Dan Snow's History Hit - Flu pandemics. Then and Now.

Episode Date: February 5, 2020

'We are very very vulnerable' says the brilliant science author and journalist Laura Spinney. Her fantastic book 'Pale Rider: The Spanish Flu of 1918 and How it Changed the World' is a shocking account of the flu pandemic that killed tens of millions of people a century ago. What was Spanish Flu and what lessons are there for us today? As the coronavirus sweeps across China this is a really important conversation about flu, anti-microbial resistance and whether we should be scared.

Welcome everybody, welcome to Dan Snow's History. You find me holed up in my citadel, my citadel with air filters on, my family in quarantine outside, they have not yet passed through the quarantine process. I'm ready, I'm ready for Armageddon, I'm ready for the pandemic and that's what happens when you spend your time reading about the Justinian plague, when you find yourself reading about the great plague that preceded the destruction of the Persian Empire and great chunks of the Roman Empire in the east by the Arabs that surged out of the desert during and after Muhammad's life. And when you read about the great pandemic of 1918 to 1920, it gets you a little bit nervous. It turns you into a little

bit of a prepper. So you won't be seeing me. I'll be doing these podcasts remotely until the danger has passed. Go to HistoryHitTV, use the code POD6 as ever. You get six weeks totally free. It's free. It's not a bad offer. It's free. So that's pretty good, I'd say. So go and check out HistoryHitTV, HistoryHit.TV. It's like Netflix, but just for history programs. the code pod six and uh and you're away go and do that the reason i'm banging on about influenza is this podcast is actually about the great influenza known uh unfairly as spanish influenza between 1918 and 1920 about 50 to 100 million people all around the world were killed by this influenza outbreak. It was possibly the largest,

I mean, this is the problem with history. It's fascinating. We're good at talking about Dresden, we're good at talking about the First World War, the trenches, we're good at writing books about that. And yet we're incredibly bad sometimes at taking a step back and looking at the things that are actually affecting the onward march of this species and the death of 50 to 100 million people in the space of two years all over the world strikes me as probably more important to study and think about and learn the lessons of even arguably than the first world war controversial point there get back to me don't at me actually my twitter mentions meltdown for the next three weeks. It is possibly the single greatest disaster in human history. And in her brilliant book, Pale Rider, Laura Spinney tells the story of that pandemic,

how it spread from Alaska to the islands of the Pacific across all continents. I wanted to ask Laura, with the backdrop of a new global health emergency announced by the World Health Organization, whether these pandemics are inevitable, if there's anything that we can do to stop their spread today, to ameliorate them, and what could have been done in 1918 to 1920. How much of it was human failing? How much was governmental indifference as their people died in their droves? Laura's a fantastic writer, specialised in science, as you'll see if you read her book,

The Pale Rider. She's adept at writing history as well, and not just writing, talking about it, as you're about to hear. Enjoy. Laura, thank you very much for coming on the podcast. That's my pleasure.

These are, this is not the happiest circumstances to come on the podcast, but history is more important than ever. Tell me, what were the first signs, the first... Do we know where Spanish influenza originated? We don't. In fact, it's one of the few certainties about that pandemic that it didn't start in Spain. Around the end of June in 1918, the health inspector, the kind of person who was in charge of health for the Spanish government,

stood in front of the Royal Academy of Sciences in Madrid and said that he was embarrassed, but he didn't know of any other cases anywhere else in Europe. But the reason that he didn't know about those other cases which existed was because other countries in Europe were censoring their press because they were at war. It was already rampant in Britain and France, for example, whereas Spain, being neutral in the war, did not censor its press and so reported on the first cases that it had that spring, which included the King of Spain, by the way, so very, very visible. And it looked to everybody else, including to the Spanish, that it was rippling out from Madrid.

Was it, okay, so I know nothing about this, but I imagine with bubonic plague or Ebola, you know you got something pretty bad straight away. With Spanish influenza, or what should we call it, the great influenza outbreak of the 1980s? Yeah, the 1918 influenza outbreak, although it lasted longer than 1918, but yes. Did it mutate? Did it get worse as it got more human vectors? Or was it immediately, like you said, the King of Spain got it? I mean, was it immediately pretty dangerous?

