JOSH SHARFSTEIN: Welcome
to Public Health On Call,
a new podcast from the Johns
Hopkins Bloomberg School
of Public Health.
Our focus is the
novel coronavirus.
I'm Josh Sharfstein, a faculty
member at Johns Hopkins
and also a former Secretary of
Maryland's Health Department.
Our goal with this podcast is
to bring evidence and experts
to help you understand
today's news about the novel
coronavirus and what
it means for tomorrow.
If you have questions,
you can email them
to publichealthquestion@jhu.edu.
That's
publichealthquestion@jhu.edu
for future podcast episodes.
Today, Paul Siegel professor
of the practice and director
of the Center for Humanitarian
Health at the Johns Hopkins
Bloomberg School
of Public Health,
speaks with John Barry, the
noted historian and the author
of The Great Influenza.
Their conversation
centers on the lessons
of the 1918 pandemic for
today's response to coronavirus.
Let's listen.
PAUL SPIEGEL: John Barry,
it's such a pleasure
to have you today
on this podcast.
Recently you published
a New York Times opinion
piece where you said the
single most important lesson
from the 1918 influenza was
that containment failed.
Can you talk a little bit
about what you meant there?
JOHN BARRY: Well,
in 1918 of course,
there actually was no
effort to contain it.
influenza would be probably
impossible to really contain,
because the incubation period is
much shorter than coronavirus.
This roughly 48 hours is the
average incubation period
for influenza.
Five to six days as average
and as long as 14 days
for coronavirus.
So influenza doesn't
give you an opportunity
to isolate contact rates
and so forth and so on.
Coronavirus does give
you that opportunity,
because of the length of time
of the incubation period.
On the other hand, it also means
that the whole cycle of a wave
is going to be lengthened.
In 1918, influenza would
pass through a given city
generally and somewhere
at six to 10 weeks.
I would expect movement
of the coronavirus
to be considerably slower.
PAUL SPIEGEL: And what are
some of the differences
that you found between
responses to the 1918 pandemic
and this current pandemic?
JOHN BARRY: Well,
of course, there
was no centralized effort in
the United States, whatsoever.
Wilson was president.
He never issued a single
statement about the disease,
even though he got a very
serious attack, although not
until the third wave in the
spring when he was negotiating
the peace treaty, which
I think the disease had
significant
repercussions because
of his mental and physical
weakness after it.
Because we were
at war, there had
been an entire
infrastructure created
designed to keep morale up,
which effectively meant to lie.
So the disease was
known as Spanish Flu,
although it did
not start in Spain.
We do know that.
And national public
health leaders
were saying things like
this is ordinary influenza
by another name.
It certainly was not.
Number one, young
people were dying.
Probably two thirds of the
deaths were between 18 and 50.
The peak age for death was 28.
Number two, people could
get horrific symptoms.
Initially, the disease
was misdiagnosed
as cholera or typhoid Dengue.
Other symptoms were even
more horrific-- bleeding
from the eyes and ears as
well as the nose and mouth.
So to tell someone this
was ordinary influenza
by another name
was not credible.
As a result, people very rapidly
lost all trust in authority.
And those cities
where a local leaders
echoed the national line.
And society began to actually
fray because of that.
In terms of the response,
that varied from city to city.
The overwhelming majority, but
not all-- like not New York,
for example--
did much of what
we're doing now.
Maybe not quite as
extreme, but they closed
schools, restaurants, bars,
banned church services,
no public gatherings
and so forth,
although businesses
continue to operate.
But as a general
rule, the cities
did that after the disease.
It already disseminated
widely in the community,
so those measurements
had very little effect.
In a few communities
who did it early,
there was some positive impact.
So I mean there is a
correlation between when
a city instituted various
restrictions and the peak--
whether you could flatten
the peak and so forth.
So I think the two lessons
are number one telling,
the truth so that you
retain your credibility.
And I think all else flows
from telling the truth
if you expect to be able
to sustain compliance
with public health
recommendations,
social distancing, hand
washing, and so forth--
if you expect
sustained compliance,
people have to believe
what you're saying.
And they have to adhere to it.
If they doubt your
credibility, they're
not going to do it at all.
It's hard enough to get
sustained compliance
under any circumstances.
PAUL SPIEGEL: Thanks, John.
