The Great Influenza: The Story of the Deadliest Pandemic in History

The Great Influenza: The Story of the Deadliest Pandemic in History➸ [Reading] ➺ The Great Influenza: The Story of the Deadliest Pandemic in History By John M. Barry ➭ – Oaklandjobs.co.uk At the height of WWI, history s most lethal influenza virus erupted in an army camp in Kansas, moved east with American troops, then exploded, killing as many as million people worldwide It killed pe At the height of WWI, Influenza: The Epub ß history s most lethal influenza virus erupted in an army camp in Kansas, moved east with American troops, then exploded, killing as many asmillion people worldwide It killed people in twenty four months than AIDS killed in twenty four years, in The Great eBook ´ a year than the Black Death killed in a century But this was not the Middle Ages, andmarked the first collision of science and epidemic disease Magisterial in its breadth of perspective and depth of research and now revised to reflect the growing danger of the avian Great Influenza: The ePUB ´ flu, The Great Influenza is ultimately a tale of triumph amid tragedy, which provides us with a precise and sobering model as we confront the epidemics looming on our own horizon John M Barry has written a new afterword for this edition that brings us up to speed on the terrible threat of the avian flu and suggest ways in which we might head off another flu pandemic. Pandemics recur, just as history repeats itself, and it s all simply a question of how much can be learned from it and how far technology has marched on They were at war, so they couldn t tell that there were outbreaks, only the neutral Spain could say it without the danger of demotivating the population Today there are mostly just trade wars any, but the rules have stayed the same and looking at the potential immense economical damage, the intuition of those trying to hide outbreaks was Pandemics recur, just as history repeats itself, and it s all simply a question of how much can be learned from it and how far technology has marched on They were at war, so they couldn t tell that there were outbreaks, only the neutral Spain could say it without the danger of demotivating the population Today there are mostly just trade wars any, but the rules have stayed the same and looking at the potential immense economical damage, the intuition of those trying to hide outbreaks was right The influence of such pandemics on human, primate, mammal, and rodent evolution must have been immense, as wiping out huge parts of the population or even the whole population until extinction, and might have happened many times Without samples andadvanced technology to detect virus DNA and RNA in archeology, or to find the right fossils, it will long stay unclear how massive the impact on the development of higher life forms on the planet might have been The differences between 1920 and 2020 are so immense that it takes time to realize how real and everrealistic this danger is, because we tend to believe that it can t get so bad Medicine was very primitive, but we didn t really come so much closer to a solution in preventing outbreaks and finding cures.They didn t have cars, planes, anything to spread it worldwide or just in a nation with such a speed as today No freeways, just trains and some roads with horses on them As long as the horses didn t get it, the spread was very slow.Fewer people having not so much contact with another.Just telephones to communicate, nothing to coordinate the efforts of a state or even a whole continent A large question is what population group is most affected and if, when the virus has found its prime target, it won t mutate again and switch the victim again The book is not just about the Spanish flu, but also about the doctors and researches that tried to deal with it with methods that seem medieval compared to nowadays standards and by mixing the historical facts with these protagonists, it becomes very vivid for a nonfiction title It has a bit much redundancy and it would be a five star if the author had putfocus on not repeating himself and telling very similar stories, wildly jumping between geography, personal stories, and the medicine of those days, making it all a bit blurry and unnecessary complicated to follow Even if nowadays governments wouldn t be incompetent, the human factor alone is highly disturbing Just some people who are immune to rudimentary hygiene rules and logical arguments are enough, and guess what one little piglet that refuses to wash hands, sneeze in the crook of the arm, etc could do for spreading diseases Not to speak of antisocial psychos who do it on purpose, try to get it, and spread it We didn t write our own history, nature in the form of plagues did a lot of it and it would be arrogant and dangerous to believe that we are now so highly advanced and have so much fancy technology and it s a techno optimist who is saying that that we are invulnerable, as if we already had nanobots patrolling each body and sending signals to produce individualized vaccines as soon as any invader is detected.But we aren t there and the incompetence, arrogance, and idiocy of the Western governments will cost many lives now and in the future, until technology will eradicate the last plagues, what is just a question of time, not of if There might even be already the potential for producing and developing new vaccines, testing methods, and preventive measures But the pharma companies make no money with developing cures for plagues that might never occur and the state has no interest in investing in protecting its citizens, although this could even be seen as military research where a bit of money is invested in general Why it s even not possible to produce enough test kits or establish a global network of testing stations that monitor the world or to have intelligent plans for pandemics or to listen to experts or to not worsen the situation with polemics and fake news or to quarantine early enough or but, as said, the politicians are like Lalalala..ignoring experts..yada yada yada Stupid decision stupid decision stupid decision , while unnecessary piles of corpses are exponentially growing.Some links dealing with the current pandemic CNN live updateshttps edition.cnn.com asia live newJohn Hopkins CSSE world maphttps gisanddata.maps.arcgis.com apYoutube statisticshttps www.youtube.com watch v qgylpA wiki walk can be as refreshing to the mind as a walk through nature in this completely overrated real life outside books Epidemiological evidence suggest that a new influenza virus originated in Haskell County, Kansas, early in 1918 Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world In its wake followed a keening sound that rose from the throats of mourners like the Epidemiological evidence suggest that a new influenza virus originated in Haskell County, Kansas, early in 1918 Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world In its wake followed a keening sound that rose from the throats of mourners like the wind John M Barry, The Great InfluenzaThis book is what happens when I combine a smart phone,s one click shopping, and my low key binge drinking I had just sat down in my favorite chair for my weekly wine drunk No sooner had I dropped some ice cubes into a pint glass full of club soda and cheap chardonnay, than Steven Soderbergh s Contagion began playing on HBO I never intended to watch the movie Based on the trailers, I had decided that it was too much like the movie Outbreak, except with fewer monkeys and 100% less helicopter chases involving Dustin Hoffman and Cuba Gooding, Jr Still, people who drink Yellow Tail out of pint glasses can t be choosers, so I let the film unspool Like all of Soderbergh s works, Contagion was slick, engaging, and sharply edited As the all star cast began dying from a mysterious and highly contagious disease, and as I started to get a buzz from that pint of cheap wine, it occurred to me that I was suddenly, desperately interested in infectious diseases So I bought John M Barry s The Great Influenza, about the so called Spanish flu of 1918 that killed as many as 100 million people Unlike influenza, my interest in the topic quickly wore off It was only several months later that I finally got around to reading it Totally worth the drunken purchase Barry s epic is a work of incredible scope and depth It combines accessible science medical writing, perceptive character sketches, and telling human anecdotes to corral a story a global pandemic that doesn t necessarily lend itself to the written word Film is theobvious medium for pandemic stories All you need is a computerized map of the world in a neutral color Then, have that map start to turn red while someone intones, 24 hours 48 hours 72 hoursIn Barry s words, the 1918 influenza pandemic was the first great collision between nature and modern science To that end, he begins the book with a brisk, wide ranging, and fascinating history of medicine, gradually narrowing his focus to the state of American medicine at the turn of the century It was, in a word, deplorable There was no consistency in education, no overarching standards, no pursuit of progress While American doctors were still pondering the leech, Europeans were making the advances In Europe, governments, universities, and wealthy donors helped support medical research In the United States, no government, institution, or philanthropist even began to approach a similar level of support As the Hopkins medical school was opening, American theological schools enjoyed endowments of 18 million, while medical school endowments totaled 500,000 The future of American medicine got a bit brighter with William Welch and the founding of the Johns Hopkins Medical School Welch is one of the titanic figures in American science, a stethoscope wearing J Robert Oppenheimer not necessarily a great scientist or discoverer, but a manager nonpareil It was Welch who would lead the U.S response to the influenza outbreak The Great Influenza attempts to tell a huge story An outbreak is hard to contain in a book and also, obviously, in real life It is not a singular event, but a worldwide phenomenon it does not happen in a single place, to a single person, but to everyplace, and millions of persons Accordingly, the narrative diffuses once Barry begins the story of the flu itself ground zero of the pandemic is hotly debated Barry pinpoints Haskell County, Kansas, as the originating spot Of necessity, the story begins to hop around a lot, to locations all over the globe There are a lot of staggering numbers x numbers infected, y numbers dead interspersed with illustrative stories that provide a micro view of a global disaster For instance, Barry relates the story of an Army camp commander World War I was the mechanism by which this disease spread so far and wide who committed suicide after failing to take proper steps to protect and quarantine his troops One of Barry s real gifts is to explain medicine and biology to a part time drunk, full time nonscientist such as myself I am a concrete thinker, a literalist My ability to imagine things I can t see such as biological processes is surpassed only by my ability to do one armed pushups while shaving Using metaphor and analogy, Barry does a wonderful job of providing both the hard science and a simple explanation to interpret it For instance, Barry explains how the immune response to influenza ultimately made healthy young adults the flu s greatest victim Macrophages and natural killer cells two kinds of white blood cells that seek and destroy all foreign invaders patrol the entirety of the respiratory tract and lungs Cells in the respiratory tracts secrete enzymes that attack bacteria and some viruses including influenza or block them from attaching to tissue beneath the mucus, and these secretions also bringwhite cells and antibacterial enzymes into a counterattack if a virus is the invader, white blood cells also secrete interferon, which can block viral infection All these defenses work so well that the lungs themselves, although directly exposed to the outside air, are normally sterile.But when the lungs do become infected, other defenses, lethal and violent defenses, come into play For the immune system is at its core a killing machine It targets infecting organisms, attacks with a complex arsenal of weapons some of them savage weapons and neutralizes or kills the invader The balance, however, between kill and overkill, response and overresponse, is a delicate one The immune system can behave like a SWAT team that kills the hostage along with the hostage taker, or the army that destroys a village to save it.The 1918 influenza pandemic killed between 21 million according to a 1927 AMA study and 100 million people according to Nobel laureate and influenza researcher Macfarlane Burnet That meant that about 5% of the population of the world died It is a terrifying proposition Using today s population numbers, the fatalities would be between 70 and 300 million people With all the different flu scares we ve had, Barry was eventually obligated perhaps by his publishers, at gunpoint to update his book to remind us how we re all going to die Like all new afterwords, the one included at the end of The Great Influenza feels halfhearted and unnecessary If you ve paid attention at all to the hundreds of preceding pages, it is not difficult to extrapolate what might happen during a present day outbreak of an infectious disease or out of control virus The thing about The Great Influenza is that it is almost always relevant Always, there is a disease, somewhere in the world, read to spring forth In the years since this was first published in 2004, we ve had Ebola, SARS, and Zika to terrify us It s hard to know what will crop up next, and