Photographs show the reach of the 1918 influenza epidemic to all parts of the nation. These records show us the human and societal cost of the pandemic. They allow us not only to look back at that time but also to look ahead as the information they contain may help guide present day inquiries and increase our understanding of the disease. Dr. Jeremy brown is an emergency physician and was the Research Director in the department of emergency medicine at the George Washington university here in d. C. Hes now director of the office of Emergency Care research at National Institutes of health. Dr. Brown is the author of more than 30 peerreviewed articles and three books including the oxford american hand book of emergency medicine and the handbook on cardiology emergencies. Hes recently received an nih directors award for his efforts supporting research in nonaddicting methods of pain relief. Jacob apple writing in the new york journal of books says brown is clearly a man who knows the flu. Not just the physiology and virus or the epidemiology of the illness, but countless fascinating and fun facts about the scourge. Also written in the wall street journal highlights browns emergency room experience. In influenza he builds effectively on his clinical and scientific career making the virus itself central to its story. He weaves history and contemporary virology and clinical practice together. Although his story is a somber one, his account is punctuated by some humor and much good advice, like the best time to visit an emergency room, for instance. Ladies and gentlemen, please welcome dr. Jeremy brown. [applause] thank you very much for those kind words. It is not every day that you get introduced by the archivist of the United States. Were to talk about influenza and the plague that struck us 100 years ago resonates all the way through till today. As you mentioned, more people were killed in the influenza virus than in the wars. 50 to 100 Million People worldwide here in the United States, 675,000 deaths, civilian deaths and of the 116,000 combat casualties, u. S. Combat casualties, killed in world war i, over half actually died from disease, and the majority of that was influenza. It is a sobering thought to think if you take those statistics and multiply them out by the Current Population of the United States, those 675,000 deaths would turn out to be about 3 Million Deaths in todays numbers. So put that into perspective and think what that would be like to live through such a thing. Another way of thinking about it was to put the cause of this, and were going to come back to this, but back in 1918, there was no known cause. Viruses had actually not been discovered yet. So people were dropping from this disease, called influenza, but nobody really knew what it was from, and were going to return to some of the thoughts that were behind this. I think about that and i think about the 1980 outbreak of hiv which was incredibly frightening and yet we knew that it had to be a virus. It took us three years to identify it, but at least we knew we suspected that we had a culprit right away. Back in 1918, think literally they literally had no idea. Were sadly living through an epidemic of a very different kind today, it is the Opioid Epidemic which has claimed so many deaths in this country. The news over the last couple of years was actually that the death rate is so high that its dropped the average Life Expectancy in the u. S. You may have heard that seen that statistic, that if you look at the average Life Expectancy because of the large numbers of deaths of younger people, the average Life Expectancy has dropped. Thats shocking. How much has it dropped by . Well, if you look at the data, its dropped by 1 10 of a year. Thats a terrible statistic but it is 1 10 of the year. The 1918 great flu epidemic caused such a large loss of life that it dropped the average Life Expectancy in the u. S. By 12 years. 12 years, 120 times greater than what we have seen with the current opioid crisis. So again, putting it into some kind of perspective, as to what this thing really was. Now since were at the archives, i thought it would be fun to actually look at some archival material that actually affects shows what happens here in the nations great capital. So these this and the following few slides are all from the Washington Post, and i think tell a very brief story of a very complicated event. This is the Washington Post from saturday, september 14, 1918. It is not the front page. And it tells us that the spanish influenza was spreading across the u. S. It wasnt really reported yet in the papers in large numbers, in washington, d. C. , but it has bedun to spread across the u. S. Flow the now, the following day the Washington Post reported that 90 people had died of influenza in boston and that it seemed to have been sweeping from east to west. It wasnt actually. It actually probably started somewhere in the midwest. But the malady was already sort of ramping up. The next day they reported that 90 people in boston had died. These were deaths amongst soldiers and sailors. The plague built momentum, more and more people die. By october 2, on the front page of the Washington Post, we were told that the work hours had changed, that the federal day has been staggered