All language subtitles for BBC.The.Flu.That.Killed.50.Million.1080p.HDTV.x265.AAC.MVGroup.org.eng

This programme contains some scenes
which some viewers may find
upsetting

November 1918, Armistice Day.

Around the world, people celebrate
the end of four long years
of conflict.

But there's another horror
unfolding in the shadow of war.

A deadly virus sweeping the world.

Schools and theatres are shut down.

Coffins are piled high.

The flu pandemic kills
over 50 million people.

Many of them die cruelly.

She'd finally drowned in her
profuse, thin, bloodstained sputum,

constantly bubbling froth.

CHILDREN SING

Only by going back
to rare and previously unseen
letters, diaries and memoirs

of those who fought the pandemic,

can we fully understand
what happened.

HE COUGHS

Just try and breathe.

The heroic efforts of nurses
and doctors.

Fateful decisions of key officials.

The relentless needs of warfare

justify the risk
of spreading infection.

The experiences of the ill
and the dying.

My grandmother tells me
my mother has gone to Jesus.

But I want my mummy.

Hidden in this personal testimony
are clues that can benefit us today.

What if the apocalyptic 1918
pandemic were to recur?

That's a scary prospect.

Pinpointing the lessons learned
and mistakes made in 1918

will help prepare us
for the next global outbreak.

Everybody would agree that another
flu pandemic will happen.

And what 1918 does is illustrate
to us how bad it could be.

CHILDREN SING

January 1918.

The Western Front.

Alexandra Jamieson of the Royal
Scots is one of the 1.5 million
British soldiers in the trenches.

He's volunteered, keen to fight
for king and country.

But the talk is of death.

I feel terrible.

I'm 19.

Only been here five weeks and
apparently I'm going to be killed.

But how am I going to be killed?

There's activity everywhere
and shouts to put on our gas masks.

Between the smoke
from the German shells,

many of which are gas shells...

..and the fog...

GUNFIRE

..it's grim.

But soldiers such as Jamieson
will soon face something
more lethal than war.

A horror from nature that will kill
ten times those who've died
fighting.

It draws no distinction between
soldiers or civilians.

Take Ada Berry.

This spirited seven-year-old lives
in a terraced house in Manchester.

# Smile, smile, smile...

Ada's father does all he can to
protect his daughter from the
hardships of war.

# Smile boys, that's the style...

Dad is in his khaki uniform and
there are other soldiers visiting

and having sing songs
n the parlour.

My sister Flora playing for them.

But every day intimacy will soon be
fraught with danger.

Meanwhile, in London, Dr Basil Hood
takes on the omnibus

to the busy hospital
that he runs in Marylebone.

For Hood, the war years
are exhausting,

his wards short-staffed because
so many of his doctors and nurses

are in France treating the wounded.

But the deadly virus is about
to rip apart all these lives

and millions like them
in the trenches, on the streets
and in homes across Britain.

Most scientists now believe the flu
wasn't born in Europe,

but 4,000 miles away.

It all starts in a remote farm
in Haskell County, Kansas.

The bird flu virus naturally lives
in waterfowl.

Only with close contact between
people and birds can the virus
make the crucial jump into humans.

Come on, girls.

At some point, a wild bird influenza

passed their virus
to a farmed animal.

Good candidates for that are ducks,

possibly chickens, possibly pigs.

And that animal is going to pass
their virus onto a human.

In general, humans have a lot more
contact with the farmed animals

and in it goes.

Albert Gitchell has just been
conscripted into the US Army.

Gitchell arrives at Camp Funston,
Kansas,

the second largest training
base in America.

56,000 recruits in crowded barracks
and tents.

Grub's up, boys?

Soon, Gitchell is working
in the kitchens.

Being a camp cook he probably comes
into contact with lots of other
soldiers.

They're all queueing up
to get their food and it's, eh,

almost like he can dish out
his virus to them all.

Albert Gitchell is Patient Zero.

One of the very first infected,

he's thought to have kick-started
the whole pandemic in March 1918.

But before the virus
can become lethal,

it needs to change further,
to mutate.

In every soldier it is capable of
mutating and getting a little bit
better.