whether this will be the one to turn the map all red Ultimately, I don t think I was half as terrified as I was supposed to be, mainly because I have a lot of other existential threats to worry about cancer heart disease wine poisoning Thus, I rate my chance of dying in a deadly pandemic as relatively low I also feel that the world isattune to these things than ever before We no longer believe in miasma theory or the humors of our bodies Conversely, we believe in quarantining, washing hands, and reverse engineering both pathogens and the journeys they travel Still, we are living you might have noticed in an extremely knitted together world All it takes is a handful of people leaving an uncontrolled hot zone, hopping on an airplane, and starting an exponential event that only Hollywood could love, and no one can halt Update, March 31, 2020 As I write this, I am in the third week of self quarantine, following a shelter in place order necessitated by the spread of Covid 19 The coronavirus has definitely made the penultimate paragraph of my original review look like the work of a prize fool Turns out, I should have beenworried about dying in a pandemic Certainly, being stuck at home has drastically increased my risk of wine poisoning Of course, when I wrote about the advanced state of science back in 2013 I had no idea how many people on this earth didn t believe in science More to the point, I did not know that there were so many people so militantly anti science that they would go to a hospital in the midst of a pandemic to take videos, all in an attempt to disprove a deadly, worldwide virus as some massive hoax On second thought, maybe I was right Maybe the virus isn t the real danger Maybe the thing we should all fear is ourselves I am really surprised at the number of positive reviews this book got, both professional and consumer I am currently a littlethan halfway through and feel the need to write something in case I don t finish it and lose the desire.Before critiquing Barry and his writing style, or lack thereof, his editor, Wendy Wolf deserves special mention This is the first book I have ever read in which I have made special note of the editor and will refuse to read anything she works on in the future I I am really surprised at the number of positive reviews this book got, both professional and consumer I am currently a littlethan halfway through and feel the need to write something in case I don t finish it and lose the desire.Before critiquing Barry and his writing style, or lack thereof, his editor, Wendy Wolf deserves special mention This is the first book I have ever read in which I have made special note of the editor and will refuse to read anything she works on in the future I was sorely tempted to tally the number of repetitions of key phrases, pieces of information and entire narrative sequences Perhaps editing this book was too daunting a task to do it well and still preserve the intent and message, but if so, I would have quit Wendy gets 1 star.Before she edited it though, he wrote it As I understand it, the 1918 Influenza outbreak, with its undercurrents of concurrent revolutions in medical science, oppressive and at times seemingly unconstitutional governmental policy, sheer human agony, and internationality, is replete with its own inherent drama No additional tear jerkers are necessary the reporting of how 50 million people died worldwide would be plenty Barry decides that manufactured melodrama is the most effective vehicle to convey this, however How can one assume how people felt during a worldwide pandemic After assuming it, how can one essentially write fiction in a non fiction book as it is described In addition to his atrocious writing style, Barry seems to thread 3 or 4 books into one, and doesn t even separate them with definitive breaks in his book In a text which is nominally about an historical event, we read biographical sketches of several men who weren t even involved in fighting the disease.I recommend this to no one Read the wikipedia article on 1918 Influenza It s probably far less annoying.UPDATE After getting through 300 out of 460 pages of this poorly organized, melodramatic, poor excuse for historiography, I realized I was not only wasting my time reading it, but I was also wasting my time complaining about it to my friends and family Thats a TRIPLE waste of time Barry is not worth this investment I caution every one of you Unless you want to boost your self esteem and have a John Irving moment of Wow, I could seriously do way better than this and this guy got published DO NOT READ THIS BOOK I hope you read this, Barry, and send me an apology.I ve never written a review this bitter Mostly because I ve never been this bitter about a book As the world is wrapped up in the COVID 19 pandemic, I thought that I would try to educate myself a littleon the general topic while forced to isolate with books I have often wanted to know a littleabout the Spanish Influenza of 1918 19, which was said to be one of the worst pandemics in modern times As we are in something similar at present, I turned to John M Barry s book to permit me to speak with ease as it relates to the spread of infection and the reactions by the public and As the world is wrapped up in the COVID 19 pandemic, I thought that I would try to educate myself a littleon the general topic while forced to isolate with books I have often wanted to know a littleabout the Spanish Influenza of 1918 19, which was said to be one of the worst pandemics in modern times As we are in something similar at present, I turned to John M Barry s book to permit me to speak with ease as it relates to the spread of infection and the reactions by the public and politicians alike Barry opens with a jaw dropping tale of the emergence of medical schools and their lax entrance requirements, making the moniker doctor seem less impressive It was only students studying in Balti at Johns Hopkins who were put through the motions of a significant medical education and who earned the title with some confidence From there, the narrative moves to offer some backstory on the emergence of the influenza, citing that its Spanish name came not from the origins, but that Spanish newspapers offered frank discussion of events taking place, not censored during the Great War Talk of an influenza with many deaths filled the headlines, which hit the newswires and the name stuck Barry explores the origins, based on his own research, as well as how infection ran rampant throughout Europe and soldiers from all countries involved brought it back to their homelands during troop replenishments or retreats With the only way to travel back to America being the ship, close quartered troops passed the infection between one another with ease, beginning an explosion of cases once troops made their way across the country Barry examines how health officials sought to contain things and pushed for hygiene campaigns, which were only somewhat effective Public Health officials pushed isolation, cleanliness, and the need to take precautions, as the spread ran through the country and left medical officials scrambling to contain the spread How things seem to parallel what is taking place now, to a differing degree.Barry offers the scientific analysis of the topic as well, discussing frankly about how viruses develop and leap from animals to humans, including how immunity develops The novice reader can learn much about this and how medicines can help occasionally, as well as what makes the virus able to overpower the human body There is also a great discussion about how the virus attaches itself to the body through the lungs and other air passages This discussion not only educates the reader into how infection takes place perhaps justifying the precautions like washing, masks, and gloves and the speed at which things can progress Barry pulls no punches, using early 20th century medical technology to explain how things spread with ease and what could be done to eradicate any further spread Fitting this medical and scientific knowledge with the narrative about the historical happenings, the reader has a better understanding of the situation While this may not arm the reader to understand the intricacies of World Health Organisation documents or the high level analysis done by leading politicians in their briefings, Barry gives the reader a better understanding of how things were during this world scare and what parallels can be drawn to the current COVID 19 pandemic.Peppered amongst these two major narratives is the handful of scientists who studied the influenza and sought to find cures The interested reader will discover a great deal about immunology and how scientists must use vigorous techniques, as well as exhausting their tests on animals and humans alike, in order to eradicate what was fast becoming a horrible disease that was growing exponentially Barry follows the work of these essential scientists throughout, from their early focus on how the influenza infected humans through the various tests and microscopic analyses Thereafter, it was infecting and watching the results in animals that permitted scientists to come up with something that could be used to stop the spread of the influenza This is a solid teachable moment for the reader about immunisation and its importance to keep disease away from the population Whatever the reader feels about needles and how their children react, Barry makes a blunt plea to eradicate new strains of long dormant diseases with some simple precautionary measures Whether these cause autism is something to COVID 19 conspiracists can bring up when fashioning tin foil hats at their upcoming social distancing picnics.Whether the reader is a strong believer in the health crisis COVID 19 is unleashing on the world or feels that this is a political conspiracy drummed up to hide bigger issues I have heard people on both sides share their sentiments with me , John M Barry s book is highly educational and fits perfectly into how things are playing out at present Barry offers a great deal of background on so many interesting topics, all of which are interconnected to the issues at hand The exploration of viruses and how their emergence in other mammals can leap to humans with relative ease explains some of the new and odd influenzas and infections that are seen across the world today Barry does not dilute the discussion, but his explanations are digestible by most readers with a general understanding of basic medical and scientific terminology Paired with the thorough discussion of the historical goings on in Europe and, eventually, America, the story iscomplete and the policies enacted make a great deal of sense The reader attuned with news reports may find parallels with what was done in 1918 19 to the present reaction in the United States, though it is sure that Woodrow Wilson allowed local governments and health officials to complete their work unimpeded with false hopes and unreasonable timelines In a number of well documented chapters, Barry illustrates just how vast the influenza infection and battle became in America, as well as how deeply felt the deaths were to many who had no idea what was going on The empathetic reader will likely feel some heart pain for the orphans, the families who lost loved ones overnight, and the emotional battle of giving up the bodies of those they loved, sure that mass graves would leave them unidentifiable in the future Barry s book is surely a great one for those who are cooped up and want to get some context, as well as the curious reader, such as myself, who wonder how reactions to past calamities compare to today s overly dramatic delivery in the 24 hour news cycle Kudos, Mr Barry, for this enlightening look at an event in world history that surely has some connections to the events in today s COVID 19 world This book fulfils Topic 7 Catastrophe, of the Equinox 10 Reading Challenge.Love hate the review An ever growing collection of others appears at Book for All Seasons, a different sort of Book Challenge History is not only learning about the past but also learning from the past to shape our present and the future This book in such a way is not only a compendium about the Spanish flu 1918 1920 but also a vivid description about the pattern of the current pandemic Covid 19 Barry wrote this book in 2004 and also the pandemics that might happen in the future Spanish flu is something every Medico might have studied during their Med school days Still, this book gave me so much new informatio History is not only learning about the past but also learning from the past to shape our present and the future This book in such a way is not only a compendium about the Spanish flu 1918 1920 but also a vivid description about the pattern of the current pandemic Covid 19 Barry wrote this book in 2004 and also the pandemics that might happen in the future Spanish flu is something every Medico might have studied during their Med school days Still, this book gave me so much new information which I haven t found anywhere else As Bill Gates said, Barry will teach you almost everything you need to know about one of the deadliest outbreaks in human history through this book Just like the striking resemblances during the repeated outbreaks of Ebola in Africa, there is a striking resemblance between the Spanish flu and the current COVID 19 outbreak even though the former occurred a century ago One big tragedy might help us to save ourselves from asignificant catastrophe in the future We can see multiple examples of these in both the pandemics I will cite a couple over here.San Francisco After suffering from one of the worst earthquakes in the history of the United States in 1906, San Francisco was recouping when the pandemic hit the USA