to check the influenza spread and the people are to take shifts. Now, washington, d. C. Was not the only city to do this by any means. In fact, it happened in most of the cities that were affected. The idea was that if we could stop people from mingling, although we didnt know it was a virus that was causing this, we did understand somehow that keeping away from people was probably a good idea, so theaters were closed down in some places. Restaurants either closed or staggered their hours. Stores had staggered hours, in an attempt to keep people spaced away from each other. So the working hours of the federal government changed around the beginning of october. I talk about this reporting in the book. It is a particularly sobering one, comes a couple weeks after the announcement about closures. By october 13, 1918, the Washington Post reported, in this headline, the coffin trust, that the price of coffins had skyrocketed, and this was an example of people taking advantage of a terrible situation. In fact, they write the coffin trust is holding the people of this city, of washington, holding the people of this city by the throat and extorting from them outrageous prices for coffins and disposal of the dead. And in fact, the Washington Post here goes on to suggest that the department of justice should step in and instantly put a stop to the high prices of coffins. It cost more to bury your dead because the coffin makers figured they could make a buck. By mid october, here in washington, more people have died in a short amount of time, and it was suggested that [inaudible] was now in sight. There were hopes that we were nearing the end of it. Throughout the epidemic, both here and nationally, people of course had various remedies, and this is an example of the remedy that actually plagued throughout the fall and winter of 1918. Were going to come back and talk about this. I want you to remember these words. This is a remedy. It contains a laxative well come back to that thought to be very very helpful in cases of influenza and a pill a medicine that until fairly recently was the goto medicine for malaria. Its now been its now been superseded by others, but it was thought to be helpful in influenza. So people were making this. I find it interesting that if you look at the beginning, it says the following, spanish influenza is an exaggerate form of influenza. The tablets should be taken in larger doses than prescribed in ordinary. It is a really big epidemic so you better take a lot of this medicine. We will come back and talk about these particular remedies. These and several others were advertised both to treat the both to treat the disease and also of course to prevent it. So again, another marketing opportunity for our businesses. By december 8, 1918, the Washington Post had thought that we were coming to an end, and it put this little snippet that said the spanish influenza is more deadly than war, and that is indeed the case. We know that. But what struck me here is the placing of this piece of journalism. Its the back page, page 20, tucked in next to an ad for dining room chairs. The epidemic was more deadly than the war. Why was this not front page news . What had happened . Theres some various suggestions there. Some believe that there was some kind of agreement not censorship, but an agreement between the newspapers and the government to play this thing down, but if youre going to put a statistic like that, that the influenza cost more than world war i in terms of lives putting it on page 20 is not going to get the attention it deserves. It is a little bit of a mystery. Im sure we have some very smart archivists who can perhaps shed some more light on why this and other reports were sort of tucked in to back of papers. Finally we hit a record. Earlier reported that we were nearing the crest here in washington, d. C. , but unfortunately, no, more deaths than any time since the record of last october occurred, 16 deaths from flu in a single day in the city of washington. Again, this was also tucked away, near the real estate and legal record recording. Again, it was reported. It wasnt hidden, but youd have to sort of look for this to really understand what was going on. The final slide i want to share with you from reporting from the Washington Post, on exactly this day, march 5, 1919, exactly a century ago, exactly 100 years ago to date, this was a small report that was in the Washington Post that cited two washington boys who volunteered to go up to boston and to take part in some experiments that were trying to understand the cause and the methods of transmission. During the recent influenza epidemic, we read men voluntarily submitted to experiments for doctors a typo there naval doctors in terming the cause and method of transmission of the disease and preventive i guess thats meant to be preventive measures. Thats another remarkable side of this story that people would volunteer to be involved research on this very deadly epidemic that was not understood and unfortunately there was no cure other than those tablets which i dont think people really looked forward to cure them. So i think an example of every day heroism, of people putting their own lives to some degree on the line, in order to try and understand what was actually going