So that's very much
a random process.

The virus throws up these random
mutations, like rolling a dice,

and if it gets lucky,
then the right combination comes up.

And then ramps up into a full-blown
airborne transmissible

pandemic flu virus.

The new virus, more deadly and more
contagious, rips through the camp.

Within three weeks
1,100 men are seriously ill.

38 young soldiers die.

Way more than expected
from normal flu.

One of the officers thought,
"There's something wrong here,

"this is not the kind of flu
that I'm used to dealing with."

And so the officer wrote to the
government in Washington and said,

"This is more sinister than
anything I have seen before."

But his warnings were ignored.

The new virus can now spread
from Kansas,

hiding inside infected troops,

to ports on the eastern seaboard.

25 transport ships carry US troops
across the Atlantic in March 1918.

At least one incubates
the deadly disease on board.

The ships dock at Brest in France.

Trains take soldiers to the front.

By April, flu breaks out
in the trenches.

Soldiers and medical staff
are taken by surprise.

Nurses like Sister Katharine McPhee.

HE COUGHS

Just try and breathe. That's it.

Almost immediately
we start taking in the wounded
and people that have flu.

We're kept very busy
and it's a most depressing time.

Sister McPhee is at a casualty
clearing station just behind
the front.

She's seen plenty of war wounds,
but this is different.

Patients' faces, their ears,
their lips,

turn blue as the flu
destroys the lungs from inside.

Many die rapidly.

It's been just 40 days since Patient
Zero caught the flu in Kansas.

Scottish Private Alexander Jamieson
is nervous.

There's an epidemic of flu.

People are being carried away
steadily from the signal section,

being carted away to hospital.

In the crowded trenches, he himself
is at risk of catching it.

Either from the breath
of an infected comrade,

or touching a contaminated object.

They didn't even know
what a virus was, really, in 1918.

But, of course, today we now know
that influenza,

as the respiratory disease,
is caused by this virus

we call Influenza A, erm,

and this is what it looks like.

These things are so tiny that I
could get 100,000 of them

across my fingernail.

Each one of these little round balls
is an influenza virus,

and once one of these gets inside
your nose or throat,

inside a single cell of your body,
it will generate perhaps a thousand,

10,000, 100,000 of itself, copies.

As the virus replicates
inside Jamieson's airways,

he shows the classic signs of flu -
headache, fever, clogged lungs.

HE COUGHS

I feel terrible.

My head is bursting.

He struggles to stay conscious.

Calling Company HQ.
Calling Company HQ.

My head feels like
a threshing machine.

The next thing there is a voice
saying,

"You know what happens to a man
who's found asleep on duty?"

We shoot them at dawn!

"He's shot at dawn."

To save his neck, Jamieson
has to persuade his captain

that he is genuinely ill.

Ill with a disease that's killing
more people than the fighting.

Over 300,000 British troops
will become infected and 10% die.

Horrifying figures repeated
across all the armies.

We can't send them down the line
because they're too ill to move

and we've ever so many deaths.

The boys are coming in with colds
and a headache

and are dead within
two or three days.

Great big, handsome fellows,

healthy men just come in and die.

Some of the seriously ill in France
are sent back to Britain
for treatment.

Other apparently healthy soldiers
on leave also carry the virus.

They're contagious,
even before any symptoms appear.

Starting in the Channel ports and
then to London, the virus follows

railways and roads,
crisscrossing Britain.

Hidden inside its human host.

Two months after the flu
hits the trenches,

the first cases appear
in Manchester.

It is June 1918.

The doctor responsible
for the health of the city

is James Niven.

Niven worries about the children
because they, and the elderly,

are usually the most vulnerable.

An epidemic of influenza is bursting
on the city of Manchester,

flaring up
with extraordinary rapidity.

The children are simply dropping
on their desks,

as if their roots are poisoned.

If you are in very close contact,
or touching somebody,

of course you can directly exchange
some secretion, saliva etc.

You then have the fairly
close contact through droplets,

large droplets, which are exhaled
or coughed and sneezed out.

And for those to actually infect
another person you'd need

the person to be pretty close,
less than one metre for sure.

