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What The 1918 Flu Pandemic Can Tell Us About The COVID-19 Crisis


This is FRESH AIR. I'm Terry Gross. Back in 2004 when I interviewed the author of the book "The Great Influenza" about the 1918 influenza pandemic, the deadliest pandemic in history, I thought, this is fascinating history. Thank goodness I'm not living through anything like this. And now here I am and here you are, our lives having been changed by the COVID-19 pandemic. And there's that 2004 book on today's bestseller list. And here's the author, my guest John Barry. He's going to tell us about some of the successful strategies and mistakes from 1918 that might give us some clues for how to proceed in this current pandemic. Barry co-wrote the paper about the future of the COVID-19 pandemic and lessons learned from pandemic influenza that was published April 30 by the Center for Infectious Disease Research and Policy at the University of Minnesota. He's a professor at Tulane University School of Public Health and Tropical Medicine.

John Barry, welcome back to FRESH AIR. Did you expect when you wrote the book that you would witness a pandemic like the one we're enduring now?

JOHN BARRY: Yes and no. I think anybody who understands anything about infectious disease recognize that we were going to sooner or later face something like this. Obviously, in last 15, 20 years, you had H5N1, SARS, MERS, H7N9, Ebola. But, you know, intellectually understanding it is one thing and having it hit you is something quite different. So I'm like everyone else in that sense.

GROSS: President Trump called the coronavirus the Democrats' new hoax early in the pandemic. That was a reference to a new hoax after the impeachment hoax. Now the virus is in the White House. One of the problems in 1918 was political denial. Give us an example of the political denial from 1918 and how that made matters worse.

BARRY: Well, we were at war. And Woodrow Wilson, the president, was entirely focused on the war - entirely - and the entire government was entirely focused on the war. And therefore, national public health leaders echoed the president, and they ignored it. The disease was called Spanish influenza, and they said things like, quote, "this is ordinary influenza with another name" - unquote - or you have nothing to worry about if proper precautions are taken. There was no Tony Fauci back then. Around the country, local public health officials almost entirely echoed that and so did local politicians. So the result was people were being lied to and, frankly, people died unnecessarily.

GROSS: How did the denial lead to more death?

BARRY: Well, there was - until it became extremely obvious how dangerous that disease was, people did not take any precautions because of the reassurances. And also once they recognized that they were being lied to, that this disease was violent and lethal, it led to almost a fraying of society in some places. I think that society ultimately is based on trust. And once trust disintegrated, society began to fray. That disease was much, much more lethal than what we are facing now.

GROSS: How lethal was it? What was the casualty count?

BARRY: Well, worldwide, the deaths were probably at least 50 million and may have reached 100 million. So if you adjust for population, that would equal about 220 million to 440 million deaths today. Thankfully, we're not facing anything like that with COVID-19. Thank God.

GROSS: One of the things that we're facing now is figuring out how to reopen cities and states and restart the economy. People are suffering not just from the virus but from unemployment. And they need money. They need food. And the question is how do you do it? How do you do it without increasing the number of people who are sick and dying from COVID-19? So what can we learn from 1918 about what happens if you reopen too soon?

BARRY: Well, a lot of cities did reopen too soon and had to close down a second time and in some cases a third time. I think San Antonio would be a good example of what happened back then. They were just about the last city to close down and just about the very first to open back up. And San Antonio 53.5% the entire population got sick; 98% of the homes had at least one person sick.

GROSS: Do you think we're starting to see something similar in places that were reasonably successful in shutting down the virus? I'm thinking of Singapore, South Korea, Wuhan, China - they're starting to see new cases again after reopening.

BARRY: Well, you know, no matter how careful you are, when you reopen, there are going to be cases. The disease, the virus is out there. The question is how careful you are going to be when you reopen, how much control you are able to maintain over the virus. And Singapore is sort of a special case. They had dormitories where foreign workers were lodged. And the overwhelming majority of new cases are in those dormitories, you know, close quarters and so forth, as opposed to the general population. In China, the overwhelming majority of cases, at least initially new cases, they were people returning from abroad. But to actually exterminate this virus, you know, maybe it could have been possible in the very, very first days. And I mean very first days. But that was before it was really recognized. And it's not possible to do that today. The virus is here. It's going to stick around unless we are fortunate enough to get a vaccine that's essentially 100% effective. Even then, it would take years to exterminate it. There is only one disease that that has ever happened with - smallpox. We came close in polio but haven't been able to do it in polio. This disease is much more transmissible. It's just too transmissible to exterminate; plus it has an animal reservoir. So even if we were able to eliminate it from humans, it would circulate in animals and eventually probably come back.

