Newsletter - Winter 2020

This month's feature article:

Maternal & perinatal mortality in the Spanish Influenza pandemic 1918-1919

In this current pandemic of COVID-19 (SARS-CoV-2) it is easy to think that the health risks to Australia have never been more dire. In pregnant women there is understandable anxiety about the risks to them and their unborn babies.

However in the first 3 months of this pandemic from March to June 2020 there have been no COVID 19 Australian maternal deaths and few SARS_COV 2 infections amongst the pregnant Australian population. By 10 May 2020 the COVID-19 pandemic had infected 3.7 million people worldwide and killed 261,000 in 187 countries.

The Spanish flu which began at the close of WWI in Spring 1918 on the other hand infected approximately one third of the world population (~500 million) and up to 100 million died. Several factors probably contributed to the high prevalence and death rate: malnutrition with low immunity, poor hygiene, overcrowded accommodation, no available antibiotics, no ventilators, poorer understanding and availability of effective quarantine controls. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. In the US one study of 101 pregnant women presenting with pneumonia in Cook County Hospital in Chicago doctors found that the maternal death rate was 51.4% compared with 33.3% in the non pregnant population. In general the women were of low socioeconomic status. Half of the women died in the first 24 hours and 73% within 48 hours. Of those 52 women who died fetal death also occurred in 39 cases and in the 49 surviving women 21 went into premature labour or miscarried. Two babies born alive also developed bronchopneumonia within 24 hours of birth (probable vertical transmission). A US Navy nurse described the daily ordeal of Spanish flu in these words:

The morgues were packed almost to the ceiling with bodies stacked one on top of another. The morticians worked day and night. You could never turn around without seeing a big red truck loaded with caskets for the train station so bodies could be sent home. We didn't have the time to treat them. We didn't take temperatures; we didn't even have time to take blood pressure. We would give them a little hot whisky toddy; that's about all we had time to do. They would have terrific nosebleeds with it. Sometimes the blood would just shoot across the room. You had to get out of the way or someone's nose would bleed all over you.

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