1918 is the year in which the First World War ends and the world begins to be plagued by one of the great pandemics of the 20th century: the so-called “Spanish flu”, an influenza that in two years killed between 25 and 50 million of people and infected more than 500 million human beings.
In small Costa Rica, a nation with less than 500,000 inhabitants, the disease raged in 1920, in March, precisely a century ago, a fearsome month.
The so-called Spanish flu wreaked havoc in the country exactly 100 years ago: it left almost 2,300 dead, canceled theaters and dances, postponed the school year and tested an incipient health system …
Abroad, the pandemic, believed by some to have originated in the United States, others in China and some in France, struck troops in combat, move between soldiers and the population affected (civilians and workers) by the war, and it advanced unstoppably across the planet.
Why was it called the Spanish Flu? Not because it arose in Spain or because it was the country hardest hit by the pandemic, but because the Spanish media were the first to report sick people with this influenza.
In the First World War, Spain was neutral, while other countries involved handled the information about the sick with great secrecy during the war so as not to affect the morale of their combatants.
The “foreign flu”, as it was said in the then Tica (Costa Rican) press, entered Costa Rica through Limón, our main port, where the vapors loaded with merchandise from abroad and passengers from places infested with the virus arrived and followed the route of the Atlantic trains to spread throughout the national territory.
The population came from the Tinoco dictatorship (1917-1919), in which mortality increased and life expectancy decreased. It had food problems, village doctors had been eliminated; there were many places without sewers, there was no Ministry Health. We were affected by typhoid, malaria, dysentery and other diseases.
On February 22 it is news in the national newspapers that influenza was raging in Limón; however, virus sufferers had begun to be detected earlier.
“Dr. Antonio Facio in charge of the Limón Hospital, owned by the United Fruit Company, attended to the first cases ten days before the news, his opinion was that it was benign. The Hospital registered the admission of some 45 cases, 4 with fatal outcome, who had arrived with bronchopneumonia and other complications, advanced anemia, and malaria. Dr. Rubén Umaña, Head of Health, and the other doctor in the city of 6,628 inhabitants attended to 80 patients,” says Costa Rican historian Ana María Botey in an article about this epidemic in the Journal of Latin American Studies Americania.
Population in poor condition
“Let’s remember that the population was not in the best conditions. It came from the Tinoco dictatorship (1917-1919), in which mortality increased and life expectancy decreased. The population had food problems, the village doctors had been eliminated; there were many places without sewers, there was no Ministry of Health. We were affected by typhoid, malaria, dysentery, and other diseases. There were serious hygienic problems in the poor neighborhoods ”, explains Botey, when talking about this epidemic that she has studied a lot.
According to the press and documents of the time, the Government put a budget to clean the different areas and provide medicines to village doctors and civil society organizations. In addition, the population was asked to improve hygiene, remove animals from their rooms, clean and whitewash lots, and clean ditches.
The Higher Health Council was created to deal with the disease.
“The first proposal of the medical community was to establish a Higher Health Council, since there was no centralizing body, but health issues were the concern of the municipalities located in the head of each canton and various dependencies of the Sub Secretariat of Police: the Department of Ankylostomiasis, the School Health Department and town medications,” the historian details.
The residents of Turrialba, Cartago, San José, Heredia and the rest of the country fell sick, which is known from the reports of the village doctors requested by the Ministry of the Interior. In the poor neighborhoods, the mustard and vinegar poultices used to disinfect were no longer available. “They were very poorly prepared,” says Botey.
March came and it was a very hard month. The dead and infected increased. Given the gravity of the situation, the Council affirms that it is a national emergency, therefore the measures were tightened, although people were upset with many of the provisions.
“Among the first initiatives taken, after issuing the necessary instructions for the public to learn to recognize influenza, the symptoms, and treatments, at the beginning of March, the closure of theaters and temples was ordered, no major gatherings of more than 10 people, dances and paeos (walks), as well as the postponement of the school year that started on the first Monday in March. News of the disease’s progression continued across the country. This measure was criticized by different sectors, including those expected by the operetta companies that would perform at the National Theater,” Botey wrote in her investigation.
History repeats itself; any resemblance to today may not be coincidental.
The teachers were a real battalion during the national emergency.
Despite the suspension, religious activities, the patronal festivities continued, which was widely criticized in the newspapers.
The national emergency became official on March 9. The call was to contribute to the general well-being and that “teachers, doctors, pharmacists, nurses and volunteers” join the Health and Relief Boards in order to support hygiene and sanitation issues in the municipalities. These boards collected funds to help respond to the emergency and distributed medicines, disinfectants (creolin and formaldehyde, for example) and food with the help of their volunteers.
“The teachers were a real battalion,” says Botey.
An emergency hospital was also opened in San José, run by Anita Tristán and attended by nurses Anita Cantillano, Leonor de Espinosa, Adelina Mora and Marta Pacheco. It was located in a girls’ school in the capital city.
With all the measures taken, 2,298 people were killed in the country due to the Spanish flu, in March 1920 alone there were 1,200 deaths from this epidemic, according to data from the Memoria de Gobernación, published in 1921.
Why so many deaths?
There were no health institutions, no adequate health infrastructure, and no such precise measures to prevent contagion, as they do now, explains the historian.
After this national emergency, which lasted until April 1920, important initiatives emerged: in 1922 the Sub Secretariat for Hygiene and Public Health was created, in charge of Solón Núñez, and in 1923 legislation with the characteristics of a health code was enacted.
This article was translated from La Nacion’s Ancora “El temible marzo de 1920: hace un siglo, Costa Rica afrontó el peor golpe de otra pandemia”. Read the original article (in Spanish).