You can go and get a microphons are your questions can be heard. Please join me in welcoming john barry. [applause] thank you very much. Its kind of funny to be sitting here in a Community Room of the Louisiana Legislature talking about this subject largely because although you might not think it, politics is very involved in the story of the pandemic i cant think of a better place to talk about politics in the legislature. When you read about the 1918 pandemic in the newspapers these days you say the death toll was over 20 million. That estimate comes from the first of the disease thats fairly accurate for the western world but wildly inaccurate for the rest of the world. In a Nobel Prize Winner that spent most of his life studying influenza concluded that the death toll was a minimum of 50 Million People and possibly as many as 100 million. All this was in a world with the population 28 the size of today. So, if you adjust the population, the death toll on 1918 was between 175 to 350 Million People in todays world. But even without adjusting for population, the death toll back then influenza killed more people than 24 weeks then aids killed in 24 years. And sometimes sometimes could be gruesome. He would be familiar if youve got it today. It wasnt a tiny minority. If its something entirely different. The symptoms could include both from the cares and the eyes. Its known as a breakthrough in a fever or cholera. Its not only a lethal virus but violent virus. And of course one of the questions that i always get is could it happen again. The National Academy of science into another pandemic is not only inevitable but overdue. And this disease put a tremendous strain on this disease put a tremendous strain on society. So much so that the dean of the university of michigan medical school, a very sober scientists said in the middle of the pandemic if this disease continues its present course for a few more weeks, civilization could disappear from the face of the earth. The story itself is a war story. It is not so much man against nature as it is nature against man. There are two interrelated contests in this story. One involved the largest society. The other involves scientists. The battlefield is important to understand the battlefield in this situation. We were already at war, in the latter days of world war i, most of the world was also at war. The whole nation, the whole world was a tinderbox. For example in the United States there was a great influx of people into the cities and no housing for them. As a result, in philadelphia where a was a single shipyard that employed 50,000 people, dozens of places, 10,000 workers, no housing, not only do people work in ships, not only did they share beds but they slept in shifts. People would be in one bed, go to work, someone else would come back from work and sleep in the same bed. It was a Public Health tinderbox waiting to happen. Even more important than that what happened in the epidemic were political context. We were already at war. I want to review a quote from a law passed by the Wilson Administration called they had an espionage act and a sedition act made it punishable by 20 years in jail to, quote, other, print, write or publish any disloyal, profane or abusive language about the government of the United States. They could send you to prison for 20 years for criticizing the United States government even if what you said was the truth. They sent a congressman to jail, or congressman, more than ten years was convicted under that law. In addition, the press certainly didnt criticize the government, they very much fell in line in terms of patriotism. There wasnt any outright censorship but it was and understood censorship. The Cleveland Plain Dealer stated what the nation demands is treason whether thinly veiled are quite unmasked be stamped out. The Providence Journal carried a banner warning, this ran above the title of the newspaper every single day, every german or austrian in the United States unless known by years of association should be treated as a spy. The Illinois Bar Association declared lawyers draft sister was unpatriotic and unprofessional. And of course the german language in many places, sauerkraut was renamed liberty cabbage and so forth and this kind of thing ultimately became very important in what happened later in the course of the disease. That is what was going on not to mention the fact that 40 of doctors and nurses were in the military. The civilian Healthcare System disappeared. When i started out i said this was also a contest between science, not just the largest society but scientists and the virus. If you think that the scientists in 1918 were backwards you need to rethink that. The book really does focus on a group of half a dozen or so extraordinary men and one woman who confronted this disease and i give you a sense how good these people were. 1966 won the nobel prize for work that he did in 1911. Another of them, the first head of the Rockefeller Institute, very interesting guy, juvenile delinquent, his father, you know the program where they take kids and walk them through jail, his father did this to him when he was a teenager, a farmer refused to take him on as an apprentice because he was such a troublemaker big he got a job as a pharmacist, the pharmacist had a microscope, told this guy dont go near the microscope. That was not the right way to handle him. He went to the microscope, found a world there that enthralled him and he became the first head of what is now rockefeller university, brilliant scientist. How good was he . Today according to the new england journal of medicine