How the 1918 Flu pandemic created inequality

October 1918 was the height of the Spanish influenza pandemic in Cape Town, South Africa.

October 1918 was the height of the Spanish influenza pandemic in Cape Town, South Africa.

Published Feb 6, 2021

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Johannesburg - Wills Bunu probably knew some of the soldiers that stepped off the train at the Queenstown station.

They had returned at a time when the mighty German army was on the run, but there would be no celebration that October.

With those troops came a virus that soon would kill hundreds of thousands of South Africans and leave millions more dead across the globe.

It struck on October 10, 1918, not long after those soldiers had returned, when the first Bunu family member, 25-year-old Nosamon Bunu, died in the Cimezile district, just south of Queenstown.

Professor Howard Phillips is a historian and historical epidemics expert and an authority on the Spanish flu pandemic which hit South Africa in 1918/19. SUPPLIED

The Spanish flu virus did not stop there. Two days later Adolphus Bunu, 17, and John Bunu, 40 died.

And two days after that Nomavengi Bunu died, followed a day later by Thomisa Bunu, 20.

In five days the virus had claimed five Bunu family members, and so typical of the killer virus, it had picked off those in the prime of their lives.

The killing continued. On October 24, Wills’s sister three-year-old Canyiwe died.

Then two days after that his uncle Matthais made the journey to Queenstown to register the death of Wills Bunu.

Jonathan Jayes found the tragic story of Wills Bunu as he sifted through 39 482 death certificates that were issued over a 100 years ago, in the Cape Province.

From these documents Jayes, of the Department of Economics, Stellenbosch University, was able to get a unique snapshot of the devastation caused by the virus that killed perhaps as many as 6% of the South African population before it disappeared and was largely forgotten.

“It was especially heartbreaking to see so many young children,” says Jayes of the death certificates that stood out. “And to think how that would have rippled through a whole generation.”

But in those death certificates are glimpses of what is happening today with the Covid 19 pandemic. The current virus is not as deadly as the one of 1918, but its spread has highlighted the existence of racial equality.

From information gleaned from those death certificates, Jayes and fellow Department of Economics, Stellenbosch University researcher Johan Fourie were able to assess the access individuals had to health care.

And it all came down to whether a death certificate was signed by a doctor or not.

“We use the absence of a doctor’s name as a proxy for lack of medical access, or an indication that the patient was not treated by a doctor immediately prior to death”, the authors wrote in an article that appeared as a working paper for the Competitive Advantage in the Global Economy (CAGE) research centre at the Department of Economics, University of Warwick.

What they found was that white residents had a high likelihood of a death certificate with a doctor's name on it both before and during the pandemic indicating, they believe, that they had better access to health care.

In Peddie, 86% of dead white residents had a death certificate bearing the name of doctor, in contrast to 23% of blacks.

This was a time before universal free health care, so money was needed if someone wanted to visit a doctor.

But as the pandemic killed more and more people the health system of the country began to take strain.

The number of times a doctor’s signature appeared on average for whites was 93.4%, for coloureds and 69.8% for blacks, in the years before the Spanish flu arrived in South Africa.

During the pandemic the figures fell to 57.7% for whites, 21% for coloureds and 6.2% for blacks.

The Spanish flu did exacerbate racial inequality, they concluded.

“Those areas which at the time struggled in terms of access are those that still have similar inequalities that we are still seeing today,” explains Jayes.

As the Covid-19 virus has spread so have signs of racial inequality.

In South Africa there is a great divide between private and public health care that the Covid 19 pandemic has exposed.

A test tube labelled with the vaccine is seen in front of AstraZeneca logo in this illustration. REUTERS/Dado Ruvi

Research released on Thursday in the US, by the APM Research Lab found that Covid had killed one in every 825 white Americans, compared to one in every 645 black Americans.

The death certificates were to reveal more about the pandemic that killed perhaps as many as 350 000 South Africans.

A surprise find was that those living in urban areas were worst hit by the virus, even as towns and cities would have had doctors and nurses closer to hand.

“People who lived in towns with a street address had better access to health care before the pandemic, but during the pandemic this reversed quite substantially,” says Jayes.

“And we think this is because the disease would have spread very quickly, where it might have spread a little slower in rural areas.”

They also found that more young black women died in the Eastern Cape than men. As yet they are not sure of the reason for this, although one possibility is that the virus killed a high portion of pregnant women.

In the future perhaps the dead of the 1918 pandemic will reveal more through the death certificates they left behind. But for the moment the researchers hope that by highlighting what happened to Wills Bunu all that time ago, whose death certificate didn’t carry a doctor’s name, will help address the world-wide problem of racial equality during this new pandemic.

“One always has to be cautious that we don't take historical lessons out of context and apply them today. But the purpose of this research was to expose that one needs to keep in mind that there are existing inequalities,” says Fourie.

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