And therefore, it's not surprising
that people living

in very densely populated areas
are much more likely to catch flu
from one another.

To fight the flu,
James Niven tracks the outbreak.

The flu spreads across
the entire city simultaneously.

But the North
is most severely affected,

more crowded and industrial.

In just six weeks,
over 100,000 are infected.

This report on the epidemic of
influenza is written by James Niven.

It's clear that he sees this
as being something exceptional.

He says the epidemic flared up
with extraordinary rapidity.

So, what this suggests is this is
not the kind of ordinary influenza,

if you like. It's not the kind of
influenza one sees most winters.

James Niven wants to close down
schools and Sunday schools

to slow it down.

But some feel
this is an overreaction.

There are managers who decline
to close the schools.

An announcement is also given
in the press that Sunday schools
should be closed.

It is difficult to understand
the perversity of those who
withstand this request to close.

It's quite clear that he was
incredibly frustrated with people

who continue to keep
these schools open

or continue to send their children
there, regardless of the risk
of being infected.

I issue a leaflet of precautions,
30,000,

distributed to a number of works
in the city, to the press
and in houses.

500 large posters are put up
in conspicuous positions
throughout the city.

In Manchester, James Niven is doing
more than anyone in the country

to actively fight
this deadly pandemic.

But for the young Ada Berry,
the warnings come too late.

It's Sunday. I'm put to bed.

I have this great, big headache

and I tell my mother
to stop the others crying.

It's making my head hurt.

At St Marylebone Hospital
in London,

Dr Basil Hood does his best
to fight the pandemic.

Hood worries his staff will catch it
from patients.

Doctors already know conventional
flu is infectious, so rightly assume

masks also help stop
the new influenza.

Where are your masks? Come on.

When a mask is taken off
it is thrown away at once

and a new mask used.

Better masks can be used, but there
is no-one left to make them.

This is a memoir by Basil Hood.

And I've always found this
profoundly moving.

He really shows what it was like to
deal with the thick of the action.

Because while he was doing his work
as a doctor,

trying to run a busy hospital,
that was overwhelmed,

he was also losing
friends and colleagues.

And that, to me, is very moving.

The corridors are now swamped
by 200 new patients

from nearby Paddington Hospital.

The place literally reels.

We could not be worse placed to
deal with an epidemic. The sick,

the labour, the distress,
it's horrific

and it hardly bears thinking about.

Not only is there an influx
of cases,

some are critically ill
because of the influenza pneumonia,

but the staff are dropping like
ninepins, nurses, domestic porters,

practically none of which
can be replaced.

As chaos sweeps through
the hospitals,

the question is how the government
will respond.

Sir Arthur Newsholme is the most
senior medical officer at Whitehall.

He's the person best placed
to help protect the whole country.

In my official capacity I have
prepared a memorandum for public
use.

It listed the official advice,
what to do in the event of

a recurrence of what they then
called epidemic influenza.

To isolate yourself at home
if you're sick,

avoid crowded public gatherings
where you might spread the disease
to other people.

And they were also very big
on not sort of spitting and coughing
in the street.

But on the balance of consideration,

its distribution is not considered
expedient at this time.

There are...

..national circumstances in which
the major duty is to carry on.

The main reason he gave for not
issuing this memorandum was because
of the war.

We need to keep munitions workers
in these factories,

we need to keep the trains, the
Postal Service, the omnibuses
running.

So Arthur Newsholme used this phrase
which you now see emblazoned

on T-shirts to this day - carry on.
We have to carry on.

The relentless needs of warfare

justify the risk
of spreading infection,

and the associated creation of
a more virulent type of disease.

Whichever way you cut it, there's no
doubt Arthur Newsholme's decision

not to issue that advice cost lives.

I think you could say safely,
thousands.

By summer, the flu virus has already
spread through France,

Germany and Britain.

It invades other European countries,
including Spain,

and an early victim is the king
himself, King Alfonso XIII.

Spanish newspapers started
speculating about it
and talking about it openly.

They were able to do this
because Spain was neutral.

There was no censorship.

It was impossible to discuss in
Britain because it was felt

by the authorities that an open
discussion of the new flu

could lead to damage to morale.

