There are several excellent reviews of the book including the one in NY Times. So I will try to capture here 10 startling insights as described in the book about the 1918 pandemic and observe potential relevance for us today.
10. How many again?!
Textbooks teach us that approximately 20 million died during the Spanish Flu. John Barry cites modern epidemiologists as citing the number to be 3X plus. That is, in the 50 - 100 million range. That is more than any pandemic in history including the black plague of Europe in the middle ages.
9. What has Spain got to do with it?
Nothing, it turns out! Most origin stories cite a farm in Kansas for this strain of Influenza. During World War I, countries at war were directing their press not to report on the flu. Spain was not involved in the war and was reporting on it. Thus the flu being reported by Spain, became the Spanish Flu.
8. Why did Wilson give in to Clemenceau at Versailles?
After the World War I armistice, Lloyd George of the UK, Woodrow Wilson from the US, Georges Clemenceau of France and Emanule Orlando of Itay were the negotiators. Wilson took a hardline that Germany would be treated fairly with Clemenceau on the other side wanting to impose severe reparations. However, Wilson fell ill. In text books we learn that he had a stroke and indeed his presidency was never the same again. In this book, John Barry details several medical observations by prominent scientists to conclude that Wilson also was struck by influenza and that it impacted his mental faculties. So much so that Wilson dramatically and suddenly agreed to all of Clemenceau's demands.
7. World War I is the forgotten war ... how about the 1918 pandemic?
John Barry describes our aversion as humans to discussing disease. We talk about wars, victories and defeats. We seldom discuss diseases and nature's destruction. If we compare movies made, books written, museum galleries and monuments dedicated to war - anything comparable written about events related to people lost due to disease pales in comparison. We just don't want to talk about it! Indeed a startling insight from this book is that in any given war, more people die due to disease than actual battlefield fatalities.
6. How many epidemics have we had since 1918?
This is truly startling. 60+ since 1918 and 70+ since 1900. The list is below.
5. How on the ball are we?
If we are to criticize and complain that our leaders are not moving fast enough, wait until you read the accounts of how slowly everybody moved during the 1918 pandemic. At that time germ theory of disease was relatively new. There is a gripping separate story in a different book about how around this time President James Garfield who was struck by a bullet and lay infected refused to be treated by the White House doctor in accordance with the new learnings about infection by sanitizing hands etc. The US was just beginning to get its act together in medicine. Communications were nowhere near where we are today. If we imagine an exponential curve, the world got to act way much up the exponential curve than we are today, thus incurring those dramatic number of fatalities.
4. How did we respond while waiting for an actual cure?
I suppose desperate humans do desperate things. But I could not help shake my head in weary recognition at the kinds of remedies that were being pushed by profiteers as well as the desperate. They included enemas and in one instance the promotion of Vicks Vaporub.
3. How about the science?
Germany was in the forefront of biological sciences at this time. The recent founding of Johns Hopkins University, the Rockefeller Institute of Medicine (now Rockerfeller University) started engaging US scientists. This part of the book was truly thrilling. The conclusion I drew from the book was that one major shift that happened post 1918 was the total revolutionizing of American Medicine and American research including the founding of the NIH. The other part of the political revolution that also contributed to progress in American Medicine was the death of President Garfiled and the White House team turning a deaf ear to innovators like Thomas Edison and others.
2. Why not from pandemic to super-pandemic?
This was a startling and a terrific scientific insight from the book. The viral contagion is typically due to single strand RNAs propagating themselves and mutating. And a typical attribute of the RNA mutation is it is rapid and pretty much uncontrolled. So as the book explains, some of these mutations are lethal. However, the mutations "revert to the mean" where they effectively become harmless. Thus if we are lucky enough to survive a pandemic as a species, like the 1918 one, the likelihood of another immediate pandemic is not immediate. But it is certain in the future!
1. What are waves in a pandemic?
This was my single most startling insight from the book. This of course is no news to an epidemiologist. But to a lay person like me,who looks askance at the annual flu shot, this was a genuine wake-up call!
As the picture below shows, the 1918 pandemic had 3 waves:
First, It is worth looking at the dates in this graph - remarkably similar to ours.
Second, the astonishing size of that second wave and it appears in the Fall of 1918.
Finally, this time next year - a third wave!
Of course, we need to get through the pandemic we are in in the spring. But we have epidemiological data for every one of these spreads - these multiple waves. So it is not new to us by any means.
My question or us to ponder is the following: Why aren’t we talking about and genuinely preparing communicating and organizing our communities against these upcoming waves, not just the current one we are in?
