Pleasure, but obviously the reason that brings us together is not fun. Thank for inviting me. Is one overriding apply from your book, to to 20 20, what would it be . A pretty easy question to answer. Tell the truth. People in authority need to be transparent and tell the truth. The countries that have done that have done pretty well, not only Asian Countries like south korea and so forth, but also germany, austria. There are some countries that have done this right, and there has been much less confusion, much better organized, much better results. Much fewer deaths. Host what were the biggest mistakes of then president Woodrow Wilson in 1918 . Was entirely focused on world war i. The disease, the second wave, the serious wave in september 1918. He was not going to be distracted by anything, and he did not want anyone in the country distracted. He thought it would hurt the war effort. He never made a single Public Statement. They had created a propaganda , it was fake because they were doing exactly what the government wanted them to do. Minimize and trivialize the pandemic. There was no tony doughty back then. Doughty back then. Fauci back then. About if proper precautions were taken. Event, farrrific more lethal and dangerous that what we are facing now. Much more. Host that is an incredible statement. That Woodrow Wilson did not get a single Public Statement on what was the greatest pandemic of the time. John not one. He was an interesting creature in a lot of ways, and when he focused on something, that was it. And he was focused on the war. Host there are a couple parts of the book that are applicable to where we are today. Let me share them with our audience. 20 first, every siren in the city signaled that mask could come on. San francisco at that point had survived with far you are deaths that had been feared. They thought they had control the, that they had stopped it. They were mistaken. The city had sibley been lucky, and two weeks later the third week struck card wave struck. Third wave struck. John they lifted the restrictions. Too soon. The disease came back. Places, a third time , not so much a wave just another cycle of that same way. They had managed to slow it, with the restrictions, and boom. It was bad. That happened in many states. That next iteration in San Francisco in particular was considered way more severe than the first one. San francisco ended up at the fourth or fifth highest mortality in the country. It was quite severe. Host and they did not apply social distancing, did they . John they did, but not the extent that we are now. They closed all places of public gathering. Close schools, churches, services. Theaters, of course. Vaudeville, any kind of show, ours, restaurants. They were not as extreme as we were. And it was not as effective as what we have done. We actually, at least temporarily, push the pause button nationally. Although, cases are continuing to increase nationally, but places like new york or that matter new orleans, was a pretty bad hotspot. New orleans, things are looking much better. New york, new orleans, a few other places have actually turned the curve downward significantly. Nationally, cases still increasing. Largely because of the war, almost every industry was considered a war industry, they did not issue the closing orders of ordinary businesses. On the other hand, there was so much fear and that pandemic was much debt they are than we are facing now. Dying,ople were primarily young people. A major impact even where formal closing orders were not issued. A major impact even where formal closing orders were not issued. Theertainly interfered with ability to produce a product. Short supplye in so you cannot get trains moving. There were impacts even without formal closing orders. Host of course, we have been dealing with this for just a couple months. The pandemic of 1918 really lesson for a number of years. You wrote in the book, and eight weeks, 11,000 influenza deaths occurred in just new york city and chicago. And the new york city, more cases were reported on a single day than on any other day in 1918. It continued to strike city sporadically as late as january of 1922, 4 years later. Washington states help the rector glared enforce absolute quarantine. Could that happen today . Or are we better prepared in 2020. John i think it is more likely to happen today. This disease is more contagious than influenza. As i said, 1918 was much more lethal. Killed much more people than this disease. I am pretty confident of that. But this is more contagious, and in 1918, influenza had circulated not that influenza virus, but other ones. So there was considerable, relatively speaking, compared to populations that had never seen in influenza virus at all. In the west, in the united states, there was considerable cross protection. That you had from being exposed from other influenza viruses. In parts of the world where the death toll, those were people who had never seen any influenza virus. World,ow, nobody in the prior to december 1919 2019 had ever seen 20 covid19. The entire world is susceptible to this, it will continue to spread. I want to make a correction. Ofant to make clear in terms what happened in terms of 1918. In a particular community, generally speaking, the virus would arrive and sweep through the community very rapidly. Much faster than covid19 is doing. Weeks, and six to 10 that it