on, what was this terrible disease, so these are just a few a few examples from the Washington Post that tell us a little bit about what happened here in washington, d. C. Im going to switch im going to switch here to a second slide show, and this one will this one will run itself. the second focus is going to be the understanding of the virus has changed over the last center. Cost influenza years ago but we know about that same time yesterday . I think we can all agree absolutely remarkable evolution whats going on. Finally, how we can prevent ourselves from catching the flu. Looking at vaccines, vaccines we are today and will find again we still have a lot of work to do. Lets start with the treatments. The treatment were not terribly effective they included mercury tree bark, inhaling factory gases, ups, could actually happen. People reported south of england they took their families and children to munitions factories toxic fumes thought to somehow reduce the likelihood of getting influenza. Activist turned out to be as crazy as it sounds because many of these gas works contain chlorine used during the work. We know its antiseptic, it kills everything including people. Very likely, work that was done factory works in these places had influenza at slightly lower rates probably because yes, they were inhaling bits of cory in the atmosphere was bathed in a public reduced the amount of free virus floating around. It wasnt completely crazy thing to cure children to inhale factory gases. Theres an upside of treatment back then, whiskey was extreme popular and somewhat champagne. They were prescribed by senior physicians so not everything was difficult as we said must used to treat everything. Emma was not to be cleaning anything out. One of the most remarkable things is bloodletting. Bloodletting is the process by which is removed from the body. This removal of the blood, taking out the bad things in the blood causing the disease. It dates back at least to the fifth century bc bc George Washington probably killed by bloodletting as he lay dying from an infection, a senior doctors suggest we let blood. The people were last to this idea and theres a bit of senior people one influx was taken from Fort Washington i see lay dying on his bed and he passed out within a few hours, he was dead. President George Washington underwent this procedure. The doctor then tried to think about reanimating George Washington using from not making this up, keeps blood that time prevailed and enough is enough with the blood but sheeps blood they let him rest in peace. Once remarkable to me bloodletting was used in the great flu epidemic of 1980. Not just by what we might call . Today but this was prescribed by mainstream physicians and this was one of the things that sparked my interest in the story of influenza. The report from the leading medical journals in the baltimore leading medical journals in the United Kingdom same doctor, its a hollow tube you take blood from. The report mentioned in 1916, two years before the breakthrough pandemic, is another pandemic, another epidemic in the camps in Great Britain doctors did everything including bloodletting, this is the time of my grandfather and physicians were trying bloodletting on these poor patients. Of course, it didnt work but the physician said it didnt work but we think it could work because we tried it too late. Had we tried bloodletting sooner with the care of these soldiers, that maybe it would work. Then in 1918, the height of the epidemic of bloodletting and the report was yes, sometimes bloodletting works for influenza. So if you can see, if it wasnt the anime that got you, the bloodletting might get you in it was a nasty array of medicines we had to try and treat it. We saw earlier and add a concoction that we said was useful drug for malaria but useless for treatment of flu. Because its a useful drug and malaria, it reduces the cycle. The idea that it reduces fevers and malaria, it would reduce fevers and influenza to a different mechanism of the disease but that was the thought process behind it. A completely useless drug and dangerous and appropriate one. Everyone was prescribed and most and one of my favorite discoveries disturbing the book was from a published paper for my think the grandchildren of patient who had influenza, not in 1890 and 1836. Eighteen years, almost two decades after the great influenza pandemic, the family preserved the records of grandfather, and published them. Im going to read a little bit passage that describes. Over a period of three weeks, he is treated with a punishing one, they brought them forth skin, fevers, a cancer causing laxative, cough medicine, oil, seven enemas, rectal tubes, dont ask. Milk of magnesia and and antiseptic. These are all administered for this patient 1936 and in the paper, you can see various things given. The patient received at least five subscribed things of whiskey and 14000. Actually, certain enemas may have been medically necessary because they were given at least 89 doses of coping which the press is coughing which also called constipation. So thats what life was like when you have influenza. Back 100 years ago or so. What about today . For the vast majority of us, influenza is a little bit of inconvenience. Like threatening it