Before the coronavirus, the ravages of Asian flu and Hong Kong flu

Audio 03:07

By: Christophe Paget Follow

The coronavirus is far from the first pandemic of the modern era. Two influenza epidemics traveled the world in the late 1950s, and ten years later in the late 1960s: the Asian flu and then the Hong Kong flu. 

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Each of these epidemics has caused between 1 and 4 million deaths worldwide. Epidemics a little forgotten, but which we can very easily compare to that of the Coronavirus today. Here, in addition to the chronicle Fréquence Asie that Christophe Paget devoted to these two pandemics, the interview he carried out with Patrice Bourdelais, historian and director of studies at the School of Advanced Studies in Social Sciences (EHESS) .

RFI  : The coronavirus, like the Asian flu or the Hong Kong flu, comes from China. Is it a coincidence?

Patrice Bourdelais: Basically, all the great epidemics know kinds of "ecological niches": cholera is rather Bengal, Ebola central Africa, and China historically gave birth to practically all influenza viruses. Even the flu from Russia, which reached Europe in 1989-90 obviously came from central China, as did the Asian flu which reached Europe in 1957-58 and ten years later the so-called Hong Kong flu, which reached Europe in 1969, but started in central China around February 1968, during the Cultural Revolution.

What paths have these two epidemics used to travel around the world, and do they resemble that taken in recent months by the coronavirus ?

An epidemic at the bottom follows the main routes of exchange and communication, therefore very traditionally caravans in the past, then the main routes of merchant exchange, but also the movements of military troops and great pilgrimages. And so these epidemics always leave through Hong Kong, which is a place that radiates a lot. From there, they typically go to Japan, then (or at the same time) to Southeast Asia: Vietnam, Singapore, Australia, India, Iran, then the United States, Europe, Africa . Pandemization is always done the same way, more or less.

And in fact it was the American soldiers returning from the Vietnam War who brought the Hong Kong flu virus to the United States.

Yes, Vietnam had been infected from Hong Kong and China, and the soldiers returning to their bases in California reported the epidemic in September 1968. From there, the epidemic spread to the United States , to the point that in December it will kill 50,000 people - so it's still a serious epidemic, even across the United States. It then heads for Europe.

And have these viruses traveled as fast as the coronavirus today ?

There are two important factors: the speed of air transport and also the number of people transported. There was a great development of this mode of transport between the two epidemics, in 1968 it is quite fast and especially used. It has nothing to do with the growth we have seen since the early 2000s, but the Hong Kong flu epidemic is the first to travel at the speed of an airliner.

Are these two pandemics as serious, or even more serious, than those of the coronavirus ?

The number of deaths is always questionable: as much we know roughly the number of victims in Western countries, as much when it comes to collecting the number of deaths in Africa or other regions of the world (Asia, etc. .) is much more difficult, hence the use of forks. For example for the Asian flu, the WHO figure is four million dead, but the range is one to four million. Hong Kong flu kills less, around a million, but estimates range up to four. It just means that these are two great pandemics of the 20th century.

What about the economic consequences?

The Asian flu had consequences, for example on the stock market, with a collapse in prices - less in France than in New York and London, because the collapse was more significant in the large stock exchanges than in the smallest - and Paris was smaller… But there was a cessation of activity, obviously, without there being what we know today, that is to say measures to stop the economy by confinement. The big difference is there anyway: this containment model given by China to control the epidemic and which was put back in the saddle in Europe by the Italians and the French.

Abandoned since the 19th century, this old medieval model had been created by the Italians for the control of pests: by quarantine, lazaret (establishment of quarantine), sanitary cordon. It had been abandoned, by England in particular, around 1860, and it was the English model which then became the great model for managing epidemics: a neo-quarantine system, with a medical examination for any boat arriving in an English port. Sick people are sent to Fever Hospitals, others are asked for an address where they can be visited so that their condition can be checked during the following week. It is this much more flexible system, which did not hinder trade and commerce, which was maintained until a few months ago.

So we are in a radically new situation on the historical level: it is a real rupture, which sends us back to more than a century and a half back, to the cholera epidemics of 1831-32 in Europe.