No, it's such a tricky enemy. Basically, there were three waves of the pandemic. The first wave in the spring of 1918, or the Northern Hemisphere spring of 1918, was relatively mild, not that different from a seasonal flu. And so everybody was kind of lulled into a false sense of security, although even that's not right, because you wouldn't be lulled into a false sense of security, it would just be flu like any other year. of security it would just be flu like any other year um it recedes you know in late spring early summer um roughly depending on where you are in the world and then it comes back with a vengeance at the end of august that year and it's so different then that it's that many people mistake it for a completely different disease it's far far far far more vicious and i mean the kind of scientific consensus at the moment is that what you saw in the spring was kind of the very vicious pandemic strain emerging through a background of seasonal flu gradually. And sometime that summer, it acquired the adaptation that meant it could transmit easily between human beings.

And then it came back in the autumn, a formidable vehicle of disease because it was very, very vicious and lethal and dangerous, but it could also transmit easily between human hosts, which is that it began to moderate its virulence because it's not in the virus's interests, evolutionarily speaking, to kill off its hosts. It wants to keep them alive long enough that they spread it to new hosts because that means it can reproduce and keep surviving. So in fact, every seasonal flu strain that we've ever had has started as a much more vicious pandemic strain and then moderated its virulence. That's how it normally works. But it may take a little while, as in 1918, for it to build up to its full peak of virulence before you see that moderation begin. And that's why it can be, what's the word, it can trick us for a while. And so the worst phase of the 1919 epidemic was the second wave?

Yeah, the second wave was absolutely the worst wave. The vast majority of deaths took place in the 13 weeks between the middle of September and the middle of December 1918. And if you think that we're talking about, on current numbers, 50 million dead in the world, possibly as much as twice that, on current numbers, 50 million dead in the world, possibly as much as twice that. That was a lot of death in a very short space of time. Obviously, the First World War was going on, and indeed the fighting chaos that followed the war, the economic dislocation. Why is it hard to find that influenza in some of the sources? I read a lot about the peace settlements following the war the division of the middle east the uh german revolution you know bavarian

republic it doesn't seem to me that influenza was was the mortality very high spread across communities or it's it's extraordinary i mean this is essentially the reason that i wrote the book because i was as a science journalist being asked around 2013-2014 to look into the science of the Great War how we're going to mark the Great War from a scientific point of view and I was doing my research and I was coming up against this other disaster which overlapped with the war and then I looked at the numbers and I'm like hang on the First World War killed we estimate roughly 17 million people and this disaster killed upwards of 50 million and we don't talk about it what's going on and I I still don't really know how to explain it um it kind of like it's like the

the warp and the weft the the I can't remember which is which but the but the war is in the front ground foreground and the and the the flu is somehow the background. But they interact at every single level. All the way along, the peace process that you just mentioned was totally woven through with the flu. Woodrow Wilson, the US president, fell ill with the flu while negotiating in Paris in the early months of 1919. And in fact, the flu, neurologists now agree, that he caught at that stage of that year, went on to provoke a major stroke in him later in the year, which left him paralyzed down one side. And some historians have argued prevented him from persuading the U.S. Congress to ratify the Treaty of Versailles. So the flu, arguably, these things are difficult to prove, but the flu had major historical repercussions.

And that's just talking about sort of the highest, you know, historical stage, the things that were most visible. Of course, it had massive effects on societies and populations and on the composition of those populations that we can also talk about. Is there a sense in which the war fell very unevenly? It fell disproportionately long upon, in the UK, for example, on the elite, actually children of the elite, curiously, you know, aristocratic young men who'd been to Eton and it was, you know, losses were, you know, extremely well recorded in poems, in letters, in verse, in speeches. in poems, in letters, in verse, in speeches. And if in the Spanish influenza, are people, you know, just, you're losing, I don't know, is there something about how the casualties are spread through society?

I think you're onto something. I think it's about how to express that kind of disaster, which definitely fell. I mean, the flu was always called the democratic disease but in many ways it wasn't democratic because it picked on the lowest uh the most deprived the hungriest the poorest the workers because they tended to be more vulnerable for all sorts of reasons they were worse fed they had worse access to health care they were worse housed and so on and those people tend to be the ones who have less access to a voice of any kind on the historical stage. Also, on top of that, people don't really know what language to use. They didn't know what they were talking about.

You have to remember that virus was a very new concept in 1918. Almost every doctor in the world thought they were dealing with a bacterial disease. So they didn't have a diagnostic test and it got massively misdiagnosed. It was called everything from a common cold to typhus or cholera because of the very extreme symptoms that affected the minority nevertheless, the minority who died of it. And so it's this very slippery beast. What are you talking about? Even the educated and the very articulate had trouble talking about it.