bacterial meningitis at massachusetts general hospital, one of the best hospitals in the world has a 25 mortality rate. In 1910, he had a treatment for bacterial meningitis that had a mortality rate of 18 better than today at mass. General hospital. Another character, i dedicate the book to him, not only proved polio was a viral disease in 1907 but in 1908 devised a vaccine that was 100 effective protecting monkeys from polio in 19081909. Took almost 50 years to move that work to man. Another major character, william wells, the most important person in history of american science, created the entire medical infrastructure of the United States. One person said he had the power to change a mans life with the flick of a wrist. One other guy you may have heard about, the army Surgeon General, all these people were in the military, every one of them. The Rockefeller Institute for medical research was incorporated into the military. William gorgas, the Surgeon General of the army, cut the death rate from yellow fever to 0 in havana, the panama the panama canal to be built. He created this infrastructure in the army. He had a nightmare and the nightmare was that during this war, with 4 million soldiers close quarters in army camps, and epidemic was going to break out and even before the influenza pandemic, he created oddly enough he expected pneumonia to be the killer. He created a pneumonia board of great scientists to try to prevent any outbreak of the disease. Every war before world war i in american history, more soldiers died of disease than died in battle. Even in the spanishamerican war, six american soldiers died of disease for every one who died in battle. The border war the british army lost 10 soldiers, 15 years before world war i, the british army lost 15 soldiers to disease, 10 or 15, to every one who died in battle. Very, very significant and very important. Gorgas tried to plan for this and prevent this by incorporating the advice of extraordinary scientists. That is the situation on one side, the largest society, wilson said, a spirit of ruthless brutality had to infuse every aspect of american life. In the Scientific Community you had these great scientists organized and trying to prepare for a disease they expected to arrive. Now you have the enemy. The enemy of course is the virus. All influenza viruses are bird viruses. Every one of them. Periodically through history this happens three to five times in a century, periodically and influenza virus will jump species from birds to people. You can do this because it is one of the fastest mutating of any viruses in existence. Biologists refer to it and a few other viruses as a swarm. There is no single, even of a viral some cycle there is no single virus, just like a swarm of hornets they are all moving around an average kind of virus. When and influenza virus affects, that single selling cell explodes and between 100,000, and 1 million new virus particles escape from that cell and every one of them is different. Most of them are so different they can be defective. Only one of those viruses, still between 1000, and 10,000 viruses from one cell are able to infect a new cell but that mutation rate allows it to jump species. In 1918, was not the only lethal pandemic in history but they are not all lethal. We went through pandemics in 1957. In 1968, while they killed considerably more people, incidentally the normal death for influenza according to the cdc, is 36,000 a year by this point. 5768, dublin 68 and in 57 about three or four times the normal numbers died of influenza but compared to 1918, just like a severe epidemic season. The story really begins when the virus jumps from birds to people. Nobody knows for certain where that happens. Most pandemics in asia but there was overlooked epidemiological evidence that i managed to trip over that strongly suggests that this virus jumped species in kansas. And it moved from rural kansas which is in the Far Southwest corner of the state to what is now fort riley. Fort riley had 56,000 troops closely packed, they were being trained to kill and as it turned out would be far more effective at killing than anyone could imagine. As i say this was a war waged by nature against man. It hit with full force. Let me read to you, it took six months for the virus to jump species. It wasnt immediately efficient at infecting man. It had to adopt to a new environment. It took a while before it really became at home in humans, really became efficient at invading humans but 6 months after it jumped it became very lethal and all over the world simultaneously it exploded in this lethal form. One of the first places hit by this severe form, the second wave, during the spring, there were outbreaks, just outside our was, it is close now, just outside boston and i will read a letter from a physician to another physician describing what was going on. These men start with what appears to be an ordinary attack of influenza, brought to the hospital, they rapidly develop the most vicious type of pneumonia that has ever been seen. Two hours after admission they have mahogany spots over the cheekbones was a few hours later you see the cyanosis, when you start turning blue because of lack of oxygen. You see it extending from their ears all over the face until it is hard to distinguish the colored men from the white. Is only a matter that is how dark people were turning, rumors of black death they were starting so dark you couldnt establish black from white. It is only a matter of a few hours until that comes. It is horrible. One can stand to see one, two or 20 men die but to see these portables