On Tuesday (16 Nov) I was concerned to hear this story on RNZ's Checkpoint (National distances itself from ex-MP after video with discredited academic). My concern here is not particularly with the "discredited academic", although no academic should suffer this kind of casual public slur. (Should we go further and call Simon Thornley, the academic slurred, a 'trailing epidemiologist'? In contrast to the epithet 'leading epidemiologist', as applied to Rod Jackson in this story from Newshub.) Academics should parley through argument, not insult.
As well as with RNZ, my concern is with Rod Jackson, who not only made an ad hominem attack on an academic colleague, but made an insensitive remark which, in some circles, would count as 'casual racism'. Casual 'institutional racism' is often cited as a reason why, for example, Māori and Pasifika appear to underachieve in a range of national statistical indicators; and, for the most part, such institutional racism is understood to be unintended. (An example I heard mentioned recently is the under-referral of Māori by general practitioners to specialists. In my view, this evidential discrimination happens mainly because Pakeha are more likely than Māori to have medical insurance; and people with medical insurance are more likely to be referred to specialists. So I am not convinced that this example is a valid indicator of institutional racism within the Health sector.)
The problem is this sentence from the RNZ synopsis: "Professor Jackson also said it [sic] claiming Covid-19 was no worse than the flu was nonsense", which, as well as being part of Jackson's attack on Thornley, was an insensitive dismissal of Pasifika and Māori experiences of influenza. In 1918/19, an estimated 22 percent of Samoa's population had died from the novel H1N1 influenza; many bodies turning black, before death, from advanced pneumonia. The 'Black Flu' arrived in Apia from Auckland on board the SS Talune, with infected passengers being allowed to disembark. The ship had previously quarantined in Fiji. The result was "one of the most disastrous epidemics recorded anywhere in the world during the present century, so far as the proportion of deaths to the population is concerned" (NZ History).
A more aware epidemiologist than Rod Jackson would have realised that, in these last few weeks, Māori continue to relate to the 1918 influenza pandemic; refer, for example, Concerns raised around how to enforce exclusion of unvaccinated from tangihanga, 24 Oct 2021.
The historiography of epidemics in Aotearoa New Zealand is very sketchy. It is appropriate here to outline the main events over the past 125 years, noting that many Pakeha and especially Māori died from epidemic diseases before 1886. (Refer A timeline of epidemics in New Zealand, 1817–2020, Te Ara)
1886 is a good year to start a timeline of recent 'influenza' pandemics; it was a census year, and it was the year of the Mt Tarawera eruption. (In 1886, 120 people, 'mostly Māori', died as a result of the Mt Tarawera eruption; 0.25% of all Māori died in one event, comparable with the present official mortality rate in the USA from Covid19.) As this chart from Te Ara shows, Māori population in 1840 was about 80,000; and that's after the Musket Wars which had already had a huge demographic impact on Māori. 250 years ago, the New Zealand population – all Māori – was almost certainly over 100,000. In 1886 the Māori population was estimated to be 44,000. Ten years later, in 1896, it was estimated at 42,000; its historical nadir.
Influenza and Coronavirus pandemics in New Zealand's History
'Influenza' (in the title to this essay) means influenza or coronavirus, given that likely past coronavirus events have been documented as influenza (indeed possibly going back to the time of Queen Elizabeth 1). From 1890 to 1894, indications are that upto 2,000 Māori died from what at the time was called the 'Russian Flu'. That's 4.0% to 4.5% of the surviving Māori population.
The Russian Flu pandemic has been one of the biggest unsung mysteries in epidemiological history. However the view is firming that this was Covid1889 (Coronavirus OC43). (Alternatively, it could have been A/H3N8 or A/H2N2 influenza.) Wikipedia, citing a Danish article, says "the 1889–1890 pandemic produced symptoms closer to those associated with COVID-19 (the infection caused by the SARS-CoV2 betacoronavirus) than to Influenza".
In New Zealand this 'flu' circulated from 1890 to 1894, and 1,393 deaths were attributed to it, based on death certificates. This documented toll largely excludes Māori, and by no means includes all Pakeha who died from this pandemic. We also know that the Māori population took its last big hit in the period from 1891 to 1895. Whether covid or influenza, this pandemic was a big deal in New Zealand; a mass death event that fell under the historiographic radar.
Black Flu (aka Spanish Flu)
Could epidemiologists – and politicians and bureaucrats – please refrain from making statements to the effect that Covid19 has been worse (or 'much worse') than influenza?
The 1918 influenza pandemic's lethal second wave took 4.2% to 4.3% of Māori lives ('small' when compared to Samoan lives!). For Māori, it appears to be very much on a par with the previous 'Russian Flu' pandemic, albeit in a more compressed time scale. The cost in lives for 'all ethnicities' in New Zealand was about 9,000; that's a 0.7% toll. While this pandemic was misleadingly called Spanish Flu (Spain was a non-combatant in World War 1, and therefore was better placed to document it), it is best called the 'Black Flu', because many of the victims turned a black colour reminiscent of pneumonic plague. (At the time, bubonic plague was very much on epidemiologists' radars, in New Zealand and elsewhere, with recurrent outbreaks in California.)
