Throughline - 1918 Flu

Episode Date: March 26, 2020

In the midst of the coronavirus pandemic it's tempting to draw comparisons to the most severe pandemic in recent history - the 1918 flu. But as much as we can learn from the comparison, it's important to also understand just how much these two pandemics differ. This week, what we can learn from what happened then and, just as importantly, where the comparison should end.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Support for this podcast and the following message come from Autograph Collection Hotels, with over 300 independent hotels around the world, each exactly like nothing else. Autograph Collection is part of the Marriott Bonvoy portfolio of hotel brands. Find the unforgettable at AutographCollection.com. Hey, I'm Randabdin Fattah. I'm Ramteen Arablui. And on this episode of ThruLine from NPR, the 1918 flu pandemic. Well, what can we say?

Here we are in the middle of a global pandemic. And many of us, including the entire ThruLine team, have been working remotely from home for over a week now, trying to practice social distancing. But of course, this isn't the first pandemic in history. Many of you have probably heard comparisons being made between what's happening today and the 1918 flu pandemic, sometimes called the Spanish flu. It was a novel virus, novel meaning never before seen in humans, that swept across the globe, infecting roughly one-third of the entire population. And I think while we have some comparisons, some similarities between what happened then and what happened now, there are of course huge differences in our understanding of the virus, our treatments of it and other things. And I think that story is also worth telling.

This is Jeremy Brown. I'm an emergency physician and I'm the author of the book Influenza, the 100-year hunt to cure the deadliest disease in history. And I also work at the National Institutes of Health, where I am the director of the Office of Emergency Care Research. Jeremy talked to us as a private citizen, not as a representative of the NIH or the federal government. And what he emphasized above all else were the differences between coronavirus and the 1918 flu. Because I think the differences are in many ways more important than the similarities and also provide us with reassurance. That's what we're going to look at in today's episode.

What happened in 1918 and how it compares to what's happening today. Hi, this is Dani from Social Isolation in Austin, Texas, and you're listening to ThruLine from NPR. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the Wise app today, or visit wise.com. T's and C's apply.

In the year 1025, a Persian Muslim physician named Abu Ali Sina wrote the influential Canon of Medicine, or in Arabic, Qanun. The book gathered much of the medical knowledge of that time and created a roadmap for recognizing and treating diseases, performing small surgeries, and even had a detailed section on herbal medicine. The Canon of Medicine was used for centuries in the Middle East and Europe.

William Osler, one of the founders of Johns Hopkins Hospital, called it the most famous medical textbook ever written, contending that it was a medical bible for longer than any other work. This isn't hyperbole. Abu Ali Sina's approach to medicine laid the groundwork for the scientific method. He correctly identified the basic causes of stroke, the relationship between nerves and muscles, and even accurately describes the way the human heart functions.

Yet amazingly, from the time of Abu Ali Sina, human understanding of the unseen viruses and germs that fill our world remained virtually unchanged. Until perhaps the 1850s, the 1860s, the 1870s, with the introduction by Lister of antiseptics that changed everything. And then we have Louis Pasteur, who develops pasteurizing, what we call pasteurization techniques. And there's this beginning of this germ theory. The microscope has now been around for a couple of hundred years. People understand bacteria. And so there is beginning of what we might see as a semblance of modern medicine, but it was a vastly different

time and one that we should all be very grateful that we're not living in, at least from a medical perspective. What was the state of medicine at this point in the world? Well, there was no understanding of viruses as we know them today as these tiny particles, perhaps one twentieth the size of a bacteria. And so people spoke about viruses in terms of a poison, something that causes disease without understanding exactly what that was. It's a time when hospitals are quite different. It's a time when hospitals are quite different. It's a time when there are no antibiotics. Your doctor was probably as likely to arrive on horseback. There was bloodletting in

which your doctor would slice into your vein and remove some of your blood on the basis that disease was a dis-ease. It was an imbalance of the four humors. And if you could remove blood, you would bring the patient back into some kind of balance and cure their disease. So everybody, one time or another, went to the doctor to get their blood let. So it was just a time that is almost inconceivably different to the time that we have today in terms of medicine and our understanding of disease. What was going on in the world around the time the 1918 flu broke out? You know, what did the world look like?