would be essentially gone. Usually, maybe six month later, maybe a year later. But after finishing that community, whether it was six weeks. Whether it was 10 quite a short. Of time. Then you really didnt have to worry about it. I do not think that is going to be the case with covid19. Again, because entire population is susceptible. And that point, i would guess right now, no more than 5 of the population has been exposed to the virus. There are are a lot of people out there that the fires can be transmitted to. On nbche story tonight news said we are seeing a spike in more rural areas, in more rural areas, and the center part of the country. Phone calls. Don from new jersey. Hi, how are you guys doing. I am a natural doctor so i hope you dont hang up on me. Because, people dont listen to natural doctors, and there should be natural doctors in the government to guide this president. I am just going to tell you, really quick what i believe this is. This is something that is envyting the third i hypothalamus. And that is bringing down the body temperature, after it puts an immune response, and it throws lipids into your organs. That you know about fat and cold . I dont know anything about what you are talking about, actually. Host lets move onto mark, from new york. Good evening mark. Angel inll go to phoenix, arizona. Hi, how are you doing today . I have got some questions. Thank you, i am well. I have questions about the mortality rate, i guess you would call it. The number who caught this influenza and who died in the world, compared to what the numbers are looking like, even though we are not at the end of it right now, is it even comparable . I also wonder, when you look at the 1918 medicine at the time, now we are in 2020 when you state that we might have this recurring in the same way, at least that is what i thought you just said, i feel, how could we not have advanced medicine to the point of stopping this, at least with everything they are working on right now . John good question. First, in terms of the mortality rate. In the west, it was probably about two to two and a half percent. In the other parts of the world, where you see other influenza viruses circulating, some cross protection. In the less developed world, the mortality was much higher. In some areas where they had never seen any influenza virus whatsoever, you had horrific numbers. You had 30 of the entire population. 20 or more would die. West, the numbers, two and a half percent is a little misleading, because the disease was so focused on young adults, maybe into middle age a little bit. Two thirds of the debts were people 18 deaths were people 18 to 45. Not case mortality, but of the entire population of industrial workers, over something of three and a quarter percent were industrial workers. Died. Does not give you a full sense of the impact, because remember, this thing would hit in an area in six to 10 weeks. 3 16 weeks, you are seeing or more of that of your popular entire population in that age group died. Ofyou are a minor, over 6 the entire population in that age group died. ,regnant women, is mortality there were a dozen or so studies. They range from 21 to 70 1 . 71 . In different subgroups of the population, it was quite frightening. West, without overall case mortality rate doesnt really give you a sense of the impact of the ds the disease. In terms of medicine, all they could do in 1918 with supportive care. All weat is essentially can do, although our ability to support someone is infinitely greater if you have an icu bed available. Things they could do in an intensive care unit are extraordinary, today. Vaccine. L hoping for a every virologist i talked to is pretty optimistic that a vaccine will be available, whether it is or january, fall, or another year from now. That is still not clear. Even after you get it scientifically, after you solve the scientific problem, you have the production and distribution problem. Lets say they get the vaccine, they know it is going to work. At the earliest, Something Like october which would be miraculous. Not just hundreds of millions, but billions of doses, and distribute them. And administer them. In terms of therapeutic drugs, obviously there are things people are working on every hour of every day, and every advanced nation in the world. We have already made a little bit of progress there, and hopefully we will make a lot of progress. Again, how soon those things will actually be available, is unclear. Even with that, the virus is going to continue to circulate. So many people are susceptible. And thus we get a very effective vaccine. Unless we get a very effective vaccine. Now toknows enough right know how effective a vaccine would be. Influenza vaccines in roughly the last 20 years have ranged ineffectiveness of a low of 10 to a high of 62 . That is the most effective vaccine we ever had is 62 effective. Not onlyl worth does it lessen your chance of getting the disease, but it is very likely it makes an attack less severe if you do get it. Be moree for this virus effective than influenza . I think more people believe it would be, because the stars is more stable. Does not mutate nearly as fast as influenza. But those are still unknowns. John what one of the definitive books on the 1918 pandemic. He is joining us from his home in new orleans. Our phone lines are open. We will go to caroline joining us from