This lethal novel H1N1 influenza strain was possibly the result of a hybridisation of two separate influenzas circulating on the western front of World War One; one variant of American origin, and one of Chinese origin. The first wave of influenza in 1918, which hit New Zealand around August of 1918, was nasty but not lethal. It appears to have given immunity to those who caught it, which is one reason why an unusually large number of younger people died, in November in New Zealand, from the lethal second wave. (It's also a reason why it's hard to trace the progress of the virus through New Zealand; while death data is quite good, infection data is at best anecdotal.)
For information on the Black Flu in New Zealand, the standard reference is Geoffrey Rice's Black November (especially the 2005 second edition, available as an e-book). For the global picture, a particularly accessible book is Laura Spinney's The Pale Rider (2017). For a shorter account of that influenza pandemic, topped-up by accounts of subsequent global epidemics (including SARS 2003), see Mark Honigsbaum's 2019 book The Pandemic Century.
Influenza Pandemics from 1957
Surprisingly, Te Ara's Timeline of epidemics in New Zealand, 1817–2020, fails to even mention the 1957 and 1968/69 influenza pandemics as New Zealand events. However, Michael Baker et.al. estimated the New Zealand toll as being 0.0064%, with high a rate of 0.04% for Māori. This overall toll is comparable with Australia's current toll for Covid19.
For 1968/69, the figure.nz chart shows how New Zealand influenza mortality relates to more recent flu seasons. While annual flu deaths were very high for that pandemic (0.05% of New Zealand's then population, for three consecutive years) they were routinely at similar levels in the 1980s, with a sudden dive in 1997 when funded influenza vaccines became available in New Zealand.
The 2009 H1N1 'Swine Flu' pandemic was a non-event in New Zealand. But, as noted in a previous essay, the 2017 influenza season was particularly bad (0.02% of New Zealanders died of it), and was a pandemic in all senses except for WHO's designation. In Europe, some countries had higher mortality tolls from the 2017-18 flu winter than from Covid19 in 2020.
Covid – whether in 1890 or 2020 – most likely affected tropical countries more than these influenzas in temperate lands. But the big novel-strain influenza pandemics also dramatically affect unprepared tropical populations, such as Samoa in 1918.
Covid19 may well be unusually problematic – as was the 1918 influenza – because it may have been a hybrid rather than a mutation. "If a bat infected with one coronavirus catches a second one, the two different viruses may end up in a single cell at once. As that cell begins to replicate each of those viruses, their genes get shuffled together, producing new virus hybrids." (Refer New York Times Newly discovered bat viruses give hint's to Covid's origins, 14 October 2021.) We also note that SARS-Cov1 (Covid02?) was a more lethal virus than Covid19's SARS-Cov2, though less transmissible; Covid19 may have hit the sweet spot – from the virus's viewpoint – of getting the optimal balance between transmissibility and lethality.
(It should be noted that a really significant development of the theory of evolution is the development of hybrid species. I first encountered this when reading Tim Flannery's 2018 book Europe. Then recently, I read Alice Roberts' excellent 2017 book Tamed, which looks at hybridisation and species' domestication. Indeed, humans are a hybrid species, and domestication is a mutual process. An interesting insight is the potential to apply these insights to microevolution, and to think of the present OC43 coronavirus as a domesticate of the original wild virus, and to think likewise of an immune urban human population as a species adaptation.)
Overall, which disease is worse – Covid or Influenza? The only sensible answer is that it is a tie. Neither disease should be downplayed. Both can be lethal in unprepared populations. Please do not trivialise influenza.
Selected References (excludes some media stories already linked to):
Clinical evidence that the pandemic from 1889 to 1891 commonly called the Russian flu might have been an earlier coronavirus pandemic, Harald Brüssow and Lutz Brüssow, Microbial Biotechnology, 13 July 2021
Death by Numbers, New Zealand Mortality Rates in the 1918 Influenza Pandemic, 2006 Fifth Year Medical students: Group E Public Health Project, Otago University [Ministry of Health website]
High Mortality for Māori and Pacific Peoples in the 2009
Influenza Pandemic and Comparisons with Previous
Nick Wilson, Lucy Barnard, Jennifer Summers, Dennis Shanks, Michael Baker [Otago University website]
Deaths caused by influenza and pneumonia in New Zealand, chart by figure.nz, using Ministry of Health data
The history of immunisation in New Zealand, Ministry of Health website
Newly discovered bat viruses give hint's to Covid's origins, New York Times, 14 October 2021 (NZ Herald 15 Oct)
The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris, 2019, by Mark Honigsbaum
Black November: The 1918 influenza pandemic in New Zealand, second edition 2005, by Geoffrey Rice
Pale Rider: The Spanish Flu of 1918 and How It Changed the World, 2017, Laura Spinney
Tamed, 2017, by Alice Roberts
Europe, 2018, by Tim Flannery
Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.