John and barry, he is a distinguished author of the rising tide in the francis for outstanding book in American History in 1997. His current new york bestseller is the great influenza, he is here to talk to us about that today, he is currently 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 if you can go and get a microphone so your questions can be heard. Come to the back of the room and they will bring you up microphone. Please join me in welcoming john abarry. Thank you very much. As the still not on, you can hear me. It is funny to be sitting here in a Committee Room of louisiana legislatures talking about the subject largely because although you might not think it, politics is very involved in the story of 1918 pandemic. So i cannot take of a better place to talk about politics then louisiana legislature. When you read about the 1918 pandemic in newspapers these days, they usually say the death toll wasea over 20 million. The reality is, it was way over 20 million, that estimate comes from the first study of the disease that is 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 studying influenza concluded that the death toll at the minimum of 50 million peoplp and possibly as many as 100 Million People. All this should of 28 the size of todays, if you just the population, the death toll in 1918 was between 175 and 350. The death toll killed more people than aids is killed in three years. And the symptoms sometimes can be gruesome. Although most people had ordinary influenza, the same kind of influenza you would be familiar with if you got it today, im a a minority had somg entirely different, the symptoms could include bleeding, not only from the nos or mouth read from the ears and even from the eyes. The aches were so extreme that the disease was misdiagnosed as being gay which is break bone fever or caller or typhoid. There was even some time of leakage of air from the lungs into the tissue so if you will the patient over, they crackled, it sounded as if they were stepping on bubblewrap. So this was not only a lethal virus but a violent virus. Of course one of the questions is that it weighs gas, cannot happen again, the answer is it not only could happen again but to quote the national academydef sciences and study, another pandemic is not only p inevitabe but overdue. This disease put a tremendous strain on the society, so much so that Victor Warren who was the dean of michigan medical school, a very sober scientist, by no means an alarmist, in the middle of the pandemic if this disease continues the present course for a few more weeks, civilization could disappear from the face of the earth. The story itself is a war story. It is not so much man against nature as it is nature against s man. And there are two interrelated contest sort of that were involved in the story, one involves a larger society, the other involves scientists. In the battlefield is important to understand the battlefield in the situation, we were already at war, the struck in the latter days of world d wr i and of course most of the world is already at war. The whole world was a tinderbox. For example in the United States there was a great influx of people into the cities and there was no housing for them, as a result, not only for example in philadelphia where there was a single shipyard thatin employed 50000 people, there were several dozens of places of more than 10000 workers, not only housing not only did they share beds but they slept in ships, people would bring one bed, go to work and someone else would come back from work and sleep from the same bed. It was a Public Health tinderbox waiting to happen. Even more important than that, ultimately what happened in the epidemic t was a political context, as i said we were already at war, i want to read you a quote from a law that was passed by the wilson a administration that had an espionage act innocent edition act. They made impressionable by 20 years in jail to quote other. , write, publish, or 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, a congressman for more than ten years. He was convicted under the law. In addition the press, didnt criticize the government, they fell in line in terms of patriotism, there was not any outright censorship but it was understood censorship, the cleveland dealers for example stated what the nation demands the treason weatherby other quite unmask, you stamp out, the problems journal carried a banner warning 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 that lawyers who defended was unpatriotic and unprofessional. And of course the german language in many places, nobodys taught anymore. Sauerkraut was renamed liberty cabbage and so forth. In this kind of thing ultimately became very important and what happened later in the course of thepp disease. So that is what was going on in the words of society, not to mention that 40 of all the doctors and nurses were in the military so the civilian Healthcare System basicall disappeared. Sa when i started out i said this was a contest between science, not just the largest of society but scientist in the virus. If you think that the scientist in 1918 were backward, you need to rethink that. The book does focus on a group of half a dozen or so extraordinary men and one woman. I will give you a sense of how good these people were, one of them in 1966 won the nobel prize for the work that he did in 1911. Another of them he was the first head of the rockefeller institute, a very interesting guy a juvenile delinquent, his father, you know the program is scared straight these days were they take kids and walk them through jails and his father actually did this to him when he was a teenager, a plumber refused to take him on as an imprint apprentice because he was such a troublemaker but he got a job in the pharmacist with the pharmacist, the pharmacist had a microscope