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Post by timothylane on May 3, 2020 17:31:47 GMT -8
John M. Barry writes exceptionally detailed books about major events, whether it be the Mississippi River floods of 1927 or the Spanish flu of 1918. He covers the latter in The Great Influenza.
Barry starts by studying the history of medicine, especially in America. A couple of centuries ago, doctors often had very little schooling. They were taught various cures (most of which didn't really work) and had no grasp of the use of science to learn more about the human body and how to treat diseases. (They were better when it came to surgery.) Then a group of American scientific doctors sought to develop American medicine to where, by the time the 1918 pandemic hit, it was as good as it was anywhere else, and ready for the great task of facing a pandemic that may have killed more people than any other in history (the Black Death killed a far higher percentage in Europe, and perhaps elsewhere, but there were a lot fewer people then).
He then goes into considerable detail about the influenza viruses (such as the H1N1 virus than caused the Spanish flu and has returned since in less virulent form). One thing that makes influenza so dangerous is its remarkable mutability. There are mechanisms by which cells protect DNA from damage that causes mutations, though they don't always work. Bacteria, being more primitive, have weaker systems and therefore mutate more rapidly. Viruses, being hardly even alive, have virtually no protection and thus mutate rapidly. Furthermore, RNA is more vulnerable than DNA, so viruses that rely on the former (such as influenza virus, HIV, and coronaviruses) mutate especially rapidly.
Indeed, a flu victim will probably have some mutation in the viruses infecting him. This is made worse because one form of damage is recombination, wherein DNA or RNA strings trade nucleotides (adenine, cytosine, guanine, and uracil in the case of RNA). This, in fact, is why Stephen King chose influenza for Captain Trips in The Stand.
Barry also looks at World War I and its effects. The flu was first reported in Haskell County, Kansas -- a rural county where a disease that tends to spread from birds to pigs to people could easily do so. From there it spread, with local boys drafted into the Army, to Camp Funston in southeastern Kansas. The US was mobilizing heavily for the war (at a great cost in civil liberties from the self-righteous, authoritarian Woodrow Wilson), which enabled a local flu to go national and then international.
In addition, the feel good censorship meant that when the flu became a serious problem it wasn't covered in the papers -- bad news was a no-no. It might hurt morale, which would hurt the war effort. (This was the justification for jailing politicians -- mostly Socialists such as Eugene Debs and Victor Berger -- for opposing the war. This was under the Sedition Act, drawing its name from John Adams's worst mistake. Wilson's people thought otherwise, and in fact thought Lincoln erred by allowing too much freedom of speech and the press. Wilson and his fellow fascists made sure not to make that "mistake".) Similar censorship happened in every country at war, which is why it became known as the Spanish flu (Spain was neutral so the disease's progress was extensively reported there).
From Camp Funston it spread to other bases and nearby cities, and eventually to Europe (and, no doubt by way of prisoners of war, to the Central Powers). At this time, it was mostly fairly mild -- more or less a normal flu. What happened? Perhaps it was a different virus hitting Europe at the same time. Perhaps it was a combination of the Kansas and European viruses. Or perhaps the virus, as it adjusted to dealing with people instead of birds or pigs, became much more virulent. No one really knows.
There were a few scattered instances even in the spring of a virulent form. And at some point, even as many thought the pandemic was pretty much finished, it returned in a second and far more virulent wave. It first appeared in America in a ship that brought it from Europe to Boston, and therefore spread to Camp Devens with devastating effects. And from there -- from civilians traveling from city to city, and soldiers being transferred to different camps -- it spread all over.