something generally deal with at home, friends or family, and usually thats it but of course, some of us and in the Emergency Department. I got to chief many, possibly hundreds or thousands of patients with influenza over the many years. There we have things we did. You have an Emergency Department, we have blood that can tell us what is happening for tests. We have xrays so we can get a good look at the lungs and see if theres any evidence of pneumonia, we can get fluid. We can get fluid and treat them in that way. Of course, we have antibiotics today. Lets be very clear, antibiotics should not be given to patients with influenza. They do not work. We all know this even though they are prescribed unnecessarily, often even today. They dont work. They do work to help treat the secondary infections, pneumonia is the bacterial of pneumonias that comes as a result of the primary viral influenza. We have as antibiotics today, they were not available in the early 30s and its a remarkable thing. Today, we believe the majority of deaths occurs in the great plains a epidemic. Secondary pneumonias we would be able to treat today. Thats good news. We also have other medications to treat fevers, medications like aspirin or motrin or tylenol i came across an interesting study that suggests perhaps we shouldnt be giving medications for people we see quite as often as we do. Its a study at a university in canada and they looked at modeling and they said what happens if you give tens of thousands of people with the flu some medicine for a fever . Well, many will feel better quicker. High fever, they will feel better quicker. So they will get out of bed quicker. What will happen . Will come down stairs and coughed all over the friends and children and go to work in a couple of them. The suggestion from this group at the university was not by treating a fever, my increased transmission by about 1 and given the enormity of this disease, they suggested he might actually get an additional 500 deaths a year in the United States as a result of treating people. With influenza today and your doctor these that you have a fever of 103 and stage suggests that you properly, probably shouldnt get something for your fever because she says somebody at the university this could increase the death rate by 100, he would probably say doctor, please give me the medicine. I know i would. I prescribed and would continue to prescribe something for peoples fevers in the presence of influenza but there is at least another way of thinking globally about what we are doing locally and how it might affect transmission and spread. So we have those medications as well to help. And there are some specific medications to treat the flu, mainly things like tamiflu and for new kids on the block, these are direct antiviral medicatio medications, im not going to go to those directly now, perhaps we could talk about them later but they are also other, they probably dont work anywhere near as efficiently as they should but theyve been counted to work. Well leave that for later. That is the treatment. Bloodletting, toxic tips, whiskey, 100 years ago today, Emergency Department and connected with a intensive care unit. The sickest of the sick go there. I opened with a story with a young lady, young mother of two who came down with influenza weekly, she ended up basically in a matter of hours being matteroffact from a small to town, she is put on a bypass machine for several weeks until she recovered from the flu. As the miracle of modern medicine today but clearly, was not around 100 years ago. So, the treatment. Lets think about the cause of influenza. What we know about the cause today and what did they know 100 years ago . I think in many respects, this is the most frightening aspect of the great influenza pandemic but they didnt know what was called. There was some suggestions, amongst those suggestions included conjunction of planet thats where we get the name influenza from, the italian influenza main influence and the early thought was that this disease from an entity that you could identify, is called caught by something up there. We still have this buried in our history so perhaps, conjunction with this routing animal carcasses were thought to be a possible explanation. Earthquakes and volcanic eruptions were suggested as possible causes. Effluvia discharged into the air the bowels of the earth and people didnt know what it was. In fact, what occurred in chicago from early in the influenza epidemic of 1918, when Public Health official said the following. We may as well admit it and call it germ x. We had no idea we didnt know what caused it and where we are. An example of the cause was really not a cause for the discovery in 1982 in berlin by a microbiologist and they found a bacterium on the lung samples of people who died from the flu and they said this must be the cause of the flu because it is everywhere. They called it the influenza is a list. The problem was that it was not caused by the disease, as a secondary pathogen found a secondary bacterial. The thought that they found the bacteria in it turns out not to be correct, it happens in several different instances in the flu. It was later changed, is called bacillus influenza but. Some of you may have heard of this. A nasty bug, fortunately, we