and he told this guy dont go near the microscope. [laughter] that was not the right way to handle simon p he did go near the microscope and he found a world there that enthralled him and he became the first head of what is now rockefeller university, a brilliant scientist, how good was he, today according to medicine, bacterial meningitis in massachusetts general hospital, one of the best hospitals in the world has a 25 ho mortality rate in 1910 he had a treatment for bacterial meningitis that had a mortality rate of 18 . Better than today in the general hospital. Another character, i dedicate the book to carl lewis, not only proof polio is a viral disease in 1907 but in 1908 the rise of a vaccine that was 100 effective protecting monkeys from polio. In 1908 and 1909, it took almost 50 years to move that work to man. Another major character william wells, probably the most important person in the history of american science, he created the entire medical and protection of the unitedd state. As one person said he had the power to change a mans life with a flick of her wrist. And one other guy who you may have heard, the army Surgeon General, all these people were in the military, every one of them, the entire rockefeller institute, they were incorporated into the military. William gorgas Surgeon General of the army had cut the death rate from yellow fever 20 in havana. And allowed the panama canal to be built. And he created the infrastructure in the army, he actually had a nightmare and the nightmare was that during this war with 4 million soldiers close quarters and army camps that an epidemic was going to break out. And even before the influenza pandemic he created oddly enough he expected the ammonia to be the killer, he created an ammonia board of great scientist to prevent any outbreak of thebe disease. Anywhere before world war i and American History and virtually everywhere in the world, the war soldiers died of disease then died in battle. And even the spanishamerican war diedar of disease for everye who died in battle in the british army lost ten soldiers andd again, sustain years before world war i and the british army lost 15 soldiers were ten or 15 to everyone who died in battle. So this is very, very significant and very, very important, again he really tried to plan for this and prevent this by incorporating the advice of extraordinary scientist, that is sort of the situation on one side, you have a larger society, wilson said a spirit of ruthless brutality had to infuse every aspect of americanam life. In the scientific community, you have these great scientist organize and trying to prepare for some disease they expected to erupt. Now you have the enemy, the enemy of course is the virus, now all influenza viruses are bird viruses, every one of them. Periodically and through history it is happened 3 5 times in a century, periodically in influenza virus will jump species from birds to people. And it can do this because it is one of the fastest mutating of any virus that exist and in fact they refer to it and a few other viruses as a mutant swarm because there is no single even a viral subtype there is no single virus, they all sort of are like a swarm of hornets, moving around like an average kind of virus, and when influenza virus infects itself, in about six hours, the single cell ends up admitting or explodesp in between 100,000 ino the million particles escape from the cell. And every one of them is different. Most of them are so different that they are defective, they cannot affect another cell, only 1 of those viruses between 1,010,000 viruses from one cell are able to infect a new cell but that mutation rate allows it to jump species in 1918 was not by any stretch the only lethal pandemic in history of influenza. But theyre not all lethal, for example we went through pandemics in 1957 ande in 1968 while they kill considerably more people, that normally died of influenza incidentally the normal death toll for end influa according to the cdc is 36000 people a year die of influenza in d d7 enter 57 68, there we double in three or four times the number that died of influenza, compared to 1918, they were just like a severe epidemic season. Now the story really begins when the virus jumps from birds to people, nobody knows exactly for certain where thatt happens. Most pandemics have begun in asia. However, there was some overlooked epidemiological evidence that i managed to trip over that strongly suggest that this virus actually jump species in kansas. And it moveded from rural kansas which is in the Far Southwest corner of the state, and move to rural kansas to what is now fort riley. Fort riley had 56000 troops, very closely packed in barretts, they were being trained to kill and as it turned out there would be far more effective at killing than anyone could imagine. As i said this was a ways by nature against man. It hit with full force, let me read to you, it took about six months for the virus once it jumped species, it was not immediately efficient at affecting man but had to adapt to the new environment. That took a while before he became at home in humans. It really became efficient at invading humans. About six months after it jumped and became very lethal and all over the world v simultaneouslyt exploded in the lethal form, one of the first places to hit by stthe severe second wave was during the spring, there was an outbreak which is camp devens outside boston. I read a lot from a physician to another physician describing what was going on, these start with what appear to be an ordinary attack of influenza, brought to the hospital they very rapidly developed the most vicious type of ammonia that is ever been seen, two hours after admission they had a monogamy with teeth bones and before you can see the cyanosis thats when you start turning blue actually because