'Deadliest Plague in History'

Review by Bill Doughty

In the first week of February, we published a review of John M. Barry's "The Great Influenza." Barry shows how fear became terror, how healthcare workers were affected, and how the Navy was center-stage as the disease changed the course of the world 100 years ago. Today the Navy is once again facing and helping defend against a global pandemic.

HN K. Kavanagh sanitizes medical equipment aboard USNS Mercy March 24. (MC2 R.Breeden)

In this follow-up Great Influenza blogpost, we offer some more important points from Barry's now-classic report.

His book has special resonance today in the wake of the current COVID-19 pandemic, where New York is again an epicenter. 

One hundred years ago, "New York City was panicking, terrified," Barry writes, after a politically appointed health commissioner named Royal Copeland – "a man with no belief in modern scientific medicine and whose ambitions were not in public health" – failed to respond or take the initial outbreak seriously, calling for a quarantine only after it was too late.

"There were literally hundreds of thousands of people sick simultaneously, many of them desperately sick. The death toll ultimately reached thirty-three thousand for New York City alone, and that understated the number considerably since statisticians later arbitrarily stopped counting people as victims of the epidemic even though people were still dying of the disease at epidemic rates – still dying months later at rates higher than anywhere else in the country. It was impossible to get a doctor, and perhaps more impossible to get a nurse."

Barry relates how nationwide "physicians attempted everything – everything – to save lives." The desperate attempts to find a cure led them to try "atropine, digitalis, strychnine, and epinephrine as stimulants."

"Physicians injected people with typhoid vaccine, thinking – or simply hoping – it might somehow boost the immune system in general even though the specificity of the immune response was well understood... Quinine worked on one disease: malaria. Many physicians gave it for influenza with no better reasoning than desperation... One physician gave hydrogen peroxide intravenously to twenty-five patients in severe pulmonary distress, believing that it would get oxygen into the blood. Thirteen recovered; twelve died. This physician, too, claimed success."

Barry writes, "No medicine and none of the vaccines developed than could prevent influenza. The masks worn by millions were useless as designed and could not prevent influenza. Only preventing exposure to the virus could." Quarantine, isolation and what we now call social distancing was the only way to slow the scourge.

Those areas that acted swiftly had less of an adverse impact. Meanwhile, Navy scientists played a key role in searching for a pathogen, vaccine and cure.

As a result of the 1918 pandemic and other smaller outbreaks – including H7N7 and SARS – over the past 25 years, the World Health Organization advised all nations to be watchful, prepared, staged and ready to respond to another pandemic.

Barry says there are two main lessons to learn: "The first involves threat assessment, planning, and allocating resources." "A centralized system should exist to allocate all resources," he writes. 

"But there is another lesson from 1918 that is clear. It is also less tangible. It involves fear and the media and the way authorities deal with the public."

In other words, tell the truth. The media and public officials made the problem worse when they downplayed the realities of the epidemic. "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 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. They way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one."

Well-written and fast-paced, this is a must-read now for everyone. For a full review of "The Great Influenza: The Epic Story of the Deadliest Plague in History" – including the key role the Navy played during and after the pandemic – visit the Navy Reads review of February 6, 2020. The review was written before the current novel coronavirus strain, originating in Wuhan, China, was given a proper name: COVID-19.

In one of several appearances over the years on C-SPAN, Barry gave a keynote address to a Pandemic Preparedness and Response forum on November 13, 2017. The Johns Hopkins meeting was attended by leading epidemiologists, other scientists and health experts, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Barry focused his remarks on the imperative for honesty and trust in a crisis, saying he despises the term "risk communication" because "it implies managing the truth, and I don't think you manage the truth; I think you tell the truth."

He concludes, "Planning does not equal preparation. I think maybe the biggest challenge to the public health community is to get political leaders to make rational decisions in crisis situations."

The Navy hospital ship USNS Mercy deployed to Los Angeles this week. USNS Comfort is scheduled to deploy to New York in the weeks ahead.

SAN DIEGO (March 23, 2020) -- Military Sealift Command hospital ship USNS Mercy (T-AH 19) navigates the San Diego channel March 23. Mercy deployed in support of the nation’s COVID-19 response efforts, and will serve as a referral hospital for non-COVID-19 patients currently admitted to shore-based hospitals. This allows shore base hospitals to focus their efforts on COVID-19 cases. One of the Department of Defense’s missions is Defense Support of Civil Authorities. DOD is supporting the Federal Emergency Management Agency, the lead federal agency, as well as state, local and public health authorities in helping protect the health and safety of the American people. (U.S. Navy photo by Mass Communication Specialist 3rd Class Lasheba James/Released)