now have vaccines against it. For many years, i had no idea as a position why am i looking at or treating this present with h flu, its nothing to do with the flu. It turns out, 100 years ago, it was thought to have been the cause of the flu and are properly named. One of the historians of the great sioux called this discovery and authoritative sign, pointing in the wrong direction. So that was bacillus influenza. In 1889, there have been a small epidemic and it was so severe that parliament commissioned a report on the epidemic. This was in 1889 by Henry Parsons and he was a very smart person. Well see why. He spoke about various theories that may have caused this epidemic. One of the theories of the time, im not making this up, painted russian oats. A suggestion was that the russians were bringing the disease from the east through europe these painted oats. Every society blamed the outsider for this. But strike me as weird that today, when we are blaming the russians for pretty much everything back in great flu and earlier, perhaps the russians were behind it as well parsons was not a thing that and he dug a little deeper. He suggested, he said it could be the weather, perhaps something floating around in the air and that is of course partially true, there is something in the air. He suggested that maybe its a particular matter, which is actually a remarkably accurate description, isnt it . A part of virus turned out to be, non living particular matter. It was describing a possible course of the flu. Could be rushing painted oats, it could be a poison. Then he suggested affect a person to person contact . Spread by not oats or volcanoes but one person gives it to another. Here, Henry Parsons showed the right boy for us to think about things. He said lets get some data. What he did was, he looked at the ellis rate in the British Railway system and he compared the rate of the engineers who were feeding for steam engines who worked outside but far away from people. He compared those influenza rates, how many reported sick from that . He compared those to the rights of influenza among the class inside. Of course, they are inside so they are not exposed to the outside they are in Constant Contact with people. He simply compared the two and he found of course, it was the clerks who had an increased rate of influenza was because they were in contact with people and the Railway Engineers driving the train standing outside, feeding them, their rate flu was much lower in the clerks even though they were outside exposed to who knows what from volcanoes. He suggested probably nothing to do with the atmosphere but more to do with persontoperson contact. From a simple look at the records, the sky figured out that probably we are onto something in the persontoperson one. Then he said the following. He also suggested perhaps animals have something to do with it. Here, he was really on the money. He suggested perhaps birds horses or dogs had something to do with the spread. It goes into some detail on the report. Do not today birds are related to the spread of influenza in a new strain. Back in 1889, Henry Parsons i think was really onto something when he discussed the possibility that birds were involved. As an example i think of people trying to think this through in a logical way and almost coming to the right conclusion. Today, course, we know what causes influenza, theres no doubt. Its a viral particle, which is many times smaller than the bacteria, we were able to take photomicrographs of this microscope was developed and able to be used around 1839 so there are pictures of the influenza virus. Pictures, diagrams. In fact, scientists know the genetic code of the influencer virus. How eight viral genes work together, what its coat look like, the proteins mock what the proteins do and how they may stick. The degree of advances from this suggestion thought it something out, something that we can see and identify and know a lot about his really, i think a remarkable example of the progression of science. For over a century. Now we can identify the viral particle down to its genetic makeup, genetic construction. In that respect, i think weve come a long way in understanding the cause of the disease. It brings us to the last part now, the way that we change in terms of vaccines and prevention. There were attempts to produce early vaccines to influenza. Louis the 1880s had developed his own set of vaccines, most famously in these, that doesnt mean he knew what the virus was but he had a suggestion that it was something from nervous tissue and he managed to propagate nervous tissue and take samples and make them weaker and weaker until he figured out what he had found his weakened virus infects how he produces vaccines. So we know people were producing vaccines back then but of course, what they were using were bacteria. And not the primary pathogen so for instance, in early 1919, edward from the mayo clinic isolated five different kinds of bacteria from patients and mixed them all together and managed to inoculate over 100,000 people with his vaccine. Were not sure what the outcomes were but he certainly tried to do something. In boston at the top medical college, doctor Timothy Leary made a vaccine. He made a blended vaccine using constraint