Note: List of epidemics since 1900:
2009 Dengue fever Bolivia
2009 Hepatitis B India
2009 Dengue fever Queensland, Australia
2008 Cholera India
2008 Dengue fever Brazil
2008 Dengue fever Cambodia
2008 Cholera Chad
2008 Hand, foot and mouth disease China
2008 Bubonic plague Madagascar
2008 Dengue fever Philippines
2008 Cholera Vietnam
2008 Cholera Zimbabwe
2007 Ebola Congo
2007 Cholera Ethiopia
2007 Cholera Iraq
2007 Poliomyelitis Nigeria
2007 Dengue fever Mexico
2007 Cholera Somalia
2007 Ebola Uganda
2007 Cholera Vietnam
2006 Cholera Luanda, Angola
2006 Plague Congo
2006 Malaria India
2006 Dengue fever India
2006 Chikungunya virus India
2006 Dengue fever Pakistan
2006 Dengue fever Philippines
2005 Yellow fever Mali
2005 Dengue fever Singapore
2004 Leishmaniasis Afghanistan
2004 Cholera Bangladesh
2004 Dengue fever Indonesia
2004 Cholera Senegal
2004 Ebola Sudan
2003 Plague Algeria
2002 Severe acute respiratory syndrome (SARS) Worldwide
2001 Cholera Nigeria
2001 Cholera South Africa
2000 Dengue fever Central America
1998 Nipah virus infection Malaysia
1996 vCJD Worldwide
1996 Meningitis West Africa
1994 Plague India
1984 Plague Western Sahara
1977 Smallpox Worldwide
1974 Smallpox India
1973 El Tor Italy
1972 Smallpox Yugoslavia
1972 Influenza A virus subtype H3N2 United States
1971 Poliomyelitis Netherlands
1968 Influenza A virus subtype H3N2 Worldwide
1961 Cholera (El Tor strain) Worldwide
1960 HIV/AIDS Worldwide
1957 Influenza A virus subtype H2N2 Worldwide
1952 Poliomyelitis United States of America
1949 Poliomyelitis United States of America
1947 Cholera Egypt
1946 Bubonic plague China
1946 Relapsing fever Egypt
1946 Poliomyelitis United States of America
1942 Malaria Egypt
1937 Typhoid fever Croydon, United Kingdom
1924 Pneumonic plague Los Angeles
1918 Influenza A virus subtype H1N1 Worldwide
1918 Typhus Russia
1916 Poliomyelitis United States of America
1915 Encephalitis lethargica Worldwide
1910 Bubonic plague China
1903 Bubonic Plague India
1903 Bubonic plague Fremantle
1902 Cholera Egypt
1900 Bubonic plague San Francisco
1900 Trypanosomiasis Uganda
9 comments:
Very good insights. I did not know that Wilson gave in to Clemenceau at Versailles.
Regarding your question, I think for those who look at it politically and can get away with willing it away will. Those who believe they will have have severe economic consequences, will take action rightly (Europe, India) and wrongly (Iran?)
Very informative. Like everyone, I hope we finally take these lessons seriously now.
And here’s another interesting angle on this – how far we have come since then in terms of biological science (we hadn’t yet discovered the organisms we now call viruses). Accordingly, we didn’t discover the cause of that pandemic until the 1930s.
And then there’s today’s medical technologies…
Given the advancements in real-time peer-to-peer communication that exists today but didn't exist then, one hopes the future waves will be less severe as the ones depicted above
Amazing. Great info. Wilson having the flu. The three waves is scary. As also talked about with COVID-19. And second wave could come right in middle of general election
This is a terrific summary of a very important book. I remember reading it in 2004 shortly after the 9/11 Commission finished its work. More importantly, I remember learning that President Bush read the book (ah, the good old days when Presidents read books!) and ordered the National Security Council to prepare a plan to deal with a pandemic. At first they resisted, but the President persisted and a plan was prepared. It was used for SARS, MERS and Ebola. Sadly President Trump’s National Security team thought the threat was exaggerated. So, we didn’t prepare.
Another important book by John Barry was the 1997 “Rising Tide” that told the story about the 1927 Mississippi River flood. In that case we believed that if we kept building higher and higher dikes this would force the river to flow faster and the river would actually get deeper. Before the Civil War James Buchanan Eads had becoming wealthy salvaging river boats using large diving bells that enabled him to see that the dikes were actually doing the opposite of what the Army Corps of Engineers believed. “Rising Tide” is another story of unskilled people with power ignoring the advice of highly skilled people with knowledge.
Thanks for reminding me about “The Great Influenza”. Thanks to Audible I can listen to it. I hope you and your family are safe.
This is excellent. Learned from you (but I’m also immediately putting the book on my to-read list). Thanks.
By the way, if you’re ever considering an encore career, you’ve got one as a reviewer. Now books, movies next?
Really well done. Disturbing content but great. Thx for the share!
Super Interesting!
Amazing insights. The treaty of Versailles point blew me away especially.
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