So very quickly, foreign
correspondents based in Madrid

labelled the flu, the Spanish flu.
OK?

Eh, and, you know,
that name just stuck.

Only a small proportion
of the people infected with this
strain of flu actually die.

The majority recover, including
young soldier Alexander Jamieson.

My flu must have cleared up.
I don't remember any more about it,

but, I mean,
you're so tough physically,
you just throw these things off.

During August 1918, the pandemic
finally appears to be receding.

The flu no longer
terrorises soldiers.

And the tide of war turns
in favour of the Allies.

We go up again to Ypres. We don't
suffer a great many casualties.

At the end of the first day you can
look ahead and see the trees

and all the rest of it that's
never been affected by the war.

It is just unbelievable.

We know then that things
are going well.

Back in Manchester, James Niven,

the doctor doing so much
to counter the flu,

tracks the slow-down
of the pandemic.

Niven actually had a degree in
mathematics, so I think

probably even more than most
medical officers of health

who had to keep statistics, he
was very attuned to those statistics

and it's clear he recorded them with
some accuracy and also with some
flair.

Niven turns individual tragedies
into valuable statistics.

Cases like Ada Bury, who's been
seriously ill but is now on the
mend.

The disease appears to have sunk
into quiescence by the 3rd
of August.

There'd been this sort of sudden
outbreak of flu at an unusual time

of year,
in the May and early summer.

But then, you know, the case numbers
drop right down.

And people thought
they'd dodged a bullet.

The war governments
feel fully justified in censoring
news of the pandemic.

Civilian life returns to normal.
But for how long?

In September,
the flu virus returns.

And it's mutated into
an even more dangerous form.

For the second time a US army camp
is the crucible.

Just outside Boston is a massive
training camp, Camp Devens.

The flu starts in the barracks.

Soon the infirmary is overflowing.

This time the virus kills
more quickly and violently.

To investigate the outbreak,
the army calls in brilliant research
scientist Dr William Welch.

This is from the second specimen.

Many more fatalities may be expected
before the epidemic has run
its course.

The deaths at Camp Devens
will probably exceed...500.

He's intrigued by a soldier
who came in coughing up blood

and dies in less than a day.

23-year-old male.

Welch has the body opened up
to try to find out more.

Tray.

The lung is heavier than normal. Mm.

Must be at least a cup and a half of
fluid there. No wonder he
asphyxiated.

He's shocked. The lungs are even
more destroyed than those damaged
by poison gas.

This must be some new kind
of infection.

Or plague.

They saw all this fluid
in the lung spaces.

The main function of the lung
is to take oxygen and deliver it

to the blood, and then the blood
pumps it around the body.

And if blood does not have
any oxygen in it, it goes bluer.

So this blueness of the lips,
the ears, was very obvious.

And then their outcome is going to
be fatal, more or less.

William Welch argues the camp
should be immediately isolated,

but his commander overrules him.

The experience at Camp Devens
may be fairly expected to occur
at every large cantonment.

New men will almost certainly
contract the disease.

Once again, blinkered officialdom
fails to contain the virus,

and this second version of the flu
is unleashed on the world.

The second wave was more deadly
because the virus had become

a better human virus. And I think
that allowed it to transmit

more efficiently to more people.

But also the change
in the virus sequence,

making it better at infecting
human cells, beefing it up,

is probably contributing
to the increased lethality
in the second wave.

29th of September 1918.

More, ever larger transport ships
are setting sail for Europe.

The Leviathan,
a converted cruise liner,

is ready to depart from New Jersey
with 9,000 troops.

A deadly cargo is hidden on board.

The second wave of flu.

What we have here is an image
of the American doughboys
sailing over to France.

What's striking about this image
is the number of men

that these ships carried.

They were generally
over capacity by 50%.

So these were stacked with soldiers,

and the ideal conditions for the
spread of influenza, a disease ship.

Down below.
Keep coming, keep coming.

Colonel Ernest Gibson commands
the 57th Vermont Pioneer Infantry.

Stow your gear where you can.

He's worried
even before the ship sails.

The victims of this epidemic fall,

as they are unable to carry
their heavy packs.

