The Great Influenza

After reading John Barry’s nonfiction epic about the great Mississippi flood of 1927, I picked up his other grand, retrospectively timely history of the 1918 influenza epidemic.
With the threat of bird flu raising the spectre of a repeat of 1918, The Great Influenza has lessons for today.

• leadership makes a difference. During the plague, communication, supplies, and basic nursing services made a big difference in the number of survivors.
• corruption kills. In Philadelphia and New York, the Tammany controlled political machines replaced competent public health administrators with unqualified cronies. When the epidemic hits, no amount of preparation will keep resources from being overwhelmed, but incompetence makes a bad situation worse.
• quarantine helps. While nothing could stop the infection, slowing the spread of infection through quarantine helped. In Wilson’s America, where military readiness counted for everything, troop transport took precedence over quarantine. At the same time, there is no evidence supporting the Bush adminstration’s proposal to use troops to enforce quarantine. The problem wasn’t the lack of ability to enforce quarantine, it was the lack of will to declare quarantine.
• communication is key. The World War 1 practices of propaganda and censorship created pseudo-news to “boost morale”. The propaganda hampered useful communication and encouraged an atmosphere of terror.

Like Rising Tide, The Great Influenza interweaves the story of the response to a great disaster with the rise of emerging science and technology of disaster prevention and response. In Rising Tide the threads came together with tragic irony — the great engineering works to control the Mississippi ended up making the disaster more severe. In the Great Influenza, the race for a cure failed. While the epidemic was raging, scientists did not find the real cause or the cure for the flu. Scientists did find the cause of the secondary bacterial infection that killed many victims, but did not isolate the virus until years after the plague. Instead, the epidemic flamed out. In the places hit by the flu, the virus flared for 4-6 weeks, and quickly exhausted the fuel of non-immune humans.
Also, it wasn’t until later that scientists discovered the reason that the 1918 epidemic was so deadly to young, healthy people. The 1918 virus triggered an extreme immune response that was more severe in the young and healthy than the old and week.
Part of the drama of Rising Tide was the conflict between the 19th century heroic engineers. The Great Influenza focuses even more strongly on the personalities of the pioneering scientists, at the expense of strong exposition of the science itself.
Also, the Great Influenza is marred by overwriting and lack of editing. Barry repeats “it was only influenza” to dramatizes the way the destructiveness of the familiar sickness was at first underestimated. The phrase is repeated over and over again across chapters, becoming overwrought and grating. One anecdote about striking miners forced into boxcars in the Arizona desert is told three different times.
As a result of these weaknesses, the book is short of brilliant, but it is well worth reading for the history and potential relevance to today’s risks.