Lindy Kato (Writer)

Lest We Forget
1918 is remembered for those that died for our freedom, yet the virus responsible for the so-called Spanish flu of 1918 resulted in more deaths globally than all the wars of the time put together. Have any lessons been learned? Here I interpret the COVID crisis from the perspective of history, science and New Zealand law.
The 1918 flu accounted for some 9,000 deaths in New Zealand, disproportionately affecting Māori with a rate of 50 deaths per thousand, whereas the death rate for Europeans was 5.9 per thousand. Australia had closed their ports and were largely unaffected. Although contagion was well understood and interventions put in place, New Zealand was too slow. Worse still, they exported flu to what was then known as Western Samoa. Almost a quarter of Samoans perished. Māori communities today are well aware of the potential for an inequitable outcome from infection by SARS-CoV-2 commonly known as COVID-19.
When the pandemic reached New Zealand in March 2020, communities responded dependant on their local circumstance, geography, and knowledge. Checkpoints were set up around the country and specifically to protect the Northland Māori communities in Kāeo, Kaikohe, Kohukohu, Mangamuka, Ngataki, Opononi, Panguru, Pawarenga, Rawene, Waitangi, and Waitiki. Each place is acutely aware of their vulnerability caused by isolation from support services and social and health inequities resulting directly from invasion and colonisation. Years of systematic deprivation have concentrated poverty leaving the divide that is evident today.
It isn’t news that First Nation people are at greater risk of death from disease than Pākehā. Europeans have been systematically sieved by disease. My European ancestors survived influenza, smallpox, diphtheria, cholera, typhoid and other diseases because of a poorly understood genetic lottery. Simply put, the most susceptible died and the stronger or less affected survived. Europeans are vulnerable to disease (unless immune by previous infection or vaccination) but more likely to survive because this genetic advantage has been concentrated by filtering throughout the ages.
Europeans lived in squalid cramped conditions frequently directly above their animals. They would throw their ‘potty’ contents into the street, contaminating their waterways. Beer and tea are staple drinks of the British because water was unsafe to drink. These disease-hardened explorers (I am being charitable here) spread sickness around the globe, killing indigenous people in swathes.
Inhabitants of the new lands lived in small groups with few animals amenable to domestication, limiting opportunities for diseases to jump species. European invaders were more likely to succumb to poor health because of inadequate nutrition due to ignorance, than to catch fatal diseases from locals.
Pandemics have swept the globe for thousands of years; the first to be documented occurred in Athens (BC 430) and was most likely typhoid. Four coronavirus variants causing roughly a quarter of common colds have been in circulation for centuries. They are more similar to bird viruses and each would have caused a pandemic when they first acquired human-to-human spread. Modern coronaviruses: Severe Acute Respiratory Syndrome (SARS 2002) and Middle East Respiratory Syndrome (MERS 2012), originated in bats. Bats do not get sick, but harbour many strains of the virus. SARS was very infectious but had a fairly low death rate (10%) and was bought under control via contact tracing and isolation. MERS was more deadly (35%) but less infectious and is still in circulation at low levels. COVID-19 has a low death rate (about 1%) but is exceedingly infectious.
Coronaviruses are RNA viruses; that is, their genetic information is in the form of ribonucleic acid rather than DNA (deoxyribonucleic acid) found in animals. At a molecular level the difference is quite subtle but DNA has sophisticated proofreading machinery – meaning that it is faithfully copied resulting in a stable genome (total DNA). RNA lacks this capability and is unstable because of copying errors (mutations). Errors at the level of RNA can translate into changes to the structural surface proteins that enable the virus to enter the host cell. We need a different flu vaccine each year because flu (an RNA virus) mutates readily. The mutants escaping the effects of the vaccine will be the ones that survive until the following season.
Coronaviruses are RNA viruses with proof reading capacity meaning that they retain stability yet can readily mutate. Another trick that a coronavirus has is that of recombination, it can mix up chunks of its own RNA and steal bits from others. Any antiviral drugs or vaccines showing initial promise are likely to become ineffective over time as the virus mutates resulting in an extended arms race.
A virus very similar to COVID-19 was isolated from a horseshoe bat in 2013, but it is different enough to make it unlikely that the virus was came directly from bats. The ‘spike’ protein of COVID-19 is more closely related to a virus found in the pangolin, but since both animals are sold in the markets of Wuhan, it is possible that two species of coronavirus could combine in the same animal.
Coronavirus is named after the spike proteins that give it the appearance of a halo. These specific surface structures act like an entry key, the COVID-19 spike will bind to the human ACE2 receptor and allow the virus to enter the cell. Many different tissues produce and use ACE2 receptors and people each produce different numbers of receptors in the same tissue. This means some people will let in more viral particles. The number of ACE2 receptors are thought to be higher in people with conditions such as hypertension, coronary heart disease and diabetes, diseases that have become common since the 1960s, related to a move away from a traditional diet where junk food has become cheaper than fresh.