Famously, the emerging future famous writers in the US, Hemingway, Fitzgerald, Dos Passos, and William Carlos Williams, they didn't talk about it in their literature. They didn't talk about it, and yet all of them were affected directly or indirectly by it. So it was something that was difficult to capture in language, which I think is fascinating in itself. Then there were, yes, to put it briefly, kind of class issues, socioeconomic issues, and it just kind of escaped our ability to capture it on the page. So did it affect crowded slum- communities whose immune systems might be weakened by the problems caused by socioeconomic deprivation more than more than rich people yeah and so you see that in different

contexts so for example in new york at the time which was a city full of immigrants of all different kinds it was in the middle of a massive wave of immigration. The biggest, poorest and newest group of immigrants at that time in New York City were the Italians. And they were living crushed in the little Italy's, like, for example, the Lower East Side, 10 people to a room, no hot water, people sleeping in shifts and so on. But also a kind of living in an environment which was very separate from the world that the public health uh language existed in in new york city so they were kind of cut off from the messages and they were suspicious of them and every and the public health workers were suspicious of them as well so there was a complete breakdown of communication and they

probably were the group that suffered the highest death rate in New York City in 1918. But then you see similar effects in different contexts. So for example, islands were often very badly affected, because they were remote, because they had little historical exposure to the flu, which meant they, which meant they, you know, they didn't have the immune priming, if you like, and were more vulnerable to it. But they also had often poorer access to healthcare. So when they did fall ill, there was little to fall back on in terms of nursing and so on. So you get these double whammies, you get these kind of effects reinforcing each other, which meant that the poorest and the hungriest and the most remote often suffered the worst. And because they were often the least likely to report their disease,

that's one of the reasons why you get this vast range of estimates from 50 to 100 million, because we think that 50 million people could have been ill without reporting it. And again, you mentioned islands. Isn't there a figure for Samoa or Fiji or something in the Pacific where there was just a mind-blowing proportion of casualties? In western Samoa, yes.

Western Samoa and also Persia, though the research there is less well-known, experienced the highest death rates. I think in western Samoa it was about a quarter of the population died. So we're approaching the more famous, perhaps, pandemics of the early medieval and medieval periods i mean a quarter of a population is roughly what people think the black death could have been yeah exactly i think uh the black death we used to say about a third of the european population died and now it's up to some estimates put it up to about half but of course the counting and the numbers are

even more sketchy from back then because nobody was really counting, nobody knew how to diagnose black death. It was long before germ theory when we connected infection to germs. I think historians aren't very good at talking about health and science sometimes. And I always find historians, they kind of struggle to understand

how someone's personality could change. You know, Napoleon, almost like he wasn't the same man as he was 10 years previously. Well, anyone who knows anything about mental health or physical health will know that that's very positive very often the case you know we we develop ailments so we're also but i think historians can be very bad at we're more interested in talking about speeches that great men make when we decide what's changing the moving the needle in history i mean when you look at this period now

as a scientist as someone who's immersed yourself in this influenza outbreak what what do you think what what was that what were the political the social the economic impact of that extraordinary pandemic i think they were enormous and i think we're just working them out so for example i mentioned the peace process following the First World War, which fell right in the middle of the third wave of the pandemic in the early months of 1919, or you could say the third wave of the pandemic fell in the middle of the peace process, depending on how you look at things. But there are those military historians, for example, who argue that it affected the outcome of the war. It certainly seems to have accelerated the end of the war. And there are those who will go out on a limb and say that it affected the outcome of the war it certainly seems to have accelerated

the end of the war and there are those who will go out on a limb and say that it actually affected who won um that that's controversial then um there's a good argument that it brought on or brought on more quickly let's say apartheid in south south africa because you know those feelings were already stirring there those those tensions. But immediately after the pandemic, you see laws come in, which are the enactment of things that had been talked about for decades previously, segregation of towns along colour lines. And that can be directly linked to the fact that blacks were blaming whites, and more importantly, whites blaming blacks for the disease that had just devastated them. were blaming whites and more importantly whites blaming blacks for the disease that had just devastated them. In India, India is a really interesting story because India we estimate

lost about 18 million people, 18, one eight, that's more dead people in India from the Spanish flu than died in the entire First World War and hardly anybody talks about it but India at the time obviously was a British colony. And the provision of health care by the colonial authorities for the native, if you like breach and helped the indians who were getting sick and dying in large numbers tended to the people who were mobilized to fight for independence it was the people who were already mobilizing themselves and cutting across caste lines to fight for independence who came to the rescue of the sick and the dying and so when the pandemic was over you see this vast