GROSS: The 1918 flu pandemic coincided with World War I. How much of the initial spread was through soldiers in tight quarters and then traveling overseas and back?

BARRY: Well, you know, it certainly was spread among soldiers, and it seemed that the shipment of U.S. troops in April spread the disease in Europe. I think that's clear. But all these things would have happened anyway. For example, the disease was in New York City in February 1918 and spreading there. And that was actually before any Army camp was infected. The disease may have been elsewhere in the world as well, probably, almost certainly was elsewhere in the world as well. So the results would have been the same. They may have moved a little bit more slowly. So I don't think the war played a major role in spreading the disease, just accelerated it a few weeks, perhaps.

GROSS: How did the Army try to control the outbreaks in its own camps?

BARRY: They were quite aggressive, actually, initially. The best scientists and physicians in the country were in the Army. The dean of the Johns Hopkins Medical School, a guy named William Welch, became a colonel. He was probably the - he's easily the most important person in the history of American medicine and maybe the most important person in the history of American science. The Army surgeon general, William Gorgas, was a terrific physician, a terrific public health person, knew what was going on.

They had sort of anticipated something like this in practically every war in history in the past. More soldiers had died from disease than from combat, and Gorgas was determined that that would not happen this time. They did everything from outfitting railroad cars, transforming them into the most advanced laboratories. They had, you know, great scientists. The Rockefeller Institute for Medical Research, which is now Rockefeller University, that was incorporated entirely into the Army. Every scientist there became a soldier.

And when the disease first erupted, you know, they tried to close down the camps, separate them from civilian communities and so forth and keep the disease from getting into the camps. And some of them were quite aggressive, but none of these things were successful. I mean, some camps, they would inspect soldiers twice a day for symptoms. If one soldier was - showed a symptom, he was isolated. If two soldiers in a unit showed symptoms, the entire unit would be quarantined. So many of the camps were very aggressive. Nonetheless, they had very little impact on the disease.

GROSS: Let me reintroduce you. If you're just joining us, my guest is John Barry. His 2004 book "The Great Influenza," about the 1918 pandemic, is on the current bestseller list. We'll talk more after we take a short break. This is FRESH AIR.


GROSS: This is FRESH AIR. Let's get back to my interview with John Barry. His 2004 book "The Great Influenza," about the 1918 flu pandemic, the deadliest pandemic in history, is on the current bestseller list. He's a professor at the Tulane University School of Public Health.

So how did the pandemic affect the war effort? You know, you write about, in your book, how - to keep up morale - you were supposed to say positive things. And there was a lot of censorship, but we'll get to that in a minute. But one of the ways the pandemic affected the war effort was the draft was eventually canceled. How was that connected to the pandemic?

BARRY: Well, the Army camps - and that was on September 26, 1918, the - incidentally, nobody realized how close the war was to ending. There was an anticipation that the allied forces would have to launch a major offensive in the spring of 1919 to end the war. But on September 26, Army camps around the country were so totally overwhelmed with disease that they didn't want anybody else entering those camps. Plus, they were afraid, in the few camps that might not have been affected already, that someone from outside might bring the disease in. So they canceled the draft. You know, that was one way the war effort was affected.

GROSS: You know, you write about how, in 1918, there were - were there bodies in the street? You write the bodies were literally piling up.

BARRY: That's correct. And...

GROSS: In the street? At homes? Like...

BARRY: In - well, you know, they were digging mass graves. They were - you know, had no place to store them. You know, they - you know, it varied, of course, from city to city and Army camp to Army camp. You know, there were - in a lot of the Army bases, there were actually special trains to carry away dead bodies.

In, you know, Philadelphia, they were using construction equipment to dig mass graves. And also in Philadelphia, you literally had priests driving horse-drawn carts through the streets, calling upon people to bring out their dead 'cause there was no other way to get the bodies out of the homes. You know, sometimes a body would lie in a home in 1918 for several days - not exactly the kind of experience anybody would enjoy.

