The Great Influenza

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“Oh, it’s just influenza”–millions of people, some of them quoted in this book

So now during this 2020 pandemic I have not just read Great Novels and comics, but have delved for almost the first time into non-fiction books about medical history. I read Crisis in the Red Zone by Richard Preston about the 2014 Ebola Crisis centered in West Africa; I read the novelistic account of the medieval plague, A Journal of My Plague Year by Daniel DeFoe, I reread the fictional but moving The Plague by Camus, and now this (though I may also read David Quammen’s Spillover still before I am done).

My main take-away from this book: I will never ever glibly decide not to get a flu shot ever ever again. My basic argument against getting one historically was that the vaccine make-up seemed to me, a non-scientist, a kind of guesswork,as it covers only some random strains (and I just have never liked getting shots).

This book reminded me that anywhere from 50-100 million died from particular strains of Influenza 1918-1919. The numbers are sketchy because a lot of people were dying at the time, public health (and medicine, epidemiology, science research) was less developed, and people didn’t have our (very.very useful, trust me) obsession with counting the dead and dying we have today. But now we know it was at least 50 million and probably closer to 100 million, but let’s just say it was 50, in comparison to today’s population, that would be like 72 million had died in the last year and a half. Though we are still not yet into the second wave, really, so our worldwide numbers of deaths could well exceed a million (or many more).

This book is really two books. A generous way of thinking of it is that it puts the “Spanish Flu” pandemic in the context of medical history, which is to say that it is as much about the still fledgling fields of scientific research and medicine we need to help us survive as a human race as it is a history of that particular pandemic. Barry romanticizes people like William Welch for playing a key role in modernizing the field of medicine in the US, and he names other key players in the development of various related fields needed to prepare us for surviving future pandemics, but none of these folks figure in all that much in the story of the pandemic itself, as they didn’t discover a cure or really impact the massive death rate. The book does give us a sense of how we need to fund science research in the area of pandemics because Covid-19 is by no means the last one we will see.

This argument happens in the last third of the book,which returns us to the development of medical research, which is as I said pretty disconnected from the middle of the book, the second whole book, on the history of the pandemic as it occurred mainly in the US. This book reveals the political contexts in which the disease took place and shows us how the disaster could have happened. What can we learn from it?!

Some other fun facts:

*It killed more people in twenty-four months than AIDS killed in twenty-five years, more in a year than the Black Death killed in a century.”

*The main way to beat a Pandemic is isolation, avoiding crowds, avoiding driving your Harley to Sturgis, SD with 300K other bikers to party and then superspreading it across the country and globe. Only in America? Well, in Brazil and in other macho-oriented cultures it seems to be happening, too. Anyway, why was there no death in Gunnison, Colorado? They stayed inside and kept visitors out until things were safe. Same with a private girl’s school in Maryland. No deaths. The countries that did that had fewer casualties, big surprise,

*Arizona, now a red state, got the idea then to wear masks and so their infection and death rate was much lower than other states. Sure, because this is America and you know, Live Free and Die, there was an Anti-Mask League then, but some people really did begin to figure out what to do and not to do.

*The Great Influenza, Barry says, started here, in Kansas, and spread to almost every corner of the world.

*One key reason for the spread is the inaction, half-truths and lies by politicians and lazy or ignorant public health officials supported by various co-opted media. MIs-information abounds. Not much was known about what to do about the flu, initially, but this did not prevent people from spreading lies and proposing unfounded solutions. “It’s almost over, it’s not that bad, it’s only the flu!”

*The state of medical education by the beginning of the twentieth century was terrible. You didn’t even need any college coursework to be a doctor, you didn’t have to see a single patient or do any medical research to become a doctor. Doctors and nurses were way underpaid, and so necessary, but there was a severe shortage when this hit and the health care system was overwhelmed.

*As with our current pandemic people focused on whether you live or die, but long term neurological and other effects may have been as serious as the number of deaths..

*The Red Cross was terrific even when government public health sucked.

*Over time, over waves of infection, as people, increasingly terrified, began to take it seriously and stop hanging out in large crowds together, as businesses and schools closed and people stayed inside, the pandemic sort of mutated and went away (though it could come back at any time)

*Ebola, SARS, Avian Flu, and on and on, are definitely changing life as we knew it; ignore this at your peril. A vaccine might help, but isolation is the best strategy for saving your and others’ lives. Humans: Develop a little discipline and willingness to self-sacrifice and get over your anti-science arrogance and let’s come together to do the right thing. How–as of today has New Zealand had new cases in six weeks? Guess! Fairy dust, right!

*There was WWI taking place, so President Woodrow Wilson made a decision to put all our resources into winning the war rather than saving people’s lives at home. And many many soldiers died, too, and Wilson and the military took most of the doctors and nurses to the front and lied to the American public that it wasn’t that bad and insisted people only say positive things in spite of the obvious rising death totals.

*Wilson also got the flu, which was kept secret for a long time, but we now know it affected him neurologically; in other words, decisions he made were flu-influenced. He died of a stroke that was likely brought on by the flu he largely tried to ignore.

*More people die of disease in wars than from guns, and very little money ever goes to military medicine. But you already know more money goes to the defense budget than public health.

*The book focuses on the US instead of the whole world but it is already 460 pages so i guess that can pass, but if it just focused on the pandemic it could have looked at things more globally.

*A lot of novelists wrote about The Great War, but why is so little written about the far greater killer, The Great Influenza? Note to self: Reread Katherine Anne Porter’s Pale Horse, Pale Rider. She writes a novella about her experience with it and obviously not dying from it.

*Barry in 2004 while finishing this book said, “It’s time to start spending serious money on influenza.” We didn’t do it. In fact the current POTUS defunded the Pandemic organization that might have helped us prepare better for these events. And broke off the US from the WHO!

This book is a good book, but it should just be one book, the history of the pandemic, rather than two books. It is obviously based on a lot of research, but it is not as well written as the other books I mention at the outset. It needs editing, The medical history goes on too long, he romanticizes science researchers and adds some melodramatic effects in places that distracted me. Why spend so much time on, for instance, Paul Lewis and others who were “original,” “brilliant,” but didn’t come up with a vaccine and had almost no impact on the progression of the disease itself. But I still learned a lot from it, from both of the books, truthfully.


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