I was thinking about some
of the many-- of course,
there are many differences
from between 1918
and now, but
certainly, one of them
is the way information
flows at the internet
and how people
get their sources.
Can you comment
on that and how--
obviously, we know how
that's changed since 1918,
but potentially, some
of the influences?
JOHN BARRY: Well, the
news media in 1918
was totally untrustworthy.
In fact, they would be
prosecuted or risk prosecution
if they told the truth.
When Philadelphia
finally closed--
and Philadelphia was one
of the hardest hit cities
in the country--
when they finally
closed everything down,
one of the newspapers
actually went so far--
and this is a time when
Philadelphia is digging mass
graves--
the newspaper said this is
not about closing orders.
This is not a public
health measure.
You have no cause for alarm.
So obviously, people
aren't that stupid.
Of course they had
cause for alarm.
So the media was useless.
In Phoenix for example,
they wrote about the disease
when it was in Boston.
But as it moved across the
country toward Phoenix,
less and less was written.
And when it was
actually in Phoenix,
there was hardly a word
in the newspaper about it.
Today is entirely different.
So back then, it was almost
as if the only news out there
was rumor.
And it was all bad
internet information
might be an analogy.
Now people can get
good information
if they want for it.
However, we have a gap between
the main source of information,
the federal government.
You have on the one hand,
the White House itself,
and on the other hand, the
rest of the administration,
whether it's Tony Fauci
at NIH or the CDC.
And the CDC has largely
been silenced most recently.
Obviously, for the
first couple of months,
Trump was trivializing
almost the outbreak.
All of a sudden, eight or
nine days ago, he got serious.
And even so, he's still
exaggerating, you might say,
or putting the best
spin on things.
In terms of the internet, you do
hear wild rumors and so forth.
And I'm not really--
and I don't really monitor that.
I think people are
paying attention to--
at least they're listening
to the main reliable sources.
I hope that's the case.
I really haven't done any
kind of study of this,
so I probably should
have just told you
that I don't know when
you asked me the question.
PAUL SPIEGEL: One,
perhaps a hypothetical
knowing that you're an award
winning historian and writer,
is what do you think was
the effect, especially
of the truth telling or lack
of it 1918 because of the war?
And if we were not in
a war-like situation,
are you able to
hazard a guess of how
it would have been
different than and can we
learn from that?
JOHN BARRY: Because
we were at war--
and I just went
through the line--
the idea that this
was ordinary-- quote,
"ordinary" influenza
by another name.
It's hard to speculate
as a historian--
I don't like to speculate
on alternative realities.
Once again, there was
no national leadership
on public health.
Again, Wilson never
issued a single statement
on the outbreak.
We did have a public
health service.
We did have a Surgeon General.
I would say the most respected
person in the country
and very possibly
in the world was
right at Hopkins, William Welch.
If he spoke, people listened.
As I say, I don't really like
to speculate on what ifs.
Very hard to figure.
PAUL SPIEGEL: Now that's
interesting about Welch, who is
obviously a hero from Hopkins.
JOHN BARRY: And indeed,
the School of Public Health
was organized and opened in
the middle of the pandemic.
PAUL SPIEGEL: Why was there
do you think at that point--
why was someone like the
president, President Wilson,
not speaking out?
Was it a different
culture at that time
or was it because of the war?
JOHN BARRY: Well,
we already had had
Teddy Roosevelt,
who was, you know,
talked about the bully pulpit.
So Wilson was not at
all averse to using
that pulpit when he wanted to.
But he was focused in
an obsessive, almost
sick, actually, way on the war.
That was the only thing
that mattered to him.
Nothing else.
Everything in the government
was focused on the war.
And I don't want to
put words in its mouth
or speculate on what he
thought, but it's crystal clear
that the war-- winning the
war was the only thing that
mattered to him.
So influenza was a side issue.
There had been a spring
wave, which was quite mild,
that hit some cities
like New York, which
is one reason why I think that
New york fared pretty well.
They had some immunity there.
And Los Angeles it
skipped entirely-- not
a single influenza death in
the spring in Los Angeles.
And because of the mildness--
it was mild compared to the fall
wave, let's make that clear.
It was maybe a little rougher
than an ordinary influenza
season.
Soldiers in camps did get sick.