Well, the world looked like a very sad place. It was three, four years now into the Great War. America had just come into the war in 1917. And the war has now been going on for these many, many years, with the deaths of so many young men in every community, virtually, certainly in Great Britain, and in France, Germany, of course, suffered its own casualties. And then the United States was pulled into the war. So when do people start actually hearing about this new flu and start paying attention to it? So the first reports that we have in the U.S. about influenza actually are well documented, and they originate in Haskell County in southwest rural Kansas, 200 miles west of Wichita. And there in January or February of 1918,

a physician by the name of Loring Minor, who was a country doctor in rural Kansas, he noted that there was more and more of this disease called influenza. In fact, he noted that on one day, 18 people in his community had come down with influenza and that three of those had died. And in a sparsely populated county like Haskell, this was a remarkable event, remarkable enough to prompt Dr. Minor to write a report to health officials.

And that is the first recorded instance of a physician warning about the outbreak of influenza. From Haskell County, Kansas, the disease quickly spread outwards about 300 miles to the east to Camp Funston, where there was a U.S. Army camp. And we know that soon afterwards, around beginning of March, the first soldier at Camp Funston fell ill with influenza as soldiers moved freely between Funston and then civilian world and then other army camps. The virus expanded outwards in waves. So that is the first theory as to where ground zero was for the great influenza epidemic. There are at least two other theories as to where it originated. The second is that it actually originated in northern France. The virus passed from birds into an intermediate host and then into the human population. And from there, it seeded around the world to rear up and to show its ugly head all at once across the world in 1918. has a lot of promise because it explains why communities that were very far apart from each

other, like China and India and the United States and Africa, why all these communities saw influenza in 1918 suddenly at the same time. There was, of course, no rapid international air travel. So how did the germ spread so quickly? And then the third possible place where this disease came from was actually from China. There are reports early in the year of a disease that resembles influenza in China. And that theory suggests that the disease originated there and then was brought to us, possibly by the large number of Chinese workers, about 140,000 Chinese workers were actually hired in a supporting capacity in the European theater of the Great War. And it's suggested that some of these people brought

the disease with them. So three possibilities. Ground Zero was right here in the good old US of A. It was in northern France. It was possibly in China. Each of these theories has good evidence to support it. And each of these theories also has weaknesses. And it's likely that we will never know for sure which is the correct one. And how did it spread? How fast did it spread? Well, it spread very fast. And I think it's fairly clear that it certainly spread with the large movement of soldiers from the military camps back and forth, both within the U.S. and then over to Europe. And then you had soldiers that were coming back from Europe in boats,

making their way back to the U.S. for rest and recreation. And so you had this great intermingling of soldiers, young men from all across Europe. And it is likely that that was one of the important features and factors that allowed this disease to spread so very quickly. I mean, this disease is often called the Spanish flu. You know, that's how a lot of people know it. But all the theories about its origins, as we heard, have nothing to do with Spain. You know, not a single one of them. No, the Spanish flu certainly did not originate in Spain. So why was it and

sometimes to this day? Why was it called the Spanish flu? And the answer is this. It was widely reported in newspapers in Spain. And that's where the first stories broke of this disease. Why wasn't reported perhaps in other newspapers in the US, or in Europe or in Great Britain? The answer is this. There was a tacit agreement between the governments of the Western powers and the newspaper editors not to report bad news. Certainly, there were reports of influenza, but they were generally small and often relegated to the back pages. And what we have, therefore, is an underreporting of influenza in the newspapers. Spain, to remind everybody, Spain was a neutral country in World War I. It did not have,

therefore, this tacit agreement between its newspaper editors and its government not to report influenza. And so the first reports of influenza being widespread came out of Spain. But this does not mean that the disease came from Spain. It certainly did not. I'm wondering, you know, if I was someone living at that time and this disease was sweeping through, like, what would it have felt like to witness its spread? Well, it must have been truly terrifying. For me, perhaps the most terrifying aspect of this illness was, as we were speaking about, people had no idea where it was coming from. So if we think of the word influenza, that word comes

