Implemented. This class was film on march 10th, 2020, during the easterly zwrajs of the coronavirus outbreak in the u. S. She compares the symptom, Economic Impact and National Response between 1918 and today. So what are we going to do today . I promise you all that that i would do a little show and tell from my own research work. And the timing of this turned out that doing something Historical Perspective on pandemic preparedness might seem like a really interesting topic for us to discuss. And i think i mentioned to you all that i have been getting a lot of calls from journalists lately and its kind of like why in the middle of an an going pandemic are they calling up people like me . So i think this is a good thing for us to talk about. This is a history methods course. Its about how you become i went too fast there. How you become a historian and what you do for a living. The first week of class we talked about the reaction. Sometimes you may get from family members when they hear youre a hist plajory major tha is this useful knowledge . Why are you bothering . I can tell you personally, i get those questions a lot because of my Research Specialty in the history of health and medicine. Science is so much better today. Why should we bother looking at the past history of diseases and how we responded to them . Come on in, justin. Im really excited about what i do. So that is objective number one. I said the first week of class i want to make you proud of being a hist plajor. So heres my way of saying why im proud to do what i do. The second goal is to talk about pandemics in this class. How were forms of Public Outreach used to try to contain and mitigate a major epidemic . My work has been on Public Education or you might call it propaganda. Do we need to justin, can you just move over a little bit . We talked the week before last about propaganda. It has a lot of negative associations to it. For much of the 20th century, it did not have those negative associations propaganda is often public information. Its trying to get messages out to people that could help them in a time of emergency. So thats what were going to be looking at today. I know a lot of you saw 1917, the movie about world wore i. You know that was a pretty brutal war with the trench warfare. A lot of people died. That film is an amazing recreation of the conditions in wartime. You remember from our readings, world war i is the first world war. The combatants span multiple contents. As we see in the readings, it inspired new propaganda. Remember our draft posters that we looked at from from both the british and the u. S. Side, uncle sam, for example. As that war ground to the horrible close, a terrible influenza pandemic broke out. Its still not clear where it came from. But it spread very quickly first to troops and then to civilians. It killed more people than it did world war i. And just to give you a sense of comparison, that is we were able to isolate that is the h1n1 spanish form of the pandemic. 8. 5 million deaths. Thats bad. But look at the influenza death toll. 50 million is now the estimate it could be even higher. So more lives lost in that influenza pandemic than lost in world war i. In our lifetime, hiv aids has been, you know, a tremendous killer. 32 million during the entire course of the aids epidemic because the death tolls were so high. Now you you may think well that was a really sad story. Lots of people died. But what is the point of studying an old pandemic . After all, science is so much better today, right . How are we doing with curing the coronavirus . No. Were not doing so well. In part because this is Mother Nature issuing major challenge to us. As a new virus form that people dont have immunity to. The coronavirus and response to it in many ways is revisiting a lot of issues that came up with in the world war i pandemic. The reason were having problems with coronavirus today are similar to the problems they encountered with this new influenza in 1918, 1919. Heres a stranger fact. En that is the methods we used today to control coronavirus are drawn from the same Public Health playbook that they used in 1918. The basics are still the same. We have not evolved hugely beyond what was available in the world war i era. The methods are still the same. There has been a growing interest in the history of this 19181919 pandemic. Now it was not always the case that people paid much attention to this pandemic. And i just show you this book. It was called americas forgotten pandemic written in 1987. Very little serious work. Talked about amnesia that no one thought about it anymore. Of im here to tell you that especially in the last 20 years, it is forgotten no more. There is an upsurge of interest in this pandemic. Out of an impulse to try to learn how to manage current epidemics more effectively. Our Public Health folks are looking at a lookback, a methodology used in Public Health, to look back at previous epidemics and see what worked and what didnt work. Public Health Emergency preparedness has become a major subfield in Public Health. Its really grown a lot since 9 11. You may remember there is bioterrorism involved in 9 11. It also reflects a kindbam of gradual recognition that for a variety both of economic factors and also environmental factors and this has a lot to do with the ecology between people and animals. It also has to do with global transportation. That means a disease, a novel disease that breaks out in wuhan can then travel very quickly through not just trains and cars but airplanes now can travel very quickly. This is just kind of list of what had been major Public Health concerns just in the past 20 years starting with sars, ebola, zika and now covid19. So starting back with sars, there was a growing sense among policy leaders that they needed to start planning ahead, thinking about, well, if a novel pandemic breaks out, how are we going to control it . Even if it spreads fast and has hay high mortality rate. So they got together to investigate in particular the pandemic that im going to talk to you about. Pook look at the plague and they look at the initial disease