grassroots movement getting behind Gandhi, the new emerging leader of the independence movement, that he had not had before the pandemic. So I think there are ways in which, you know, I talked about the warp and the weft. If you look, it's there, you can see it, it's in front of your eyes. It's just that it's not written down. And so, you know, in the defence of historians, it's not easy to find in the records what the impact of the Spanish flu was. We're getting there slowly, but it has to be a joint effort between the epidemiologists and the scientists and the historians to piece all this together. land a viking longship on island shores scramble over the dunes of ancient egypt and avoid the poisoner's cup in renaissance florence each week on echoes of history we uncover the epic stories

that inspire assassin's creed we're stepping into feudal Japan in our special series, Chasing Shadows, where samurai warlords and shinobi spies teach us the tactics and skills needed not only to survive, but to conquer. Whether you're preparing for Assassin's Creed Shadows or fascinated by history and great stories, listen to Echoes of History, a Ubisoft podcast brought to you by History Hits. There are new episodes every week so so let's also now talk about official response because this is something that is of absolutely essential importance over the next weeks hours weeks and months when we're dealing with this influenza outbreak um government had had undergone

a revolution over the previous 150 years they were reaching into people's lives never before they were conscripting and mobilizing vast numbers of people they're fighting the greatest wars in history were they any good at public health so it depends where you were in the world uh in new york city which suffered one of the lowest flu-related death rates in 1918, they were very good at it. They'd been fighting TB for 20 years, stopping people spitting in the streets, threatening them with fines and jail time if they did. And they'd made serious inroads into that horrible disease, which preyed on the town, especially with these very crowded tenements and so on. disease which preyed on the town especially with these very crowded tenements and so on but what it means is that New Yorkers were used to as you meant as you suggested to the authorities intervening in their lives for their own good or for the collective good at least telling them to

wear masks not spit so on they were used to that whereas in large swathes of the world that was really foreign how dare you tell us you know how to live our lives and so on at the same time it was a world in which people were more likely to obey authority we're far more rebellious today so we're dealing with a complex interlocking set of conditions which change between eras i mean mean, today, I think we're less likely to respect authority, but at the same time, we're better educated in terms of public health. So we know about contagion, we know about basic measures of social distancing that keep it in check. And, you know, I just went to my local chemist yesterday, and they're all out of face masks,

there's been a run on them. So I think, you know, maybe the risk for us is a little bit more panicking, not listening to the authorities, the fact that we can travel so easily. That's going to be the major problem. We're dealing with a different set of conditions entirely. But we are also, we're all, and certainly I'd say in the society I live in, if the government tells us to do something for public health reasons, we're pretty likely to do it, I'd say, aren't we? I think we're pretty likely to do it. But then you'd have to look, for example, at what we're now calling vaccine hesitancy, which is on the

rise in the West and even further than the West. You know, people are beginning to question some of the things that some of the messages that come down from above so to speak um and uh you know we're just going to wait and see how these things come together and how they mesh together we don't have a vaccine for the corona virus yet and it may be a few weeks um until we do uh but will people take it when it's there i suspect they will i suspect they will i suspect i suspect that common sense and and and fear will override everything else at that point but we'll have to wait and see um when you're writing this book is of course this is 1919 was just one of you know a huge number of pandemics we've we are all too quick to forget that something like 90% of indigenous American peoples died within 200 years of Christopher Columbus

arriving in the new world. So astonishing, astonishing destruction of life. And we think about the great plagues of the medieval period, but also the one that helped to bring down the rope, you know, that helped to help pave the way for the Muslim conquest of the ancient Near East or the early medieval Near East. So they've been a huge part of human history.

When you're writing this book, does it leave you convinced that we're just, there's another one in the offing? Or is our response, our ability to respond now just inconceivably different? No, I think that we are very, very, very vulnerable. I mean, just to think about flu, because every disease is differently. So let me just speak about flu. In 1918, we had no flu vaccine, no antiviral medicines for treating it once people were sick. And we had no antibiotics which would have treated the secondary bacterial infections that actually killed most people through pneumonia so they're completely bereft they had nothing really except for good nursing care aspirin and

a myriad of folk medicines we have today flu vaccine antivirals antibiotics but we're also four times more numerous in the world. We have a large proportion of our population who are immunocompromised in some way, either because the population is ageing and the immune system falls off with age, loses potency, and various other reasons. And we're also just that much better connected. You know, just the travel thing is extraordinary. A virus can circumnavigate the globe these days in hours or days, whereas it would have taken months then. So in those ways, we're much more vulnerable. There have been 15 flu pandemics in the last 500 years, and there will be another one.