On board the transport,
men continue to be stricken.

"While the embarkation troops
were lined up on the big pier,

"some of the dropped helpless
on the deck.

"A number of men had fallen
by the wayside, limp and listless,

"on their march from the camp
to the scene of the transportation.

"Our first death was recorded
on the next day out."

Hundreds of men on the ship
would never reach the front,

never get to write home
of their fears and hopes.

Casualties not of war,
but the pandemic.

Also travelling to France
are 200 nurses.

US Army nurse Mary Dobson catches
the flu as the ship departs.

You've terrific pain
all over your body,

especially in your back
and in your head, and you just feel

your head is going to fall off.

The odour is terrible
in the ship's infirmary.

I've never smelt
anything like it.

There is no-one spare
to look after us

because hundreds of troops go
down with it as well.

THEY COUGH

The new virus is spreading
to the rest of the world.

It's truly a global pandemic now.

This flu often hits the colonies
of the Imperial powers first,

emerging where ships arrive.

The pandemic in India begins
in the port city of Bombay and,

thanks to the railways,
quickly spreads through
the rest of the country.

India was one of the worst affected
countries, if not THE worst
affected.

Probably killed
about 70 million people.

Compared to, certainly to Britain,

the mortality rate was about
four times greater in India.

This flu is turning out to be
more deadly than any other pandemic
in history.

Scientist William Welsh
is desperate to find out
exactly what this flu is.

There was a lot of confusion.

Scientists really didn't know what
agent was causing this disease.

But the favourite candidate
at the time was a bacteria,

Pfeiffer's bacillus.

If I could just ask you
to spit in here, sir. That's it.

So, in 1918,
they took sputum and they cultured

whatever was in it on an agar plate
in their laboratory.

And all sorts
of bacteria grew in it,

because there's all sorts of
bacteria in our nose and throat
the whole time.

The bacteria they find are only
responsible for secondary
infections,

such as pneumonia,
not the actual flu.

The real culprit, a virus,
is a thousand times smaller
than bacteria,

making it extremely hard
for scientists of the time
to study the flu.

People didn't really know much about
what a virus was.

They didn't have the methodologies,
the technologies,

everything was a little bit
hit and miss.

And so if you don't even know
what the causative agent is,

erm, how scary must that be?

Without identifying the true killer,
scientists can't develop
effective drugs or vaccines.

And doctors and nurses rely
on the most basic of treatments.

Hot drinks such as Bovril, bed rest
and opium to suppress coughs.

Meanwhile, the second wave of flu
spreads unchecked

through the Leviathan, as it voyages
across the Atlantic.

By October the 3rd, they're halfway,
taking the southern convoy route.

As the epidemic rapidly progressed,
the hospital was immediately
filled up.

So, they started trying to find
isolation beds,

separate from the healthy population
in other parts of the ship.

First in E deck then in other cargo
holds such as F deck.

In F deck, In the Leviathan report,

there are up to
nearly 900 men in there.

The U-boat menace means that every
portal has to be shut at night.

And the air below decks,
where the men sleep,

grows hot and heavy.

The number of sick increases
rapidly.

COUGHING
You'll be all right, son.

You have to remember
that the Leviathan,

like any ship going across
to France, was blacked out.

Inside, outside, no lights on,
not even a cigarette.

COUGHING

Pools of blood from severe nasal
haemorrhages of many patients

are scattered throughout
the compartments.

And the attendants are powerless
to escape trekking through the mess

because of the narrow passages
between the bunks.

The decks become wet and slippery.

Groans and cries of the terrified

add to the confusion
of the soldiers,

clamouring for treatment.

And altogether,
a true inferno reigns supreme.

HE READS: "Things seem to grow worse
instead of better.

"Cleaning details were demanded of
the army, but few men responded.

"There is no organisation
for control.

"The nurses made a valiant effort
to clean up,

"but always against
tremendous odds."

As it becomes evident that this ship
is being engulfed by a terrible

plague, this also explains the fear.

To see your fellow soldiers
suffering from something

that had never been
encountered before...

Flu was a mild disease -

it's not supposed to do this.

If this is influenza,
it's a strange kind of influenza.