exchange with native peoples when the europeans came with columbus. But of all the lookbacks, the one on the influenza pandemic has gotten the most attention because in many ways its the first modern Global Pandemic in the sense of what we are experiencing. One of the historians that got invited to participate in the lookback is me. Im a big player in this there are other historian thats have been much more at the forefront of where can i see this . I call out my colleagues at the embassy of michigan and alexandra stern as leading this team. But they invited me in to help because of my historical specialization in popular Public Health education. So thats my book. In many circles im called the germ lady. I get calls from journalists is germs and the gospel of germs comes right up. What was this book about . I wrote it a long time ago, 1998. I was interested in how ordinary people came to believe in the existence of something they couldnt see which was a germ. A microbe. And then to alter the way they behaved like, you know, doing the not shaking hands but the kinds of stuff were now doing, how did they learn to do that . And they were really purposeful in Public Health campaigns to teach people how to avoid giving each other germs. What i call the gospel of germs is the foundation of the kind of containment practices that we still use today. How do you minimize the sharing of microbes between human beings . I always like to give students something really a fancy phrase so you can sound really, you know, smart when youre talking to the other people. Anything that doesnt involve giving you a vaccine or drug is a nonpharmaceutical intervention so all the stuff i was looking at and by the way, there are no antibiotics. There are relatively few vaccines in this time period. The way you kept from getting sick was by practicing these habits. Easier to say is social distancing measures. You read in the newspaper and they are talking about that all the time now. When they tell us no the to shake hands or sneeze into your elbow, thats a social distancing method. Exactly the same stuff they were telling americans to do at the turn of the last century. Why is this important . Because even though we have made astounding improvements in the health sciences, we still cannot cure a virus. Limited medications to this day to slow down a viral infection. So when were faced with a novel virus using the tactics is the most important ways we have to keep people from getting sick and dying. If you have a highly contagious epidemic on your hands, the best bet is slow the spread, stop the spread and the techniques are very, very valuable. That was a lesson Public Health expert learned in world war i that we still use today. So my work has been kind of studying first i did basic germ education. I look specifically at world war i and how they tried to ramp up the Public Health education in the face of the pandemic. And thats what im going to show you more of. So let me give you some quick overview of the 1918, 1919 pandemic. This were multiple outbreaks in different parts of the world. Tsz no t its not clear which one is first. What we are sure of is that it did not start in spain. It is called the it became nicknamed the spanish flu not baust because it started in spain, spain was not a combatant in world war i so the newspapers were not being as careful about reporting on the early stages of the pandemic. They ran a story about it and somehow they got associated well, its the spanish flu. I started with troops and then civilian populations. This particular flu was much scarier. It spread easily from person to person. And the death rate was higher than the usual flu. Also, the normal flu usually kills fragile people. That can be very young or very old. People who are already sh symptoms under stress. It keilled people your age. It didnt concentrate on just the very old or very young. In Public Health circles, they talk about the dreaded w shape. Ill tell you thats the w. You can see the normal flinfluea pattern. Look at the 1918. Big spike up. It changed the life expend ancy in the United States because so many young people had their lives shortened dramatically. As a result of the influenza pandemic. This just gives you another this is from Public Health report published after. You see the extraordinary spike in death rates due to this pandemic. What did Public Health experts know about influenza in 1918 . Compared to the last biggish epidemic which was in the easterly 1890s, they learned a lot. They had convincing Laboratory Proof of something you may have heard of as the germ theory of disease. The idea that communicable disguises are caused by microbes. There had been a lot work showing that it wasnt a mysterious thing in the air that made you sick. It thats what micro organism that in the indication of bacteria they could see under a microscope and they could prove caused specific diseases. They made huge leaps forward. They were able with the current micro scopes of the time to see bacteria. They could not yet see a virus. The difference between a bacteria and virus, let me show you this very quickly. A little contagion 101. Viruses are tiny compared to bacteria. The analogy is virus is the size of a mouse and the bacteria is the size of a person. Viruss are much more primitive. But theyre more deadly in that they insert themselves into your cells and take control of your machinery to replicate. They mutate quickly which is one reason theyre still so difficult to control. Even to this day, we have limited pharmaceutical treatments for viral diseases. We can slow some of them down but were not able to cure the flu. Today we rely on vaccines. Bacteria are much bigger and a single cells micro organism. It turns out i mean they are can do incredible damage to the body. But eventually effective drug treatments were found for bacteria, antibiotics. Only work against bacteria. They dont work against viruses. Theyre easier to disrupt their machinery. The big question to go back to this is what did they know in 1918, 1919, they had a suspicion then that there was an effective particle smaller than a bacteria but