Hong Kong flu, the first modern pandemic

In the years 1968-1970, the influenza of Hong Kong made a million deaths around the world in an almost general indifference. In 2020, with the Covid-19, it’s a whole different story. The world and our perceptions have changed. A look at what is considered to be the first modern pandemic today.

Many pandemics have marked our history dramatically. Some were more virulent than others, all had an unknown element when they developed, but according to the times, they left different traces. History has been strongly marked by great pandemics: the Antonine plague, between 165 and 180, killed five million; the plague of Justinian, who left Egypt in 541, claimed the lives of nearly 25 million people around the Mediterranean; the black plague, part of the Black Sea caused, between 1347 and 1352, nearly 200 million deaths, decimating between 30 and 50% of the European population; smallpox killed 56 million people in 1520; cholera, with its six pandemics, killed a million between 1817 and 1923; the dreaded Spanish flu killed between 40 and 50 million between 1918 and 1919, to name only the most important.

Closer to home, our contemporary history confronts us, among other things, with HIV (human immunodeficiency virus – AIDS), revealed in the United States in the 1970s and which has already caused the death of 25 to 36 million people, according to the sources ; tuberculosis, which killed more than 1.8 million people worldwide in 2015 and which is still raging persistently in economically disadvantaged countries. A recent history also marked by the Asian flu, initially identified in the province of Guizhou in China, which will spread throughout the world, in 1957-1958, killing between one and four million people and which will be at the origin, between 1968 and 1969, another lesser-known pandemic known as Hong Kong fever or influenza.

The plague of 1348 in Florence, engraving after a painting by Luigi Sabatelli (1772-1850)
The plague of 1348 in Florence, engraving after a painting by Luigi Sabatelli (1772-1850) Gettyimages

The history of Hong Kong fever

It is an evolution of the Asian flu strain, which appeared 10 years earlier, into the H3N2 antigen that is the source of the Hong Kong flu. This flu probably appeared in Central Asia or China in February 1968 and very quickly became pandemic. In mid-July 1968, it developed in Singapore and then in the British colony of Hong Kong, where it affected 15% of the population.

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At the end of July, Doctor W. Chang warns that ” there are half a million cases in Hong Kong », The disease then takes the name of the port city. Hong Kong flu then spread to Southeast Asia, India, Australia, Japan and reached the northern hemisphere during the winter of 1968-1969. American soldiers returning from the Vietnam War will import the disease to America. In three months, there will be 50,000 deaths in the United States. The pandemic spreads to Europe and in the fall of 1969, France experienced its first peak with 6,000 deaths in January 1969 alone.

In October 1969,the World Health Organization (WHO)organizes an international conference on the flu of Hong Kong with many scientific experts and believes that the pandemic is over. However during this same period, it continued to spread and between December 1969 and January 1970, a second wave, more virulent, swept across Europe and left thousands of people dead. France and Germany then posted an excess mortality rate of more than 40,000 deaths.

Hong Kong flu, which was the third pandemic of the 20th century after the Spanish flu and the Asian flu, will remain underestimated for a long time. It was not until the publication of research by epidemiologist Antoine Flahault in 2003 that the total number of deaths in France was known: 31,226 deaths.

According to the WHO World Assessment, between the summer of 1968 and the spring of 1970, the Hong Kong flu killed one million people.

January 1969. Precautions were taken in Russia with the wearing of surgical masks as the influenza epidemic from Hong Kong crossed the Soviet Union.
January 1969. Precautions were taken in Russia with the wearing of surgical masks as the influenza epidemic from Hong Kong crossed the Soviet Union. Getty Images / Bettmann / Contributor

An undervalued pandemic

Despite its high mortality rate, the pandemic has generated little interest in the West. The era was agitated by other concerns, the world was changing, we were in the general optimism of the Thirty Glorious Years, but also in a Cold War between West and East. It’s the Vietnam War and its contestation, the models of society are questioned by part of the youth. In France, as the historian Patrice Bourdelais explains, we are in the post-68 management, local strikes are multiplying in many factories, Georges Pompidou replaces de Gaulle, we are indignant at the famine in Biafra , but we are nevertheless in a dynamic of progress which means that we are not very worried.

Politicians have other priorities than Hong Kong fever and scientists do not seem to measure the magnitude of the pandemic. In July 1968, the Institut Pasteur spoke in the newspaper The world and comments on the epidemic considering that it does not appear to be of any severity. Doctor Geneviève Cateigne of the Institut Pasteur, cited by Release, said in 1969: ” In France there is no real epidemic. In Europe no longer have. There is no need to panic. This epidemic will certainly evolve like a fairly banal seasonal epidemic.

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Hong Kong flu initially goes relatively unnoticed, with the exception of an article cited by Release, of Time from London on July 12, 1968 alerting to a strong wave of respiratory illness in Hong Kong. But in the press as a whole, no one uses the term “pandemic” which had been used for the Asian flu.

Despite the closure of schools due to lack of teachers, certain shops, major disruptions in transport due to a large number of sick staff, and a sharp increase in the number of deaths, the press treats this epidemic with some lightness , considering, as various newspapers quoted by Releasethat the flu is stationary … that it seems to be regressing … that we should not add to the ills the risks of a collective psychosis … “At the height of the crisis, France-Soir will give the figure of 12 million patients but the flu of Hong Kong will not make the headlines of the time.

The first pandemic of the modern era

For epidemiologist Antoine Flahault, the Hong Kong flu has made history as the first pandemic of the modern era, perhaps because, as defined by Serge Jaumain, historian at the Free University of Brussels, ” it is characterized by its speed of propagation, due to the very rapid evolution of the means of transport and the multiplication of rapid air transport ” But also because it was the first pandemic to have been monitored by an international network and because it is the source of numerous modeling works to predict new pandemics.

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As of September 1968, the viral strain responsible for the influenza virus was isolated by the Institut Pasteur, but there will be no production of effective influenza vaccine and this production will in any case remain very insufficient to protect the population at a time when getting the flu shot is not very common. Yet a vaccine would have saved many lives and we learned from it. As Patrice Bourdelais points out, “ it was from this point that a systematic policy of encouraging the vaccination of the elderly population [contre les grippes] is set up

From Hong Kong fever to coronavirus

At the time of the Hong Kong flu, in the years 1968-1970, life expectancy was not the same but above all, it was socially accepted that if a person over the age of 65 died, it was natural whereas today we no longer accept death.

For the historian of the École Pratique des Hautes Etudes de Paris, Vincent Genin, quoted by RTBF, ” a few years ago, the prospect of dying from an epidemic was frightening but not unacceptable. There has been an evolution in mentalities and today we have reached an anthropological threshold. We no longer accept death. We observe besides in our societies, a disappearance of death and its representation. Movements like transhumanism plead for an increased humanity, that is to say, a humanity which crosses death and becomes immortal. “Serge Jaumain adding that” the cost of human life was probably very different at the time. With the coronavirus crisis, for the first time, societies have chosen life rather than the economy ” Another era…


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