Many die.

They want to take the bodies
to Brest

and bury them in military graves,

but we are on the southern group,
and it is very hot.

They have to take all the food
out of the refrigerator

and put bodies in.

COUGHING

Even before the Leviathan completes
her voyage,

the second deadly wave of flu
is reaching London.

It's now autumn 1918,

and conditions at Basil Hood's
hospital have deteriorated further.

At the end of October, we lose
our first nurse to the influenza,

nurse Armitage.

And by November the 7th,

I have to record the death
of four more nurses.

Sister Walker....

..Nurse Hunt...

..Nurse Ireland...

..Nurse Giles...

The last of whom was with us
for just four days.

The new strain of flu kills rapidly.

CLATTERING

One poor nurse with a terribly acute
influenza and pneumonia had become

so distressed that she cannot stay
in bed

and insists on being propped up

against a wall by her bed.

Until she finally draws in her
profuse, thin, bloodstained sputum,

constantly bubbling forth.

I know she is doomed
and that her end is near,

so we do as she urgently desires us,

making her as comfortable
as possible.

Back in Manchester,
young Ada Berry has recovered,

but her mother is now critically ill
with flu.

And since Ada's father
has caught it too,

there is no-one left at home
to look after her.

My mother is watching me as I get
dressed and go with Auntie Annie.

She looks so sad.

I thought because I am leaving,

but now I think it is because
she probably knows

she might never see me again.

Ada's mother dies the next day.

Unlike other types of flu,

this time children often recover
while adults are more likely to die.

Also in Manchester, James Niven
tracks the flu casualties,

far higher than the first wave.

A real calamity
has befallen the city.

Great difficulty occurs
in getting the dead buried,

partly due to the lack
of grave-diggers,

partly due to the difficulty
in getting coffins.

Bodies are left as long
as a fortnight unburied.

Niven continues to pioneer ways
of fighting the pandemic.

We are also loaned a film
on influenza called Dr Wise.

This is shown in a number of cinemas
in Manchester.

Precautions like this ensure
Manchester is less severely hit

than other cities.

I think it's probably likely
that hundreds of lives,

possibly thousands of lives

would have been saved
by what Niven was doing.

All around the world,

people do their best to cope
with the flu pandemic.

Public entertainment is curtailed.

If people go out, they wear masks.

People are keeping calm
and carrying on,

but they are still wearing
these strange white gauze masks.

It reminded me of early sci-fi,

as if some strange alien virus
had arrived on Earth,

and everybody was just trying
to carry on as normal.

WHISTLE BLOWS

The Leviathan is approaching
the coast of France,

but the situation onboard
is anything but normal.

Of the 9,000 soldiers,
2,000 are seriously ill.

Nearly 100 are dead.

The Leviathan arrived
on the 7th of October.

In Brest, there was,
well, continuing chaos.

There was an urgency
around dealing with the dead.

Now, some of the dead had already
been embalmed and put into caskets.

A few of the dead
had been put overboard.

And the sick, when they disembarked,
had to make their way to a hospital,

which was a full two miles
away from the port.

And of course many died.

When we get to France, I am put
in charge of the flu cases.

Because I've had the flu,

they thought I'd be immune
to the infection.

But half the men we are nursing

have been brought in
straight off the boat.

They just die within 24 hours
after they get there.

The cemetery is just up the hill,

and every morning you can hear
the bugle blowing

as they bury the bodies.

It is gruesome.

It really is.
BUGLE BLOWS

But one country on the other side
of the world

decides to take drastic action.

The government of Australia
nervously observes the tentacles

of the virus spread towards them.

In October 1918,

they seal the entire country off
from the outside world.

The Australians made sure that any
ship that was arriving from other

countries was kept in quarantine
for a long period in time,

and they maintained a very strict
vigilance over the people who were

embarked from the ships
into the quarantine station,

to make sure there was no cases
of influenza.

The quarantine
is the first international attempt

to stave off the flu
and saves thousands of lives.

But elsewhere,
the flu continues to rage.

The armistice is declared at 11am,
on the 11th of November, 1918.

Alexander Jamieson,
still at the front,

has survived the horrors of battle
and the Spanish flu.