from the Italian influencia, meaning influence. And it reminds us that for many, many hundreds of years, maybe thousands of years, people thought that you got sick because of a misalignment of the stars and of the planets Saturn and Jupiter. So the word influential meaning influence means that we were under the influence of the stars. And that, as good as any other theory, was an explanation of why people were getting sick. So here you were living in perhaps in very cramped conditions in a tenement building in a city like Philadelphia or New York or San Francisco. As this disease was sweeping through the community, people were becoming sick, and you really had no idea what the causes were. People had no idea what was killing them, how it started, or how to stop it.

And with poor news coverage, no cure, and rumors running wild, fears were rampant. And it was anyone's guess how to stay safe. When we come back, we find out who was most vulnerable to this flu and what society did to flatten the curve. Hello, my name is Busola from Lagos, Nigeria, and you're listening to True Line from NPR. Bye. Over the past few weeks, we've quickly watched many parts of society shut down. Businesses, places of worship, schools, restaurants, gyms, professional sports leagues. And now even the Olympics have been postponed.

But it turns out all these social distancing measures aren't new. People in 1918 also started keeping their distance as the flu began to spread. That's right. Back in 1918, similar things were done. People understood that there was something about interpersonal contact that made it more likely to catch the disease. And so churches were not meeting. Department stores were going to only have a staggered opening time so that people would only be allowed in at certain times. And few people would be allowed in. Dance halls closed down.

Places where people would gather to dance to the sound of a piano, those were closed down. Door-to-door salesmen, something that we really don't have anymore, but door-to-door salesmen trying perhaps to sell you an encyclopedia, those were banned. Funerals were banned. You could only have a couple of people

attend a funeral. They didn't want too many people to gather together in that setting either. Newspapers of the times were full of articles recommending that people use handkerchiefs. There were reminders not to spit in public. That's another rather anachronistic feature of the disease that back then spitting in public was actually outlawed and you could be arrested for spitting in public. And there were signs that simply said, sleep well, eat well, play well, and don't worry. As if telling people in large letters not to worry would alleviate their worry. And so very quickly, this disease not only became the problem of those who were suffering from it, but it really changed the shape of society.

So I read that the 1918 flu disproportionately impacted people in their 20s, 30s, and 40s, young, healthy people. And we're so used to this idea that the flu kills the very young and the very old. But it must have been especially shocking for society to realize that its most productive population was most at risk. Yes. The group of people who normally don't get complications, the young, healthy people, people in the workforce generally, they were, for whatever reason, more likely to suffer from the complications and have an increased mortality. And so once that happened,

that meant that people were being taken out of the workforce as either they were dying or they were ill or they were convalescing and jobs couldn't be filled. So police had a hard time, you know, filling their patrols and even things like the telephone system, which we take for granted today. Back then, the telephone system was rather primitive and you needed to route your call through an operator who would connect your call with a cable plugging you in. Well, those telephone operators were sick and couldn't get to work. And so, for example, the telephone exchange in Philadelphia shut down and said, we're only going to route calls of an emergency nature. We

don't have the staff to do anything else. So even if you were lucky enough to have a telephone back then, it was even difficult to place a call to your friends or family elsewhere to see how they were doing. So it affected every part of life. I think it's very likely that everybody knew somebody who was ill and many people knew somebody who had died. One of the features that is very dramatic, as we said, was the fact that it took young, healthy people and very often killed them. The degree to which this was felt is the following. The average life expectancy in 1918, 1919 dropped. It dropped by 12 years. Just to put that into perspective, we've heard a lot about the terrible opioid epidemic that swept this country.