You were talking about the stock market collapses during the Asian flu, during that of Hong Kong ten years later, in France, the economy is affected ?

Touched, but not stopped. We note that in the Toulouse region there are 15% of railway workers who are seized, so there are canceled trains. We know that this epidemic is causing many work stoppages to the point that the Health Insurance Fund is forced to close its doors for the duration of the Christmas holidays. Industrial capacity is falling, it is notable, but there is no such general shutdown, these plant closings as it is today. The factories were running with 20% fewer staff.

In France in any case, at the end of the 1960s, neither the press nor the government seemed to take the pandemic seriously ...

The 1957-1958 Asian flu had been treated because the dread of the Spanish flu was still there - it was only a few decades ago. In addition antibiotics had just been developed, and new families of antibiotics appeared every two years or so, so there was some form of assurance that we were going to be able to cope with this flu, in particular by reducing mortality thanks to antibiotics.

The medical and pasteurian community is mobilizing, he had just prepared vaccines ... And finally it is a flu that passes; it still does a lot of deaths (between 15 and 20,000 anyway in France), but less than the flu from Hong Kong, much more serious: 25,000 died in December, 6,200 died at the end of the epidemic in January.

The Hong Kong flu, which will therefore be little publicized.

The political manages at that time after the 68, with a social movement always present. General De Gaulle left in April, Georges Pompidou arrived in the June elections, and Jacques Chaban Delmas launched his major project for a new society in September. The political agenda occupies the entire media, political and social field, so sanitation no longer has its place. Same thing in the world where attention is focused on wars - that of Biafra for example.

In addition we are there in the last years of a faith in scientific and medical progress such that we thought that we would not control, but eradicate all infectious diseases (we finally succeeded only for the smallpox, and almost for polio).

How did Asia experience this Hong Kong flu epidemic ?

Their terror was the Cultural Revolution in China, and all the troubles it caused. Obviously, from the moment that China "exports" via Hong Kong its flu virus, tension and vigilance are important, with obviously at the forefront the people of Hong Kong - still under English control at that time. But also the Japanese with their great scientists and their tradition of strong research in the field of bacteriology. And then also behavior that respects physical distances; and there is a widespread use of a mask very early in Japan as a model of prevention, we see all these Japanese masked in the news at the time of the Hong Kong flu. In the country, public hygiene has been very strong since the beginning of the 20th century.

As for China, it no longer manages anything at that time: the Red Guards have left for the big Chinese cities, the structure of the Communist Party in these big cities is disputed, even overturned. There is no room for sanitary facilities at this time in China. We have estimates of the figures for contamination and death, but so fanciful in my opinion that it is a waste of time.

What about Taiwan ?

In China, throughout the previous period of Asian flu, there were also dangers of plague and cholera. So in Taiwan, which protects a lot from China, you were very vigilant in terms of public health: the Taiwanese really track down meticulously any immigrant or person returning from mainland China. They are subjected to medical examinations and quarantines to avoid the importation of cases of cholera and plague, but also of flu, frequent in this region.

So there is a kind of “acquired skills”, as you have seen, Taiwan has handled the Covid-19 epidemic rather well. Obviously with methods that can sometimes shock us, because they always favor the collective interest over individual freedoms - and we know that it is a couple in tension as soon as there is an epidemic to manage. But the results so far from Japan, South Korea, but also from Taiwan are quite remarkable and show that there are surely several models for managing an epidemic.

What have we learned from these two pandemics, what have they changed ?

Hong Kong flu gave a lot of information and helped start modeling influenza epidemics, which was epidemiologically important. This second flu also convinced that it was necessary to industrialize the production of vaccines, since the Mérieux and Pasteur laboratories were not able at that time to provide enough doses to vaccinate a few million French people.

In addition, it was also noticed in 1968-69 in particular that there was an excess mortality of the elderly, and it was from the Hong Kong flu that they were strongly advised to be vaccinated against influenza. Besides, a few years later, in 1984, vaccination against influenza will be reimbursed for people over 75 by social security.

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