We've gone to bed in a hayloft,

and a sergeant comes in and shouts
that the war is over.

Everybody gets up, we go into this
wee village, and it's inhabited.

The owner opens up his pub
and issues free drinks.

MERRYMAKING

What they don't realise is that the
killing is about to accelerate.

COUGHING

CHEERING

The crowded streets,

the hugging and kissing are perfect
vectors for the virus.

Armistice celebrations,

instead of celebrating the fact
that the war was over,

were simply making it possible
for the Spanish flu to spread.

Some families suffered
the cruellest of blows,

losing loved ones to war
and then the pandemic.

Catherine Garvin is in London
with her mother for Armistice Day.

Fantastic news.

As the crowds celebrate,

for the Garvin family,
a tragedy unfolds.

SHE COUGHS

On Armistice Day,

she's crying and crying through
all the rejoicing and saying,

"It is too late for me."

The doctor had been in the morning
and said she was better.

But on the eve
of her 43rd birthday...

..her heart gives up and she goes.

My father finds her
as she lies in bed.

The flu piles tragedy upon tragedy.

He has lost a son
at the Battle of the Somme.

He is inconsolable.

Ada Berry has already lost
her mother to the flu.

Now her father dies, too.

And her young brother, Noel,
also perishes.

Two more of her close-knit family
killed by the flu in as many days.

There were the black horses with the
plumes made from ostrich feathers,

then the gun carriage with Dad's
coffin covered with the Union Flag.

My mother's coffin was
in a big glass hearse,

with Noel's coffin
under the driver's seat.

My grandmother tells me
my mother has gone to Jesus.

And I say,

"Jesus has got plenty of people.

"I want my mummy."

In London, Doctor Basil Hood
struggles to keep his hospital

running through
this terrible pandemic.

I am finding it increasingly
difficult to get about the place,

as some 15 or 16 rounds a day
are required of me.

All the work has to be done
at top speed.

And the stress and distress,
all coming at the end

of four and a quarter years of war.

I become incapable of continuing.

Hood's collapse turns out to be
exhaustion rather than influenza.

But his time away leads
to important changes.

In my absence, my deputy feels it
necessary to engage

three more medical officers,
and two of these are women.

This is the first time women doctors
have ever been engaged

in the infirmary.

He was not only impressed by this,
but proud.

The importance of this occasion
demands their names be recorded.

Elizabeth and Marcella Kelly.

The Spanish flu brought around
an enormous amount of social change.

Not only did it bring women doctors
into hospitals,

but the organised response required
to deal with the pandemic led to the

creation of the Ministry of Health.

In January 1919,
the flu starts to decline.

And over the first half of the year,
the number of victims falls.

500 days after the virus
first appears,

the pandemic is ending.

The pandemic killed
at least 50 million people,

possibly as many as 100 million,

which, compared with any pandemic,

is, you know, absolutely staggering.

The death toll of the pandemic

dwarfs the death toll
from the First World War.

We're probably talking about
ten to one, I would say,

at the very least.

In terms of death,

there are few comparisons.

I mean, the standard comparison
is with the Black Death,

but the Black Death really affected
continental Europe.

This affected the globe,
and it did so in the speed of...

..of months rather than years
or decades.

The success of the disease
has become its own worst enemy.

By July 1919,

the virus has infected pretty much
everyone in the world it can.

But as time goes by,

the number of vulnerable
or susceptible people decreases

because they have already had
that virus and their immune system

remembers that and protects them
against it when they encounter it.

So the pandemic itself
will almost burn itself out.

Take Alexander Jamieson.

Once he's had the flu,
he's protected.

Survivors help end
the spread of the disease.

The virus has also changed,
evolving to become less deadly.

To be good at transmitting,

it's no good if you kill your host,

because that host
is not going to transmit on,

so actually what you see
with nearly all viruses is,

as they become accustomed
to their new host, they calm down,

they become less dangerous
in the new host,

because that gives them a longer
chance of transmitting onwards,

and they are better adapted.

The virus has mutated into
a form similar to normal flu.

The pandemic type
has all but disappeared.

But could the killer return
100 years on?