And a couple of years ago, for the first time in a long, long time, our average life expectancy also dropped as a result of the terrible deaths of many young men and women who statistically brought the average life expectancy down in the U.S. by 0.1 of a year, one-tenth of a year. And we read a great deal about it. Imagine a disease that doesn't just drop it by a 0.1 of a year, but by 12 years. It's remarkable. And that is a feature of the 1918 virus. It dropped the average life expectancy in the U.S. by 12 full years. There's a very dramatic eyewitness account that we have of the carnage that influenza caused

by a very prominent physician at the time called Victor Vaughan, who was the dean of the medical school in the University of Michigan. And in his memoir, he wrote that the deadly influenza demonstrated the inferiority of human interventions in the destruction of human life. It's a very frightening description and one that really brings us all to a very different place, a place that is very far from where we are today. When we come back, the similarities and differences between 1918 and now. Hi, this is Jeff calling from self-quarantine in Shanghai, China.

I just wanted to thank you guys. Every episode feels like a window into some curious, interesting part of the world and reminds me of all the unique and wonderful things that are out there beyond my apartment walls. So thanks again for getting me through this time of virus and wish you guys the best. You're listening to ThruLine from NPR. The flu appeared in the spring of 1918 and raged on until that summer. This was the first wave of the pandemic. The warmer months caused the seasonal flu to die down, but it quickly returned with a second wave in the fall when the temperature dropped again. The virus ran its course all the way into the beginning of 1919 and finally puttered

out around February, a full year after it first began. It's not easy to hear about the devastating impacts of the 1918 pandemic, especially while we're living through our own pandemic right now. But as Jeremy said before the break, we're in a very different place than we were 100 years ago. And it's really important to understand how the coronavirus is and is not like the 1918 flu. First, let's get to the similarities. Number one, both are novel viruses. In 1918, we have a pretty good understanding now that the virus was a bird influenza virus that spent some time in an intermediate host, likely a pig or a horse, and then it crossed over into us. And that's how we got the 1918 influenza epidemic. And coronavirus appears to have originated in bats. Then it crossed over through an intermediate animal.

In this case, it seems to be the pangolin, which is a scaly anteater, a very cute but very endangered and commonly trafficked mammal. And then it spread out further into humans. The second similarity is that both are winter viruses. Coronaviruses are winter viruses and are likely to disappear as we get the warmer weather in the spring. That's why the 1918 influenza virus disappeared. But what

happened then was it returned in the fall of 1918 in the second wave of the epidemic. The question is what will happen to coronavirus? Will this then come back in the fall of this year or not? 1918 certainly did come back in the fall when it disappeared over the summer. Personally, I suspect we will see fewer and fewer cases as the warm weather comes around because that's what happens every year with our winter viruses. So let's keep our fingers crossed and hope that that will be a feature of COVID-19 as well. And the third similarity between influenza of 1918 and the coronavirus is that it too has rapidly become a worldwide problem. So those are the three similarities. But let's pause for a moment and think about the differences between them.

Because I think the differences are in many ways more important than the similarities. But let's pause for a moment and think about the differences between them, because I think the differences are in many ways more important than the similarities, and also provide us with reassurance. First of all, in our understanding of the virus, within about two weeks of the very first cases of coronavirus, a Chinese team had published the full genome of COVID-19 in a major US medical journal in English. And this goes to show just how quickly our understanding of at least what the virus was, of at least what the cause was, how quickly we got to it, and also how well there is this international sharing of data. So the first big difference, therefore, is in our understanding of the virus. The second big, big difference is in our treatments. As we've mentioned in 1918, you were likely to get a whiskey, an enema, and perhaps some

bloodletting from your doctor for your influenza. And it occurred, as we said, in the pre-antibiotic era. Coronavirus is here in the antibiotic era. Now, to remind everybody, the coronavirus is a virus, so giving you antibiotics to treat it are of no use whatsoever. But just like with influenza today and back in 1918, some people will get a complication from the infection, and that complication is commonly a bacterial pneumonia, and we have good antibiotics for bacterial pneumonias. So we are now living in an antibiotic era that did not exist back then, and that's a very big difference. As we think about medical treatments, we also have to remember that today we have hospitals and intensive care units.