Evidence also suggests that COVID-19 can hijack cells and make them ramp up receptor production, even in cells that usually make only a few. This was described in the New Scientist as having a burglar break into your home through an open widow and then open all the other windows to let in many more burglars. This accounts for the number of unusual presentations where the virus attacks tissues outside of the respiratory system. Children appear more likely to have diarrhoea and vomiting and so go undiagnosed. It may be that by identifying the tissue most affected – appropriate treatment can be started earlier. Some people (including children) will have a lingering illness known as ‘long COVID’ which can have a wide variety of symptom including respiratory problems, brain fog and fatigue. Viral infections can also activate some serious diseases such as leukaemia or autoimmune disorders such as Guillain-Barré syndrome. Spanish flu gave rise to an increase in cases of Parkinson’s disease. NZ researchers at the Liggins Institute have already found an increase in numbers of Parkinson’s and in heart disease above expectations amongst those infected by the COVI-19.
Our own immune response is likely to have caused at least a third of COVID deaths due to what is termed a ‘cytokine storm’. Cytokines cause blood vessels to leak and lungs fill with fluid, it is like breathing through jelly. The patient’s own immune system killed many during the 1918 flu. Some people are genetically predisposed to a cytokine overreaction, which can be treated with early access to good medical care.
It is likely that everyone is vulnerable to COVID-19, though research is currently underway to see if some people have resistance to it. Some people are resistant to HIV by a quirk of genetic fate, so it is within the realms of possibility. Generally those in poor quality overcrowded, multigenerational homes are more likely to catch any virus, more likely to have pre-existing conditions, and have poorer access to health care. So Māori and Pacifica peoples in NZ and the Islands and aboriginal people from Australia, South America, North America and Africa are especially vulnerable because they lack the advantage of the European sieve. Knowing this, in 2020, Aboriginals in Australia and Indian Nations in the USA were placed under what amounted to a curfew ‘for their own protection’.
In Māori Kaitiakitanga provides specifically for the obligation, or stewardship to protect one’s own. Usually we hear it used to refer to environmental protection, for example a rahui is in place over the Mermaid Pools in Matapouri because excessive tourism has resulted in severe degradation. In the case of the checkpoints mentioned earlier, police were seen to be supporting the Māori led activity of restricting entry and exit to vulnerable communities.
Dr. David Williams FRSNZ – (Professor Emeritus and Honorary Research Fellow in the Faculty of Law at The University of Auckland who describes himself as an activist with a respectable job), was invited to speak at NorthTec (now Te Pukenga) in 2020. In New Zealand, the Public Health Act (1956) has a division called ‘Duty to Protect’. He explained that the Police are empowered under the Police Act of 2008 to accept the assistance of the public, and they are required to have ‘a local community focus’. The Police Commissioner, Andrew Costner, was therefore correctly, and legally, in support of the community led action. Iwi and hapū liaising with police demonstrates an example of the Treaty relationship working in a practical way. For local iwi to have been in breach of the offence of ‘obstruction’ they would need to be acting ‘without good reason’, it would be hard to argue that checking movement of potential carriers of a virus likely to cause harm was ‘unreasonable’.
On a local level many rural areas have one resident policeman to protect a large geographic area, it makes sense for the police to take a supportive and educative role, rather than an authoritarian one. Having communities take their own action to restrict movement of people in and out of vulnerable neighbourhoods is very different from the restrictions placed on travel in and out of the reservations of the American Indians or of the Australian Aboriginal communities enforced by their Governments.
Dr. Williams additionally pointed out that it should be of more concern to the citizens of New Zealand that legislation (COVID-19 Public Health Act 2020) was rushed through on May 13th under urgency, giving police powers to enter buildings, including Marae, without a warrant if a ‘non-compliant gathering’ is suspected. The lack of consultation, particularly with respect to the Treaty of Waitangi, was insensitive given the 2017 apology made for the Parihaka incident of 1881 and the Rua Kēnana Pardon Act signed in 2019 less than six months prior to the COVID Act. The Labour Government had also put out a directive in October 2019 that ‘requires policy-makers to consider the Treaty of Waitangi in policy development and implementation’. The COVID Act has a 2 year expiry date but must be reviewed every 90 days. At the end of 2022 some of the provisions (lockdowns, quarantine and managed isolation) were scrapped but until newer legislation can be decided upon, the Government retain the right to impose mask use, seven-day isolation periods, and control border entry requirements. The Act was due to expire in May 2023 but the COVID-19 Amendment Act extended the expiry date to 26 November 2024.
New Zealand could not hold back the virus forever; the lockdowns and border control bought time to vaccinate the majority of the community. China held out longer than most countries but eventually, towards the end of 2022, public outcry forced the Chinese Government to relent and thus put at risk the largely unvaccinated population. Of course the pandemic will remain a threat long into this year and probably the next.
