Outstanding books on American History 1997. His current New York Times bestseller is the great influenza the epic story of the deadliest plague in history. He is here to talk to us about that today. He is a consultant with the World Health Organization on the subject of influenza. When he is done speaking, if you would like to ask questions there will be two microphones at the back of the room. Get a microphone so your questions can be heard. Join me in welcoming yvette wiltgen. John barry. Thank you very much. It is kind of funny to be sitting here in a Committee Room with the louisiana legislature, talking about the subject largely because you might not think it, the story of the 1918 pandemic. The louisiana legislature, when you read about the 1918 pandemic, they usually say the death toll was over 20 million. The reality is it was way over 20 million. That estimate comes from the first study of the disease, fairly accurate for the western world, but wildly inaccurate for the rest of the world. The reality is a Nobel Prize Winner who spent most of his life battling influenza concluded the death toll was a minimum of 15 Million People and as many as 100 Million People. All this was in a world with a population 28 the size of today. If you adjust for population the death toll in 1918, 350 million, even without adjusting the population, the death toll, influenza, in 24 years. The symptoms could be crucial but most people had an ordinary influenza, something you would be familiar with if you got it today. He might already, it was not a tiny minority, had something entirely different. The symptoms could include bleeding not only from the nose and mouth but from the years and even from the eyes. The aches were so extreme the disease was often misdiagnosed as dengue which is known as break bones sever or cholera or typhoid. There was even sometimes leakage a from the lungs, outside the lungs into the tissues so that if you rolled the patient over they crackled, sounded as if you were stepping on bubblewrap. This was not only a lethal virus but a violent virus and of course one of the questions that i always get asked, could happen again . The answer is it not only could happen again but to quote the National Academy of sciencess recent study another pandemic is not only inevitable but overdue. This disease put tremendous strain on society, so much so that the dean of the university of the medical school, very sober scientist, by no means an alarmist, in the middle of a pandemic if this disease continues its present course for a few more weeks, civilization could disappear from the face of the earth. The story itself is a war story, not so much man against nature as it is nature against man. There are two interrelated contests that were involved in this story. One involved the largest society. The other involved scientists. The battlefield, it is important to understand the battlefield in this situation. We were already at war, struck in the latter days of world war i, most of the world was also at war. The whole nation was a tinderbox. In the United States, and influx of people into the city. In philadelphia, a single shipyard, there were dozens of places, more than 10,000 workers, not only did people work in shifts, not only did they share beds but they slept in shifts. People would be in one bed, go to work, someone else would come back and sleep in the same bed. It was a Public Health tinderbox waiting to happen and even more important than that, what happened in the epidemic for political context, we were already at war, i want to read from a law that was passed by the Wilson Administration and it was called an espionage act. 20 years in jail, later published, and abusive language about the government of the United States. They could send you to prison for 20 years for criticizing the United States government even if what you said was the truth and they sent a congressman to jail for more than ten years, convicted under that law. In addition, the press certainly didnt criticize the government, they fell in line in terms of patriotism. There wasnt any outright censorship but it was understood censorship. The Cleveland Plain Dealer stated what the nation demands, treason, thinly veiled are quite unmasked, to stamp out. The journal carried a banner warning, this ran above the title of the newspaper every single day, every german or austrian in the United States unless known by years of association should be treated as a spy. The Illinois Bar Association declared lawyers sent a draft, it was unpatriotic and unprofessional and of course the german language in many places, nobody taught it anymore. Sauerkraut was renamed liberty cabbage and so forth. This kind of thing became very important in what happened later in the course of the disease. That was going on in the largest society, 40 of all doctors and nurses were in the military so the civilian healthcare disappeared. When we started out, this was also a contest between science, scientists and the virus. And if you think scientist in 1918 were backwards you need to rethink that. They focus on a group of half a dozen or so, extraordinary men and one women. One of them in 1966 won the nobel prize for work he did in 1911. Another of them, the head of reconciler institute, an interesting guy, and they take kids and they did this to him as a teenager, a plumber refused to take him on as an apprentice because he was such a troublemaker but he got a job as a pharmacist, the pharmacist had a microscope and told those guys dont go near the microscope. That is not the right way to handle simon flexner. The world that enthralled him, it was rockefeller university, a brilliant scientist, how good was it today for the new england journal of medicine, bacterial meningitis, massachusetts general hospital, one of the best in the world, 25 mortality rate. In 1910, flexner had bacterial meningitis, mortality rate of 18 . That event, another character i dedicate the book to, proved fully was