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October 20 - November 17, 2020
Epidemiologists today estimate that influenza likely caused at least fifty million deaths worldwide, and possibly as many as one hundred million.
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.
In every war in American history so far, disease had killed more soldiers than combat.
The two most important questions in science are “What can I know?” and “How can I know it?”
biology is chaos. Biological systems are the product not of logic but of evolution, an inelegant process. Life does not choose the logically best design to meet a new situation. It adapts what already exists.
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 defenses, allowing bacteria to invade the lungs and cause a more common and slower-killing bacterial pneumonia.
Simply put, the germ theory said that minute living organisms invaded the body, multiplied, and caused disease, and that a specific germ caused a specific disease.
The greatest challenge of science, its art, lies in asking an important question and framing it in a way that allows it to be broken into manageable pieces, into experiments that can be conducted that ultimately lead to answers. To do this requires a certain kind of genius, one that probes vertically and sees horizontally.
In 1880 Pasteur—who observed, “Chance favors the prepared mind”—was
In December 1890, Koch protégés Emil Behring, who would later win the Nobel Prize, and Shibasaburo Kitasato showed that serum—the fluid left after all solids are removed from blood—drawn from one animal made immune to tetanus could be injected into a different animal and protect it from disease.
Flexner said, “The ablest men are often the most diffident and self-deprecatory. They require in many cases to be reassured and made to believe in themselves.”
There are three different types of influenza viruses: A, B, and C. Type C rarely causes disease in humans. Type B does cause disease, but not epidemics. Only influenza A viruses cause epidemics or pandemics, an epidemic being a local or national outbreak, a pandemic a worldwide one.
By entering the cell, as opposed to fusing with the cell on the cell membrane—which many other viruses do—the influenza virus hides from the immune system. The body’s defenses cannot find it and kill it.
Antigen drift can create epidemics. One study found nineteen discrete, identifiable epidemics in the United States in a thirty-three-year period—more than one every other year. Each one caused between ten thousand and forty thousand “excess deaths” in the United States alone—an excess over and above the death toll usually caused by the disease. As a result influenza kills more people in the United States than any other infectious disease, including AIDS.
Creel demanded “100% Americanism” and planned for “every printed bullet [to] reach its mark.” Simultaneously, he told the Four Minute Men that fear was “an important element to be bred in the civilian population. It is difficult to unite a people by talking only on the highest ethical plane. To fight for an ideal, perhaps, must be coupled with thoughts of self-preservation.”
The dangers in mobilization steps followed were pointed out to the proper authorities before there was any assembly, but the answer was: ‘The purpose of mobilization is to convert civilians into trained soldiers as quickly as possible and not to make a demonstration in preventive medicine.’”
Then he demonstrated for them an innovation he had experimented with: the wearing of gauze masks by patients with respiratory disease. Welch called the mask “a great thing . . . an important contribution in prevention of spray infections.” He encouraged Capps to write an article for the Journal of the American Medical Association and advised Pearce to conduct studies of the masks’ effectiveness. Cole agreed: “This is a very important matter in connection with the prevention of pneumonia.”
On October 5, doctors reported that 254 people died that day from the epidemic, and the papers quoted public health authorities as saying, “The peak of the influenza epidemic has been reached.” When 289 Philadelphians died the next day, the papers said, “Believing that the peak of the epidemic has passed, health officials are confident.”
In Philadelphia, meanwhile, fear came and stayed. Death could come from anyone, anytime. People moved away from others on the sidewalk, avoided conversation; if they did speak, they turned their faces away to avoid the other person’s breathing. People became isolated, increasing the fear.
To be a scientist requires not only intelligence and curiosity, but passion, patience, creativity, self-sufficiency, and courage. It is not the courage to venture into the unknown. It is the courage to accept—indeed, embrace—uncertainty.
Fear began to break down the community of the city. Trust broke down. Signs began to surface of not just edginess but anger, not just finger-pointing or protecting one’s own interests but active selfishness in the face of general calamity. The hundreds of thousands sick in the city became a great weight dragging upon it. And the city began to implode in chaos and fear.
“Don’t Get Scared!” was the advice printed in virtually every newspaper in the country, in large, blocked-off parts of pages labeled “Advice on How to Avoid Influenza.” The Albuquerque Morning Journal issued instructions on “How to Dodge ‘Flu.’” The most prominent advice was the usual: “Don’t Get Scared.” Almost daily it repeated, “Don’t Let Flu Frighten You to Death,” “Don’t Panic.”
There is no cause for alarm if proper precautions are taken, or Influenza is nothing more or less than old-fashioned grippe, the more people believed themselves cast adrift, adrift with no one to trust, adrift on an ocean of death.
“aid in forming a proper frame of mind” in the public. That frame of mind was fear. Parsons wanted to create fear, believing it “prepared the public mind to receive and act on our suggestions.”
But the closing orders that most cities issued could not prevent exposure; they were not extreme enough. Closing saloons and theaters and churches meant nothing if significant numbers of people continued to climb onto streetcars, continued to go to work, continued to go to the grocer. Even where fear closed down businesses, where both store owners and customers refused to stand face-to-face and left orders on sidewalks, there was still too much interaction to break the chain of infection.
He was speaking of the world of which F. Scott Fitzgerald declared “all Gods dead, all wars fought, all faiths in man shaken.”
“[T]he ideas that kept recurring to me, perhaps because of that pacing the floor with my father, was that I had inadvertently walked through a door that I shouldn’t have gone through and couldn’t get back to the place I hadn’t meant to leave.”
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.
It is also impossible to state with any accuracy the death toll. The statistics are estimates only, and one can only say that the totals are numbing.
in 1920 Welch made a frustrating prediction: “I think that this epidemic is likely to pass away and we are no more familiar with the control of the disease than we were in the epidemic of 1889. It is humiliating, but true.”
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.