in 1918 According to Barry of all the major cities in America, San Francisco confronted the fall wave most honestly and efficiently That may have had something to do with surviving and rebuilding after the major earthquake Well begun is half done Even though it is true, it doesn t give us the liberty to be complacent or overconfident after a good beginning It seems that it is what happened in San Francisco later during the third wave Dr William Hassler, Chief of San Francisco s Board of Health, was an early advocate of taking strong preventative measures against the flu He, however, seemed to curb his concern and went so far as to predict that influenza would not even reach San Francisco San Franciscans had to pay very severely for it, and the third wave hit San Francisco severely Kerala The second example I can cite is from my personal experience from our God s own country Kerala had a significant outbreak of Nipah virus infection a couple of years ago The disease was so severe that the Government and health sector had to take extraordinary measures to prevent the spread of the infection Then the COVID 19 happened The first COVID 19 case in India was reported in my native place in Kerala way before it was declared a pandemic But the health sector here took it very seriously and took all the measures to prevent the spread, and we were able to control the infection to a very significant extent Even though the health sector in our State is one of the best in India, nobody will argue with me when I say that the previous Nipah outbreak and the experience gained from it was a significant factor which enabled us to tackle the COVID 19 pandemic to a great extent until now These two examples shows the importance of knowing our past well Books like these are there to serve this exact purpose.Racism and influenza This book also says about the vital relationship between racism and influenza According to Barry, The 1918 pandemic did not, in general, follow any pattern of race and class antagonism In epidemiological terms, there was a correlation between population density and hence class and deaths But the disease struck down everywhere and everyone almost similarly Leaders in time of Crisis and Lost trust This is a crucial topic we all are facing especially during this pandemic Barry says Whoever held power whether it is city Government or some private gathering of the locals generally failed to keep the community together They failed because they lost trust They lost trust because they lied It is impossible to quantify how many deaths the lies caused San Francisco was a rare exception Its leader told the truth and the city respnded heroically during the fall wave Those in authority everywhere else were reassuring the people that it is the just influenza, only influenza Some people have had believed them Some people must have exposed to the virus in ways they would not have otherwise Atleast some of these people must have died who would have otherwise lived Leadership is as important as the infrastructure when we are dealing with a crisis like a pandemic We can see the countries which had great infrastructure yet suffered severly in both the 1918 and 2020 pandemics due to poor leadership Around 5% of world population were wiped out from this world within 2 years with most of the deaths occuring in a span of 12 weeks This shows how severe was the 1918 pandemic Among the developed countries Italy and America suffered the worst while India suffered the worst among the developing countries in both the pandemics Barry in 2004 while finishing this book was saying, It s time to start spending serious money on influenza We didn t do it We had to suffer for it in 2020 We can hope that at least by now we have learned a lesson and we will spend the adequate amount of money to ensure that such severe outbreaks won t happen in the future People are of different opinions whether we could have prevented the current pandemic or not But there is no doubt amongst anyone that all of us could have responded to it in a better way This book had promise, and is good in spots but the overall product suffers greatly from lack of direction and editorial control If I could rate the best third of the book, I would give it five stars The other two thirds of the book suffers substantially from a lack of focus, inclusion of unnecessary information, and overly dramatic narrative And, to add insult to injury, the footnotes are handled in such a fashion that they become nearly useless.In the afterword, it becomes quite obvious t This book had promise, and is good in spots but the overall product suffers greatly from lack of direction and editorial control If I could rate the best third of the book, I would give it five stars The other two thirds of the book suffers substantially from a lack of focus, inclusion of unnecessary information, and overly dramatic narrative And, to add insult to injury, the footnotes are handled in such a fashion that they become nearly useless.In the afterword, it becomes quite obvious that the author made a bad assumption at the start of his endeavor After spending seven years researching the book, he concluded that he could not tell the story of the epidemic without covering the history medical science leading up until that time He also wanted to write the book from the perspective of the scientists and politicians who reacted to the influenza outbreak he seemedinterested in covering their actions than the virus itself.These assumptions are incorrect The most interesting and relevant portion of the book is the history of the virus itself If Barry had simply explained how the virus worked, how it may have come into being, and then followed each wave of the epidemic in chronological order, this book would have been muchenjoyable and much shorter Instead, he covers material which is not relevant and by focusing on this material he breaks up his coverage of the virus, thereby rendering the best part of the book less enjoyable.The first third of the book is dedicated to the history of modern medical science Some of the material is of interest, but this history is not necessary for any discussion of the influenza virus It has absolutely no impact on the remainder of the book The reader could simply skip the first 30% of the book and would not notice it I actually found this information to be interesting, that that does not warrant their inclusion in a 450 page book with a supposed focus on the 1918 epidemic.The second portion of the book is the most direct discussion of the virus in the book, and it is quite good Barry provides a brief explanation of how the virus works and why it is so successful He then discusses the impact of the disease, rivaling any horror story while doing so The amount of chaos and suffering caused by the outbreak is quite sobering.During this time, Barry also discusses the prevailing political climate As this outbreak occurred during WWI President Wilson s desire to turn the entire country into a weapon required news of the virus to be controlled rather tightly This was exacerbated by a good deal of corruption at lower levels of government The result was a climate in which misinformation and inaction killed tens of thousands of Americans This material is entirely relevant, and I actually might have liked for him to focuson it.The last portion of the book covers the scientific community s attempts to control the virus This is really a misguided effort, as there is no significant discovery to work towards While the scientists Barry introduces the reader to are all very accomplished, none of them are able to make any headway with their influenza work The book becomes a spastic collection of various experiments carried out by a handful of scientists The text is hard to follow as it is all over the map, and after you finish it you realized that the last third of the book is about as relevant as the first third, only less interesting It is almost comical one of the scientists he covers during the entire book is Paul Lewis Towards the end of the book, after discussing Paul Lewis troubled family life ad nauseam, and filling the reader in on all sorts of work Lewis did with tuberculosis which had no impact on any influenza research , Barry goes on to tell us how Lewis died while working with the yellow fever in Brazil So essentially, any mention of Paul Lewis in the book was completely superfluous This was a fascinating read about the 1918 flu pandemic, and a good overview of the history of medicine in America I don t remember learning much about this topic in school teachers seemed to treat it likeof a footnote to World War I, which was itself treated as a footnote to all the coverage of World War II But a friend had recommended this book to methan a decade ago he was always recommending big works of nonfiction , and it took the coronavirus outbreak for me to finally get This was a fascinating read about the 1918 flu pandemic, and a good overview of the history of medicine in America I don t remember learning much about this topic in school teachers seemed to treat it likeof a footnote to World War I, which was itself treated as a footnote to all the coverage of World War II But a friend had recommended this book to methan a decade ago he was always recommending big works of nonfiction , and it took the coronavirus outbreak for me to finally get it from the library and dedicate myself to reading it Here is a good introductory section from the Prologue In 1918 an influenza virus emerged probably in the United States that would spread around the world, and one of its earliest appearances in lethal form came in Philadelphia Before that worldwide pandemic faded away in 1920, it would killpeople than any other outbreak of disease in human history Plague in the 1300s killed a far larger proportion of the populationthan one quarter of Europe but in raw numbers influenza killedthan plague then,than AIDS today And they died with extraordinary ferocity and speed Although the influenza pandemic stretched over two years, perhaps two thirds of the deaths occurred in a period of twenty four weeks, andthan half of those deaths occurred in even less time, from mid September to early December 2018 Influenza killedpeople in a year than the Black Death of the Middle Ages killed in a century it killedpeople in twenty four weeks than AIDS has killed in twenty four years.Barry has a gift for writing narrative nonfiction I was engrossed in this book, even though parts of it were a bit technical and required extra focus to follow along I listened to this on audio, narrated by Scott Brick, who gave an excellent performance I appreciated this book so much I looked up Barry s other works and intend to read them as well.While a lot has changed in 100 years, a lot has also stayed the same, including how selfish and stubborn people can be, how elected officials often fail to lead during a crisis, and that some people get angry when scientists and experts tell them things they don t want to hear Here is a good quote from the Afterword that has stayed with me In 1918 the lies of officials and of the press never allowed the terror to condense into the concrete The public could trust nothing and so they knew nothing So a terror seeped into the society that prevented one woman from caring for her sister, that prevented volunteers from bringing food to families too ill to feed themselves and who starved to death because of it, that prevented trained nurses from responding to the most urgent calls for their services The fear, not the disease, threatened to break the society apart As Victor Vaughan a careful man, a measured man, a man who did not overstate to make a point warned, Civilization could have disappeared within a fewweeks So the final lesson, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society Society cannot function if it is every man for himself By definition, civilization cannot survive that.