of a lack of oxygen. You see the cyanosis extending from their ears and spreading all over the face until its hard to distinguish the colored men from the white. It is only a matter thats how dark people were turning, thats rumors of black death they were turning so dark you cannot distinguish black from white. It is only a matter of a few hours until dusk comes, it is horrible. One can stand it to see one, two or 20 men die but to see these poor devils dropping like flies, weve been averaging about 100 deaths per day. Ammonia means 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 there were no coffins in the bodies piled up something fierce it beats any site they ever had in france after a battle, goodbye old pal, god be with you until we meet again. As this virus spreads across the world and throughout the United States it put extreme pressures on the political system and in fact its a very good case study that is quite relevant, fortunately to relevant of bioterrorism and not to mention the possibility of another influenza outbreak. It demonstrated that the political system then did not appear to handle it. Cheaply because the politician had a long priority. They were so focused on the war and the irony is the unfortunate irony that this hit when we were literally only four or five weeks away from the end of the war. Virtually every enemy country where we were fighting except germany itself had already stopped in germany had already started and sent out feelers for peace. But wilson and the entire administration was so focused that they would not do anything for Public Health that might in any way jeopardize the hundred war effort that wit wilson had called the ruthless brutality that wanted to infuse the american spiritten with. And asit a result, not only the federal officials but Public Health officials and governors and mayors all over the United States essentially lied. First they told people that this was only ordinaryrs influenza. Then they told people that fear kills more people than they disease. In philadelphia where they were planning a huge liberty lo rall, hundreds of thousands of people were about to be in the streets, this is very early in the outbreaks to the general public was not aware that there was a problem,m, privately one doctor was warning the Public Health commissioner that this rally would create a readymade inflammable mask, he was trained to get every newspaper to. Warnings, they all refused, the Public Health commissioner refused to pay r any attention, there were many other physicians saying the same thing, they held this rally, hundreds of thousands of people in 72 hours later in philadelphia influenza absolutely exploded to the point that not only did they run out of coffins which happened in almost city in the United States but they actually used steam shovels to dig mass graves were they simply rolled bodies in sheets in. And priest literally drove horsedrawn carriages down the street pulling upon people to bring out the dead. Very reminiscent of the black death. The same thing was happening all over the country and very rapidly society began to disintegrate, thepi reason was that people very soon were getting a great disconnect, they could see their spouse was dying in 24 hours sometimes. And the bodies were lying there, you cannot get the body out, theres nobody to take the body out, down the street somebody else is dying in a few hours or a few days, the Emergency Hospital being created all over the place and at the same time the Public House Authority in the mayors and the only thing you read in t the newspaper is fear kills more than the disease, dont worry, you can keep yourself safe. So this ridiculous reassurance they were getting was so conflicted with what they were seeing about them that it destroyed their trust and all authority, ultimately society is built on trust. And without it as i said and 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, people started killing their pets, if those of you who have pets, you understand the emotional attachment, and if they had too much love forth their pets to kl the dog themselves, they were handing them over to the police who would kill the dogs and they said phoenix will soon be douglas. And let me rea review some comms from people who lived through this. In North Carolina one man said we were actually almost afraid to breathe, the theaters were closed, everything was close, every place was closed, so you did not get to any crowds, you felt like you were walking on egg shells coming were afraid to go out, the fear was so great that people were actually afraid to leave theirfr homes. They were afraid to talk to onee another. It was almost like dont breathe in my face, dont look at me and breathe in my face. You never knew from day to day who is going to be next on the death list. His father had a store four of the sales girls died, former stopped farming an emergent stop selling merchandise in the country more or less shut down holding their breath. Another man from washington, d. C. That kept people apart, he took away all the community rights, you had no community rights, you had no school right, you c had no churches, church is also close, you had nothing. People were afraid to kiss one another, people were afraid to eat with one another, they were afraid to have anything that may contacts because thats how you got the flu. Impress god out, it was illegal to shake hands and in kentucky one red cross chapter was begging for help because there were hundreds of cases in the mountains that they couldun not reach and people were starving to death, they were too sick to prepare food for themselves and they were starving, they could have survived otherwise. But there was so much fear that nobody would help them, nobody would go near them, in kentucky and part of the world where you had such a clos