Influenza doesn't actually kill that many people in most epidemics. It weakens the system, and pneumonia shows up and can kill. (Until 1936, pneumonia was the leading cause of death in America.) It can also follow other infections; as the Army mobilized, there were epidemics of measles followed by pneumonia. But today, influenza and pneumonia are so commonly linked that the official statistics group them as one cause of death. (This goes back decades, as I noticed long ago studying my World Almanac each year. I trust readers can figure out what "malignant neoplasms" and "congenital malformations", two other causes of death, are in more common parlance.) Barry goes into considerable detail about the main form of pneumonia, from the "Captain of Death" (the pneumoncoccus Streptococcus pneumoniae).
However, the Spanish flu was different. There were certainly many cases of influenza leading to pneumonia, but there were also cases where the body's immune system (Barry goes into considerable detail about this) fights the disease but inflicts considerable damage to the lungs. Naturally, this was a greater threat in those with the strongest immune systems -- mostly young adults. This is why the 1918 influenza killed so many of them.
In many ways, this is a very appropriate book now. Many of the solutions are the same, such as forms of social distancing and the extensive use of masks. And there are problems such as Philadelphia putting on a major parade when it might have been wiser to cancel it (a problem repeated this year). There was also the usual quarantining of the sick. But they didn't quarantine the healthy or shut down the economy, even though the flu was as deadly as the worst case (and very dubious) models for Wuhan fever.
I'm only about half done, so I no doubt will have more to add later, which is why I'm doing this as a separate thread.
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Post by timothylane on May 4, 2020 18:04:54 GMT -8
Medicine had been greatly modernized by 1918, but it was still primitive compared to today. Although there were a number of antiseptics used (for example) to keep wounds from festering, only a decade or so back had an actual chemical disease cure been discovered. Paul Ehrlich called his syphilis cure Salvarsan-606 because it was the 606th chemical he tested (and he initially rejected it and ultimately tried about 900 before going back to it). Only a few vaccinations (aside from smallpox) existed (such as for diphtheria and tetanus). Some diseases had serums available (including a couple of versions of pneumonia).
One problem was that no one knew for sure what caused influenza. A top German scientist discovered a bacterium commonly present in influenza cases, which he called Bacillus influenzae. But it was very hard to detect, and never was quite proven (by the standard method of proof set up by Robert Koch, discoverer of the bacteria that caused anthrax and tuberculosis). Some suspected it was actually a virus, like the cause of polio (which had been discovered a few years back).
Meanwhile, the war was coming to its climax, and troops were being sent to France to replace losses due to combat and disease. Many never made it; one transport, despite excluding influenza patients at embarkation, had hundreds dying in a single day. (This wouldn't have been such a problem if Wilson had been willing to accept peace offers from Germany and Austria-Hungary. They wouldn't have had to send all those troops. But no one had any idea how long the war would last until it ended rather suddenly.)
Another problem (very familiar today) was shortages of supplies and personnel. There weren't that many nurses at the time, and not enough doctors (particularly since there were plenty of incompetents). When it hit hard, volunteers were requested to take care of people who needed basic care, to say nothing of actual medical assistance (such as whole families stricken). One suspects that contributed to the death rate, which reached 4597 in one day -- in Philadelphia. (This may have been a typo, something one often gets in Kindle volumes though I haven't noticed so many here. A later chapter said this was the toll for the week ending that day, which sounds more reasonable.) In the same city, a nursing hot line left 93% of calls unfulfilled, no doubt due to a lack of personnel.
In other words, the Spanish flu is what people were afraid (or convinced to be afraid) that Wuhan fever would (or at least could) become. In reality, Wuhan fever death rates are lower (often as many as 10% of flu victims died, and they weren't old people with lots of co-morbidities) despite its highly contagious nature.
One might also note that even the authoritarian Wilson regime left it largely to states and localities to deal with the flu. This could be a problem in highly corrupt cities, of which there were many (such as Democrat New York with Tammany Hall and Republican Philadelphia with its own machine). Machine cities handed out jobs -- even important positions in public health -- based on loyalty rather than ability.
