The Great Influenza

1918 marked the first collision between science and epidemic disease. John Barry describes how the deadliest flu virus in history broke out in an army camp in Kansas, moved east with American troops, and then exploded, killing up to 100 million people worldwide.

Favorite quotes from the book:

Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty-four weeks than AIDS has killed in twenty-four years.

Influenza is a viral disease. When it kills, it usually does so in one of two ways: either quickly and directly with a violent viral pneumonia so damaging that it has been compared to burning the lungs; or more slowly and indirectly by stripping the body of defences, allowing bacteria to invade the lungs and cause a more common and slower-killing bacterial pneumonia.

Viruses are themselves an enigma that exist on the edges of life. They are not simply small bacteria. Bacteria consist of only one cell, but they are fully alive. Each has a metabolism, requires food, produces waste, and reproduces by division. Viruses do not eat or burn oxygen for energy. They do not engage in any process that could be considered metabolic. They do not produce waste. They do not have sex. They make no side products, by accident or design. They do not even reproduce independently. They are less than a fully living organism but more than an inert collection of chemicals.

Whatever the origin, a virus has only one function: to replicate itself. But unlike other life forms (if a virus is considered a life form), a virus does not even do that itself. It invades cells that have energy and then, ke some alien puppet master, it subverts them, takes them over, forces them to make thousands, and in some cases hundreds of thousands of new viruses. The power to do this lies in their genes.

Influenza is an RNA virus. So are HIV and the coronavirus. And of all RNA viruses, influenza and HIV are among those that mutate the fastest.

In 1918 all infectious disease was frightening. Americans had already learned that “Spanish influenza” was serious enough that it had slowed the German offensive. Rumors now unsettled the city that these deaths too came from Spanish influenza. Those in control of the war’s propaganda machine wanted nothing printed that could hurt morale. Two physicians stated flatly to newspapers that the men had not died of influenza. They were lying.

In virtually every home, someone was ill. People were already avoiding each other, turning their heads away if they had to talk, isolating themselves. The telephone company increased the isolation: with eighteen hundred telephone company employees out, the phone company allowed only emergency calls: operators listened to calls randomly and cut off phone service of those who made routine calls. And the isolation increased the fear. Clifford Adams recalled, “They stopped people from communicating, from going to churches, closed the schools, … closed all the saloons. … Everything was quiet.”

It was a time when the phrase “brisk fighting” meant that more than 50 percent of a unit was killed or wounded; a time when the memoir of a nurse at the front, published in 1916, was withdrawn by her publisher after America entered the war because she told the truth about gruesome conditions; a time when newspapers insisted, “There is plenty of gasoline and oil for automobile use,” even while gas stations were ordered to close “voluntarily” at night and Sundays and a national campaign was being waged against driving on “gasless Sundays” - and police pulled over motorists who did not “voluntarily” comply.

Newspapers reported on the disease with the same mixture of truth and half-truth, truth and distortion, truth and lies with which they reported everything else. And no national official ever publicly acknowledged the danger of influenza.

Influenza did visit the peace conference. Influenza did strike Wilson. Influenza did weaken him physically, and precisely at the most crucial point of negotiations - influenza did at the least drain from him stamina and the ability to concentrate. That much is certain. And it is almost certain that influenza affected his mind in other, deeper ways.

People write about war. They write about the Holocaust. They write about horrors that people inflict on people. Apparently they forget the horrors that nature inflicts on people, the horrors that make humans least significant. And yet the pandemic resonated. When the Nazis took control of Germany in 1933, Christopher Isherwood wrote of Berlin: “The whole city lay under an epidemic of discreet, infectious fear. I could feel it, like influenza, in my bones.”

Those historians who have examined epidemics and analyzed how societies have responded to them have generally argued that those with power blamed the poor for their own suffering, and sometimes tried to stigmatize and isolate them.

Those in power, historians have observed, often sought security in imposing order, which gave them some feeling of control, some feeling that the world still made sense.

Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.