they couldnt see it. They did xpirmenexperiments thas there. I can tell you ho you this he figured it out. They didnt know whether the flu was caused by a bacteria or a virus. They had a lot of scientists who tried to get in there and figure out what was the x germ. And just so you know, not until microscopes were invented in the 1930s could you actually see a virus under a microscope. It wasnt until the 1990s that our tools of extracting the influenza virus and replicating the dna that our tools were good enough that we could actually extract it and replicate the dna. This is another whole school story there about how they went and got samples of people who died from the flu. Its really pretty creepy. But interesting that i can tell you on is it bake teara or virus . They dont find out. In the end, that doesnt make a whole lot of difference. Because the way you protect against a bacteria and the way you protect against the virus is basically the same. And so the social distancing methods that as the pandemic spread, people were supposed to use to keep from catching it were essentially the same ones that were used for any upper respiratory infection. They understood influenza as an upper respiratory infection was caused through sneezing, could having, spitting, that is a habit we have given up. But they spit a lot. Also if you shared glasses or utensils, sometimes thats called fomite. That is a really weird word. Its an object that carries, like if i had coronavirus and you touch my phone and you get this is a fomite. You should not be messing with other peoples phones right now. But you know that. It can be transmitted that way and various kinds of casual contact, you know, you all are hearing now dont touch your face. Dont touch your nose. They basically have figured that out that stuff is getting on your hands and that could make you sick. And they already had the idea not just about influenza but about a lot of other diseases. Now one of the things that they realized pretty soon, remember that w i showed you, is this strain seemed much more deadly than the usual annual influenza. And experts are still arguing, they reconstructed the virus that they thought out of people that died from the spanish flu. Some of them look and scary information about this. There is a context. Remember 1917, you look at those trenches. You think, boy, you would get a lot of yucky stuff being in that trench. And the wartime hygiene may have made people more vulnerable and perhaps that is why it was so deadly. As a historian and not a virologyist, i dont know. My guess is theyre never going to be able to firmly determine why it was that this particular virus caused that w shape. Yeah . [ inaudible ] is there like a specific reason why it was affecting people in their 20s to 30s compared to the normal flu . We dont know. And thats kind of the puzzle of this is thats so unlike the normal flu. Now that agegroup we know would have been military. That would have been the young men and troops. But it also in the civilian population killed a lot of young people as well. Maybe the nutrition overall. I mean even though it was the home front things were maybe people werent fed as well. But i am not sure they really come up with a good answer yet. For why it took that y shape. And to be honest, the uncertainty about this one is something that carries over into other new ones is there is always this worry that its going to happen again and we dont know exactly why. Fortunately, it does not appear in the coronavirus to be doing that w shape so far, so good. Whatever the call so again, we dont know was it a mutation that made it so bad or was it the underlying wartime conditions . What do know is xpacompared to annual flu, the 1918 version was really, really scary in the symptomology. People would come do with an extremely high fever. They would develop a really is severe upper respiratory infection. Often compounded by nausea and diarrhea. In the worst cases it caused such a devastating assault on the lungs that the lung tissue was destroyed and they could not get enough oxygen in the lungs. The lungs were that damaged. There was also a secondary problem and this is true with flu to this day is that the virus weakens you and then a bacteria comes along in the case of the influenza pandemic, it was pneumonia. Viral or bacterial would come in and if the flu hadnt killed you, the pneumonia would do it. Yeah . Can you hold on just a immun this virus . A very good question. So one thing about when you do have a virus, you may then have an immunity to it. One of the theories about why this was so bad is that, in fact, it had been almost 20 years the one i mentioned in the early 1890s may have been this strain. And that the people who had that immunity had either lost it or had died off. So it was basically a virgin population that had not been exposed to this particular flu and then that would make it you wouldnt have the immunity of having been exposed to it. So thats one possible explanation to why a lot of people didnt have an immunity to this particular strain of it. Okay. So its hard to exaggerate how scary this epidemic became very, very quickly. And im just going to talk about the United States here but it was, in fact, a Global Pandemic. The first two cities hit were boston and philadelphia. And in part they got hit first because they had military camps that jumped to the civilian population. We were caught unawares by the speed and the deadliness of the pandemic. And by the time they started to put those distancing, quarantining, isolating measures into place, the epidemic was already out in the general population and very hard to shut down. In boston, the kind of center of infection was camp devins. There were 14, again, military camps, 14,000 cases of the influenza, 757 deaths. In philadelphia, it was the navy yards that became the kind of focal point for the spread. So many people were dying in philadelphia that they were having to take cold storage plants that they used for other purposes and turn them into morgues. The death tolls of that original pandemic in those two cities were really staggering. Seei