from the chelsea hospital, the naval hospital, a nurses note from connie hospital and infected words of cap devon not far from boston. He made a concoction and gave them to people in his vaccine ended up sent to San Francisco for 18000 people were inoculated with his vaccine. In case you are wondering, yes, the answer is it is the same doctor Timothy Leary. This is the uncle of the famous doctor Timothy Leary in boston, he wanted us to turn on and tune in and drop out, his uncle created this attempt at a vaccine 100 years ago. So thats a terms of vaccines back then. What we do today . What we have today . Well, we do have vaccines against the flu. Many of us in this room will take them every year and those of us or both in healthcare, we have to get the flu vaccine, it makes sense for us to prevent the transmission but its really not a very good vaccine. If you think about it, mumps, measles, rubella, you get it once as a kid and youre done. Youre finished, youre good to go. You wont get the disease ever. But in terms of flu, we could get it every year. I just had it last year end the year before. A vaccine is not on the same level of effectiveness as these others. In fact, in a good year with the wind blowing in the light right direction, flu vaccine is about 50 to 60 effective at best. Last flu season it was less than that, 20 to 30 range. So why is this . Why is the flu vaccine so hard to create . The answer is that we have this eight genes of the flu virus and it makes these proteins on the surface, the problem is, the flu is such a good disguise, master of disguise that it changes, the makeup of the proteins very quickly. It mutates from one kind to another. We think weve got, we figured out what kind of flu is going to be around, it turns out it mutates into vaccine is no longer effective. By the way, we didnt realize they were going to be the ones so we can include those in the vaccine and you want vaccinated against those. Its the reason some of us get the flu vaccine and end up with the flu. Its not because the vaccines didnt work on that particular strength but because there are either either other strains or the original strain changed its structure so its like changing an overcoat from abound overcoat to a black overcoat and the immune system didnt recognize it. It stayed one step ahead of us all the time. This is a similar strike with hiv. The promise of a vaccine for hiv probably in a year or two we were told in 1980. These viruses are clever at changing their service and hiding from the immune system and we still dont have a good influenza vaccine. The way we make the vaccine as we have about 20 or so across the world by the world organization, they look at samples sent to the lab and get the exactly type of flu species thats probably, we look at australia and what they had in their most recent influenza topic because there in the winter, our summer and we tried to figure that and they do the same for us. They look to see what happened Northern Hemisphere and adjust themselves in the summer. Then the best educated guess they can, they say based on the evidence we have, the most likely species will be this and this and we will make the vaccine. Much of the vaccine produced using eggs, its hard to grow, it was grown on eggs. It something used century ago. Theres some vaccines made using Self Technology that allows us to have a vaccine not created on eggs but still, those are the methods we have today that are left over for us 100 years ago. The majority of the vaccines still to this day have something to do with eggs and needing to be grown on that medium. In many respects, we are at the beginning of the fight here against influenza by preventing it and creating a vaccine. While that is all true is not very effective vaccine, we must remember certain groups its extremely important to get the vaccine. High risk people. Children, elderly, those with immune compromised conditions, people often taking steroids and undergoing chemotherapy, pregnant women. For some reason, they are at increased risk of complications from influenza. Those are some of the High Risk Groups that should be vaccinated, no question there. In terms of everybody else, the data after is harder to find an effect on the flu. In the United Kingdom, the highest risk groups targeted and everybody else say well, if you want one, you can get one. But theres no campaign. Here in the u. S. , we have a campaign of the cdc says everybody over there over the age of six months should be vaccinated. That is the advice we are given in the United States. This is not the advice given over seas and we can talk about why that might be another time but its an important different in the way we think about the flu. The High Risk Group is important for otherwise healthy adult, the evidence is that influenza vaccine doesnt really do a lot. What we need instead . We need a universal flu vaccine. A vaccine that will work year to year without having to get again each year. A vaccine that will work in all age groups in a vaccine that will work in all geographic areas regardless of what pacific strain of flu is running rampant in your area. So thats the goal of the universal flu vaccine. To do that, we have to target that flu virus which we understand very well and find a bit of it that