A Key Lesson From The 1918 Flu Pandemic? 'Tell The Truth,' One Historian Says

The death toll from the 1918 flu pandemic surpassed all the military deaths in the two world wars.

Here & Now's Peter O'Dowd speaks with historian John M. Barry (@johnmbarry), who wrote about it in his book "The Great Influenza: The Story of the Deadliest Pandemic in History."

On the virus

"You had a lethal new influenza virus that entered the population. No one is sure exactly where. It may have been in southwestern Kansas, it could have been Indonesia, could have been France, there are several theories. Worldwide, the death toll was between 50 and 100 million, obviously a huge range. If you adjust for population today, that would equal 200 to 450 million."

On what life was like at that time

"We were in the middle of the war, and I think that very definitely contributed to the chaos. I don't think it had much impact on the actual spread of disease, but in terms of how society dealt with it, yes, I think it had quite a bit to do with the chaos. Chiefly, because everyone in authority, from the surgeon general of the United States to your local mayor, lied. Everyone could see that this was a lethal pandemic. Some of the symptoms were horrific — bleeding not only from your nose and mouth but from your eyes and ears. And yet the authorities were saying, 'This is just ordinary influenza. If proper precautions are taken, you have nothing to fear.' But people knew they had something to fear. You know, their neighbors or spouses were dying sometimes in 24 hours."

On why health officials took that stance

"That's of course because of the war, and the idea was you don't say anything that might be bad news and hurt morale. This is exactly the wrong thing to do. I think ultimately society is based on trust, and once you breach that trust, then people become alienated, particularly from authority. And the worse things get, the more you feel it's everybody out for himself or herself. I mean, in most disasters, people rise to the occasion help each other out. In this disaster, there were people starving to death, both in places like Philadelphia and in rural communities in Kentucky because others were afraid to bring them food."

"I think ultimately society is based on trust, and once you breach that trust, then people become alienated, particularly from authority. And the worse things get, the more you feel it's everybody out for himself or herself."

John M. Barry

On the threat of the disease

"There was a sober serious scientist named Victor Vaughan who had been dean of the University of Michigan Medical School before the war, and was head of communicable diseases for the Army, who said at one point, 'if the present rate of acceleration of the disease continues for a few more weeks, civilization could easily disappear from the face of the earth.' That's how bad it was. And it wasn't just in the United States like that. In Philadelphia there was a doctor who drove 12 miles home from his hospital every night, and there were so few cars on the road, he started counting them. And one night, in 12 miles in one of the biggest cities in the country, there was not a single other car on the road. He said the life of the city has almost stopped. But in Wellington, New Zealand, at exactly the same time, another doctor stepped outside of his emergency hospital and saw nothing on the street whatsoever in the middle of the afternoon, and said, 'It's a city of the dead.' And that was the fear that drove everyone inside.

"And again, it was not just fear but the lies that they were being told. You know, I was part of the process that produced recommendations for what are called non-pharmaceutical interventions in the event of another serious pandemic. You know, this effort started in the United States really in 2004 when the so-called bird flu surfaced, a potentially lethal virus. And one of the things that I kept preaching has, I think, been pretty much incorporated into every plan that I know of, is that you tell the truth."

On what the next pandemic might be like

"Of course there have been an unlimited number of pandemics, and we know about a dozen or so in the last 300 years, and it will keep happening. It's the nature of the virus. In 2009, we had a mild one, the mildest on record, but there were probably, in history, many events like 2009 that nobody noticed because they weren't lethal. Now our molecular biology and surveillance alerts us even to the mild ones. Sooner or later, there will likely be another very dangerous virus. I think the only real answer is to develop a vaccine that will work against all influenza viruses, and the science suggests that that is possible. There is work being done on it. I think more resources need go to that exercise. I think if influenza had been taken seriously over the past decades, there's a good chance we'd have such a vaccine today."

On whether a flu vaccine can stop the next pandemic

"The virus mutates — it's one of the fastest mutating viruses in existence, and it changes from year to year. That's why you can get sick two years in a row. That's why you need a new shot, a new vaccine inoculation every year. That's why the vaccine sometimes misses a target. But a pandemic virus is one that's entirely new, or has some entirely new features, as opposed to simply changing from the past. And when that enters a population, there are a lot more people who are vulnerable to it."

On how we'll know the next pandemic is coming

"We'll know it's coming because we do monitor that stuff, there's a lot of surveillance. We won't know, until it starts moving through the human population, just how lethal it's going to be. As I said, 2009 was milder than a normal flu season, but there are probably many events we didn't know about just like that. So just because it's a new pandemic virus doesn't automatically mean it's deadly. However, you know, it could be. And we have no way of knowing until it arrives."

On what we can learn from 1918

"No. 1, if you want society to continue to function I think you need to tell the truth. I think, No. 2, or maybe this is the most important lesson, is to take the disease seriously and put some resources into finding a universal vaccine. There are measures you can take that, you know, which would work for any infectious disease or seasonal influenza that could do some good, but they're not going to do tremendous amount of good. For example, washing your hands, as simple as that sounds, that helps protect you. The so-called non-pharmaceutical interventions I mentioned a few minutes ago are are pretty much self-explanatory. They generally refer to social distancing. I mean, that's self-explanatory. Basically keeping yourself away from from other people. But since this has to be sustained over a period of weeks, you know, it's not feasible to just lock yourself in a closet. Even in a lethal pandemic, that's not going to work very well."