cincinnati. Thank you. Iq mr. Berry for taking my call. Mr. Barry for taking my call. Understand, today i am 75. Time, thend at that flute was gravitated towards the toddlers to the young children. Today it is gravitating towards the elderly. Just wondering, why is that different . Thank you. John these are different viruses. Influenza normally kills the elderly and the very young. In 1918, it certainly killed the very young. It did not kill the elderly. Over 90 of the excess mortality was people over 65. Under sissy five. The peak age for death in 1918 was 28. It definitely did kill the young, thanks to for these numbers. I hope i quoted correctly. Five, thender age ints in 1918 the deaths 1918 we will all cause mortality for. Of 14 years for kids and that a true. So just imagine the impact on parents. All causes of death for over a 14 year. Of kids in that age group, then a period oft to six to 10 weeks. The psychological impact of what that had. Back to this virus, the virus is killing the elderly. There are some hypotheses. It is a different virus. Elderly,s targets the probably because their immune systems are weaker. Your immune system changes over time. People with weaker immune systems are more vulnerable, or core morbidity. Comorbidity. Which is making it harder for them to defeat the buyers. Whether it is diabetes, or something else. Host under the category. Other parallels, lessons learned, you wrote the following. Manyg the second wave, local governments collapse. They generally failed to keep the community together, they failed because they lost trust, they lost trust because they lied. Can you elaborate . John as i said at the beginning, we were at war. Most of the local Public Health officials. Not only was there dont found iheat nationally, no fauc nationally. Backed up by the political leaders in charge. Again, the war. The plan was to keep the war effort in fullbore, but it was counterproductive when people were being lied to, and there was a lethal threat. I think, ultimately society is based on trust. When trust starts to disintegrate, it becomes every person for him or herself. Every family for itself. Society itself began to fray. Cases, it almost began to break apart. There were reports not only in big cities, but in rural communities, very solid, very reliable reports that people were starving to death because some cases family members, were afraid to bring food. When an entire family was sick. Fortunately, i dont see anything like that right now. Get a sense of the Community Coming together. Certainly, i dont have quantitative data on that,. But certainly in new orleans, my neighbors, friends who have volunteered to go to the Grocery Store for me, to minimize my wrist. My risk. I have a neighbor who is a did not have an n95 mask. He had given his masks and gloves, donated him to a hospital. Volunteered to do medical procedures that he was capable of doing. I do sense Real Community spirit. The way you would hope things to be, i get that sense nationally. Wonthe not happen i say it never happened, of course there were heroes. There was much less of it. There was something we havent seen here, we have not seen society anywhere in this country begin to fall apart. To give you a sense of how cap how bad it got at its worst the dean of the university of Michigan Medical School before the war. He was a colonel during the war, head of kindred Communicable Diseases for the army. At the peak of pandemic, he wrote in his own hand up private note. If this disease continues at its present rate of acceleration for a few more weeks, civilization could easily disappear from the face of the earth. That is how bad it got. That happened to be right at the peak and things turned around right after that. What was the final death toll in 1918, here in the u. S. , and worldwide . About 675,000. S. , out of a population of less than 110 million. Worldwide, the u. S. Actually did pretty well. Worldwide, we dont really know. At 50f the estimate start million and go up to 100 million. If you were just too, that would be the equivalent to 220 million to 440 million today. That is why i say, fortunately we are not facing anything like that. With covid19. He is also a professor in the school of Public Health, and tropical medicine at tulane university. Kim from rockford, illinois. Thank you very much. We appreciate you cspan. You are a profound researcher, a historian. I just want to know, what is the difference . You mentioned various populations, different, specific populations. What is the difference in treatment from the government from those back in 1918, as it applies to the covid19 right now . To, letshat relate say first and foremost, the rockefellers, carnegie, Margaret Thatcher . Gates. Way up to bill can you correlate that all for me . Host Margaret Thatcher was already prime minister, do you want to respond to the other points . John im not exactly sure what the question was. Everybody was vulnerable to disease. Rockefeller actually founded what is now rockefeller university, was then called Rockefeller Institute for research, probably the leading Scientific Research institute in the world. Have a dozen people there want nobel prizes. That entire institution is dedicated to research on the pandemic, and they did some incredible science that stands up today. Just as right now, every Science Institution in the world is working on this. In