Book Recommendation - The Great Influenza by John Barry

By Anthony and Sara:

We both recently read The Great Influenza, by John M. Barry, and would like to recommend it during this time of crisis due to Covid-19. It is a timely topic to read about and both of us found the book very educational and interesting.  There is so much we can learn from history. It's long and a bit technical in some places, but well worth persevering through.

I, Anthony, really enjoyed learning about the individual doctors, not only about their work, but about their lives, and how they persevered through trials to finally make groundbreaking discoveries. It was also really interesting learning about World War I and all the failures of our government during that time. I was shocked to learn about the amount of lying and propaganda and suppression of freedom of speech by the American government.  Here's a quote relating to that:

"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."

In addition to the book, it is very interesting to read John Barry's remarks about the current covid-19 crisis.  You can read or listen to an interview with him here: What The 1918 Flu Pandemic Can Tell Us About The COVID-19 Crisis

I, Sara, thought the background information on the development of "modern medicine" in the United States was particularly interesting.  I had no idea how far ahead Europe was compared to the US in the late 1800s in terms of understanding the way diseases spread and how to treat them.  The US was still bleeding patients and many medical schools allowed students who failed many courses and who had zero experience working with an actual patient to graduate with a medical degree...  Basically, we can be grateful we live in a time when doctors are much more qualified and knowledgeable about how to care for sick people.

Who knows how these would work out in reality, but the author's recommendations based on attempted quarantines and use of masks during the 1918 pandemic (and written prior to the Covid-19 outbreak) are thought provoking:

"One tool of no use is widespread quarantine. For some diseases quarantine makes good sense, and in theory in some circumstances it could help even for influenza—but only in theory. An unpublished 1918 study of army camps demonstrates this. The army had data on 120 training camps—99 imposed quarantine and 21 did not. But there was no difference in mortality or morbidity between camps implementing quarantine and those that didn’t; there was not even any difference in how long it took influenza to pass through the camp. The story, however, isn’t quite that simple: the epidemiologist who performed the study looked not just at numbers but at actual practice, and found that out of the 99 camps that imposed quarantine, only a half dozen or so rigidly enforced it. Those few did benefit. But if the overwhelming majority of army bases in wartime could not enforce a quarantine rigidly enough to benefit, a civilian community in peacetime certainly could not. Closing borders would be of no benefit either. It would be impossible to shut down trade, prevent citizens from returning to the country, etc. That would shut down the entire economy and enormously magnify supply chain problems by ending imports—including all health-related imports like drugs, syringes, gowns, everything. Even at that, models show that a 90 percent effective border closing would delay the disease by only a few days, at most a week, and a 99 percent effective shutting of borders would delay it at most a month."

"Surgical masks are next to useless except in very limited circumstances, chiefly in the home. Putting a mask on someone sick is most effective because it will contain droplets otherwise expelled into the room—a fact that experiments in 1918 proved. Will a parent put a mask on a sick child and make that child more uncomfortable? Maybe, if he or she knows it will protect the rest of the family. And even a surgical mask when combined with rigorous hand washing may provide some protection for those in close contact with a sick person. N95 masks would be more appropriate in that situation and they do protect, but they need to be properly fitted and properly worn. This is harder than it sounds. A study of professionals wearing N95s to protect themselves from toxic mold found that more than 60 percent did not wear them properly. In addition, they are extremely uncomfortable. For a few individuals and situations N95 masks may make sense, but for the general public over a period of weeks they do not."

Of course, this book is about influenza, rather than coronavirus, but we can still learn lessons from the actions of people and countries in the past.  So, if you like science and history or are interested in epidemiology, this is the book for you.