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.Leadership must make whatever horror exists concrete Only then will people be able to break it apart This book took me a long time to read, for several reasons First, it really is two books in one The first book is a history of the men and women and institutions involved in the change to scientific medicine in this country around the turn of the century The second is the story of the influenza plague of 1918 1922 itself, the horrors of it, the death rate, the physical symptoms, the psychological effects, and the rather interesting fact that it seems to have been largely forgotten as the hist This book took me a long time to read, for several reasons First, it really is two books in one The first book is a history of the men and women and institutions involved in the change to scientific medicine in this country around the turn of the century The second is the story of the influenza plague of 1918 1922 itself, the horrors of it, the death rate, the physical symptoms, the psychological effects, and the rather interesting fact that it seems to have been largely forgotten as the history of the 20th century wore on Barry bookends the second book with the first book, and you get the impression of an author who has researched the bejeesus out of his subject and time period, and is just brimming over with information that he needs to get down on paper But the book on scientific medicine really needs to be edited out of the book about the flu plague, because the interaction of the two stories is bizarrely very small when the plague comes, the scientists and researchers he has spent so much time describing have very little, almost no, impact on the progression of the disease itself When the flu passes, the researchers continue to work on it, frantically, but nearly everyone is wrong about the cause of the disease for years and year Other scientific discoveries are made in studies of other diseases, and finally a study of infected pigs sheds light onto the causative agent The organization of the telling of the influenza epidemic also needs editing, as Barry tells the story roughly chronologically but then diverts around geographically, sometimes telling the same kinds of stories again and again So by the end of the book, you ve read several horrifying stories of deaths by neglect, several accounts of the desperate medicinal efforts made, several accounts of rapid movement of the virus through populations All of this loose organization makes the book a bit of a slog The second reason the book took me so long to read is just how painful the descriptions of the virus, the horrible effects it had on the bodies of its victims, the families of its victims, the communities of its victims, the mindsets of its victims and those who lived with the epidemic, wereit was horrifying in its scope and scale The author certainly succeeds in one of his objectives, and that is to let everyone know that FLU CAN KILL, and even though everyone treats it with nonchalance, it is only through luck that we haven t encountered a very virulent and lethal strain lately Reading this book would be an important thing to do for people who routinely skip their flu shot every year, and will spur the reader to think about what they would do with sick family members if the healthcare system was completely overwhelmed The most interesting part of the book was a chapter on the psychological damage the virus wrought on some people, and trying to link Woodrow Wilson s actions during the Paris peace conference of 1919 with changes brought on by a bought of the flu in April of that year I think he proves his case that Wilson was changed mentally by the illness What is less clear is whether the outcome of the Peace Conference would have been different because of it the Germans were delusional about the end of WWI in any case, so it is a bit hard to lay Hitler and WWII at the feet of the flu I still would recommend this to nearly everyone It is important to realize what we might have to deal with during any given flu season, and this book should be enough to scare anyone straight with regard to that The author does a great job of describing the science of the pathology and doesn t make any big mistakes with the molecular biology that I caught Lots of information in this book that applies to the COVID 19 pandemic. People write about war They write about the Holocaust They write about the horrors that people inflict on people Apparently they forget the horrors that nature inflicts on people, the horrors that make humans least significant Like so many people nowadays, I have been scrambling to wrap my mind around the current pandemic This led me, naturally, to the last major worldwide outbreak the 1918 influenza I have a distant connection to this disease My great grandfather after whom I was naPeople write about war They write about the Holocaust They write about the horrors that people inflict on people Apparently they forget the horrors that nature inflicts on people, the horrors that make humans least significant Like so many people nowadays, I have been scrambling to wrap my mind around the current pandemic This led me, naturally, to the last major worldwide outbreak the 1918 influenza I have a distant connection to this disease My great grandfather after whom I was named was drafted out of Cornell s veterinary school to work as a nurse in a temporary hospital set up for flu victims I read the letters he sent to his mother, describing the experience.John Barry s account of this virulent flu is sobering to say the least In a matter of months, the flu spread across the world and caused between 50 and 100 million deaths More American soldiers died from this flu than from the entire Vietnam War In most places the mortality rate hovered around two percent, but it struck muchfiercely elsewhere In the Fiji Islands, 14 percent of its population succumbed in Western Samoa, twenty two percent and in Labrador, a third of the population died And because the disease mainly struck young people people in their twenties and thirties thousands were left orphans.Barry s book is not, however, simply a record of deaths He sets the historical scene by giving a brief overview of contemporary medicine In the early 1900s, modern medicine was just coming into its own After centuries in which it was thought that bad air miasma caused illness, and in which bleeding was the most popular cure, researchers were beginning to discover viruses and bacteria, and were beginning to understand how the immune system combats these germs Major public health initiatives were just getting underway The John Hopkins School of Public Health had been founded, and the Rockefeller Institute was making new types of research possible It was not the Dark Ages.The other major piece of historical context is, of course, the First World War Undoubtedly this played a major role in the epidemic Not only did troop movements help to spread the disease, but press censorship virtually guaranteed that communities were unprepared Barry notes how newspapers all across the country consistently downplayed the danger, which ironically only further increased panic The pandemic is sometimes called the Spanish flu, because the press in neutral Spain was uncensored, and so reported freely on the disease The war effort overrode all of the warnings of disease experts and by the time the disease struck many communities, most of the available doctors and nurses had been sent to the military.Barry s narration mainly focuses on the United States Partly this is because this is where he believes the disease originated there are several competing theories , partly this is because the disease s impact in Europe was overshadowed by the war, and partly this is simply because of the amount of easily available sources I did wish he had spenttime on other countries especially on India, which suffered horribly The sections on science both on the history of science, and summarizing what we know now about flu viruses were in general quite strong What was lacking, for me, were sections on the cultural impact of the disease.But perhaps there are not so many As Barry notes, no major novelist of the time Hemingway, Fitzgerald, Lawrence mentioned the pandemic in their works I have noticed the same thing myself I cannot recall a single mention of this flu in biographies and autobiographies of people who lived through the pandemic, such as John Maynard Keynes or even John D Rockefeller who personally funded research on the disease This is perhaps understandable in Europe, where the deaths from the pandemic were swallowed up in news of the war but it seems odd elsewhere What is , the pandemic did not seem to exacerbate existing racial or class tensions In many ways the virus seems to have swept through communities and then disappeared from memory Barry does have one fairly controversial claim in the book that Woodrow Wilson contracted the flu while negotiating the treaty of Versailles, and that it caused him to capitulate to Clemenceau s demands If this is true, it would be a major historical consequence It is illuminating to compare the 1918 pandemic to the current crisis There are many similarities Both are caused by easily transmissible viruses, and both spread around the world The H1N1 flu virus and the SARS CoV 2 virus both infect the respiratory system, causing fever, coughing, and in severe cases pneumonia and ARDS acute respiratory distress syndrome In both cases, no vaccine is available and no known treatment is effective As in 1918, doctors are turning desperately to other therapies and medicines those developed for other, unrelated diseases like malaria and as in 1918, researchers are publishing at a frantic pace, with no time for peer review Police are again wearing masks, hospitals are again overrun, and officials are struggling to catch up with the progress of the virus.But of course, there are many important differences, too One is the disease itself The 1918 flu was almost certainly worse than the novel coronavirus It wasdeadly in general, and it killed younger people in far greater numbers which resulted in a much bigger dip in life expectancy Young people died because their immune systems overreacted in what is called a cytokine storm The H1N1 flu also had a far shorter incubation period This meant that the gap between infection and the first symptoms was short often within 24 hours and patients deteriorated farquickly Barry describes people being struck down within mere hours of showing their first symptoms The challenge of the SARS CoV 2 virus, however, is the very long incubation period potentially up to two weeks in which people may be infectious and yet not show symptoms This makes it very difficult to keep track of who has it.The explanation for this difference lies in the nature of the virus A virus is basically a free floating piece of genetic code incased in a protein shell It needs to highjack animal cells in order to reproduce and it infiltrates cells using proteins that link up with structures on the cells surface Once inside, the virus begins to replicate until the cell literally bursts, spilling virus into adjacent cells, which in turn get infected, and which in turn burst Each burst can release thousands of copies The rate at which the virus replicates within the cells determine the incubation period between first infection and first symptoms , and coronaviruses replicate significantlyslowly in animal cells, thus explaining the slower onset of symptoms Their greater speed also means that flu viruses change faster, undergoing antigenic drift and antigenic shift, meaning that new strains of the virus are inevitable The novel coronavirus is likelystable.Another potential difference is seasonality Flu viruses come in seasonal waves The 1918 virus struck first in spring, receded in summer, and then returned in autumn and one last time in the winter of 1919 Every wave hit very quickly and then left just as quickly Most cities experienced a sharp drop off in cases after about six weeks of the first patients The seasonality of the 1918 flu was partly a result of the genetic drift just mentioned, as the different waves of this flu were all at least subtly different strains of the virus Atmospheric conditions humidity and temperature also presumably make some difference in the flu virus s spread COVID 19 may exhibit a very different pattern It may, perhaps, be less affected by atmospheric conditions and if it mutates and reproducesslowly, it may linger around for one long wave rather than several short ones This is just my speculation.Well, so much for the virus How about us The world has changed a lot since 1918 However, not all of those changes have made us better prepared Fast and cheap air travel allowed the virus to spreadquickly And economic globalization did not help, either, as both medicines and medical equipment are often produced overseas and then imported, thus rendering countriesvulnerable to supply chain disruption than in the past As we witness countries and states compete for supplies, this vulnerability is very apparent.But of course we have many advantages, too Many of the deaths caused by the flu and the coronavirus are not from the virus infection itself, but because the virus renders us vulnerable to secondary infections by bacteria, causing pneumonia Antibiotics which did not exist in 1918 can save many lives Another advantage is medical care The most severe patients of both epidemics were struck with ARDS, a condition with an almost 100% mortality rate for those who do not receive intensive medical care using a ventilator machine In 1918 they were able to administer oxygen, but far less effectively than we can Even so, even with the best intensive care, the survival rate of ARDS is between 40 60% And our ability to administer intensive care is quite limited The ventilator shortage has become a global emergency in itself, as hospitals are overrun.Medical science has also advanced considerably Now we can isolate the virus which they could not do in 1918 , test individuals for it, and work on a vaccine However, testing has so far been unable to keep up with the virus And the most optimistic estimate of an available vaccine is in a year Arguably a much bigger advantage is information technology The press is not censored so citizens have a much better idea of the risks involved and experts can communicate with each other in real time We can coordinate large scale societal responses to the pandemic, and can potentially even use technology to track individual cases As we come to better understand the virus, we will be able to usesophisticated statistical methods to understand its progress None of this was possible in 1918.One thing that we will have to contend with something that is hardly even mentioned in Barry s book is the economic toll that this virus will take Even in the ugliest days of the 1918 pandemic, governments did not require businesses or restaurants to close War preparations went on unabated In 1918, after years of slaughter and at the height of the war, life was simply cheaper than it is now Our societal response will likely mitigate the health crisis but will create a secondary economic crisis that may ultimately bedifficult to solve The solutions to this crisis could be our most lasting legacies Already Spain s government is talking of adopting universal basic income Though of course it is far too early to predict anything with confidence.Comparisons with 1918 are partly depressing, and partly uplifting Depressing, because we knew this was possible and did not prepare Depressing, because so many governments have gone through the same cycle of early denial and disorganized response as they did back then Uplifting, because we do know muchthan we did Uplifting, because after our early fumbles we are finally coordinating as a global community to deal with the crisis Perhaps most uplifting of all, despite some ugly stories here and there, the crisis has revealed a basic sense of solidarity in the face of a universal threat Hopefully, unlike 1918, we will not do our best to forget about this one