GROSS: You know, actually, when President Woodrow Wilson was negotiating the end of the war in Paris, he came down with the virus.

BARRY: Right. And I think it affected what happened in a very deleterious way.

GROSS: What happened in the peace plan or what happened to Wilson? Or both?

BARRY: Both. Wilson was quite sick. Classic case of the 1918 virus - very high fever, violent coughing, so violent that he had difficulty breathing, other symptoms as well. But a comprehensive look written in 1927 by - sponsored by the American Medical Association of, you know, everything that virus did. Anyway, it concluded that, second only to pulmonary damage, the virus seemed to affect mental functioning, and that happened to Wilson. He was - everybody around him commented on how disoriented he was, how his mind just wasn't working.

Anyway, prior to getting sick, Wilson was adamant on - you know, the U.S. had entered the war on Fourteen Points. You know, these are principal positions that he took about self-determination for - you know anti-colonial, the League of Nations and so forth - peace without victory, you know, don't blame anybody, things like that. And he had been sticking to those points. And he reentered negotiations while he was still sick. In fact, some of them came in his sickbed.

Anyway, after his illness, Wilson caved in on basically every point except for the League of Nations, and the result was a peace treaty that was not very satisfactory. You know, the reparations, the Germans - you know, the Germans lost territory to France. They paid reparations - all sorts of things that - you know, I think most historians believe that the peace treaty was a major contributor to the rise of Hitler and the eruption of World War II.

GROSS: President Wilson never publicly addressed the pandemic. Why not?

BARRY: You know, it's a good question. I don't really have an answer other than his personality. He was so focused on the war. That was everything to him, and he would not allow anything to distract him, and he tried not to allow anything to distract the country. You know, I never saw any papers, private or otherwise, explaining why he didn't. It makes no sense, but it's a true statement.

GROSS: So the flu pandemic of 1918 coincided with World War I, and there were policies to prevent anything that would lower morale, including the Sedition Act, which made it punishable by 20 years in jail to, quote, "utter, print, write or publish any disloyal, profane, scurrilous or abusive language about the government of the U.S." And you could go to jail for cursing the government or criticizing it, even if what you said was true.

So how did this emphasis on saying positive things, keeping up morale and not saying anything negative about the government or anything that would lower morale, how did that affect information - helpful, useful, important information - about the pandemic and how it was spreading and what you needed to do to protect yourself?

BARRY: Well, there was fake news in 1918, but it was coming from the government, and it was being echoed by newspapers around the country. You know, consistent with that law that you just quoted, that's why almost everywhere in the country - not quite everywhere - public health leaders, locally and local politicians, were saying this is nothing to worry about. But it was something to worry about.

It got so bad in Philadelphia, when they finally, belatedly, you know, issued their closing orders - you know, closed schools, churches, no church services, you know, bars, restaurants, so forth and so on, theaters - one of the newspapers said, quote, "this is not a public health measure; you have no cause for panic or alarm," unquote. You know, I mean, how stupid did they think people were?

Obviously - I mean, but that was an attempt to reassure, by saying these closings are not public health measures. But, of course, they were and, of course, people knew that. And the only effect a statement like that had was that people stopped believing anything they were being told, and that meant that rumor and bad information was dominant. Nobody knew what was going on. And when they're getting no information, when they're being told this is ordinary influenza by another name and these things are happening or, in some cases, people are dying 24 hours after the first symptoms, all that did was spread fear and, in some cases, panic.

GROSS: Let me reintroduce you here. If you're just joining us, my guest is John Barry. His 2004 book "The Great Influenza," about the flu pandemic of 1918, is on the current bestseller list. We'll talk more about 1918 and today's pandemic after we take a short break. I'm Terry Gross, and this is FRESH AIR.


GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with John Barry. His 2004 book, "The Great Influenza," about the 1918 flu pandemic, the deadliest pandemic in history, is on the current bestseller list. He co-wrote a paper about the future of the COVID-19 pandemic and lessons learned from pandemic influenza, which was published last month by the Center for Infectious Disease Research and Policy at the University of Minnesota. Barry is a professor at the Tulane University School of Public Health and Tropical Medicine.

What about the newspapers? Were they accurately reporting what was going on?

BARRY: You know, they were, as a general rule, not. In fact, early in the pandemic when one Wisconsin newspaper actually tried to report the truth, the Army initiated prosecution proceedings under the law you quoted.