But possibly, in
their defense, they
may have felt that this was
the same thing coming back,
and it wouldn't be
that big a deal,
although it very
quickly became apparent
that it was a very big deal.
I mean, on September 26,
they canceled the draft,
because every army camp in the
United States, every training
camp was filled with
nothing but six soldiers.
They couldn't accept any
more people in those camps
to be trained.
And although that was
less than two months
from the end of the war, at
the time, nobody knew it.
Everything was being geared
up for a major offensive
in the spring of 1919.
So everyone expected
the war to continue.
So I think it's very
safe speculation
say Wilson's focus on the war
pushed everything else out
of his mind.
PAUL SPIEGEL:
That's interesting.
It's very interesting to see how
contemporaneous events of that
time influence a response.
My last question--
and thank you,
because this has
been fascinating-- is
that I've been reading what
you've been writing recently.
And if I understood
correctly, it
was extremely hard to
undertake quarantine,
even amongst the military,
which one would think it
would be much more disciplined.
And so how do you
think then, one,
at that time, how did the
military quarantine compare to,
let's say, the civilians?
But I think you also
wrote that ultimately, it
didn't have a major effect,
and therefore, how does
that relate to what
we're trying to do today?
JOHN BARRY: I think
the data I quoted
was a very good epidemiological
study of army camps.
There were 120 of roughly
5,000 or more soldiers.
And 99 in camps impose some
form of quarantine isolation.
In some camps, they inspected
soldiers twice a day
for any symptom.
If they had one symptom,
they were isolated.
If there were two soldiers
in a unit with symptoms,
the entire unit was quarantined.
That was in some camps.
They didn't all do that,
even the ones that did impose
quarantine and isolation.
In 21 camps, they
didn't do any of that.
And there was no
statistical dust friends
between camps that did
and did not quarantine.
But the epidemiologist who
did the study, George Soper--
very good pioneer
epidemiologist.
Later did the first studies of
cancer epidemiological studies
and later, head of the
American Cancer Society,
went beyond simply
the statistics
and did a qualitative analysis.
And he discovered that the
camps that originally enforced
the various measures
did in fact benefit
and did significantly
flatten the curve.
I made the point in the
article that of the Army
in the middle of a
war, them successfully
sustaining quarantine
over a period of weeks.
What happened?
These things had to be continued
and there was too much leakage.
In only a few camps
was it sustainable--
then it would be
a great challenge
to a civilian community.
However, there are of
course, differences
that made it harder in the
Army if you have any leakage.
And that is soldiers
in barracks.
Certainly, no social distancing
once it's in the barracks.
That's hugely important
when you compare it
to the civilian community.
In addition, even the places
that closed down everything--
they didn't close businesses.
There was tremendous
absenteeism out of fear
or staying home to take
care of somebody sick
or being sick yourself.
So it wasn't unusual to have
at least 40% absenteeism--
in many cases, far,
far more absenteeism.
But that's still a long
way from what we're
trying to accomplish here.
Essentially, I'm speaking
to you from New Orleans,
which shut down everything
roughly a week ago.
And that brings us
back to compliance,
which brings us back to telling
the truth and being credible
for these measures to work.
They are much more widespread
and with more chance of success
than an Army camp with
soldiers and a barracks,
but for these things to work,
you still need a compliance
and you still need people to
believe what they're being told
and what they're being advised.
And that's why I messaging
is absolutely crucial and so
important to this whole process.
And why I'm quite
concerned about what
the White House had been saying.
They seemed to get on
message for a week,
but I'm afraid they
may drift away soon.
PAUL SPIEGEL: John
Barry, thank you so much,
both for your work and recording
history of the 1918 pandemic,
but also, for also trying
to with your experience,
help us deal with
this current pandemic.
Thank you again very much.
JOHN BARRY: Oh, thank you, Paul.
Good to see you.
Stay well.
JOSH SHARFSTEIN: Thank you
for listening to Public Health
On Call, a new podcast from the
Johns Hopkins Bloomberg School
of Public Health.
Please send questions to be
covered in future podcasts
to publichealthquestion@jhu.edu.
this podcast is produced by
Josh Sharfstein, Lindsey Smith
Rogers, and Lymari Morales.
Audio production by Niall Owen
McCusker and Spencer Greer,
with support from Chip Hickey.
Distribution by Nick Moran.
Thank you for listening.
