The Great Influenza: The Story of the Deadliest Pandemic in History< by John M. Barry
I know - you’re wondering why Bob in the Basement hasn’t written about a pandemic book in several weeks. The previously considered books, The Stand and The End of October, were fiction; this one is about a real plague.
The Pandemic of 1918, known as the Spanish Flu which it wasn’t, was the worst pandemic ever. It killed more people in a year than the Black Plague did over 100 years. Data collection wasn’t great back then, but 50 to 100 million people died worldwide, with the United States having “only” 650,000 deaths. It was estimated that one-third of the world - 600 million people - were infected by the influenza.
In comparison, today we have 30 million world-wide cases and 930,000 deaths. In the United States, there are 6 million cases and 200,000 deaths. Even if we double or triple those numbers, our current malaise pales in comparison to what happened 100 years ago.
It was a much bigger deal than our pandemic.
The author makes a pretty good case that the disease started in Kansas at Camp Funston, an army base. Initially, the virus (they never figured out that it was a virus until long after the pandemic had ended) was spread from camp to camp, and then via troop ships traveling back and forth to Europe for World War 1.
It wasn’t just the military that was spreading the flu. Much of the disease’s contagion among civilians could be traced to commercial ships that would carry infected crew members from port to port.
The fact that we were at war in 1918 really boosted the seriousness of the plague. One problem with containing the virus among the military was that the demand for troops for WW 1 (2 million sent overseas) led to great overcrowding of military facilities and troop ships. That made physically distancing soldiers impossible, even though doctors did realize that keeping people apart from each other was the best way to reduce contagion.
Boston played a prominent role in the disaster because it was the major receiving port for soldiers returning from Europe, many of whom were infected. That put an unsustainable burden on local hospitals. Many of the soldiers were transferred to Fort Devens where the infected ones infected others. The fort, built for WW 1, was designed to hold 36,000 men but held 45,000 in very crowded conditions. The virus spread rapidly, overwhelming the 1200-bed hospital. Doctors autopsied some of the victims and found that the lungs and respiratory systems were really messed up; this was no ordinary flu.
Other soldiers went to other cities, including Philadelphia, which ended up with perhaps the worst outcomes related to the disease. Philadelphia had a very corrupt local government, really crowded slums, and huge manufacturing plants where workers were literally right next to each other for ten hours a day. These elements made the City of Brotherly Love the City of Pandemic Pandemonium.
The local boss, a Republican state senator, ran everything for the benefit of his cronies. His health commissioner was, to be polite, a hack. Despite warnings from the medical community, which had seen what had happened in Boston and Fort Devens, the government refused to take any action to slow the pandemic. A major local paper, the Evening Bulletin, constantly reported that the disease posed no danger to Philadelphia. The board of health – owned by the political bosses – advised residents to avoid danger: “Stay warm, keep the feet dry and the bowels open.” Always good advice.
Around the same time, the city was planning a huge parade to raise awareness about buying Liberty Bonds to finance the war. By now, doctors knew that crowds spread the disease so having hundreds of thousands of people congregating for a parade was not a good idea. Despite that, the health commissioner gave the go-ahead. The results were a disaster.
Within five days, hospitals were overwhelmed, all public meetings, schools, churches, whatever, were suspended. Soon, 500 to 800 people were dying each day, with a total of 16,000 deaths due to the flu over a few weeks.
New York City also demonstrated how not to deal with a pandemic. In January, 1918, Tammany Hall, the notorious political gang, took over the government, bad timing as it turned out. Getting a good job depended on one thing: loyalty to the boss. The health commissioner wasn't a doctor, and he didn’t believe in science. His job was to dismantle the health department. (This may sound familiar to some.) The commissioner refused to heed medical professionals' calls to shut down the city to control the virus. New York City had 33,000 deaths due to the pandemic and the incompetence of its politicians.
Challenges One problem with the pandemic was that no one ever figured out what caused it, so developing a treatment was impossible, and there were no therapeutics available that worked. You basically treated the symptoms, prescribed bed rest, and hoped for the best.
Another problem was that no one developed a vaccine for it, although there were hundreds of efforts to produce one. Researchers in Illinois came up with two dozen on their own, none of which worked. Since doctors never figured out what pathogen caused the infection, there was no way to create a shot to prevent it.
One continuing issue was the same as we have had with our pandemic – there was a constant shortage of personal protective equipment (PPE). There is some evidence that wearing masks was not very effective at preventing this infection, although that was better than nothing, but there weren’t a lot of masks available anyway.
Another difference between then and now was that no one paid much attention to “flattening the curve” which essentially meant slowing down the infection rate so as to not overwhelm treatment capacity. There wasn’t any serious social distancing, and there was a shortage of masks and little inclination among the public to wear them. As a result, hospitals and medical providers were soon overwhelmed. The bad news is that many people could not get treatment; during the second, more fatal wave, lots of people died without medical attention. The good news is that the virus was only around for 10 to 12 weeks each cycle. It went away for a while and then came back after an antigen shift to do its thing once again. While the pandemic technically lasted two years, almost all of the action was between March 1918 and April 1919.
A final, major challenge was that the disease morphed over time into three diseases. The first outbreak in March and April, 1918, infected a lot of people (mainly soldiers), but it was mild; almost no one died. After two or three days of not feeling well, the patient was as good as new. The second phase, in the fall of 1918, was much deadlier, with thousands of people dying each day. The final phase was in late 1918 to nearly 1919. It was was not as deadly as the fall flu but worse than the spring outbreak.
The presidency and the pandemic One interesting similarity to our COVID-19 situation is the impact of the presidency on the course of the disease. President Trump delegated dealing with the outbreak down to the state level, and he has consistently voiced optimism about the course of the outbreak while minimizing the seriousness of the pandemic.