The Great Influenza: The Story of the Deadliest Pandemic
    The Great Influenza: The Story of the Deadliest Pandemic speed on the terrible threat of the avian flu and suggest ways in which we might head off another flu pandemic. Pandemics recur, just as history repeats itself, and it s all simply a question of how much can be learned from it and how far technology has marched on They were at war, so they couldn t tell that there were outbreaks, only the neutral Spain could say it without the danger of demotivating the population Today there are mostly just trade wars any, but the rules have stayed the same and looking at the potential immense economical damage, the intuition of those trying to hide outbreaks was Pandemics recur, just as history repeats itself, and it s all simply a question of how much can be learned from it and how far technology has marched on They were at war, so they couldn t tell that there were outbreaks, only the neutral Spain could say it without the danger of demotivating the population Today there are mostly just trade wars any, but the rules have stayed the same and looking at the potential immense economical damage, the intuition of those trying to hide outbreaks was right The influence of such pandemics on human, primate, mammal, and rodent evolution must have been immense, as wiping out huge parts of the population or even the whole population until extinction, and might have happened many times Without samples andadvanced technology to detect virus DNA and RNA in archeology, or to find the right fossils, it will long stay unclear how massive the impact on the development of higher life forms on the planet might have been The differences between 1920 and 2020 are so immense that it takes time to realize how real and everrealistic this danger is, because we tend to believe that it can t get so bad Medicine was very primitive, but we didn t really come so much closer to a solution in preventing outbreaks and finding cures.They didn t have cars, planes, anything to spread it worldwide or just in a nation with such a speed as today No freeways, just trains and some roads with horses on them As long as the horses didn t get it, the spread was very slow.Fewer people having not so much contact with another.Just telephones to communicate, nothing to coordinate the efforts of a state or even a whole continent A large question is what population group is most affected and if, when the virus has found its prime target, it won t mutate again and switch the victim again The book is not just about the Spanish flu, but also about the doctors and researches that tried to deal with it with methods that seem medieval compared to nowadays standards and by mixing the historical facts with these protagonists, it becomes very vivid for a nonfiction title It has a bit much redundancy and it would be a five star if the author had putfocus on not repeating himself and telling very similar stories, wildly jumping between geography, personal stories, and the medicine of those days, making it all a bit blurry and unnecessary complicated to follow Even if nowadays governments wouldn t be incompetent, the human factor alone is highly disturbing Just some people who are immune to rudimentary hygiene rules and logical arguments are enough, and guess what one little piglet that refuses to wash hands, sneeze in the crook of the arm, etc could do for spreading diseases Not to speak of antisocial psychos who do it on purpose, try to get it, and spread it We didn t write our own history, nature in the form of plagues did a lot of it and it would be arrogant and dangerous to believe that we are now so highly advanced and have so much fancy technology and it s a techno optimist who is saying that that we are invulnerable, as if we already had nanobots patrolling each body and sending signals to produce individualized vaccines as soon as any invader is detected.But we aren t there and the incompetence, arrogance, and idiocy of the Western governments will cost many lives now and in the future, until technology will eradicate the last plagues, what is just a question of time, not of if There might even be already the potential for producing and developing new vaccines, testing methods, and preventive measures But the pharma companies make no money with developing cures for plagues that might never occur and the state has no interest in investing in protecting its citizens, although this could even be seen as military research where a bit of money is invested in general Why it s even not possible to produce enough test kits or establish a global network of testing stations that monitor the world or to have intelligent plans for pandemics or to listen to experts or to not worsen the situation with polemics and fake news or to quarantine early enough or but, as said, the politicians are like Lalalala..ignoring experts..yada yada yada Stupid decision stupid decision stupid decision , while unnecessary piles of corpses are exponentially growing.Some links dealing with the current pandemic CNN live updateshttps edition.cnn.com asia live newJohn Hopkins CSSE world maphttps gisanddata.maps.arcgis.com apYoutube statisticshttps www.youtube.com watch v qgylpA wiki walk can be as refreshing to the mind as a walk through nature in this completely overrated real life outside books Epidemiological evidence suggest that a new influenza virus originated in Haskell County, Kansas, early in 1918 Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world In its wake followed a keening sound that rose from the throats of mourners like the Epidemiological evidence suggest that a new influenza virus originated in Haskell County, Kansas, early in 1918 Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world In its wake followed a keening sound that rose from the throats of mourners like the wind John M Barry, The Great InfluenzaThis book is what happens when I combine a smart phone,s one click shopping, and my low key binge drinking I had just sat down in my favorite chair for my weekly wine drunk No sooner had I dropped some ice cubes into a pint glass full of club soda and cheap chardonnay, than Steven Soderbergh s Contagion began playing on HBO I never intended to watch the movie Based on the trailers, I had decided that it was too much like the movie Outbreak, except with fewer monkeys and 100% less helicopter chases involving Dustin Hoffman and Cuba Gooding, Jr Still, people who drink Yellow Tail out of pint glasses can t be choosers, so I let the film unspool Like all of Soderbergh s works, Contagion was slick, engaging, and sharply edited As the all star cast began dying from a mysterious and highly contagious disease, and as I started to get a buzz from that pint of cheap wine, it occurred to me that I was suddenly, desperately interested in infectious diseases So I bought John M Barry s The Great Influenza, about the so called Spanish flu of 1918 that killed as many as 100 million people Unlike influenza, my interest in the topic quickly wore off It was only several months later that I finally got around to reading it Totally worth the drunken purchase Barry s epic is a work of incredible scope and depth It combines accessible science medical writing, perceptive character sketches, and telling human anecdotes to corral a story a global pandemic that doesn t necessarily lend itself to the written word Film is theobvious medium for pandemic stories All you need is a computerized map of the world in a neutral color Then, have that map start to turn red while someone intones, 24 hours 48 hours 72 hoursIn Barry s words, the 1918 influenza pandemic was the first great collision between nature and modern science To that end, he begins the book with a brisk, wide ranging, and fascinating history of medicine, gradually narrowing his focus to the state of American medicine at the turn of the century It was, in a word, deplorable There was no consistency in education, no overarching standards, no pursuit of progress While American doctors were still pondering the leech, Europeans were making the advances In Europe, governments, universities, and wealthy donors helped support medical research In the United States, no government, institution, or philanthropist even began to approach a similar level of support As the Hopkins medical school was opening, American theological schools enjoyed endowments of 18 million, while medical school endowments totaled 500,000 The future of American medicine got a bit brighter with William Welch and the founding of the Johns Hopkins Medical School Welch is one of the titanic figures in American science, a stethoscope wearing J Robert Oppenheimer not necessarily a great scientist or discoverer, but a manager nonpareil It was Welch who would lead the U.S response to the influenza outbreak The Great Influenza attempts to tell a huge story An outbreak is hard to contain in a book and also, obviously, in real life It is not a singular event, but a worldwide phenomenon it does not happen in a single place, to a single person, but to everyplace, and millions of persons Accordingly, the narrative diffuses once Barry begins the story of the flu itself ground zero of the pandemic is hotly debated Barry pinpoints Haskell County, Kansas, as the originating spot Of necessity, the story begins to hop around a lot, to locations all over the globe There are a lot of staggering numbers x numbers infected, y numbers dead interspersed with illustrative stories that provide a micro view of a global disaster For instance, Barry relates the story of an Army camp commander World War I was the mechanism by which this disease spread so far and wide who committed suicide after failing to take proper steps to protect and quarantine his troops One of Barry s real gifts is to explain medicine and biology to a part time drunk, full time nonscientist such as myself I am a concrete thinker, a literalist My ability to imagine things I can t see such as biological processes is surpassed only by my ability to do one armed pushups while shaving Using metaphor and analogy, Barry does a wonderful job of providing both the hard science and a simple explanation to interpret it For instance, Barry explains how the immune response to influenza ultimately made healthy young adults the flu s greatest victim Macrophages and natural killer cells two kinds of white blood cells that seek and destroy all foreign invaders patrol the entirety of the respiratory tract and lungs Cells in the respiratory tracts secrete enzymes that attack bacteria and some viruses including influenza or block them from attaching to tissue beneath the mucus, and these secretions also bringwhite cells and antibacterial enzymes into a counterattack if a virus is the invader, white blood cells also secrete interferon, which can block viral infection All these defenses work so well that the lungs themselves, although directly exposed to the outside air, are normally sterile.But when the lungs do become infected, other defenses, lethal and violent defenses, come into play For the immune system is at its core a killing machine It targets infecting organisms, attacks with a complex arsenal of weapons some of them savage weapons and neutralizes or kills the invader The balance, however, between kill and overkill, response and overresponse, is a delicate one The immune system can behave like a SWAT team that kills the hostage along with the hostage taker, or the army that destroys a village to save it.The 1918 influenza pandemic killed between 21 million according to a 1927 AMA study and 100 million people according to Nobel laureate and influenza researcher Macfarlane Burnet That meant that about 5% of the population of the world died It is a terrifying proposition Using today s population numbers, the fatalities would be between 70 and 300 million people With all the different flu scares we ve had, Barry was eventually obligated perhaps by his publishers, at gunpoint to update his book to remind us how we re all going to die Like all new afterwords, the one included at the end of The Great Influenza feels halfhearted and unnecessary If you ve paid attention at all to the hundreds of preceding pages, it is not difficult to extrapolate what might happen during a present day outbreak of an infectious disease or out of control virus The thing about The Great Influenza is that it is almost always relevant Always, there is a disease, somewhere in the world, read to spring forth In the years since this was first published in 2004, we ve had Ebola, SARS, and Zika to terrify us It s hard to know what will crop up next, and whether this will be the one to turn the map all red Ultimately, I don t think I was half as terrified as I was supposed to be, mainly because I have a lot of other existential threats to worry about cancer heart disease wine poisoning Thus, I rate my chance of dying in a deadly pandemic as relatively low I also feel that the world isattune to these things than ever before We no longer believe in miasma theory or the humors of our bodies Conversely, we believe in quarantining, washing hands, and reverse engineering both pathogens and the journeys they travel Still, we are living you might have noticed in an extremely knitted together world All it takes is a handful of people