A virus is an opportunist. It will be more successful when its host lives long enough, and remains well enough to spread the viral particles. A virus has a tendency to become less deadly over time but more contagious. The second wave of the Spanish flu was more deadly than the first because it mutated to be better adapted for human-to-human transfer than the first wave of the virus. That second wave was responsible for the majority of deaths in New Zealand. It is likely that despite better treatment, any new successful variant will be responsible for more deaths simply by being capable of infecting more people. The variants in circulation today have all descended from Omicron such is its success. in 2023 the variant dubbed ‘The Kraken’ (XBB.1.5), named after a sea monster originally described in 1700 off the coast of Norway, is just one of many hundreds of variants spawned from Omicron. A variant that is too successful at killing people is unlikely to spread and will ultimately die out.
It bodes less well that there isn’t a cure for the common cold and no ‘herd immunity’ either. Herd immunity is generally said to be where at least 60% of people recovered from the virus protect those more vulnerable, because the virus has less ability to circulate. Ethically it is not reasonable to aspire to herd immunity because many millions would die worldwide. Latest research also throws doubt on lasting immunity and many people are confirmed to have caught the virus twice (or more). Manaus is the state capital city of Amazonas in Northern Brazil. It is in the middle of the jungle and home to more than two million people, however it is estimated that 76% of the population were infected with COVID-19 in the early part of 2020. However a large increase in hospital admissions in January 2021 left them without oxygen to supply the ventilators. It is possible that the original rate of infection was overestimated but more likely that the initial immune response dwindled, reinfection occurred and there were more deaths due to the lack of oxygen rather than any extra competency on the part of the virus.
There are hundreds of vaccines under development, many now aimed at multiple variants. Traditional vaccines work by introducing disabled virus or viral parts to the body. The latest vaccines work by slipping DNA or RNA that will make a protein the same as the coronavirus spike into a harmless chimpanzee virus or lipid nanoparticle. The idea of both is that the human body will recognise the spike protein and produce antibodies to it. Ideally producing long-term memory cells so that when the real virus comes along the appropriate antibody can be rushed into production right away. Those first vaccines will have put the virus under pressure to mutate. Already the new variants seem to have changed the spike protein sufficiently to render the Oxford-AstraZeneca vaccine less protective against them. The good news is that the proof reading capability of the coronavirus means that it will not change as rapidly as the flu virus does.
There has been a great deal of misinformation and huge public outcry resulting in behaviour amongst some people that they would never have recognised in themselves had they not felt so provoked. Much of this was deliberate scaremongering and we now know that false information is entrenched on the Internet where so many people now get their information. The vaccines were purported to be untested but essentially all vaccines are untested initially. The difference here is that many thousands of man-hours (person hours) went into this vaccine and was responsible for saving the lives of thousands even before its approval. Most vaccines are the work of a very few people over decades and it could be argued that much less work went into any of them.
The new RNA vaccines should be simpler to tweak as the spike protein evolves. It is important to keep in mind that developing vaccines are not tested on those that need protecting the most and that some of the vaccines need to be stored at −70° C. This limits the options for countries where such a cold chain is not viable. NZ bought into four different vaccines and plumped for the Pfizer/BioNTech mRNA vaccine though others are available. This has a great safety profile and remains affective against serious illness even though less so in preventing infection. This was to be expected, there are always ‘escape variants’ because vaccination drives the virus to mutate. Not to vaccinate would have delivered millions of deaths.
There is another issue, most RNA viruses do not allow for more than one viral infection at a time but coronaviruses will happily coexist with another virus. The ancient viruses that cause the flu or the common cold are too different to combine with COVID-19 but SARS or MERS are similar enough. The result could be a more virulent virus, more contagious, or not viable at all, but are technically possible given that the global population makes for a very large incubator.
A longer-term vaccine strategy requires development of a vaccine recognising proteins crucial to all of the coronavirus family because they are less likely to be able to mutate. This should have been started years ago in response to SARS or MERS. Some virologists suggested this at the time but the reality is that those infections did not cause enough havoc on the world stage to have the huge amounts of money thrown at them as COVID-19 has had.
Although the world may be in chaos, there was an unexpected fall in the number of deaths in New Zealand during the winter of 2020. Fewer deaths from traffic and workplace accidents could have been predicted because people stayed home, but closing our borders blocked influenza arriving from the northern hemisphere and saved around 1500 lives. This is one reason that some vaccines under development ore flu and COVID combined because with the borders open, flu will be back. The usual parade of snotty nosed kids were absent during 2020 and 2021 resulting in an increase in many common viruses that very young children usually encounter and provide early training for their immune system. How this plays out in the future remains to be seen.
The emergence of a deadly virus has been predicted by virologists for decades but fallen on deaf ears. If we don’t learn from this then it will happen again. We need to stay out of the environment that is the domain of wild animals and live animal markets must be closed but no time has been lost reopening the Wuhan market and history is destined to repeat.

Much of the history of the 1918 flu came from Laura Spinney’s excellent book:
Pale Rider: The Spanish Flu of 1918 and How It Changed the World
https://doi.org/10.1111/padr.12215
Recent information regarding herd immunity (or rather lack of herd immunity) was published in The Lancet:
Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence
The Lancet, Comment, volume 397, issue 10273, P452-455, Published:January 27, 2021
https://doi.org/10.1016/S0140-6736(21)00183-5
The virus information is mostly from my own musings since my PhD topic was the evolution of RNA