Woodrow Wilson was president during the 1918-19 outbreak which coincided with our country’s involvement in WW 1. While Wilson was very reluctant to join the fray, he was all in after we had declared war in April of 1917. We didn't send troops over until the spring of 1918 when the plague erupted. Wilson was insistent that there be no delay in getting our troops over to Europe, and his administration resisted any pleas to slow down troop dispersal and socially distance the soldiers on the ships. Overcrowded transports greatly increased the infection rate, with many of the vessels becoming death ships, with hundreds of bodies routinely being buried at sea.
One irony here is that more American soldiers were evacuated from the battlefront with influenza than with wounds. Another irony is that the war was essentially over by the time we were involved in actual battles since the German army had been decimated by the plague.
Wilson also was a big booster of the war on the home front. He was fixated on maintaining high morale among Americans. Realizing that acknowledging that there was a deadly pandemic afoot would be a bummer, he had his health care people pretty much ignore the plague. Wilson never mentioned it. The US Surgeon General, Rupert Blue, was pretty useless. He turned down requests for research money to find a vaccine, probably because of his belief that this was just the flu, no big deal.
Governors and mayors across the land were being swamped by the disease and asked for federal help. In September, 1918, Governor Samuel McCall of Massachusetts formally requested help from the federal government. Finally, Blue decided to use federal funds to pay for nurses and doctors. The problem was that by then there weren’t too many medical professionals available and the virus was out of control. He had waited too long to act.
Positive consequences of the pandemic
— Scientists got better at cultivating pathogens and bacteria and at doing the research needed to identify what caused diseases.
— Researchers began to talk to each other. The pandemic got rid of a lot of the silos that characterized medical research back then.
— Elected officials took public health departments more seriously as a result of the plague. It would be hard to have taken those agencies less seriously than did the leaders of New York City and Philadelphia in 1918.
— International institutions such as the World Health Organization were created to become clearinghouses for information about serious diseases.
The bad consequences Obviously, the horrendous death toll and infection rate were bad, but the overwhelming percentage of people recovered from the sickness. One lingering problem was that many survivors suffered mental illness – delirium, depression, agitation, fear – all of which sound like what we know of today as post-traumatic stress disorder (PTSD). Suicides increased after the pandemic faded, another possible consequence of PTSD. Some studies found an increased incidence of Parkinson’s Disease among influenza victims.
It is likely that once our pandemic has receded, many people will still be paying a price for what we did and didn’t do to deal with it.
Hitler and the pandemic of 1918 Perhaps the most damaging outcome of the disease didn’t happen until the 1930s when the Nazis came to power. One can make a pretty good argument that events related to the plague led to Germany’s post-war demise and Hitler’s ascendancy.
After Germany surrendered on the 11th hour of the 11th day in the 11th month in 1918, Great Britain, France and the United States - the winners - had to negotiate the peace treaty. Wilson was consumed with establishing the League of Nations, an international body to resolve differences before they led to war. He was the good guy who didn’t want to embarrass Germany with an onerous treaty. Lloyd George of England and Georges Clemenceau of France (two Georges - how neat is that!) were more hardline, no surprise since their countries had suffered much more in the war. France had 1.3 million soldiers killed and 600,000 civilians dead, and Great Britain had 700,000 military and 600,000 civilian deaths. The United States had 120,000 dead, the majority caused by non-combat situations. Germany lost 2 million soldiers and 700,000 civilians.
In late March of 1919, the players were negotiating. Wilson was pretty much going it alone, with no staff, no secretary of state and no Colonel House, a trusted adviser who came down with the flu and was out of action. Despite that, Wilson was in the driver's seat since the US was an emerging power that the world respected.
In early April, Wilson took sick with the influenza, whose existence he had ignored throughout his presidency. He came back to the negotiating table a few days later but he was a changed man. He had lost his fastball. As Herbert Hoover, a major player in the post-war recovery effort, observed, Wilson’s mind had “lost its resiliency.” Wilson’s advisers noticed a big difference in their boss’s approach to crafting a deal. He basically caved in to the extreme demands of Great Britain and France, including massive, impossible reparations by Germany. The resulting Treaty of Versailles emasculated Germany and set the stage for Hitler and World War 2 and the Holocaust and all of the related evil of that war.
The Germans, who had trusted Wilson to negotiate a deal that left them some dignity, were aghast that he had betrayed them, but he had. A host of future figures in American history –Christian Herter, Samuel Eliot Morrison, John Foster Dulles, Walter Lippman – denounced Wilson and the treaty. It is clear that Wilson was sick with the virus while caving in on the treaty, a bad deal that lit the slow fuse to set off World War 2.
Bob’s Take
This is a very dense, detailed book of 546 pages. I thought that I was back in grad school. The first hundred pages set out the evolution of the medical profession, starting in Ancient Greece and ending after the pandemic receded. One of the author’s main points is that the plague helped the United States medical system mature and become more professional.
Fun Fact: In 1870, when Harvard established its medical school, you could flunk 5 out of 9 required courses and still get your MD degree. Bob in the Basement could easily flunk 5 courses and get that degree! Say “Ahh!”
The rest of the book is compelling. It basically documents how unprepared the world was for the pandemic, just like today. I, like the author, hope that we all will learn from our COVID-19 experience that we need to get serious about the next pandemic before it gets here.
Barry’s main point is that a lot of people lied/trimmed/ignored reality in the 1918 pandemic. That led to incalculable suffering, much of which was avoidable if leaders had taken the threat seriously. As Barry says, “For if there is a single dominant lesson from 1918, it is that governments need to tell the truth in a crisis.”
The last two paragraphs of the book offer good advice: "Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart."