leaving an uncontrolled hot zone, hopping on an airplane, and starting an exponential event that only Hollywood could love, and no one can halt Update, March 31, 2020 As I write this, I am in the third week of self quarantine, following a shelter in place order necessitated by the spread of Covid 19 The coronavirus has definitely made the penultimate paragraph of my original review look like the work of a prize fool Turns out, I should have beenworried about dying in a pandemic Certainly, being stuck at home has drastically increased my risk of wine poisoning Of course, when I wrote about the advanced state of science back in 2013 I had no idea how many people on this earth didn t believe in science More to the point, I did not know that there were so many people so militantly anti science that they would go to a hospital in the midst of a pandemic to take videos, all in an attempt to disprove a deadly, worldwide virus as some massive hoax On second thought, maybe I was right Maybe the virus isn t the real danger Maybe the thing we should all fear is ourselves I am really surprised at the number of positive reviews this book got, both professional and consumer I am currently a littlethan halfway through and feel the need to write something in case I don t finish it and lose the desire.Before critiquing Barry and his writing style, or lack thereof, his editor, Wendy Wolf deserves special mention This is the first book I have ever read in which I have made special note of the editor and will refuse to read anything she works on in the future I I am really surprised at the number of positive reviews this book got, both professional and consumer I am currently a littlethan halfway through and feel the need to write something in case I don t finish it and lose the desire.Before critiquing Barry and his writing style, or lack thereof, his editor, Wendy Wolf deserves special mention This is the first book I have ever read in which I have made special note of the editor and will refuse to read anything she works on in the future I was sorely tempted to tally the number of repetitions of key phrases, pieces of information and entire narrative sequences Perhaps editing this book was too daunting a task to do it well and still preserve the intent and message, but if so, I would have quit Wendy gets 1 star.Before she edited it though, he wrote it As I understand it, the 1918 Influenza outbreak, with its undercurrents of concurrent revolutions in medical science, oppressive and at times seemingly unconstitutional governmental policy, sheer human agony, and internationality, is replete with its own inherent drama No additional tear jerkers are necessary the reporting of how 50 million people died worldwide would be plenty Barry decides that manufactured melodrama is the most effective vehicle to convey this, however How can one assume how people felt during a worldwide pandemic After assuming it, how can one essentially write fiction in a non fiction book as it is described In addition to his atrocious writing style, Barry seems to thread 3 or 4 books into one, and doesn t even separate them with definitive breaks in his book In a text which is nominally about an historical event, we read biographical sketches of several men who weren t even involved in fighting the disease.I recommend this to no one Read the wikipedia article on 1918 Influenza It s probably far less annoying.UPDATE After getting through 300 out of 460 pages of this poorly organized, melodramatic, poor excuse for historiography, I realized I was not only wasting my time reading it, but I was also wasting my time complaining about it to my friends and family Thats a TRIPLE waste of time Barry is not worth this investment I caution every one of you Unless you want to boost your self esteem and have a John Irving moment of Wow, I could seriously do way better than this and this guy got published DO NOT READ THIS BOOK I hope you read this, Barry, and send me an apology.I ve never written a review this bitter Mostly because I ve never been this bitter about a book As the world is wrapped up in the COVID 19 pandemic, I thought that I would try to educate myself a littleon the general topic while forced to isolate with books I have often wanted to know a littleabout the Spanish Influenza of 1918 19, which was said to be one of the worst pandemics in modern times As we are in something similar at present, I turned to John M Barry s book to permit me to speak with ease as it relates to the spread of infection and the reactions by the public and As the world is wrapped up in the COVID 19 pandemic, I thought that I would try to educate myself a littleon the general topic while forced to isolate with books I have often wanted to know a littleabout the Spanish Influenza of 1918 19, which was said to be one of the worst pandemics in modern times As we are in something similar at present, I turned to John M Barry s book to permit me to speak with ease as it relates to the spread of infection and the reactions by the public and politicians alike Barry opens with a jaw dropping tale of the emergence of medical schools and their lax entrance requirements, making the moniker doctor seem less impressive It was only students studying in Balti at Johns Hopkins who were put through the motions of a significant medical education and who earned the title with some confidence From there, the narrative moves to offer some backstory on the emergence of the influenza, citing that its Spanish name came not from the origins, but that Spanish newspapers offered frank discussion of events taking place, not censored during the Great War Talk of an influenza with many deaths filled the headlines, which hit the newswires and the name stuck Barry explores the origins, based on his own research, as well as how infection ran rampant throughout Europe and soldiers from all countries involved brought it back to their homelands during troop replenishments or retreats With the only way to travel back to America being the ship, close quartered troops passed the infection between one another with ease, beginning an explosion of cases once troops made their way across the country Barry examines how health officials sought to contain things and pushed for hygiene campaigns, which were only somewhat effective Public Health officials pushed isolation, cleanliness, and the need to take precautions, as the spread ran through the country and left medical officials scrambling to contain the spread How things seem to parallel what is taking place now, to a differing degree.Barry offers the scientific analysis of the topic as well, discussing frankly about how viruses develop and leap from animals to humans, including how immunity develops The novice reader can learn much about this and how medicines can help occasionally, as well as what makes the virus able to overpower the human body There is also a great discussion about how the virus attaches itself to the body through the lungs and other air passages This discussion not only educates the reader into how infection takes place perhaps justifying the precautions like washing, masks, and gloves and the speed at which things can progress Barry pulls no punches, using early 20th century medical technology to explain how things spread with ease and what could be done to eradicate any further spread Fitting this medical and scientific knowledge with the narrative about the historical happenings, the reader has a better understanding of the situation While this may not arm the reader to understand the intricacies of World Health Organisation documents or the high level analysis done by leading politicians in their briefings, Barry gives the reader a better understanding of how things were during this world scare and what parallels can be drawn to the current COVID 19 pandemic.Peppered amongst these two major narratives is the handful of scientists who studied the influenza and sought to find cures The interested reader will discover a great deal about immunology and how scientists must use vigorous techniques, as well as exhausting their tests on animals and humans alike, in order to eradicate what was fast becoming a horrible disease that was growing exponentially Barry follows the work of these essential scientists throughout, from their early focus on how the influenza infected humans through the various tests and microscopic analyses Thereafter, it was infecting and watching the results in animals that permitted scientists to come up with something that could be used to stop the spread of the influenza This is a solid teachable moment for the reader about immunisation and its importance to keep disease away from the population Whatever the reader feels about needles and how their children react, Barry makes a blunt plea to eradicate new strains of long dormant diseases with some simple precautionary measures Whether these cause autism is something to COVID 19 conspiracists can bring up when fashioning tin foil hats at their upcoming social distancing picnics.Whether the reader is a strong believer in the health crisis COVID 19 is unleashing on the world or feels that this is a political conspiracy drummed up to hide bigger issues I have heard people on both sides share their sentiments with me , John M Barry s book is highly educational and fits perfectly into how things are playing out at present Barry offers a great deal of background on so many interesting topics, all of which are interconnected to the issues at hand The exploration of viruses and how their emergence in other mammals can leap to humans with relative ease explains some of the new and odd influenzas and infections that are seen across the world today Barry does not dilute the discussion, but his explanations are digestible by most readers with a general understanding of basic medical and scientific terminology Paired with the thorough discussion of the historical goings on in Europe and, eventually, America, the story iscomplete and the policies enacted make a great deal of sense The reader attuned with news reports may find parallels with what was done in 1918 19 to the present reaction in the United States, though it is sure that Woodrow Wilson allowed local governments and health officials to complete their work unimpeded with false hopes and unreasonable timelines In a number of well documented chapters, Barry illustrates just how vast the influenza infection and battle became in America, as well as how deeply felt the deaths were to many who had no idea what was going on The empathetic reader will likely feel some heart pain for the orphans, the families who lost loved ones overnight, and the emotional battle of giving up the bodies of those they loved, sure that mass graves would leave them unidentifiable in the future Barry s book is surely a great one for those who are cooped up and want to get some context, as well as the curious reader, such as myself, who wonder how reactions to past calamities compare to today s overly dramatic delivery in the 24 hour news cycle Kudos, Mr Barry, for this enlightening look at an event in world history that surely has some connections to the events in today s COVID 19 world This book fulfils Topic 7 Catastrophe, of the Equinox 10 Reading Challenge.Love hate the review An ever growing collection of others appears at Book for All Seasons, a different sort of Book Challenge History is not only learning about the past but also learning from the past to shape our present and the future This book in such a way is not only a compendium about the Spanish flu 1918 1920 but also a vivid description about the pattern of the current pandemic Covid 19 Barry wrote this book in 2004 and also the pandemics that might happen in the future Spanish flu is something every Medico might have studied during their Med school days Still, this book gave me so much new informatio History is not only learning about the past but also learning from the past to shape our present and the future This book in such a way is not only a compendium about the Spanish flu 1918 1920 but also a vivid description about the pattern of the current pandemic Covid 19 Barry wrote this book in 2004 and also the pandemics that might happen in the future Spanish flu is something every Medico might have studied during their Med school days Still, this book gave me so much new information which I haven t found anywhere else As Bill Gates said, Barry will teach you almost everything you need to know about one of the deadliest outbreaks in human history through this book Just like the striking resemblances during the repeated outbreaks of Ebola in Africa, there is a striking resemblance between the Spanish flu and the current COVID 19 outbreak even though the former occurred a century ago One big tragedy might help us to save ourselves from asignificant catastrophe in the future We can see multiple examples of these in both the pandemics I will cite a couple over here.San Francisco After suffering from one of the worst earthquakes in the history of the United States in 1906, San Francisco was recouping when the pandemic hit the USA in 1918 According to Barry of all the major cities in America, San Francisco confronted the fall wave most honestly and efficiently That may have had something to do with surviving and rebuilding after the major earthquake Well begun is half done Even though it is true, it doesn t give us the liberty to be complacent or overconfident after a good beginning It seems that it is what happened in San Francisco later during the third wave Dr William Hassler, Chief of San Francisco s Board of Health, was an early advocate of taking strong preventative measures against the flu He, however, seemed to curb his concern and went so far as to predict that influenza would not even reach