dropping like flies we have been averaging 100 deaths per day. Pneumonia means and about all cases death. We have lost an outrageous number of nurses and doctors. It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce. Dirksen Senate Office building 0 site they had in france after a battle. God be with you, we will meet again. As this virus spread across the world and throughout the United States, it put the extreme pressure on the political system and in fact a very good case study that is quite relevant, too relevant to fears about bioterrorism not to mention the possibility of another influenza outbreak. And it demonstrated the political system then was not prepared to handle it. The politicians have the wrong priorities. They were so focused on the war. The irony, the unfortunate irony is that this hit when we were literally only four or five weeks away from the end of the war. Virtually every enemy country we were fighting except germany itself had already stopped. Germany had already started sent out feelers for peace, but wilson and the entire administration were so focused they would not do anything for Public Health that might in any way jeopardize the 100 war effort, the ruthless brutality wanted to accuse the american spirit of. As a result not only the federal officials but Public Health officials, mayors and governors all over the United States essentially lied. First they told people this was ordinary influenza. Then they told people fear kills more people than the disease. In philadelphia, where they were planning a huge liberty loan rally hundreds of thousands of people were in the streets, this was early in the outbreak, the general public wasnt aware that there was a problem. One doctor was warning Public Health commissioner this rally would create a readymade inflammable mass. He was trying to get every newspaper to print warnings, they all refused. The Public Health commissioner refused to pay any attention. Many other physicians were saying the same thing. They held this rally, hundreds of thousands of people. 72 hours later in philadelphia influenza absolutely exploded to the point that not only do they run out of coffins which happened in almost every city in the United States but they used steam shovels to dig mass graves where they rolled bodies wrapped in sheets in. Priests literally drove horsedrawn carriages down the streets calling upon people to bring out their dead. Very reminiscent of the black death. The same thing was happening all over the country and very rapidly society began to disintegrate and the reason was that people soon were getting this great disconnect. They could see their spouse was dying in 24 hours sometimes and the body was lying there. You cant get the body out, nobody can take the body out. Down the street someone else is dying in a few hours or a few days. There are emergency hospitals being formed, being created all over the place and at the same time the Public Health authority and the mayor, the only thing you read in the newspaper is fear kills more than the disease, dont worry, you can keep yourself safe. This ridiculous reassurance they were getting which so conflicted with what they were seeing about them destroyed their trust in all authorities and ultimately society is built on trust and without it, it began to disintegrate. Fear was everywhere. I will give you one example how much fear. For some reason in phoenix, im not sure why, there was a rumor spread that dogs carried influenza. People started killing their pets. Those of you who have pets understand the emotional attachment and if they had too much love for their pet to kill the dog themselves they were handing them over to the police who killed the dogs and local newspapers said phoenix will soon be dog lists. Let me read you a couple comments from people who lived through this. In north carolina, one man said we were almost afraid to breathe. The theaters were closed, everything was closed, schools were closed, every place was closed. You didnt get into any crowd. You felt you were walking on eggshells, afraid to go out. Fear was so great people were afraid to leave their homes. They were afraid to talk to one another. It was almost like dont breathe in my face, dont look at me. You never knew from day today who was going to be next on the death list. His father had a store, 408 sales girls died. Farmers stopped farming, merchants stopped selling merchandise and the country shutdown holding their breath. Another man from washington dc, kept people apart, took away all your community life. You had no community life, no school life, no church life. Churches were also closed. You had nothing. People were afraid to kiss one another, afraid to eat with one another, afraid to have anything that made contact because that is how you got the flu. In prescott, arizona, it was illegal to shake hands. In kentucky, one red cross chapter chairman begging for help, hundreds of cases in the mountains that they couldnt reach, people were starving to death. They were too sick to prepare food for themselves and they were starving. There was so much fear that nobody would help them. Nobody would go near them. In kentucky, in a part of the world you had such close family kinship, hatfield and mccoys and things like this, this area of kentucky where family mattered so much one red cross worker found a woman and family, children, husband and wife so sick they couldnt care for themselves, red cross worker tried to get the womans sister to help. She refused. He wouldnt come to the house. They got her to come to the house, she knocked on the window and walked back 50 