We have specially trained emergency medicine physicians who will quickly diagnose and treat your illness. We have intensive care physicians. We have pulmonologists who spend all day treating nothing but lung problems and lung infections. And we have infectious disease experts who can help fine-tune any treatment for infectious diseases. All this was, of course, unheard of even 50 years ago, let alone 100 years ago. So that's the second difference. And the final difference that I want to think about with you is the reporting. We've mentioned that in 1918, there was this tacit agreement between the government and the newspaper editors

to keep the news of influenza epidemic off of the front page as best as they could. Compare that with today, where we have heard nothing other than coronavirus on the front pages of our newspapers, on the top of our screens and on our feeds that we get electronically. We are living in a very different time. You can go online and see a real-time update of the number of cases worldwide, you know, that are updated perhaps every 12 or 24 hours. So our reporting of the illness is very, very different today than it was in 1918. And that is the third very important difference between coronavirus and the influenza epidemic of 1918. So, you know, there are a lot of differences between then and now. But this comparison, you know, which was the starting

point for this whole conversation, it worries people, you know, and some of that fear is warranted, some of it isn't. So from your perspective, what are the things we shouldn't worry about as, you know, we deal with this pandemic? And how do we not let the panic overtake us? Sure. I think your question points to another feature that I hadn't really discussed until now, but it's the feature of commonality between 1918 and 2020, and it's the fear. We mentioned that there were these large notices in newspapers that, among the other helpful pieces of medical advice were don't worry, which probably didn't do very much to calm everybody down. And today we are also clearly experiencing a degree of discomfort, a degree of fear of the unknown. But this fear must

be put in perspective. As I mentioned, we have an understanding of the virus. We have treatments that were unthinkable just a few decades ago. And we have an open reporting system that tells us how we're doing. But I think another key feature of the disease back then was this idea that we're all in this together. of 2020 reminds us that however we may separate ourselves, whether by ethnicity as Americans, or places of origin, or how we vote, or what we think about the economy, or our feelings about whether we should have a decrease or an increase in the base tax rate, we can all agree that we are at the end of the day people who need to help each other. And this is a disease that I think has the possibility of bringing Americans together in a much needed way. It's too bad it has to be in this way. But I think as a people, we can really rally around this and do great things and help

each other. When you were writing this book about 1918, were there any examples of resilience that we could draw from, you know, as we're dealing with coronavirus today? Hmm. Sadly, most of these things, most of these recollections are of how hard it was to pull through. It was a very, very difficult time. And we mustn't forget that. But one story or one picture that I like to recall is a picture of a group of Red Cross

nurses, and they're putting together cloth masks. And in the background, there is a sign and it says, if I fail, he dies. And it's a reminder to these nurses that just putting together these masks, you're taking part in a life-saving chain that can make a difference to people and that if you fail, somebody may actually die. It's a reminder of how we can take even the small things, the small things that we're doing, washing our hands, and really magnify that and say, okay, in a microcosm, this seems like a relatively insignificant activity to do. But of course, we know that multiplied across the U.S., these things are of great importance.

If I fail, he dies. That was what the nurses in 1918 thought about as they were putting together these masks. We can perhaps think that we too today can do our bit so that there will be fewer examples of illness and death from coronavirus across the US. Perhaps this disease will remind us that we need a system that can take care of the most vulnerable. We need a system that can take care of us in times when the regular medical system and its accessibility to only those who have certain insurance. I think we need to sort of think about the lessons of that as we move forward as a society. And who knows, perhaps it too will result in some improvements in the way that we take care of not only the most vulnerable people in our society, but of each other as well. Transcription by CastingWords That's it for this week's show. I'm Rondabne Fateh. I'm Ramtin Arablui. And you've been listening to ThruLine from NPR.

This episode was produced by me. And me and... Jamie York. Lawrence Wu. Lane Kaplan-Levinson. Lou Olkowski. Nigeri Eaton. Fact-checking for this episode was done by Kevin Vocal.