terms of different populations, there were epidemiological studies that came up with what you would expect. People living in more densely populated areas, where there were more People Living in a home, had less Square Footage per person, per home. They suffered worse than other people did who had more space. Obviously, that connected to race. It connected to how much money you made. Those things were all related. Treatmentf the actual you got if you were sick in a there wasnt much anybody could do, anyway. A majority ofaken the best doctors, and the youngest doctors, the best trained doctors. In the country, not just the army but the navy as well. The dean of the Michigan Medical School was a colonel, the dean of the hopkins Nickel School was a colonel. Basically, every topflight physician who was under the age of 50 was in the military. Care was very little available in the civilian community, not much they could have done anyway. There were a lot of nurses who were in the military as well, shortage of nurses, chores of doctors. There were certainly hospitals that operated, again, there were certainly little they could do other than supportive care. People who ended up going to emergency hospitals which were outside, actually seem to do better. People who were inside in a hospital, because they had more space. Better ventilation. Things like that. Met me go back to your earlier point. If there was a level of miss trust among the communities and you were not getting support from president Woodrow Wilson, who was taking charge during this pandemic . Locally. Te a bit you know, we mentioned San Francisco earlier. A badancisco had experience. They were the fourth or fifth highest in mortality in the country. And yet, that community continued to function much better than most of the other communities that i studied any of the other , thereat i know about may have been some small community. Instead of saying this is nothing to worry about, this is ordinary influenza by another name, the mayor, there may have been some small community. , the leaders of the medical community, the business leaders, the union leaders, all jointly signed a statement which ran on a full page in the newspaper in huge type. Saveid wear a mask and your life. Those masks were not that effective, if they had any impact at all, it was relatively minimal, but that is a very different message than saying this is ordinary influenza by another name. San francisco, we were talking earlier about a Community Coming together and functioning, which i see outside me here in the world and i get the sense this is happening elsewhere in the country. That happened in San Francisco. You know, when schools were volunteered ass everything from telephone operators, which mattered. Communication. Also as ambulance drivers. You know, that is risking your life, being willing to risk your life to help others. In 1918, i am not saying that did not happen. Of course, it happened. But by and large, it was not that common. Contrast, i wrote at length about a city that did not function because of the lies that were being told by the Public Health commissioner and the political leadership. Philadelphia, they were issuing calls begging for volunteers to do anything, and finally, the head of the volunteer effort said people had the false i wish i could remember the exact quote because it is much more effective than what i am saying, but she was attacking the readers of the newspaper for not coming out and volunteering, that everybody was phony, that they had kidded themselves that they had the courage and spirit of giving and so forth, but she said, now, there are people starving to death, and still, no one comes. And that was because, in philadelphia, they lied. Belatedly, very belatedly, closed schools, banned Church Services and restaurants and so forth. When they finally did that, one of the newspapers went so far as to say this is not a Public Health measure. You have no cause for panic or alarm. They are saying this is not a Public Health measure. How stupid did they think their readers were . You know, by all they are doing is demonstrating how horrific everything really is and how no one can believe you know, by anything they ar. Jules joining to us from ashburn, virginia. Good evening. Welcome to the program. Caller good evening, and so much thank you so much for taking the call. It is a pleasure to speak with. R. John i have your book. What a fascinating read, to say the least. It scared the but jesus out of me bejeezus out of me. What role do you think Climate Change will play in future pandemics . Wonder with droughts and famine, is this thing going to be an amber in the future and is this thing going to explode . Horrifyingt somewhat. We wille will host get a response. Guest i think Climate Change will play a factor. There are literally millions of viruses out there in the animal kingdom. Could jump species to humans, and as humans have pressed into what used to be wild areas, they have been exposed to these pathogens. More and more. Also a factor is in sectors. Mosquitoborne disease. A has never really been factor, a problem in the united states. It could be. A lot of people would expect it to become a factor, i would say, but the scarier part are other virusesa lot of people would exe amazon or in the middle of africa. Species. D jump hiv being, you know, a prime example. Influenza has been around for centuries and may be millennia. It has jump species. That is not really climate related, but obviously, that has occurred in the past and it could possibly occur in the future. I think if you talked to any pathogens,merging any of them, they will tell you they expect Climate Change to be a factor, and not a good one. The book did you write and how long did it take to complete . Years andtook seven it is a long story why i wrote it but i did not intend to write it. I started out writing a book about world war i culminating in the events of 1919. To shorten the story, i never did write that book. Yearsd up spending seven on the pandemic, which, when i started looking at it, i thought it would take me, worst case, 2. 