go early' to keep Covid-19 at bay is exactly the right move," Rice says.

"Tracing close contacts of people who show symptoms, usually from overseas travel, and voluntary quarantine enables the virus to be stamped out before it spreads."

There was a positive lesson from 1918, too.

During that pandemic, people did what they could to look after each other, he says - it's important to do the same and remember that all pandemics, eventually, run their course.

"Covid-19 could get worse before it gets better, and this may only be the first of several waves, but like all pandemics it will burn itself out and life will one day return to normal," he says.

"We must all try to remain calm and optimistic, doing the best we can, and looking forward to that day."