How bad it is, and this is kind of the message of my book, is kind of dependent on us. And one of the big messages is to try not to have a war, because the convergence of the war and the pandemic in 1918 is, it looks as if, you know, many historians now would agree with this and scientists, it looks as if it was the convergence of the two that made it so bad. None of the other pandemics, there have been five pandemics since the 1890s flu pandemics and that was the only one that killed more than two million people and it killed many more than two million people so there's one lesson not to have a war because it has unintended consequences and as you say the secrecy the kind of the whereas at the moment one hopes of course the

chinese government's been uh criticized for secrecy and many much else. But one hopes that if the WHO are able to kind of combine, there's public health information, there's free exchange of information and knowledge between medics, that hopefully will have a huge effect rather than everyone covering everything up and pretending everything's fine until it's absolutely pandemic levels. Transparency is absolutely key. Communication is absolutely key. Building trust witharency is absolutely key. Communication is absolutely key. Building trust

with the population is absolutely key. And I think one of the worries at the moment is that there's quite a lot of evidence, at least in Western societies, and the cultural differences are important and we don't know so much about China. At least here, we don't know so much about China. The evidence in the West is that imposing health measures, making them mandatory, tends to be rather counterproductive. So, you know, we're going to have to wait and see. I think that the general opinion in the medical community of how the Chinese have handled this so far has been that they've done a pretty good job. And we may find that the fact that they, you know, have a one party system and kind of can tell people how to behave, they're not dealing with democracy,

democracy can be counterproductive in a pandemic. Unfortunately, they may have the upper hand in that way. So we're going to have to wait and see. But yes, you're absolutely right. Transparency is key to managing a pandemic. What other lessons, transparency is important, what other lessons are there? Why does history matter as we grapple with what could be another serious contagion? Well, why does history matter? I've seen a lot of messages today saying get your flu vaccine. And I think it's a little bit confusing. It's like, does the flu vaccine protect me against the coronavirus? No, not at all. I think the point is, whoever said that originally, and then it got kind of repeated around social networks,

whoever said it originally wanted us to remember that flu is actually a bigger risk at the moment from what we can tell of this coronavirus. And so if you neglect to get your flu vaccine, you know, the whole population is going to be laid bare to another flu pandemic while we're fighting this, what might turn out to be a slightly lesser threat. I think that was the thinking behind that. So what history tells us is that we are still incredibly vulnerable to infectious diseases. You know, only 50 years ago, after smallpox was

eradicated in 1980, the medical community was very high on that triumph and they were basically closing their medical schools down and saying right that problem's licked and you know how wrong they were we're learning that today it's still a major threat viruses and bacteria managed to evolve much faster than us there's a big problem of antimicrobial resistance that we're fighting in the world today, which essentially means that our weapons are getting weaker and we need new weapons. So the fight has never been more important than today

and history can teach us that. Are you, in an underground location, stockpiling food and weapons? I'm asking for a friend. No, no, no. I've had my flu vaccine and I'm living my life normally. If the coronavirus comes to France where I live and starts spreading fast, then I might think again, I'm not going to travel more than I need to. And I'm going to wash my hands regularly. Well, that's it. You heard it there, everybody.

I will be doing all of those things as well. Very good. And buying cans of tin tuna. Don't do that. Don't do that. Okay, I won't. I'll be around them. Okay, yeah, exactly. Okay, no, everyone do that.

By the time you hear this podcast, I will have a massive stockpile. Thank you. You'll be livingpile thank you you'll be living in new zealand i'll be living don't do that either well i've just come from st helena where i got i felt quite smart that's a good place to go it's the only one of the very few places in 1918 that didn't catch the spanish flu that's what they all said out there exactly um so i might head back out there uh thank you so much laura spinning your fantastic book pale rider the spanish flu of 1918 and how it changed the world is a huge success unbelievably well reviewed so everyone go out and uh go and

buy that and um and don't stop don't stop yeah stop all that stop all that uh thank you so much coming on the podcast and can people how can they um follow what you're up to at the moment uh i'm writing all over the place as a journalist, and I'm on Twitter, but I'm not very good at it, I confess. Okay, well, you can, okay, well, they can Google you. They can Google me. I have a website. Perfect. Thank you very much for coming on. Thank you.

I feel the hand of history upon our shoulders. All this tradition of ours, our school history, our songs, this part of the history of our country, all were gone and finished and liquidated. One child, one teacher, one book, and one pen can change the world. He tells us what is possible, not just in the pages of history books, but in our own lives as well. I have faith in you. Hope you enjoyed the podcast. Just before you go, a bit of a favour to ask.

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