feet and talked to the red cross worker. That is how much fear there was. In philadelphia, which was a city of almost 2 Million People there was one physician running an emergency hospital, only a medical student, he lived 12 miles from where this hospital was in the middle of the city. The city was so he started counting the cars he passed on the street on his way home. In a city of 2 Million People, over a distance of 12 miles, one night he noted that he did not pass a single other car. He said the life of the city was almost stopped. In the illustrations in the book, there is one from downtown manhattan, there are a couple sanitation workers, all these cars parked on street. Middle manhattan theres not a single car on the street, not a single pedestrian on the sidewalk. Again society was on the verge of disintegrating. I said when i started this was largely about a group of scientists who confronted the disease, the first collusion between modern science and epidemic disease. The scientists of course had quite a problem. One of the things the book gets into that im very interested in is how you do science, how you approach a problem. Really, in the book i get into the history of medicine. One of the things that seems crazy to us, the therapy that lasted 2300 years but was makes no sense at all is bleeding patients to get them well. It seems so stupid. The reality is science had been made from the days of hippocrates or two things, observation and logic. Based on both observation and logical conclusions you draw from observation, bleeding made great sense. I dont have time to get into it here but what changed in science in the nineteenth century, much later than at other times was the idea you cant observe and reason, you have to test, you have to create a hypothesis and probe nature and test it. They had started to do this by then. I talk about how amazingly successful some of these people were. And epidemic moving over weeks killing hundreds of thousands of people in the United States alone is not the best place to do this. Even so, there is a hard kernel, while society allows them, is toppling. This hard kernel of a dozen or a little bit more than that scientists, great men really who i am focusing on, who were making almost unbelievable progress against this disease. Among other things they actually developed they didnt know this was a virus, they didnt even know what a virus was at this point. One thing that came out was the definition of a virus but not for a couple years, one of the characters i write about, they were not sure of a virus, just really small bacteria as opposed to a different organism. They did develop bacterial vaccines and if you ever get a flu shot this year you get the pneumonia vaccine, that is a direct descendent of a vaccine against bacterial pneumonia from back then. A Straight Line and not that much significantly improved. I want to leave time for questions. I want to jump ahead. Initially, of course, scientists were overwhelmed. The disease moved too rapidly. In the wake of the disease, victor wong saying civilization could very well disappear from the face of the earth and in the wake of the disease he said never again allow me to say that science is on the verge of conquering disease. Doctors now knew more about this than 14thcentury knew about the black death. He was too pessimistic about the outcome. I dont know if you ever heard the arrow in the air theory of basic science but what it is, you shoot an arrow, wherever it lands that is where you draw the target. Probably my favorite character in the book, took me 7 years to write full time and when i started i actually believed it would be a fairly quick book at least for me. I was almost certain i could do it in two years, certainly to a half. I was mistaken. One of my favorite characters in the book who i identified with was oswald avery, one of the greatest medical scientists of the Twentieth Century and arguably even the greatest. Avery started studying the pneumococcus, nobody was nobody knew what was causing it but that was an obvious place to begin. He stuck with it after the pandemic ended. He came to say he wasnt making much progress. He was presented with a difficult question. He said failure is my daily bread. I thrive on it. Year after year of solving this problem, science takes different angels at it, chipping away at a rock or like water on a rock, looking at ways to get into this thing. He didnt really thrive on this. Many times he wanted to throw experiments out the window. At one point he had a nervous breakdown. But 25 years after the pandemic he came up with what one Nobel Prize Winner called the greatest biological experiment of the Twentieth Century. As a direct result of the Influenza Research it was a very who discovered the dna that carries the genetic code by studying the pneumococcus. Jim watson, who credit for this, watson another Nobel Prize Winner says avery created the field of molecular biology. That is probably a good point to end the story of 1918. Under current circumstances some obvious things to say, one of the lessons for it, one is the influenza virus comes from birds, they that virus will jump species. Another pandemic is inevitable. That is why i said in the introduction since the book came out, i have become an unofficial advisor to people in the World Health Organization and federal government, last week i was at a meeting with several vaccine manufacturers if this is the case study you want to teach us you have to take influenza very seriously, we have to prepare for another pandemic. It will not be a tremendously legal pandemic like 1918, could