Book Report: The Great Influenza

10. John M. Barry, The Great Influenza: The Story of the Deadliest Pandemic in History (2004/2018) (5/19/2020)

This book took me an impressively long time to finish. As I noted on April 28, I was then only halfway through—and the book, at 461 pages, isn't really that long. But it is dense, replete with detail. It's also unwieldy, being about a big story: the spread of disease around the world and through time (it got started in the spring of 1918, had a second, more severe wave that fall, and continued into a third wave the following spring), about the movements of people and ideas, and about the infrastructural readiness, especially in this country—political, scientific—to fight back, at just the moment the U.S. finally entered the war in Europe. Normally, I might have abandoned the effort—just stopped. I have many half-finished books on my shelves. But I was doggedly determined to learn all Mr. Barry could teach me about the influenza of 1918. How much will I retain? Well, I won't worry about that. For the moment, I'm simply happy to be done. I am looking forward to moving on to something more lively (and I mean that literally; there's a lot of death in this book).

Barry tells the story in ten parts, plus a prologue and a new afterword from a couple of years ago. His story begins before 1918 (in part 1, "The Warriors"), as he recounts the development and growth of American medicine from a quack enterprise with virtually no science behind it into something noble, searching, and rigorous focusing on high-quality education and research. Barry identifies various important players in these early chapters, whom we continue to meet throughout the book as the influenza sweeps the nation.

He moves on (in part 2, "The Swarm") to locate the possible ground zero of the virus: rural Haskell County, Kansas—farming country. The theory is that the disease got a toehold there in January or February 1918, then was carried to the army's nearby Camp Funston, and from there—well, everywhere, as the U.S. mustered for war.

Part 3, "The Tinderbox," takes us back to President Woodrow Wilson's reluctant but ultimately all-out decision to declare war on Germany, on April 2, 1917. Along with this came a crackdown on truth-telling, and a concomitant ascendance of propaganda, which played a significant role not just in national morale, but in the fight against the coming pandemic. The Red Cross, charged with "bind[ing] the nation together," grew its forces, who went into every corner of the country, ready to serve. Meanwhile, what few scientific institutions there were (such as the enormously influential Rockefeller Institute) were inducted into the military as growing medical needs were anticipated. For before the influenza hit, the camps experienced a virulent measles outbreak, followed by the bigger killer, pneumonia. Doctors and researchers both were recruited by the thousands.

In parts 4–8—"It Begins," "Explosion," "The Pestilence," "The Race," and "The Tolling of the Bell"—Barry goes into all the wretched details of how people, both in military encampments and in civilian populations, came down with the disease, how they suffered, how they died, how communities coped, how officials proved largely helpless, and how scientists raced to figure out what was causing the disease. Censorship and a desire not to inspire fear kept real news to a minimum; lies were rampant. But death was all around. There was no avoiding it in most towns and cities. Fear, even terror, was inevitable.

Part 9, "Lingerer," takes us into 1919 and beyond. The influenza continued, but largely in a less virulent state. One momentous story (for world history) concerns Woodrow Wilson in Paris, conferring with Georges Clemenceau and Lloyd George in their efforts to wrap up the WWI peace. It was not going well: Wilson especially did not like Clemenceau's demands, which were extremely harsh regarding Germany. And then Wilson got sick. Perhaps with the influenza. And the virus affected his brain—everyone close to him could see that. The negotiations suddenly ceased, and Wilson essentially capitulated. The Versailles Treaty was itself a victim of the influenza. At least, that is Barry's contention. (The illness that felled Wilson has traditionally been blamed on a different disease, but influenza is certainly a real possibility. We'll never know.)

Part 10, "Endgame," takes us back to the researchers who launched the book, and to their discoveries—and personalities—and failures. One of the big successes was the discovery that DNA, first isolated in the late 1860s and more or less ignored since then, actually had a crucial function: to carry the genetic code. This discovery came because of one man's incredibly patient effort to understand how one kind of pneumococcus—a bacterium that causes pneumonia, and is frequently seen in cases of influenza—transforms into another kind, that is, mutates, to remain virulent. The answer lay in the bacterium's own genes, it's own DNA.

In the afterword, Barry discusses the several serious influenzas that have caused alarm in the past century, ending with a few words on what might be done to stave off "the next pandemic." Almost everything he mentions—some of which he notes would be very difficult to achieve, like rigid sheltering-in-place and closing of borders—we are doing now. Ultimately, though, he says that

if there is a single dominant lesson from 1918, it's that governments need to tell the truth in a crisis. Risk communication implies managing the truth. You don't manage the truth. You tell the truth.
 Terror rises in the dark of the mind, in the unknown beast tracking us in the jungle. The fear of the dark is an almost physical manifestation of that. Horror movies build upon the fear of the unknown, the uncertain threat that we cannot see and do not know and can find no safe haven from. But in every horror movie, once the monster appears, terror condenses into the concrete and diminishes. Fear remains. But the edge of panic created by the unknown dissipates. The power of the imagination dissipates.
 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. Society is, ultimately, based on trust; as trust broke down, people became alienated not only from those in authority, but from each other. So a terror seeped into the society that prevented one woman from caring for her sister, that prevented volunteers from bringing food to families too ill to feed themselves and who starved to death because of it, that prevented trained nurses from responding to the most urgent calls for their services. The fear, not the disease, threatened to break the society apart. . . .
 So the final lesson of 1918, 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. . . .
 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. Lincoln said that first, and best.
 A leader must make whatever horror exists concrete. Only then will people be able to break it apart.

I guess Mr. Trump hasn't read this book . . . (Yeah, yeah, I know.)

I flagged various sections where I enjoyed the writing, or the way Barry presented difficult, technical information in an understandable way, or conveyed a telling sentiment that might strike those of us living with Covid-19 today. But this report is long enough.

I do recommend the book, though it isn't an easy read. The topic is encyclopedic, and difficult to keep under control. But I learned a tremendous amount, about history, about humanity, about scientific institutions, about virus. And much more.

And now, I'm ready for something completely different.

(Here is a conversation CNN's Jake Tapper had with Barry on March 27, about the current pandemic.)

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Monterey County's confirmed cases are up to 349, 8 more than on Sunday; deaths remains at 8.

Stay healthy. Get some fresh air. Read something uplifting!