a viral disease in 19071908 to buy a vaccine. Protecting monkeys from polio in 19081909. Another major character, the most important his in the history of American Science and the medical infrastructure of the United States. Had the power to change a mans life. One other guy you may have heard of, william garg us, the army surgeon general, every one of them, the Rockefeller Institute for medical research is incorporated into the military. They cut the death rate from yellow fever to 0 in havana and allowed the panama canal to be built. He actually had a nightmare and the nightmare was that during this war with 4 million soldiers, and epidemic was going to break out. He created oddly enough for pneumonia to be a killer. He tried to prevent any outbreak of the disease. In every war before world war i in American History, more soldiers died of disease and died in battle. Even in the spanishamerican war six american soldiers died of disease for every one who died in battle. In the border war the bridge on the last we 10 soldiers for every 15 years before world war i, the army lost 15 soldiers to disease or 10 or 15 to every one who died in battle. Very very significant and very important. Gorgas tried to plan for this and prevent this by incorporating these extraordinary scientists. That is the situation on one side. You had the largest society, a spirit of ruthless brutality to infuse every aspect of American Life and in the Scientific Community you had great scientists trying to prepare for some disease they expected to erupt. Now you have the enemy, the virus. All influenza viruses are bird viruses, every one of them. Periodically through history, it happens three to five times a century, periodically and influenza virus will jump species from bird to people. They do this because it is one of the fastest mutating of any virus in existence. Referring to it and a few other viruses as a mutant swarm. There is no single, even a viral some cycle, there is no single virus. It is like a swarm of hornets moving around, and average kind of virus. When an influenza virus affects a cell, in about 6 hours the single cell ends up, it explodes, between 100,000, and 1 million new virus particles escape from that cell and every one of them is different. Most of them are so different that they are defective. They cant infect another cell. One of those viruses but still between 1000, and 10,000 viruses from one cell. Are able to infect a new cell. That mutation rate allows it to jump species. In 1918, not by any stretch the only lethal pandemic in history of influenza but they are not all lethal. We went through pandemics in 1957 and in 1968 that while they killed considerably more people than normally dive influenza, the normal death toll for influenza according to the cdc is 36,000 people a year die of influenza, 5768, dublin 68 and in 57 three or four times the normal numbers of people dive influenza but compared to 1918, just like a severe epidemic. The story really begins when the virus jumps from birds to people. Nobody really knows for certain where that happens. Most pandemics have begun in asia. However, there was some overworked epidemiological evidence that i managed to trip over that strongly suggests that this virus jumped species in kansas, and that it moved from rural kansas, in the far south corner of the state, moved from rural kansas to what is now for riley. Fort riley had 56,000 troops, very closely packed in barracks. They were being trained to kill and as it turned out, would be far more effective at killing than anyone could imagine. As i say, this was a war waged by nature against man. It hit with full force. Let me read to you. It took six months for the virus once it jumped species, it wasnt immediately efficient at infecting man. It had to adopt to a human environment and that took a while before it became at home in humans, really became efficient at invading humans but about six months after it jumped it became very lethal. All over the world simultaneously it exploded in this lethal form. One of the first places hit by this severe form, the second wave was during the spring there were outbreaks, just outside, it is closed now, just outside boston. I will read a letter from a physician to another physician describing what was going on. These men start with what appears to be an ordinary attack of influenza. When brought to the hospital they developed the most vicious type of pneumonia that has ever been seen. Two hours after admission they have monogamy mahogany spots on the cheekbones and then you see cyanosis, cyanosis is when you start turning blue because of lack of oxygen. You see the cyanosis extending from their years and spreading all over their face until it is hard to distinguish the colored men from the white. It is only a matter, that is how dark people would turn, spreading rumors of black death they were turning so dark you couldnt distinguish black from white. It is only a matter of a few hours until death comes. It is horrible. One can stand one or 2 or 20 men die but to see these poor devils dropping like flies, we have been averaging 100 deaths per day. Pneumonia means and about all cases death. We have lost an outrageous number of nurses and doctors. It takes special trains to carry away the dead. For several days the bodies piled up something fierce, it beats any site they ever had in france after a battle. God be with you until we meet again. As the virus spread across the world, and throughout the United States, i if extreme pressures n the political system and in fact its a very good case study thats quite relevant. Unfortunately, too relevant to fears about bioterrorism, not to mention the possibility of another influenza outbreak. And it demonstrated that the political system then was not prepared to handle it. Chiefly because the politicians had the wrong priorities. They were soio focused on the w, and the irony is, and the unfortunate irony is that this hit when we were literally