be much milder but even at best, cdc has a study out that predictive we do have a vaccine there would still be probably 150,000 deaths in the United States. If we do not have a vaccine it is off the scale. The real determinant is how lethal the virus is. Right now there is a very lethal of virus in asia. A jump species, it could make 1918 are not trying to scare people but it is a frightening situation we need to prepare for. One of the other lessons aside from taking influenza seriously as governments need to tell the truth on Public Health issues. As china demonstrated during the sars outbreak it did not tell the truth. If it had gotten a head start of several months there would be millions if not tens of millions of deaths right now from that. Similarly when the asian bird flu erupted earlier this year thailand and a couple other countries didnt fully tell the truth either and the reason in chinas case, political, they didnt they believed in keeping more row up which was the same reason the United States lied during 1918. In the case of the Southeast Asian countries it was economic. Poultry was a huge part of their economy. Damaging that, talking about the truth, the bird flu would hurt their economy, we need to find a way to compensate those countries so they will not be penalized economically for telling the truth and protecting the worlds population. Since we are short for time, 5 minutes, i want to leave more time, there is a microphone over there. What happened to the 1918 virus . Did die out . Didnt mutate to a nonlethal form . What happened . Number one influenza viruses are not normally that lethal. There is a statistical concept called aversion to the means. When you start as an outlier away from average, chances are a mutation is going to bring you back toward the average. The virus mutated back toward the average influenza virus. At least as important and maybe more important, the reason it was so lethal initially was no one had any immunity because it was a new virus, they had never seen it before and once it made the cycle of the world a few times peoples immune systems could react to it. The one thing i didnt say was the largest number of groups of people who died in 1918 were young adults, 2035 years old. The reason was ironically their immune systems were stronger than old people who normally die from influenza. They were being killed by their immune systems. There in the insistence, instead of normally and immune system uses very specific weapons against an invader but without any specific weapons they unleashed every tocsin, some very lethal ones, the battlefield was the lungs and the lungs were being destroyed by the immune system trying to attack the virus. Another question . One of the question. The only thing analogous to this in a smaller geographical area is the yellow fever epidemic that hit new orleans. Because of new orleans at history of that could we have a better Public Health system here to combat that . Are we better prepared than anywhere else . It depends. By 1905 the last yellow fever epidemic we knew how to fight yellow fever. We are fairly effective at it. Earlier when they didnt have the faintest idea, i dont think the same lies were being told though there were some of them. People in new orleans were trying to convince the rest of the country that it was not an unhealthy place which was ally. [laughter] some of the same things occurred that yellow fever was seen in mosquitoes and so forth and it was not every year. Over there. Microphone. I urge you to choose this particular subject. It turns out it is a very timely subject. I planned that we 7 years ago. I almost became a scientist. My best friends tend to be scientists. I was always interested in this plus i was very interested in world war i in 1919 and eventually i expected to write a book about the home front, in 1990 the most interesting era in american history, one of the three most interesting, i cant get into it now. This allowed me to do research in the same time. Go but i thought this would be a quick book but instead, we 7 years. On an annual basis, i dont know the time frame, you know better than i, mutating viruses from yeartoyear, the vaccine we might make today, i dont know how far in advance they make vaccines but how effective will they be next fall . The virus, the redesign the vaccine every year. The virus mutates so rapidly, one year it isnt going to work very well the next year. The virus drifts away from where it was and they try to anticipate where it is drifting to before they make the vaccine each year. And they are usually pretty good at. The vaccine works pretty well. It can be and 85 executive rate. Even when they dont have the target like last year it is pretty effective in protecting you. A pandemic is a different problem, an entirely new virus, you have to isolate it, make the vaccine, test it for safety, produce hundreds of millions if not billions of doses, distribute and administer them all in a period of months. As i said earlier last week i was at a conference which included vaccines, companies from around the world, the World Health Organization, hhs, some other people, and the ceo of a major Vaccine Company predicted that given todays circumstances and capabilities, if a new pandemic virus appeared, six months after they isolated they will have it best 100 million doses worldwide. Another problem that everyone at the conference was unanimous that any country the vaccine was made in was going to nationalize it at not allow exports, only use it for their own people first. There were other people who were more optimistic about the Production Capacity but it is a real problem. We need to address vaccine production infrastructure in the United States particularly as this year pointed out just for our regular vaccines much less if we face a pandemic and i think it is a National Security issue. People need to take influenza seriously. Last year during the sars outbreak, you never read a word about this because sars dominated the news but in holland there was another bird virus that jumped, threatening to jump to people and infected 89 people, only killed a single person. 