History of major Flu-type Pandemics in India

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The first seven cases of the 1918 Flu Pandemic, referred to as “The Bombay Influenza” or “The Bombay Fever”, was reported on June 10. [“Deja flu” article – The Times of India]. They were all police sepoys at the Mumbai (then Bombay) docks.

Image courtesy : TimesOfIndia

Within two weeks, this flu crippled Mumbai and quickly moved North to Punjab and Uttar Pradesh via railway lines. The flu resurfaced violently in September 1918, believed to have been brought by returning flu-infected World War I soldiers, and quickly spread all over the Indian subcontinent.

It claimed an estimated 10-20 million lives in India, the largest number of deaths in a single country. Just as we knew nothing about SARS-CoV-2 (the COVID-19 causing virus) when it first struck in Wuhan, China in 2019, nothing was known about the influenza virus in 1918. In fact, the influenza was thought to be caused by a bacteria, and needless to say, there was neither a vaccine nor anti-viral drugs.

Multiple possible prevention strategies were discussed in India Sanitary Commissioners Reports from 1918 and 1920 (e.g., “strict isolation, at home, of the first case occurring in a household”, “Personal prophylaxis”, “avoidance of churches, crowded railway carriages, theatres, cinemas and other large aggregations of people”, “regular use of an antiseptic nasopharyngeal douche”) but it is unclear if any of these measures were successfully undertaken.

In fact, Dr. Phipson expressed their apprehension about being able to implement either of these measures in their report from 1918: “No country and no city, which has lain in the natural path of influenza in its pandemic form, has ever succeeded in avoiding its incidence, and in the present state of our knowledge there is no prospect of doing so, except by the imposition of restrictions of such severity that no community could be expected to tolerate them. With a disease of low mortality like influenza, the public prefer to take their chance, and preventive measures on a large scale in Bombay or any other Eastern city demand a degree of public enlightenment and co-operation which is not likely to be realized before the millennium.”

Severe Acute Respiratory Syndrome (SARS) was a multi-country outbreak that was recognized at the end of February 2003. In India, the first SARS case was reported on 17 April 2003 in a person stopping over in Mumbai after visiting Singapore and Hong Kong. According to Wikipedia, only 3 cases were reported in India and no fatality was reported. Middle East respiratory syndrome (MERS) was another multi-country outbreak first recognized in 2012. There seems to have been no reported MERS case in India between 2012 and 2017. [WHO MERS-CoV map and epicurves]

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