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A dozen Bahrain hospitals have joined the battle against Covid-19, but in 1918, when the country endured its first flu pandemic – the American Mission Hospital (AMH), then known as the Mason Memorial Hospital, was the only one.
The pandemic, popularly known as the Spanish flu, claimed 50 million lives globally after infecting nearly 500 million people. In Bahrain, which had a population of approximately 100,000, the pandemic started in September 1918 and lasted 10 months. Nearly 20,000 people or a fifth of the population succumbed to the disease. Its disastrous impact was exacerbated by the kingdom’s position as a hub of travel and trade in the region.
Dr George Cheriyan, AMH’s chief executive, noted in an interview with GulfWeekly: “It’s a very sobering thought that within the span of a few months, nearly a fifth of Bahrain’s population and many in the Arabian Peninsula died. This was also a time when there were no other hospitals in the Gulf region, so the three doctors and 20 medical staff here had to treat all of them. Dr Paul Harrison along with a team from AMH were dispatched to the Royal Court in Riyadh to diagnose and provide care.
“There came a time when gravediggers were exhausted from the sheer number of bodies they had to bury every day.”
The AMH had, by 1918, already seen several epidemics in the kingdom. In March 1903, smallpox became the first of many to hit Bahrain. A month later, a rumour started that foreigners had poisoned the water in Bahrain, but this turned out to be the bubonic plague, found in a patient by Dr Sharon Thoms at the Mason Memorial Hospital.
Most of the victims hit by the plague died within 48 hours of their first symptoms. Each night a long death wail could be heard through Manama as yet another funeral procession made its way to the hastily dug graves in the cemetery behind the hospital.
Despite this experience managing public health, the Spanish flu, also an H1N1 virus like Covid-19, proved to be the greatest tax on the healthcare system.
Even back then, the most important public health precaution was isolation, according to Dr George.
In fact, the word quarantine originates from the Venetian word ‘quarantena’ meaning 40 days, which was, historically, the length of time, ships and travellers were isolated to prevent the spread of disease.
In most pandemics and plagues, the practice of quarantine ensures that the sickest people with the most deadly strain of the virus are kept away from the general population. As a result, the milder form of the virus tends to spread amongst the population, sometimes taking its toll on weak immune systems but overall, building the herd immunity of the population.
This is what happened during the first wave of the 1918 flu pandemic - those most at risk were the sick and elderly, while younger, healthier people recovered quickly.
However, WW1, which had just ended, reversed this ‘natural selection’. Soldiers with a mild strain stayed where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus during the second wave of the pandemic.
The second wave is what decimated the Bahrain of 1918, but has also provided some of the greatest lessons to deal with Covid-19 today.
Dr George said: “Public awareness around Spanish flu was just superstition. Initially people thought that a curse had been cast on people. And in those days, hand washing was never considered an important part of prevention. And of course, at the time, the government infrastructure was not at the same level it is today.
“All this has, of course, changed. The Ministry has been very proactive about testing as well as public health awareness. The lockdown and education about social distancing is timely and necessary. The infrastructure that the government has set up in the last few weeks alone is significant. As we endure through this, and we will, I cannot stress enough how important it is that people practice social distancing.
“Yes, the second arm of any pandemic, the economic impact is devastating and directly affects the livelihoods of many people. We have started to see that globally, but that makes it even more important to stay physically and mentally healthy, otherwise the impact is worse.
“And in terms of medical information about Covid-19, stick to factual information and verified sources, instead of sensationalised news that quickly spreads on social media but may be completely false, like the idea that those who have once contracted this virus may contract the disease again.
“That has not been proven clinically and that’s why it’s so important to stick to vetted information produced through scientific evidence.”