doesnt change. And a bit about flu virus that we can target and then our immune system will recognize and latch on to it and killed the virus no matter what particular strain it was. It sounds easy but its a very hard thing to do in reality and we are still not there yet but i will say the institute of health where i work, want to let you know im not here representing the federal governments views on the influencer epidemic of 18, im here on my own time but the nih is very focused on trying to fight universal flu vaccine. They poured a lot of Money Research and time and effort into. In a trial of possible Company Called by fax from israel, there are other Companies Offer are underway right now and who knows, will it work . With it not . We see universal flu vaccine . I dont. I dont know if we will seem foreign student but that certainly the goal of what we are trying to do with vaccines. We certainly have a long way to go. So if we look at where we were 100 years ago and where we are today, the treatment are very different, thankfully but there still will good treatments for influenza. We understand the virus in a remarkable and deep and profound way in a way that was unimaginable century ago. Ill be able to use that knowledge and build the vaccine . Not quite yet. Not there yet. Thats for the Research Efforts are going. My hope and looking forward is that will be able to see influenza, not just story of the past but a disease of the past and the way we think about smallpox is a disease of the past, a disease that was eradicated. Its important to move toward this goal, the cdc estimates anywhere between 1315000 people in the u. S. Dies each year of influenza. Its a soft number, not a great, not a extremely accurate number but a lot of people still get this disease and die from it. So we have to try and think about ways we can improve our own vaccinations so we will be able to hopefully make one day, influenza a thing of the past. Thank you. [applause] any questions . Somebody made a lot of money with facemask back then and we see them today. In this culture, we dont see them as commonly as they are in asia when they wear them when they get cold or dont want to give a call to somebody else. How effective are those . There is a picture he showed and if you spit in your eye, it was probably uncomfortable and potentially dangerous. Can you talk about that perspective in regards to the filtering or is it just a comfort on all of ours and becton, they used masks . Is it a reality i can help prevent the spreading of fact . Wonderful question. Thank you. Of course, must do something. In the cheap masks you can buy at the local pharmacy of a filtered mesh so if you cover it, you will breathe through the mesh but its going to stop something. The question is, what is it stopping . It might be stopping your secretions if you cough on the mask. Does it stop the viral particles someone else popped up from creeping through the mask . Most certainly not. The other thing about facemask after a short amount of time from they get clogged. Then they are completely useless. Theyre not doing anything. I think what we are seeing is an interesting idea, in other words, dont sneeze over people, please. Dont cough over people. That makes sense but the suggestion that we are going to stop this by wearing a facemask . I think you may have seen the picture of a happily married couple, husband and wife hugging each other wearing facemasks. Thats clearly an example on something that probably does very little. We do know that one of the most important the most important thing you can do to prevent the flu is integral get an antiviral medicine from your doctor, its to not turn up to work when youre sick, foster hands if you help somebody after somebody with the flu and dont cough over people. Mask reminds us of what we need to do when we have the flu but in terms of an intervention, paper masks are most certainly doing very little. Thank you for the talk. Id be curious to hear you say more about the cultural differences between the way three u. S. Encourages everyone to be vaccinated, wheres sometimes they dont. Why is that . Which approach you think is a correct . I go into this in detail. To be clear, in the United States, cdc accommodation is that everybody over the age of six months get vaccinated and in the uk part of europe, High Risk Groups only. Everybody else you can if you want but its not being pushed. I think the difference is how we approach the flu. If you look on the cdc website, for example, you will read that influenza is a serious disease with publications that include death. Since thats the case, everybody over six months should get the vaccine. Figure on the website, was looking at some of them recently on the National Health service in england, it basically says the following. Influenza is a bit of a nuisan nuisance. You may not feel well for a couple of days, you dont have to seek your primary care doctor about it because its probably not a whole lot they can do but if you need to, stay indoors and you will be fine. Thats basically what the National Health service view of influenza is. If you have these two very different approaches to describing a disease, its a potentially dangerous disease that can kill you for this a bit of a nuisance but youll