From the plague to Spanish flu:

Coronavirus not first time health officials call for isolation

Malulani Hospital in Wailuku, which became Maui Memorial Medical Center, was established by St. Marianne in 1884.

The coronavirus is not the first deadly scourge to come ashore in Maui County to cause death and wreak havoc on daily life.

From the time Capt. James Cook arrived to the overthrow of the Hawaiian Kingdom, the Native Hawaiian population collapsed from nearly 1 million to 40,000. So serious was the threat of disease that in 1840, King Kamehameha III adopted a law punishing anyone who knowingly violated the quarantine law with hanging.

By 1850, the Kingdom had instituted a Board of Health that was given very broad powers to prevent the spread of disease as well as the power to provide relief to those affected by quarantines and sanitary cordons.

The Board of Health system of managing infectious disease continued when Hawaii became a territory. Its first big test was the bubonic or “Great Black” plague outbreak late in 1899. Bubonic plague was not well understood and the board had near absolute authority to contain and eliminate it in Hawaii.

The board focused its attention on Honolulu’s crowded Chinatown, with controlled burning of buildings where deaths had occurred. Then, on Jan. 20, 1900, unexpected winds caused a controlled fire to jump and 38 acres of downtown Honolulu burned down over the following two weeks. Additional controlled burns, including the burning down of Kahului’s own Chinatown, occurred as the plague appeared on Maui.

Isolation wards were set up at Malulani Hospital during the Spanish flu outbreak on Maui.

The bubonic plague quarantine was lifted in April 1900.

Maui suffered isolated child deaths from diphtheria until 1910 when Russian immigrants to Honolulu brought an outbreak to Hawaii. By the end of 1910, an outbreak in Makawao caused the territory to close schools and temporarily quarantine the entire Makawao district. Unlike the bubonic plague, a treatment for diphtheria was known and administered which, The Maui News reported, brought the death rate down from 60 percent of infected children to 10 percent. The quarantine ended, but diphtheria continued to persist with occasional outbreaks until the vaccine was available and widely administered.

Around the same time, the county set aside land and funding for a public health farm at Keokea to address the so-called “Great White Plague,” or tuberculosis. The Farm, eventually named Kula Sanitarium, was to be used to isolate and treat tuberculosis patients. The Maui News reported in 1919 that “Kula San” had 100 residents with a wait list of 200 more. These histories of contagion should have readied Hawaii authorities to address a bigger threat.

In 1916, a particularly fatal illness had been affecting British and French troops on the Western Front. When the United States entered World War I in 1917, hundreds of young men from Maui volunteered or were conscripted into the U.S. Army to fight in Europe and would encounter the illness. Because Spain was neutral during the war and did not have press censorship, the outbreak of the disease was widely reported there, and this new illness became known as the Spanish flu.

By July 1918, Oahu military camps reported over 600 soldiers infected with the illness that was being described as similar to “la grippe” — an older French term for influenza.

Ephraim Ezera, a native of Ulupalakua and private in the Army, died at Schofield Barracks that July.

In mid-January 1919, the Spanish flu epidemic arrived in Maui. Over 300 schoolchildren in West Maui were out of school and the hospitals were overflowing with patients. The following week, hundreds of discharged soldiers returned from Europe via Honolulu, landing in Lahaina and Kahului. Hamakuapoko and Paia reported outbreaks.

The Board of Health closed movie theaters, churches or any public gatherings in closed buildings. The County Fair was canceled. The public was encouraged to ventilate closed rooms, to routinely wash hands with soap and to avoid hand-shaking.

Within a week, 1,500 new cases were reported. The county sheriff divided Wailuku up and systematically searched every house — discovering dozens of cases not previously reported. Lahaina and Hamakuapoko seemed to have reached a peak at that point while Hana, Makawao and Kula were just beginning to show signs of outbreak. A controversial decision was made to keep schools open as a way to detect spread of the disease and to better control it.

In mid-February, nearly 3,500 cases of infection and over 50 deaths had been reported. Puunene had become a hot spot while Hana and Keanae had contained the spread. School absences due to illness were reported at 50 percent and many school teachers were also sick. Half of the county police force was out sick. By the end of February, the number of cases stood at 4,500. The Board of Health lifted restrictions on theaters, churches and public gatherings.

In March, the number of infections had slowed and the peak for each outbreak area had passed. Some, however, were concerned about a recurrence, as was occurring in many other places.

The following January saw infections of the Spanish flu suddenly reappear in Wailuku. Plantations and the government immediately performed a systematic search of homes in the camps to identify the sick and implemented isolation wards at Malulani Hospital and established a field hospital at the Armory. Within two weeks, nearly 500 cases of infection and 15 deaths had been reported. But because of the quick action, in the weeks that followed, the number of infected did not significantly increase and by February’s end, the field hospital was closed.

Oahu was not so lucky. The second wave hit Honolulu much harder. Filipino and Japanese sugar workers had joined together to strike for better wages and working conditions. Management responded by evicting over 12,000 workers from plantation housing, sending many workers and their families into the crowded tenements of Honolulu. Over 1,200 Spanish flu deaths in Hawaii were members of striking families.

In March, a resident physician of Ualapue, Molokai, reported that people were flocking to Molokai to escape from the flu or recover from it. He noted Molokai had 90 cases and lacked facilities to care for sick visitors. He also asked that even visitors, who were not ill, not come without ensuring they had a place to stay. By April, leeward Molokai’s outbreak had peaked at over 250 cases.

In all, nearly 2,400 people died of Spanish flu in Hawaii between 1918 and 1920. The death rate impacted Native Hawaiians the hardest at 11 percent mortality, Filipinos at 6 percent mortality, Japanese at 4 percent mortality and Caucasians at under 3 percent.

Mortality was highest in children under 5 and people over 60 years old, and lowest for children 5 to 19.


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