5 years, and probably one or two years. But it took seven, fulltime, doing nothing else. Host title, the great influenza the story of the deadliest pandemic in history. Good evening. You are on the air. Countrymr. Barry, this has shut down its economy, and didyou compare, if they shut down the economy in 1918, with what we have done today . Guest they did not have the formal closing orders that we had today on the entire economy. There was quite a bit of economy quite a bit of the economy continues to function today. Had enor earlier, you mous absenteeism. I was quoting mortality rates among industrial workers. If you see your friend, who is 24 years old, dropdead possibly in two or three days, in some cases, 24 hours after the first symptom, most people took longer to die, then you are not real keen on going in to work, particularly when everybody is lying to you and telling you this is nothing to worry about. The areas where we have good numbers are the shipbuilding industry because that was the war industry. In the shipyards, where they save time, not get into the details absenteeism, 60 . Those people were told they were important for the war, soldiers right on the front nine. Patriotism. They had to come to work. They also had medical care at work, which was not available really any place else in the civilian community, but even with that, you had 60 absenteeism. In other factories, it reached considerably higher numbers, which certainly disrupted the economy, the national economy. Also, as i said earlier, the it was almoste never longer than 10 weeks. And then the virus seemed to disappear. Most of the time, it would come back, but that would be later. Then, you could get back to normal. Economy,of the considerably less stress than what we are experiencing right now. Fairlyas a very intense but short recession probably tied to the pandemic, but we do not know that for certain. The other factors, you know, because of i think we are safe to say it was tied to the pandemic. Rejoinedllion soldiers the war force, there was another recession. There was a recent study that found that cities that stayed close to longest or longer actually did better economically in the months and year or so after the disease. Maybe they had fewer deaths. Frankly, there was not an deathus difference in that was statistically significant. Stayedrate, the cities close to longest and went through the most pain economically in the short term from staying closed, recovered much better after the fact. Host i know we studied in history, it was called the spanish flu, but it did not originate in spain, did it . Guest it might have been the united states, although that is what i argued for in the book, but the book came out in 2004. There has been Research Since then. I think it is more likely china. But there are plenty of good virologists who think it started in france had vietnam is another possibility and so is new york city. Host our last call is from north carolina. I am sorry. Your final point . Guest i was going to answer your question, which i did not get too, that it is called the spanish flu because spain was not at war and the european outright answered them. Spring,hit spain in the the king of spain also got sick. Got the name spanish flu. Minutee have about one left. Lucas, you are on the air with john barry. Quick question. Caller good evening. I am a nurse in a small medical group in north carolina. I heard that the death rate for the 1918 influenza pandemic was around 50 million. Do you ever think that this recent pandemic will ever reach those numbers . I hope everyone has a great night. Guest thank god, no. I dont think that this, even without adjusting for population, i do not think we will have numbers like that. Host you are also university. What will the fall look like for you, for the students . Guest for me, i do not teach. Write. Research and i hope they come back. I have not actually heard definitive plans for you it i think they probably will come back. I do not know. I know they were just in the university of louisiana system, which in louisiana is separate from lsu. Different universities. They plan to come back on campus in person. Joining us from his home in new orleans. His book on the 1918 great pandemic, the great influenza. Thank you very much for being itico. Com. Cspan and thank you thank you very much for joining you so much for having me. Host joining us from his home in maryland is democratic senator ben cardin. Thank you for joining us here on cspan tonight. Guest it is good to be with you. Thank you. Host from my home to your home. Lets talk about this hearing tomorrow that will be potentially the new norm in t