only four or five weeks away from the end of the war. Virtually every any country we were fighting except germany itself had already stopped, and germany had already started sending out, it sent out feelers for peace. But wilson and the entire administration was so focused they would not do anything that Public Health that might in any way jeopardize the 100 100 wr effort, what wilson had called ruthless brutality he wanted to infuse the american spirit with. And as a result not only the federal officials, but Public Health officials and mayors and governors all over the United States essentially lied. First, they told people that visit only ordinary influenza. Then they told people that fear kills more people than the disease. In philadelphia where they actually were planning a huge liberty loan rally, hundreds of thousands of people were about to be in the streets. This was very early in the outbreak, so the public wasnt aware that there was a problem. Privately, when doctor was warning the publicel Health Commissioner that this would create ara readymade inflammabe mask. He was trying to get every newspaper to print warnings. They all refused. The Public Health commissioner refused to payy any attention. There were many other physicians saying the same thing. They help this rally, again, hundreds of thousands of people, and 72 hours later philadelphia influence absolutely exploded, to the point that not only did they run out of conference which have met in almost every city in the United States, but the actually used steam shovels to dig mass graves where they simply rolled bodies wrapped in sheets in. Priests literally drove horsedrawn carriages down the street calling upon people to bring out their dead. Very reminiscent of the black death. The same thing was happening all over the country. And very rapidly society began to disintegrate, and the reason was that people were very soon getting this great disconnect. You know, they could see, you know, their spouse was dying in 24 hours sometimes, and they couldnt, and the body is lying there, you can get the body out that theres nobody to take the body out. Down the street somebody elsehes dying in a few days. There were emergency hospitals being formed, being created all over the place. And at the same time the Public Health authorities in the mayors, the only thing you read in newspaper is, fear kills more than the disease. Dont worry, you can keep yourself safe. So this ridiculous reassurance they were getting which so conflicted with what they were saying about them, destroyed the trust of all authority. And ultimately society is built on trust. And without it, as i say, it began to disintegrate. And fear was everywhere. Ill give you one example of how much fear. For some reason in phoenix, im not sure why, there was a rumor spread that dogs carried influenza, and people started killing their pets. Those of you who have pets understand the emotional attachment. And if they had too much love for l their pet to kill the dog themselves, they were handing them over to the police who would kill the dogs, and the local newspaper said phoenix will soon be dogless. Let me read you a couple of comments from people who lived through this. In North Carolina one man said, we were actually almost afraid to breathe. The theaters were close. Everything was closed. Schools were closed. Theaters was close. Every place was closed. So you didnt get into any crowd. You felt like youre walking on eggshells. You are afraid to even go out. The fear was so great people were actually afraid to leave their homes. They were afraid to talk to one another. It was almost like dont breathe in my face, dont look at me and brief in my face. You never knew from day to day whos going to be next on the death card, of the death list. His father had a store, four of eight sales girls died. Farmers stopped farming and the merchants stop selling merchandise and country really more or less shut down, holding the breath. Another man from washington, d. C. , it kept people apart. It took away all your community life. You have no community life, new school life, no church life. Church also close. You had nothing. People were afraid to kiss one another. People were afraid to eat with one another. They were afraid of anything that may contact because thats how you got the flu. In prescott arizona it was illegal to shake hands. In kentucky one red cross chapter chairman was begging for help because there were hundreds of cases in the mountains that they couldnt reach and people were starving to death. They were too sick to prepare food for themselves, and they were starving. They couldnt survive otherwise. But there was so much fear that nobody would help them. Nobody would go near them. In kentucky in a part of the world where you had such close family can chips, you know, you have hatfields and mccoys feuds and things like that, and this wasnt very of kentucky where family mattered so much, one red cross worker found a woman, you know, a family come several children, husband and wife so sick they couldnt care for themselves. The red cross worker tried to get the womens sister to help. She refused. She wouldnt come to the house. Finally, they got her to come to the house but she only knocked on the window, then walked back 50 feet and talk to the red cross worker. Thats a much fear there was. And in philadelphia, which was then the city of almost 2 Million People, therere was oe physician was running an emergency house, actually at the time was only a medical student. And he lived 12 miles from where this hospital was in the middle of the city. The city was so quiet he started counting the cars he passed on the street. On his way home. And in the city of 2 Million People, over a distance of 12 miles, one night he noted that he did not ask a single car. As he said, the life of the city is almost stopped. And in the illustrations in the book, theres one from downtown from manhattan, and there are a couple of san