San Francisco San Franciscans had to pay very severely for it, and the third wave hit San Francisco severely Kerala The second example I can cite is from my personal experience from our God s own country Kerala had a significant outbreak of Nipah virus infection a couple of years ago The disease was so severe that the Government and health sector had to take extraordinary measures to prevent the spread of the infection Then the COVID 19 happened The first COVID 19 case in India was reported in my native place in Kerala way before it was declared a pandemic But the health sector here took it very seriously and took all the measures to prevent the spread, and we were able to control the infection to a very significant extent Even though the health sector in our State is one of the best in India, nobody will argue with me when I say that the previous Nipah outbreak and the experience gained from it was a significant factor which enabled us to tackle the COVID 19 pandemic to a great extent until now These two examples shows the importance of knowing our past well Books like these are there to serve this exact purpose.Racism and influenza This book also says about the vital relationship between racism and influenza According to Barry, The 1918 pandemic did not, in general, follow any pattern of race and class antagonism In epidemiological terms, there was a correlation between population density and hence class and deaths But the disease struck down everywhere and everyone almost similarly Leaders in time of Crisis and Lost trust This is a crucial topic we all are facing especially during this pandemic Barry says Whoever held power whether it is city Government or some private gathering of the locals generally failed to keep the community together They failed because they lost trust They lost trust because they lied It is impossible to quantify how many deaths the lies caused San Francisco was a rare exception Its leader told the truth and the city respnded heroically during the fall wave Those in authority everywhere else were reassuring the people that it is the just influenza, only influenza Some people have had believed them Some people must have exposed to the virus in ways they would not have otherwise Atleast some of these people must have died who would have otherwise lived Leadership is as important as the infrastructure when we are dealing with a crisis like a pandemic We can see the countries which had great infrastructure yet suffered severly in both the 1918 and 2020 pandemics due to poor leadership Around 5% of world population were wiped out from this world within 2 years with most of the deaths occuring in a span of 12 weeks This shows how severe was the 1918 pandemic Among the developed countries Italy and America suffered the worst while India suffered the worst among the developing countries in both the pandemics Barry in 2004 while finishing this book was saying, It s time to start spending serious money on influenza We didn t do it We had to suffer for it in 2020 We can hope that at least by now we have learned a lesson and we will spend the adequate amount of money to ensure that such severe outbreaks won t happen in the future People are of different opinions whether we could have prevented the current pandemic or not But there is no doubt amongst anyone that all of us could have responded to it in a better way This book had promise, and is good in spots but the overall product suffers greatly from lack of direction and editorial control If I could rate the best third of the book, I would give it five stars The other two thirds of the book suffers substantially from a lack of focus, inclusion of unnecessary information, and overly dramatic narrative And, to add insult to injury, the footnotes are handled in such a fashion that they become nearly useless.In the afterword, it becomes quite obvious t This book had promise, and is good in spots but the overall product suffers greatly from lack of direction and editorial control If I could rate the best third of the book, I would give it five stars The other two thirds of the book suffers substantially from a lack of focus, inclusion of unnecessary information, and overly dramatic narrative And, to add insult to injury, the footnotes are handled in such a fashion that they become nearly useless.In the afterword, it becomes quite obvious that the author made a bad assumption at the start of his endeavor After spending seven years researching the book, he concluded that he could not tell the story of the epidemic without covering the history medical science leading up until that time He also wanted to write the book from the perspective of the scientists and politicians who reacted to the influenza outbreak he seemedinterested in covering their actions than the virus itself.These assumptions are incorrect The most interesting and relevant portion of the book is the history of the virus itself If Barry had simply explained how the virus worked, how it may have come into being, and then followed each wave of the epidemic in chronological order, this book would have been muchenjoyable and much shorter Instead, he covers material which is not relevant and by focusing on this material he breaks up his coverage of the virus, thereby rendering the best part of the book less enjoyable.The first third of the book is dedicated to the history of modern medical science Some of the material is of interest, but this history is not necessary for any discussion of the influenza virus It has absolutely no impact on the remainder of the book The reader could simply skip the first 30% of the book and would not notice it I actually found this information to be interesting, that that does not warrant their inclusion in a 450 page book with a supposed focus on the 1918 epidemic.The second portion of the book is the most direct discussion of the virus in the book, and it is quite good Barry provides a brief explanation of how the virus works and why it is so successful He then discusses the impact of the disease, rivaling any horror story while doing so The amount of chaos and suffering caused by the outbreak is quite sobering.During this time, Barry also discusses the prevailing political climate As this outbreak occurred during WWI President Wilson s desire to turn the entire country into a weapon required news of the virus to be controlled rather tightly This was exacerbated by a good deal of corruption at lower levels of government The result was a climate in which misinformation and inaction killed tens of thousands of Americans This material is entirely relevant, and I actually might have liked for him to focuson it.The last portion of the book covers the scientific community s attempts to control the virus This is really a misguided effort, as there is no significant discovery to work towards While the scientists Barry introduces the reader to are all very accomplished, none of them are able to make any headway with their influenza work The book becomes a spastic collection of various experiments carried out by a handful of scientists The text is hard to follow as it is all over the map, and after you finish it you realized that the last third of the book is about as relevant as the first third, only less interesting It is almost comical one of the scientists he covers during the entire book is Paul Lewis Towards the end of the book, after discussing Paul Lewis troubled family life ad nauseam, and filling the reader in on all sorts of work Lewis did with tuberculosis which had no impact on any influenza research , Barry goes on to tell us how Lewis died while working with the yellow fever in Brazil So essentially, any mention of Paul Lewis in the book was completely superfluous This was a fascinating read about the 1918 flu pandemic, and a good overview of the history of medicine in America I don t remember learning much about this topic in school teachers seemed to treat it likeof a footnote to World War I, which was itself treated as a footnote to all the coverage of World War II But a friend had recommended this book to methan a decade ago he was always recommending big works of nonfiction , and it took the coronavirus outbreak for me to finally get This was a fascinating read about the 1918 flu pandemic, and a good overview of the history of medicine in America I don t remember learning much about this topic in school teachers seemed to treat it likeof a footnote to World War I, which was itself treated as a footnote to all the coverage of World War II But a friend had recommended this book to methan a decade ago he was always recommending big works of nonfiction , and it took the coronavirus outbreak for me to finally get it from the library and dedicate myself to reading it Here is a good introductory section from the Prologue In 1918 an influenza virus emerged probably in the United States that would spread around the world, and one of its earliest appearances in lethal form came in Philadelphia Before that worldwide pandemic faded away in 1920, it would killpeople than any other outbreak of disease in human history Plague in the 1300s killed a far larger proportion of the populationthan one quarter of Europe but in raw numbers influenza killedthan plague then,than AIDS today And they died with extraordinary ferocity and speed Although the influenza pandemic stretched over two years, perhaps two thirds of the deaths occurred in a period of twenty four weeks, andthan half of those deaths occurred in even less time, from mid September to early December 2018 Influenza killedpeople in a year than the Black Death of the Middle Ages killed in a century it killedpeople in twenty four weeks than AIDS has killed in twenty four years.Barry has a gift for writing narrative nonfiction I was engrossed in this book, even though parts of it were a bit technical and required extra focus to follow along I listened to this on audio, narrated by Scott Brick, who gave an excellent performance I appreciated this book so much I looked up Barry s other works and intend to read them as well.While a lot has changed in 100 years, a lot has also stayed the same, including how selfish and stubborn people can be, how elected officials often fail to lead during a crisis, and that some people get angry when scientists and experts tell them things they don t want to hear Here is a good quote from the Afterword that has stayed with me In 1918 the lies of officials and of the press never allowed the terror to condense into the concrete The public could trust nothing and so they knew nothing So a terror seeped into the society that prevented one woman from caring for her sister, that prevented volunteers from bringing food to families too ill to feed themselves and who starved to death because of it, that prevented trained nurses from responding to the most urgent calls for their services The fear, not the disease, threatened to break the society apart As Victor Vaughan a careful man, a measured man, a man who did not overstate to make a point warned, Civilization could have disappeared within a fewweeks So the final lesson, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society Society cannot function if it is every man for himself By definition, civilization cannot survive that.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.Leadership must make whatever horror exists concrete Only then will people be able to break it apart This book took me a long time to read, for several reasons First, it really is two books in one The first book is a history of the men and women and institutions involved in the change to scientific medicine in this country around the turn of the century The second is the story of the influenza plague of 1918 1922 itself, the horrors of it, the death rate, the physical symptoms, the psychological effects, and the rather interesting fact that it seems to have been largely forgotten as the hist This book took me a long time to read, for several reasons First, it really is two books in one The first book is a history of the men and women and institutions involved in the change to scientific medicine in this country around the turn of the century The second is the story of the influenza plague of 1918 1922 itself, the horrors of it, the death rate, the physical symptoms, the psychological effects, and the rather interesting fact that it seems to have been largely forgotten as the history of the 20th century wore on Barry bookends the second book with the first book, and you get the impression of an author who has researched the bejeesus out of his subject and time period, and is just brimming over with information that he needs to get down on paper But the book on scientific medicine really needs to be edited out of the book about the flu plague, because the interaction of the two stories is bizarrely very small when the plague comes, the scientists and researchers he has spent so much time describing have very little, almost no, impact on the progression of the disease itself When the flu passes, the researchers continue to work on it, frantically, but nearly everyone is wrong about the cause of the disease for years and year Other scientific discoveries are made in studies of other diseases, and finally a study of infected pigs sheds light onto the causative agent The organization of the telling of the influenza epidemic also needs editing, as Barry tells the story roughly chronologically but then diverts around geographically, sometimes telling the same kinds of stories again and again So by the end of the book, you ve read several horrifying stories of deaths by neglect, several accounts of the desperate medicinal efforts made, several accounts of rapid movement of the virus through populations All of this loose organization makes the book a bit of a slog The