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Post by timothylane on May 5, 2020 17:13:40 GMT -8
In some ways, life still went on even with a plague savaging the population. There was an interesting request (unfulfilled, like so many of them) from Portsmouth, Virgina for two colored physicians. Blacks had to take a black seat, but Jim Crow never did. Even as many cities shut down bars (this was just before Prohibition began), churches, and schools, they still had streetcars available for those going to work.
Desperate doctors came up with all sorts of solutions, which they convinced themselves worked. One gave his remedy to 6 patients, of whom 2 died and 4 recovered well. Of course, a test of 6 isn't very meaningful, and influenza generally didn't kill a third of its patients. But he recommended this to readers of JAMA. One doctor blew some powder into patients' noses in order to stimulate the mucous membranes to act (that being one of the body's defenses against aerial infections). It might even have worked until the powder was ejected and the mucus was no longer running.
The disease was deadly in locations all across the world, except a few that managed to isolate themselves sufficiently. American Samoa had no influenza deaths -- but after a ship with someone infected landed in Western Samoa, 23% of the population was killed. Natives with no prior experience with influenza, and thus no natural immunity, were very vulnerable. In Fiji, 14% of the population died from November 25 through December 10. Similar losses were often seen in Africa and South America.
It was even worse in frigid climes. Labrador was hard hit, and Alaska Eskimos were devastated, whole villages being wiped out. In some places large families lived in round huts largely underground to reduce exposure to the wind. And in many cases these families all died there, too. Barry wonders if the last to go -- alone and sick -- weren't happy to go join their families. If so, I can't say as I blame them. One suspects there were similar problems in Yukon, the Northwest Territories, and Siberia.
The civilized parts of Asia, despite no doubt having the same ingrained immunity seen among Europeans, also suffered heavily. Statistics in China are hard to come by, but India was hit hard. Bombay's death rate was nearly twice that from a 1900 epidemic -- of bubonic plague. (What is sometimes called the Third Plague Pandemic -- the first was the Plague of Justinian and the second was the Black Death -- started in India. The story at the heart of the tale of the vanishing lady involved a visitor returning from India.)
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Brad Nelson
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Post by Brad Nelson on May 6, 2020 8:56:59 GMT -8
That is definitely a timely book to read. Thanks for the extended review.
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Post by timothylane on May 6, 2020 19:35:15 GMT -8
The major outbreaks would last about 6-8 weeks (something that some also report today about Wuhan fever, though I don't think the evidence in America supports this) and then come to an end. Only a few weeks after Philadelphia peaked, it had no more cases. People celebrated its end.
Of course, they were wrong. With winter coming on, the usual flu season started, and it's believed that it was this same flu, though much milder. It would continue for some time, and then later turn up in swine, whence it may (or may not) have come in the beginning. As it finally died down, there were fewer researchers looking into it, but still some. Indeed, when Alexander Fleming discovered penicillin in 1929, he mainly found it useful for isolating influenza pathogens because it didn't kill them even as it killed bacteria that competed with it in his cultures. (It was a decade later that someone else got the idea of using it as an antibiotic medicine.)
But even as it declined, it continued to cause harm. For one thing, people began to find indications that it could infect the brain as well as the respiratory tract, even causing permanent mental decline. As it happens, at a key moment in the discussions at Versailles, when an irritated Wilson thought of leaving for home as a protest against French vindictiveness, he came down with what his doctor identified as flu. It's usually thought by historians to be a stroke, but a stroke doesn't have flu symptoms. (It's possible that flu induced a stroke, something Wilson had a history of being susceptible to).
This wasn't the big stroke that hit him as he campaigned for the treaty, but at any rate he seemed to lose something mentally. It was at this point that, for the sake of his League of Nations (which ended up doing virtually nothing, and not just because the US never joined), Wilson traded everything else and let the treaty become highly vengeful diktat not at all like the peace the Germans (the embryonic Weimar Republic, who signed the armistice as well as the treaty) thought they had agreed to in the armistice. What difference would a healthy Wilson have made? No one can know. Some of the provisions -- such as the return of Alsace-Lorraine to France and the creation of the Polish Corridor to give Poland an outlet to the sea -- were already in accord with the Fourteen Points. But perhaps he would have gotten rid of some of the worst aspects. We'll never know.