be all right, those are two very different ways of approaching what we should do about the disease. The cdc says its a potentially deadly disease even though they influenza vaccine isnt terribly good, but use it, its at least something. In the United Kingdom they think look, lets use it where we really need to use it but most need it. Which of those two is correct . They are both right. Influenza is a potentially deadly disease parts that. 001 of the people who are going to get it and the tiny number of people who get it, its only those who are at increased risk from the disease, the high risk population. The United Kingdom approach, its a bit of a nuisance but thats about it, but also correct. Which of these two messages drives us . It is how we respond to the yardstick. We have decided that youd added states, this is the best Public Health approach. I think the data is far as i know, the data is not in High Risk Group, people should get it, its not effective but its something. Talk about everybody else, the young and healthy middleaged adults, it does very little. Yet, as you know, beginning august, usc signs in pharmacy think we are getting ready to get the flu vaccine, get it. Well give you a coupon or Something Like that. Two very different approaches. Potentially deadly disease, a bit of a nuisance and i think that drives how we look at the vaccine and of course, i think this is a bit of a larger discussion, the kind of works, we should use it. Seems to be the approach of many aspects of the american health. If it works, put it out there. Even though it might not work terribly well, it works, get out there. United kingdom, i talked to the chief medical officer of the uk faxing program was the person who had the discussion and he said thinking about things beyond how well the vaccine works, they include things like is it safe economic things to do . He said it doesnt make sense economically to have a campaign for healthy adult to get the influenza vaccine when so few are going to end up getting si sick. So well leave it at a different approach in the two different cultures. Good afternoon. Im a history graduate student at george mason anniversary. Quite a stickler on sources. I was just curious what sampling of sources used, i know you had mentioned these paper articles and medical diaries but i was more specifically understood and your use of secondary sources to bolster your own medical knowledge that you already have. Good question. I think i might get trouble with a historian in the room, the truth is, i use both. Obviously i began with one of the secondary sources i could, i read published everything in the last decade or so from several books, very good books out there. On influenza. In our talking before we came in from banana you have the resource of this thing called the internet. I dont know that this was available to the degree it is with the other books that came up. You can do a search for hundred newspapers with keyword influenza by city, state and time and you couldnt get these gems of information like i showed you just now so as her primary sources. I dont think anybody agog into that. The Washington Post reported that the death rate for influenza was rated the death rate in world war i. The back page, ive never seen that as a reporter observation. What it tells us about how they approach the flu. Thankfully, here we are in the remarkable archives, national archives, a jump of history where we have a lot available with relatively simple tools. Historians discover something that no one else has found hidden away in a book and as a historian, you and others are keen to find that. A lot of primary sources going back and reading the original articles, teasing out the medicine from both the reports of bloodletting in 1916 from if they were mentioned in secondary triple when you reap the primary you can get a different view on things. So, thank you for that question. Okay, we are out of time so thank you very much for your time and attention. I hope each and every one of you will stay healthy as we and this flu season. [applause] you are watching a special edition of book to be enough during the week while members of congress are working in their districts because of the coronavirus. Tonight at 8 00 p. M. Eastern from wheel feature bestsellers. First, journalist nicholas cheryl, tight rope. About issues facing the working class in rural america. They were interviewed by organ democratic senator jeff merkley. Tara westover recalls growing up in idaho found in her introduction to formal education, the age of 17. Typical educated, a memoir. After that, usa founder charlie in his book, the mega doctrine on the conservative agenda. Please enjoy book tv now and watch over the weekend on cspan2. Cspan has roundtheclock coverage of the federal response to the coronavirus pandemic. Its all available on demand cspan. Org coronavirus. Watch white house briefings, updates from governors and state officials, tractor spread throughout the u. S. And the world with interactive maps. Watch on demand anytime from unfiltered cspan. Or cspan. Org coronavirus. Thank you all for coming. Youre on a channel called microsoft virus destiny. This is a discussion in which we will reveal how microbes
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