second reason the book took me so long to read is just how painful the descriptions of the virus, the horrible effects it had on the bodies of its victims, the families of its victims, the communities of its victims, the mindsets of its victims and those who lived with the epidemic, wereit was horrifying in its scope and scale The author certainly succeeds in one of his objectives, and that is to let everyone know that FLU CAN KILL, and even though everyone treats it with nonchalance, it is only through luck that we haven t encountered a very virulent and lethal strain lately Reading this book would be an important thing to do for people who routinely skip their flu shot every year, and will spur the reader to think about what they would do with sick family members if the healthcare system was completely overwhelmed The most interesting part of the book was a chapter on the psychological damage the virus wrought on some people, and trying to link Woodrow Wilson s actions during the Paris peace conference of 1919 with changes brought on by a bought of the flu in April of that year I think he proves his case that Wilson was changed mentally by the illness What is less clear is whether the outcome of the Peace Conference would have been different because of it the Germans were delusional about the end of WWI in any case, so it is a bit hard to lay Hitler and WWII at the feet of the flu I still would recommend this to nearly everyone It is important to realize what we might have to deal with during any given flu season, and this book should be enough to scare anyone straight with regard to that The author does a great job of describing the science of the pathology and doesn t make any big mistakes with the molecular biology that I caught Lots of information in this book that applies to the COVID 19 pandemic. People write about war They write about the Holocaust They write about the horrors that people inflict on people Apparently they forget the horrors that nature inflicts on people, the horrors that make humans least significant Like so many people nowadays, I have been scrambling to wrap my mind around the current pandemic This led me, naturally, to the last major worldwide outbreak the 1918 influenza I have a distant connection to this disease My great grandfather after whom I was naPeople write about war They write about the Holocaust They write about the horrors that people inflict on people Apparently they forget the horrors that nature inflicts on people, the horrors that make humans least significant Like so many people nowadays, I have been scrambling to wrap my mind around the current pandemic This led me, naturally, to the last major worldwide outbreak the 1918 influenza I have a distant connection to this disease My great grandfather after whom I was named was drafted out of Cornell s veterinary school to work as a nurse in a temporary hospital set up for flu victims I read the letters he sent to his mother, describing the experience.John Barry s account of this virulent flu is sobering to say the least In a matter of months, the flu spread across the world and caused between 50 and 100 million deaths More American soldiers died from this flu than from the entire Vietnam War In most places the mortality rate hovered around two percent, but it struck muchfiercely elsewhere In the Fiji Islands, 14 percent of its population succumbed in Western Samoa, twenty two percent and in Labrador, a third of the population died And because the disease mainly struck young people people in their twenties and thirties thousands were left orphans.Barry s book is not, however, simply a record of deaths He sets the historical scene by giving a brief overview of contemporary medicine In the early 1900s, modern medicine was just coming into its own After centuries in which it was thought that bad air miasma caused illness, and in which bleeding was the most popular cure, researchers were beginning to discover viruses and bacteria, and were beginning to understand how the immune system combats these germs Major public health initiatives were just getting underway The John Hopkins School of Public Health had been founded, and the Rockefeller Institute was making new types of research possible It was not the Dark Ages.The other major piece of historical context is, of course, the First World War Undoubtedly this played a major role in the epidemic Not only did troop movements help to spread the disease, but press censorship virtually guaranteed that communities were unprepared Barry notes how newspapers all across the country consistently downplayed the danger, which ironically only further increased panic The pandemic is sometimes called the Spanish flu, because the press in neutral Spain was uncensored, and so reported freely on the disease The war effort overrode all of the warnings of disease experts and by the time the disease struck many communities, most of the available doctors and nurses had been sent to the military.Barry s narration mainly focuses on the United States Partly this is because this is where he believes the disease originated there are several competing theories , partly this is because the disease s impact in Europe was overshadowed by the war, and partly this is simply because of the amount of easily available sources I did wish he had spenttime on other countries especially on India, which suffered horribly The sections on science both on the history of science, and summarizing what we know now about flu viruses were in general quite strong What was lacking, for me, were sections on the cultural impact of the disease.But perhaps there are not so many As Barry notes, no major novelist of the time Hemingway, Fitzgerald, Lawrence mentioned the pandemic in their works I have noticed the same thing myself I cannot recall a single mention of this flu in biographies and autobiographies of people who lived through the pandemic, such as John Maynard Keynes or even John D Rockefeller who personally funded research on the disease This is perhaps understandable in Europe, where the deaths from the pandemic were swallowed up in news of the war but it seems odd elsewhere What is , the pandemic did not seem to exacerbate existing racial or class tensions In many ways the virus seems to have swept through communities and then disappeared from memory Barry does have one fairly controversial claim in the book that Woodrow Wilson contracted the flu while negotiating the treaty of Versailles, and that it caused him to capitulate to Clemenceau s demands If this is true, it would be a major historical consequence It is illuminating to compare the 1918 pandemic to the current crisis There are many similarities Both are caused by easily transmissible viruses, and both spread around the world The H1N1 flu virus and the SARS CoV 2 virus both infect the respiratory system, causing fever, coughing, and in severe cases pneumonia and ARDS acute respiratory distress syndrome In both cases, no vaccine is available and no known treatment is effective As in 1918, doctors are turning desperately to other therapies and medicines those developed for other, unrelated diseases like malaria and as in 1918, researchers are publishing at a frantic pace, with no time for peer review Police are again wearing masks, hospitals are again overrun, and officials are struggling to catch up with the progress of the virus.But of course, there are many important differences, too One is the disease itself The 1918 flu was almost certainly worse than the novel coronavirus It wasdeadly in general, and it killed younger people in far greater numbers which resulted in a much bigger dip in life expectancy Young people died because their immune systems overreacted in what is called a cytokine storm The H1N1 flu also had a far shorter incubation period This meant that the gap between infection and the first symptoms was short often within 24 hours and patients deteriorated farquickly Barry describes people being struck down within mere hours of showing their first symptoms The challenge of the SARS CoV 2 virus, however, is the very long incubation period potentially up to two weeks in which people may be infectious and yet not show symptoms This makes it very difficult to keep track of who has it.The explanation for this difference lies in the nature of the virus A virus is basically a free floating piece of genetic code incased in a protein shell It needs to highjack animal cells in order to reproduce and it infiltrates cells using proteins that link up with structures on the cells surface Once inside, the virus begins to replicate until the cell literally bursts, spilling virus into adjacent cells, which in turn get infected, and which in turn burst Each burst can release thousands of copies The rate at which the virus replicates within the cells determine the incubation period between first infection and first symptoms , and coronaviruses replicate significantlyslowly in animal cells, thus explaining the slower onset of symptoms Their greater speed also means that flu viruses change faster, undergoing antigenic drift and antigenic shift, meaning that new strains of the virus are inevitable The novel coronavirus is likelystable.Another potential difference is seasonality Flu viruses come in seasonal waves The 1918 virus struck first in spring, receded in summer, and then returned in autumn and one last time in the winter of 1919 Every wave hit very quickly and then left just as quickly Most cities experienced a sharp drop off in cases after about six weeks of the first patients The seasonality of the 1918 flu was partly a result of the genetic drift just mentioned, as the different waves of this flu were all at least subtly different strains of the virus Atmospheric conditions humidity and temperature also presumably make some difference in the flu virus s spread COVID 19 may exhibit a very different pattern It may, perhaps, be less affected by atmospheric conditions and if it mutates and reproducesslowly, it may linger around for one long wave rather than several short ones This is just my speculation.Well, so much for the virus How about us The world has changed a lot since 1918 However, not all of those changes have made us better prepared Fast and cheap air travel allowed the virus to spreadquickly And economic globalization did not help, either, as both medicines and medical equipment are often produced overseas and then imported, thus rendering countriesvulnerable to supply chain disruption than in the past As we witness countries and states compete for supplies, this vulnerability is very apparent.But of course we have many advantages, too Many of the deaths caused by the flu and the coronavirus are not from the virus infection itself, but because the virus renders us vulnerable to secondary infections by bacteria, causing pneumonia Antibiotics which did not exist in 1918 can save many lives Another advantage is medical care The most severe patients of both epidemics were struck with ARDS, a condition with an almost 100% mortality rate for those who do not receive intensive medical care using a ventilator machine In 1918 they were able to administer oxygen, but far less effectively than we can Even so, even with the best intensive care, the survival rate of ARDS is between 40 60% And our ability to administer intensive care is quite limited The ventilator shortage has become a global emergency in itself, as hospitals are overrun.Medical science has also advanced considerably Now we can isolate the virus which they could not do in 1918 , test individuals for it, and work on a vaccine However, testing has so far been unable to keep up with the virus And the most optimistic estimate of an available vaccine is in a year Arguably a much bigger advantage is information technology The press is not censored so citizens have a much better idea of the risks involved and experts can communicate with each other in real time We can coordinate large scale societal responses to the pandemic, and can potentially even use technology to track individual cases As we come to better understand the virus, we will be able to usesophisticated statistical methods to understand its progress None of this was possible in 1918.One thing that we will have to contend with something that is hardly even mentioned in Barry s book is the economic toll that this virus will take Even in the ugliest days of the 1918 pandemic, governments did not require businesses or restaurants to close War preparations went on unabated In 1918, after years of slaughter and at the height of the war, life was simply cheaper than it is now Our societal response will likely mitigate the health crisis but will create a secondary economic crisis that may ultimately bedifficult to solve The solutions to this crisis could be our most lasting legacies Already Spain s government is talking of adopting universal basic income Though of course it is far too early to predict anything with confidence.Comparisons with 1918 are partly depressing, and partly uplifting Depressing, because we knew this was possible and did not prepare Depressing, because so many governments have gone through the same cycle of early denial and disorganized response as they did back then Uplifting, because we do know muchthan we did Uplifting, because after our early fumbles we are finally coordinating as a global community to deal with the crisis Perhaps most uplifting of all, despite some ugly stories here and there, the crisis has revealed a basic sense of solidarity in the face of a universal threat Hopefully, unlike 1918, we will not do our best to forget about this one "/>
  • Paperback
  • 546 pages
  • The Great Influenza: The Story of the Deadliest Pandemic in History
  • John M. Barry
  • English
  • 27 August 2019
  • 0143036491