Barry concludes by looking at what the various medical researchers did. There were some interesting results -- one, investigating the pneumococcus and why uncoated (and harmless) bacteria could acquire the coats that made them dangerous, eventually connnected it to the action of DNA, which he thus linked to heredity. Watson and Crick would later make use of his research.
And eventually they found the virus that caused influenza, actually isolating it from infected swine. Until then most of them thought it was Bacillus influenzae (hence the name).
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Post by timothylane on May 7, 2020 16:45:04 GMT -8
Barry considers in an afterword what the prospects for such a pandemic today. There have certainly been some pandemics since then, even fairly bad ones, but nowhere near as bad as what hit in the final few months of 1918. Could another one that bad strike? There's no inherent reason why some new version couldn't be that bad, though the improved quality of medicine and public health since then would probably keep the death toll from rising so high, at least in the First World. Captain Trips is extremely unlikely.
There are things we can learn. For one thing, having enough nurses (and other caregivers) would be very useful. Patients need nursing, and in a really bad outbreak a lot of people will need care even aside from that. (He was on FNC tonight and talked about an army -- not just for nursing and non-medical care, but also for contact tracing. I suppose that would be useful in reducing unemployment.)
It's interesting to compare SARS (caused by a very similar coronavirus to the one causing Wuhan fever) to influenza and the present day. SARS was much deadlier than influenza, though probably not worse than the Spanish flu. But it was much less contagious, and therefore it didn't spread as badly despite the all-too-familiar story of gross Chicom dishonesty in reporting it. Wuhan fever seems to be less deadly, perhaps no more deadly than a normal flu for most people. But there are some indications that it's far more contagious. This, no doubt, is why the repeated Chicom dishonesty (Barry hoped that they would learn better from SARS, but knew that there was no way to know until it happened again) this time enabled the disease to spread throughout the world.
All too often we see so much in the past, be it the Spanish flu or SARS, that sounds so much like today. But never before have we seen such a shutdown. Sweden chose otherwise (though they urged social distancing just like everyone else did), so did 8 American states (and others were slower to close down, some perhaps doing so only out of political cowardice) and perhaps some scattered third-world nations with little contact with China (if there are any). |
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Post by Brad Nelson on May 8, 2020 17:36:34 GMT -8
Another black plaque would spread like wildfire. That kind of lethal pathogen is something to get excited about and worthy of a lockdown. But treating a season flu like the black plaque has been one of the greatest and costliest mistakes mankind has ever made…which is the opinion extolled by Dennis Prager.
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Post by timothylane on May 8, 2020 18:01:21 GMT -8
Barry pointed out how rapidly something highly contagious could spread. Of course, we know that already now, but he was writing about 15 years ago. And a serious pneumonic plague outbreak could indeed be serious. I once thought about how easily it might be spread from a science fiction convention (especially a worldcon), though much would depend on how well an aerosol version could be used to spread it in a large, full room.
What I suspect happened is that, early on, their worst-case models were based on something like the 1918 Spanish flu, and they wanted to prevent both the heavy loss of life and especially (because it would make such an outcome likelier) overstressing medical capacity and personnel, and running short on supplies. Whether they ever had any reason to anticipate a worst-case scenario is another matter.
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Brad Nelson
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Post by Brad Nelson on May 8, 2020 20:54:44 GMT -8
It’s risky ascribing competence or good faith to today’s “scientific” modelers. Rob Williamson has an article at American Thinker titled: The unscientific method that caused worldwide panics and lockdowns. Summary: The modeling software these “experts” are using is worse than junk. I think the point was to stoke fear which plays to the Progressive apocalyptic notions of just about everything. |
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