New research from two UTSC Anthropology professors is shedding new light on the way that the Spanish Flu spread across the island of Malta during the pandemic of 1918-19.
Professors Larry Sawchuk and Lianne Tripp recently published The emergence of a suburban penalty during the 1918/19 influenza pandemic in Malta: The role of a marketplace, railway, and measles in PLOS Global Public Health. The article demonstrates that suburban mortality rates from the Spanish Flu on the island of Malta were higher than their urban and rural counterparts, and explores reasons for the disparity.
Malta has many unique characteristics that make it ideal for studying the course of the epidemic. “There is the fact that it's an island, and has a population at this time of only about 100,000,” notes Prof. Tripp. “Because the population is quite contained, it's easier to sort of follow epidemics and people as well. There was low immigration into the island or between communities, so you have a pretty static population that allows you to follow people over time.”
Malta was also a British colony at the time, which means that there are extensive records to aid in research.
“We were looking at the overall mortality rates attributed to the virus,” explains Prof. Tripp. “We were comparing rural, urban and suburban settlement types. You would expect the highest rate in the urban settlements. But that wasn’t the case.”
Professor Sawchuk and Professor Tripp started digging into the mortality rates, focusing on the second wave of the pandemic, during which 80 percent of the deaths on the island occurred. “What we noticed was that overall suburban areas had the highest mortality. When we dug a bit deeper we noticed that there was one central suburban area that had the highest rate of all, right in the middle of the island. The name of this settlement is Birchichara.”
So what caused Birchichara’s elevated mortality rates? “It wasn't a large population, and we concluded things like population density, where you maybe a lot of people are living together in housing or within a room, didn't seem to be a factor,” says Prof. Tripp. “What did make a difference was there was marketplace, where all the farmers would meet with middle men, who would then sell the produce to other people.”
Significantly, Birchichara was also a transit hub. The main rail line ran from the capital, Valetta to Mdina on the other side of the island. The railway transported large numbers of workers to the dockyards in Valetta, particularly during the First World War, to assist the British Navy. “There was a special fare from Birchichara to the dockyards in Valetta, and so there would have been a lot of people on the trains going to and from there. There was even a special carriage just for the workmen. And the spread was pretty concentrated in that carriage.”
Finally, Professors Sawchuk and Tripp also examined the influence that childhood infections might have on the susceptibility to diseases later in life. They noted in Malta there were unusually high numbers of deaths to Spanish Flu in children. They looked at previous epidemics of whooping cough and measles and found a statistical link between childhood measles and influenza. “We think that measles was doing something to the immunity of the children, perhaps the adults too. We found a significance statistical relationship between certain age groups of children having measles and later dying from influenza. Birchichara had the highest rates of these childhood diseases as well.”
Prof. Tripp sees parallels in the spread of the Spanish Flu in Malta to the way COVID spread across the GTA. “We noticed very high rates in the suburbs, especially in the West End, in Mississauga and Brampton, and similar to this situation there were transportation hubs, like Pearson Airport. People working at the airport or going to and from there was one explanation for why we were seeing higher rates in these areas.”
“I definitely think the suburbs are an area that gets generally overlooked in many population studies looking at infectious diseases and pandemics throughout time,” concludes Prof. Tripp. “We find for instance, a lot of people moving from the urban communities out to the suburbs to get away from the crowded areas, but then what was happening is that people were having to commute to work and that was contributing to the spread of the disease.”