Influenza expert claims New Zealand is ill-prepared if a major pandemic hit

One hundred years ago, thousands of Kiwi soldiers began dying in France during the First World War from a violent strain of influenza that eventually reached New Zealand.

The so-called Spanish Flu killed 9000 people in just six weeks, including a disproportionate number of Māori and one-fifth of the population of New Zealand-occupied Samoa.

Unlike the hundreds of war memorials throughout New Zealand, there are few memorials that acknowledge the Spanish Flu - but it was one of the most traumatic experiences our young country has ever faced.

"You could go to work in the morning and have no symptoms, and be dead by the end of that day, and it was just the sheer numbers," Historian Dr Stephen Clarke told Newshub Nation.

"In Auckland, over 1200 died within a few weeks."

Grave diggers worked 24-hour shifts to bury the dead at Waikumete Cemetery in West Auckland, Dr Clarke says entire families perished together.

"There's some terrible stories where families were totally stricken, because you had to rely on your neighbours and your family, and you think about that today, do we know our neighbours?

"Back then they really did know their neighbours, but in some cases families went down really quickly, and there was a case in central Auckland with a sign put up in the window saying please help us, and by the time the services got round to them, the whole family had died of flu in there.

"Another case a wife almost went mad because she was suffering from flu, couldn't move and next to her was her dead husband."

While there have been major advancements in the understanding, prevention and treatment of influenza in the hundred years since, how would New Zealand cope if a similar deadly strain arrived in 2018?

Influenza specialist Professor Michael Baker told Newshub Nation there is a current pandemic plan in place, but nothing could totally prepare us for a pandemic event like 1918, or another virus, that might be just as bad, or worse.

"The one big advantage is modern day surveillance so we can detect these things, we have global systems alerting us to what's happened, and in other countries where these things emerge, we have much more sophisticated virology and molecular biology to understand these things."

But Prof Baker believes the ability of New Zealand's health services to deal with large outbreaks of disease has been eroded, and compromised.

"We've wound down our National Public Health capacity, we've got great people say in the Ministry of Health, we just don't have enough of them, and we've also fragmented our activities and we saw that with the Havelock North response."

Medical authorities struggled to deal with the Havelock North gastro outbreak in 2016 when 5500 people, a third of the town's population, fell seriously ill.

"I think Havelock North and the enquiry was very critical of the Ministry of Health and it's actually worth reading their recommendations," Prof Baker says.

"They are really calling for a very significant increase in New Zealand's capacity to manage these kinds of events. It's time for a major stock take of our national capacity for managing emerging infectious diseases."

However, Health Minister David Clark believes there were plenty of positives to take from the Havelock North outbreak.

"One of the really good things that came out of Havelock North was that 5000 people needed to be seen and primary care proved to be incredibly flexible, they adopted a new model and everybody got seen in very short order, so what we do know is primary care is very adaptable when situations like that happen," the Minister claimed.

He is also is adamant the national pandemic plan could work if called upon.

"I'm convinced that the pandemic plan we have in place is as good as it could be, we as a Government now, many of us in opposition did petition to make sure health was more sustainably funded over time.

"We will want to improve things of course, but the pandemic plan we have in place is up to date and I'm confident that if an outbreak happened we'd be in the right position to deal with it."

There have been a myriad of recent pandemics worldwide, a major SARS outbreak in 2002, several deadly cholera and measles outbreaks, the H1N1 or Swine flu pandemic in 2009 which killed over 14,000, and the Ebola epidemic in 2013 that killed over 11,000 in West Africa.

Swine Flu affected 1 in every 1,380 New Zealanders and put a major strain on medical services.

While the 1918 influenza arrived by boat - H1N1 turned up at the airport.

"The big minuses are obviously very rapid air travel," Prof Baker says.

"We saw that in 2009 with the most recent influenza pandemic where it arrived in New Zealand almost simultaneously with it being identified in Mexico, so that's a minus."

"The other minus I think is there are a lot more humans on the planet, there appear to be more emerging infectious diseases, and also unfortunately humans now have the capacity now, fortunately or unfortunately, to modify micro-organisms."

The unpredictability of the influenza virus was highlighted in the Northern Hemisphere this past winter, when the flu vaccine didn't work as well as predicted. Tens of thousands were infected and hospitalised by the H3N2 strain - commonly known as 'the Aussie flu'.

New Zealand's Immunisation Advisory Centre says the flu vaccine has been delayed this year - because it is being altered to better protect us.

"Our vaccines are based on our best prediction of matching what we think are going to be the prevailing circulating strains," Director Dr Nicky Turner told Newshub Nation.

"But we're always somewhat chasing our tails checking out what strains are circulating, how the strains are shifting, and what we're expecting, so we do our best predictions, sometimes our predictions are better than others."

Dr Turner says we cannot foretell how severe the coming flu season will be - but that we must always prepare for the worst.

"Last year we were lucky, we had a fairly mild season, but even in the mild seasons people get sick and people die, so flu is always a killer and is always a nasty disease, and every winter our hospitals struggle with flu."

It's estimated around 500 Kiwis die of flu-related causes each winter, but the officially recorded number is only a fraction of that figure.

Prof Baker believes the reason is that many people who die from influenza have other chronic conditions such as heart disease or chronic respiratory disease.

"So that's recorded as anything they've died from, chronic disease, but the event that actually did kill them is influenza, and that's one reason why we have free vaccination for everyone 65 and over."

And just like a hundred years ago, the people most at risk are the very old, or the very young, and admission into hospital is only reserved for extreme cases.

"In winter we always have a percentage of patients with the flu and some of those turn into admissions and some of those are very, very sick," Acting Chief Medical Officer of the Counties Manukau DHB Vanessa Thornton says.

"Because flu can be a very serious condition, but generally patients are treated in the community with the flu, and obviously we recommend the vaccination in advance."

So like one hundred years ago, it's the community that really battles a mass outbreak of disease, it would be largely up us to look after our loved ones, and our neighbours.

"People are living longer now, often on their own, and I think that is a potential risk to have, not just influenza but any civil defence problem you really need the support of your neighbours," Prof Baker says.

"You can't wait for necessarily rescue services to arrive, nursing services may be overwhelmed as they were in 1918, so I think that community resilience is really important."

Follow Tony Wright on Twitter @TonyWrightNZ

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