What if the apocalyptic 1918
pandemic were to recur?

That's a scary prospect.

Of all the major disasters
that could befall the human race,

I think pandemic is the most likely.

And it's growing more likely
all the time.

This is a copy of the UK
Pandemic Influenza Response Plan,

and the impact could be a 1918-type
pandemic with severe illness

in young, healthy adults, which of
course would be pretty devastating,

or it could be
a pretty mild pandemic.

And in some ways, you have to plan
for the worst case scenario,

because if that one comes
and you're not ready for it,

then, you know,
then you're in big trouble.

Planning for a modern pandemic
has built on the work of pioneers

such as James Nevin.

More might have been done
to limit the spread of the disease,

and the public health authorities

might be expected
in future outbreaks to press

for further precautions to be taken.

Contrast Nevin's approach
in Manchester

to that of Sir Arthur Newsholme,

responsible for the whole
of Britain.

You tend to be remembered for
the big mistakes, and, you know,

his failure to intervene
more vigorously in 1918,

in the pandemic, was a mistake.

Even today, there is always a risk
of someone making a catastrophic

mistake because other factors
cloud their judgment.

Some aspects of a modern pandemic

will make it more dangerous
than the one of 1918.

Colonel Gibson's hellish voyage
across the Atlantic

took eight long days.

The story of the Leviathan
is a microcosm

of how soldiers converging in Europe
brought the virus with them.

But the flu will not travel by ships
any more,

it will travel by planes
and by other means.

So the potential for a virus
to travel fast and further

is a reality here and now.

A new virus could crisscross
the globe in 24 hours...

..making a quarantine
like that of Australia in 1918

almost impossible to sustain.

But medicine has improved enormously
in the last 100 years.

Doctor Basil Hood had
no effective drugs to counter flu.

Most of what he and his nurses
did was palliative.

If we look back from 2018 to 1918,

some significant things
have changed.

The vaccines we have against it
and the therapeutics that we have -

antibiotics against things
like pneumonia,

which killed most of the soldiers
at the time.

The science of influenza
has also advanced.

Back in 1918,

William Welch couldn't possibly know

the cause of human flu was a virus

that originated in waterfowl...

..and that it jumped from
a farm animal to a patient zero.

Nor did doctors understand why
the flu killed healthy adults,

yet so often spared the children.

Ada represents in many ways
a typical demographic.

Her mother got ill,

and eventually her father
also got ill,

and they both died.

Ada survived.
Although children fell ill,

they tended to survive,

whereas adults might get
more serious illnesses,

but all were exposed
to the same virus.

Science now has an answer.

What we do know about the 1918 virus
is that it's a virus which can kick

off a thing called
the cytokine storm,

so this is where your own immune
system does more damage than good.

It ends up damaging organs,

and people with the very fittest
and best responding immune systems -

young, healthy adults -

were the people who reacted worst
to the virus.

This cytokine storm is driven by
high levels of virus replication,

and today we have anti-viral drugs
that help calm this storm.

So how bad
could a modern pandemic be?

In 1918, about 3% of all the people
infected with flu died.

This is called the fatality rate.

A worst case modern pandemic
is estimated to be 1%.

It's reassuring to say that we do
have ways of dealing with influenza

pandemics today,
which were not available in 1918.

But I think that if we saw anything
like, you know,

a 1% case fatality rate,

then it would be
a terrible experience for everyone.

If a third of the British public
caught a deadly new flu,

then a 1% fatality rate
results in about 200,000 deaths.

We hope that
with the various plans in place,

with the mitigating strategies,
antibiotics, antivirals, vaccines,

good communication,

public health plans in place
to stop spread of disease,

even with a serious virus emerging,

the idea behind all of these plans

is that that sort of case
fatality rate would not be seen.

But the ever mutating nature of the
bird flu virus means the threat of a

killer flu enveloping the world

will long remain
our number one health risk.

# I opened up the window
and in flew Enza... #

This nursery rhyme, influenza,
they talked about it being a bird.

They had no idea, of course,
that influenza was an avian virus.

So history doesn't always echo,
but it rhymes.

So here's a great example
of history rhyming, in a way.