Thanks also to Anya Grunman. Our music was composed by Ramtin and his band, Drop Electric, which includes... Anya Mizani. Naveed Marvi. Cho Fujiwara. If you have an idea or like something on this show, please write us at ThruLine at NPR.org or find us on Twitter at ThruLine NPR. And before we end today's episode, we want to share something with all of you. So obviously, the coronavirus has been dominating all of our attention recently, and

we're all very worried about our loved ones. Sadly, before this even became a concern for any of us, Rund had to deal with the loss of someone incredibly special to her. In late January, Rund's father, Nael Abdel Fattah, suddenly and tragically passed away. He was only 60 years old. Nael was a kind, gregarious person who always had a joke to tell and an encyclopedic knowledge of basically everything. He was a big supporter of Rund and this show. His voice even appeared on our episode, The Siege of Mecca, doing Arabic translations. Needless to say, it's been a very difficult time for Rund and her family. Yet she's amazed us all with her strength and incredible focus carrying on in her work

as the leader of this show and the same way her father dedicated himself to his work. In honor of her father's legacy, she created this beautiful piece capturing the spirit of who he was and the close relationship he had with his family. And now we'd like to share it with you. It's hard to find the words. I don't really know how to begin to capture who he was.

All the amazing things he did. Baba was no ordinary person. His generosity was extraordinary. His patience was extraordinary. His generosity was extraordinary. His patience was extraordinary. His humility was extraordinary. His love as a father. My name is Ayman Abdul-Fattah. I'm Raghad. I'm the youngest of four. Husband. My name is Sumaya. I'm the wife of Dr. Fattah. Son, brother, friend. I am Ayman's wife. Physician and colleague. He didn't just try to lift himself up, he tried to lift up those around him as well. Was extraordinary.

His humor was extraordinary. He always made an uncomfortable situation funny. Like when he walks into a room, you know he's there. He just wanted everyone to just have a good time. He liked messing with people a little bit in a good-hearted way. Provoke conversation. Challenge the conventional wisdom. So please, laugh today.

Because he loved to make people smile. He was a refugee from Palestine from a very young age. I have such good memories of visiting my teta, Baba's mom, in Jordan. My dad would tell me when he was a kid growing up in a refugee camp and his family had little, he spent his days studying on a small hilltop. He was really, really smart and so determined to support his family, even then. It's that determination that pretty much brought him to this country with the goal of, you know, giving us a better life than he had growing up because he didn't have a lot.

I married him since 1985. That's been 35 years. He was my love. We start our life, but we are together. I don't think Baba could have predicted that life would take him and my mom to the U.S. I can only imagine how difficult it was for them to leave everything and everyone behind. But they came. And worked really hard to build a life for us.

To give us all the things he didn't have growing up. But even after he came to America, he never forgot where he came from. He was able to support every single person in his life. I love my dad. He taught me to live your life on your terms. And being a good person and doing good for others is really what matters. I am who I am today because of Baba.

I try to treat people with an open mind and an open heart because that's what he did. He taught me what a good man is. Say your name. What's your name, Dan? Say, yeah, my name is Dan. Me. Yeah. Say your name. What's your name, Nan? Say, yeah, my name is Nan.

One of my favorite memories were probably when I was pregnant with Nan. Every day he'd call me, like, is the baby here? No, she's not here yet. Is she here yet? No, she's not here yet. Every day you'd call me. So I was actually in the delivery room with my wife and she had been in labor for a few hours and pretty much everyone in the family was waiting in the waiting room. And then when I had her, my wife had just had the baby and my dad had just made it down from the hospital, and he kind of convinced them to let him into the room. And because of that, he was actually the first person who came in to see my daughter. When he held her, he was, like, crying, and I was like, oh.

Did he cry very much? Nope. He always came over, and he wanted to feed her, play with her. She was his first granddaughter. Our father had a very interesting way of saying hello. So he'd always basically hold her and be like, hello, hello. Hello. Hello. Baba, if you hear me, I love you.

We all love you. We will miss you so, so much. But we will carry you in our hearts always and try to spread the same goodness in the world that you did. I wish I had said it more while you were here. Thank you for all you did for us. We will never forget you.