30 million poultry, they slaughtered 100 million in asia to contain a virus. One death out of 89 might night sound absolutely horrific but influenza infects so many people, if that virus had the United States it would cause a minimum depending on how many people were attacked, half 1 Million Deaths in a single influenza season. It could exceed 1 Million Deaths, kill one out of 89 people. You have to get your priorities straight. No one knows an exact figure what we spend on west nile virus. West nile virus in the last five years in total has killed 650 americans total in five years. Although theres no exact figure it is very likely, over 300 million a year. On influenza we spend 250 275 million a year to kill 36,000 a year. 180,000 in five years. West nile gets the news headlines. Influenza doesnt. If i have time, you tell me. Do i have time for one more question . Okay. America outsourced very few were made in the United States. Some are and some arent. Antiviral drugs could be very effective that we need to stockpile them. Unfortunately it is being given over to somebody else. [applause] thank you. [inaudible conversations] it is easy to follow the federal response to the coronavirus outbreak, cspan. Org coronavirus. Track the spread with interactive maps and charts. Watch briefings and hearings with Public Health specialists anytime, unfiltered, cspan. Org coronavirus. Weeknights this week we are featuring booktv programs showcasing what is available at cspan2. Watch discussions on healthcare beginning with our pipes who made the argument against medicare for all, and Arthur Timothy diane ream on her book when my time comes. Booktv beginning at 8 00 pm eastern on cspan2. Tuesday on cspan, charlie cook talks about the coronavirus topic and impact on the 2020 president ial race. On cspan2 the senate is back at 10 00 am to consider an economic aid package passed by the house that provides free testing, paid sick leave and other Public Resources in response to the coronavirus. The winners are in for the student cam video documentary competition. What issue do you most want the president ial candidates to address in the 2020 campaign . We received 2500 entries from 44 states with 5000 students participating with winners telling us the most important issues are climate change, gun violence, college affordability, the opioid crisis, Mental Health and immigration. Time to announce our first prize winners. Our first Prize Middle School winners from eastern middle school. It is titled blackout. Doesnt matter which party you associate with or who you end up voting. We have to exercise Critical Thinking and keep an eye on sources we choose to follow otherwise the United States will be the next social media victim. It goes to 10thgrader Thomas Mckenna from mckenna homeschooling love it still, virginia where cspan is provided by comcast, his winning documentary is titled overreach from the oval office. A buddy wants action but nobody wants a dictator. By raining an effective power we can ensure control wielded in washington remains balance among the two balance of government. I asked the 2020 campaign how will you put a halt to the runaway train of executive overreach. Reporter the eleventh grader leviathan lee and mason chow from oklahoma where cspan is available, the documentary is titled 200,000, about the opioid crisis. Johnson johnson through misleading marketing over prescribes opioids. As a result became addicted creating this nuisance, this opioid epidemic. It goes to 10thgrader pia h howe and katherine padilla. It is located in long beach, california where cspan is available through spectrum. They winning document recital vision 2020, restoring the integrity of american democracy. We want you to get money from certain sources. What you want to be is to be free enough to make decisions based on what is in the best interest of your district and the nation. Reporter time to announce our grand prize winners. Eleventh graders jason lynn, omar qureshi and sarah yang from san jose, california worst cspan is provided by comcast. They won the top right for their documentary, Technology Damaging effect on democracy in 2020 about technology and data privacy. In 2013, cambridge analytical collected data to influence the 2016 election from 80 million facebook users, only 270,000 were affected. This time we are not faced with music piracy but personal information piracy. Congratulations to our grand prize winners. None of us have taken formal Video Production classes. We got together we are partners school right now in this is one of the top schools in the country. Everyone is doing these project and thinking about working for Tech Companies but we were thinking there are evident issues on data breaches and that kind of stuff. We saw it bringing a voice to the concerns of many, data breaches and privacy breaches would be important. The influence on values for tech change. Reporter our student cam video document the competition has awarded more than 1 million since 2004. The top 21 winning entries will air on cspan starting april 1st. You can watch all