GROSS: The Sedition Act?

BARRY: Correct. So they were going to try to put those editors and writers in jail. They dropped the prosecution as the pandemic proceeded. But again, all around the country, in most cases, newspapers were not printing the truth. In Phoenix - it was funny. Normally, local news predominates. But in Phoenix, when the disease first hit Boston, which was the first place in the country that was hit by the second wave, the lethal wave, you could read about it a little bit in Phoenix.

But when the disease actually got to Phoenix, there was hardly a word about it anywhere in the newspapers. At least they weren't lying. But they weren't printing anything about it because they thought that would be bad for the war effort, bad for morale. And again, the only effect of that was to spread fear because people did not know. And they need to know.

GROSS: A famous example of something that was done wrong during the 1918 pandemic that we've heard a lot of references to recently is what happened in Philadelphia, when it decided to have a war bond drive and not call it off in the face of the pandemic. And I want you to describe that war bond drive. And this, of course, was to raise money for the war effort. So what was that? This was basically a parade that stretched for, like, two miles. Describe what you know about that.

BARRY: Well, it was heavily promoted. Philadelphians were supposed to demonstrate their patriotism by coming out, by supporting the war effort, buying Liberty loans, bonds, and, you know, was going to be one of the great events in the city's history. The medical community, to a person, urged the public health commissioner and the mayor to cancel the parade. That didn't happen.

Several hundred thousand people turned out. And, I mean, by then, the virus was already circulating pretty widely in the community. And like clockwork, 48, 72 hours later after the parade, the disease just exploded in Philadelphia. And it was, you know, sort of a classic example, as you said, of what not to do.

GROSS: Did you think about the Philadelphia example when New Orleans held its Mardi Gras parade just a few weeks ago?

BARRY: I didn't. You know, as I mentioned earlier, in January, I actually wrote a piece for The Washington Post saying, you know, this - arguing, making the point, really, that the virus could not be contained, that it was going to get here and it was going to be pretty serious. But at the time of Mardi Gras, I don't think there had even been a single death, at the time, known. Now we know there had been deaths. But at the time, there was not a single known death, I don't think. And, you know, no cases known - although, now we know there had been - in Louisiana, very little testing anywhere in the United States.

And it didn't seem dangerous to me then because, although I anticipated that the virus would get to the United States and that it would be quite severe, I didn't think it had arrived yet based on the information I was getting on testing. Obviously, on that point, I was wrong. I live in the French Quarter. I was even King of Krewe du Vieux, one satiric crew, a few years ago. But I, actually, am not a parade person, fortunately. And I usually go to one parade a year at least. But I didn't go to any this year, fortunately, because it clearly did spread the virus.

GROSS: Do you feel very frustrated and worried watching us fall - like, making some of the same mistakes that were made in 1918.

BARRY: Yes. There's a short answer (laughter).

GROSS: What are some of the major mistakes you think we are repeating or we have repeated?

BARRY: Well, first, for very different reasons, the outbreak was trivialized for a long time. And if these public health measures - social distancing and so forth - are going to be successful, people have to comply with the recommendations. So by trivializing the threat for a period of months, that sort of encourages people to ignore recommendations, gets it implanted in people's minds that this is not a real threat and that it's being overblown by the media. You know, that's No. 1. No. 2, the testing debacle, which continues, unfortunately, is just a huge, huge problem. When places come out of lockdown, they really should have the testing and the contact tracing in place.

These things work. They have been demonstrated to be highly successful in saving lives and also allowing the economy to function in many countries around the world. I won't say we're dead last. We're not dead last. There are other - plenty of other countries worse off than we are on a policy and execution basis. But for a country that should be the best in the world, to be where we are in these areas is almost beyond belief.

GROSS: John Barry, thank you so much for coming back to FRESH AIR. Be well. Be safe.

BARRY: And same to you.

GROSS: Thank you so much.

John Barry is the author of the 2004 book "The Great Influenza" about the 1918 pandemic. It's on the current bestseller list. He's a professor at the Tulane University School of Public Health. After we take a short break, we'll listen back to an interview with Ian Whitcomb, who had the 1965 novelty hit "You Turn Me On" and left the rock world soon after to perform and write about pop music of the early 20th century. This is FRESH AIR.

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