Does 1918 Even Apply Here?

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S1: He went next, listeners. Before we start the show, I wanted to just thank you for sharing your stories to our voicemail box. We are listening and we really appreciate it. Keep them coming. Our number is 2 0 2 8 8 8 2 5 8 8. Or you can just tweeted me. I’m at Mary’s desk. All right. Onto the show. About a month ago, before we were all socially distancing ourselves, before New York and California and Illinois were all on lockdown. Harvard University hosted this panel.

S2: They called it going viral, looking at video of this event now. It’s sort of weird to see people jammed together shoulder to shoulder.

S3: OK. I think we’re going to begin I think everybody’s settled here and there’s now some people moving into the overflow room over in the Belfer room as remember, overflow rooms.

S4: Feels like it’s worlds ago where everyone’s all together sitting at a table talking about pandemics, but all the things you guys were talking about back then are now very, very relevant right now.

S1: Yeah, it’s very strange. Like when David Jones was one of the people speaking at this event, though, in truth, he didn’t really want to be there.

S5: I would periodically get calls from reporters in February and I’d say, look, I haven’t really engaged with this. You need to talk to people in public health who actually have the inside knowledge. I don’t think I have anything to say yet.

S6: And so when I when I was asked to participate in that panel, I would have said no to the person who asked me was one of my old mentors. And so I couldn’t say no. And then very quickly thereafter, things have totally spiraled, not out of control, but in an all consuming way that I don’t think anyone would have expected. As recently as two weeks ago.

S7: David was at this gathering to try to explain what history has to say about a pandemic. He got in front of his audience and he said, if you look at enough of them outbreaks like this one, they play out in an almost predictable way. Step by step, it’s all laid out most clearly in a work of fiction. Albert Camus, The Plague.

S8: The first 20 pages of that book are a description of a society ignoring early signs of a pandemic, and he describes it really well and it’s very sad to see us re-enacting. This drama that has been so well described.

S1: Seventy years ago, David says that part of the reason historians like him are looking at this novel to explain what’s happening right now is that it’s impossible to find a perfect historical allegory for this coronavirus.

S9: And when you try, it can limit you really so much of the political conversation and action now is driven really by a historical question, which is will this be like 1918?

S10: And is there anything we can do to prevent that from happening?

S11: So it’s the only parallel, I think is not only the 1918 Spanish influenza and dealing with the 1918 influenza pandemic, where the worst public health care crisis we’ve had since 1918 and over 100 years.

S9: And that’s a totally reasonable question to ask. It’s just an incredibly difficult question to answer.

S12: Why? Because the world in 2020 is quite different than it was in 1918.

S6: And we don’t know whether this current coronavirus is more like influenza or will do its own thing. And there’s just so much uncertainty in every aspect of that question.

S13: Today on the show, what history can and can’t tell you about the way this coronavirus story is going to play out.

S14: David knows better than anyone that looking back, can give you tunnel vision. He’s been looking back anyway. I’m Mary Harris. You’re listening to what next. Stick with us.

S15: You’ve said that pandemics like this, they actually have like a natural dramatic arc. Can you explain that a little bit?

S16: So so what happens is you you’ll have a community that is, you know, cruising along at baseline with all of these latent inequalities and structures that people tend to pay not much attention to. And then something will start to happen as the virus starts to spread. And so in epidemics of plague, either real ones are the ones that Kamu described. You know, it’s the rats who die first. And so the famous opening scene in the doctor comes out of his office, sees a dead rat on the stoop and sort of kicks it aside and doesn’t really register to him significant until he starts to see more and more dead rats. So the first step is denial. Denial. And there are a number of reasons that drive that. So one, I think is a psychological reason, which is that people want to reassure themselves that the world they know is going to continue as it has been. The sun rose yesterday. We assume it will rise tomorrow. That is a psychological minimization. Sometimes I think it’s bolder economic interests. So any. Business or any city leaders know that if they declare an epidemic in their city, it’s going to cause catastrophic economic damage. You know, this goes back to early modern Europe. No, no city wanted to declare that plague was present in the city that would bring trade to a halt. And so there have been economic reasons to deny the presence of an epidemic of a contagious disease in a city that sounds familiar.

S4: I mean, when you saw President Trump over the past month saying this is no big deal and sort of pointing to the financial system, it must have felt familiar.

S17: The virus, they’re working hard, looks like by April. You know, in theory, when it gets a little warmer, miraculously goes away. That’s true. But we’re doing great in our country. China, I spoke with President Xi and they’re working very, very hard. And I think it’s going to all work out fine. Rough stuff like your rough, rough stuff. But I think it’s going to work out.

S18: We only have 11 cases and they’re all getting better.

S16: Yep. Oh, exactly. And in time, people just just keep doing your things. Keep going out to restaurants. Not a problem at all. I’m going to keep doing my campaign rallies. There’s nothing to worry about here. Nothing significant. But then what happens is because of the exponential growth potential driven by the relationship between the pathogen in the population, eventually the signal becomes so strong that it can’t be ignored. You just accumulate enough sick people, enough deaths. And once it has been recognized, you then see the mad rush to explain what what happened. Why is this app going on? And that almost always involves blame. So. So, you know, one part of explanation is a very medical microbiological explanation. A new corona virus entered the human population and began to spread. That’s true. But no one is fully satisfied with that story. You have all these other stories that there were these bizarre exotic meat markets where bats are crapping on pangolins and spreading viruses and then people buy these raw anteaters and somehow fry them up and infect themselves. And who knows what actually happened?

S4: Or are you just hear someone call it the woo horn virus or that Chinese virus or it is Trump?

S8: Another other senior officials are saying now that, you know, this is China’s fault because they failed to contain it.

S19: It could have been stopped right where it came from, China. If we would have known about it, if they would have known about it, it could have been stopped in its tracks. Unfortunately, they didn’t decide to make it public. But the whole world is suffering because of it.

S16: Secondly, it’s our fault. We failed to prevent it from entering the country. There’s plenty of fault to go around. But again, there’s a sort of a ubiquitous part of the epidemic response.

S20: And so the blame always involves accusations made across lines of race, ethnicity and AIDS. In the 1980s, it was gender identity.

S21: Scholars have come up with lists of really scathing things that were said about gay population in the U.S. in the 1980s, that this is divine wrath. These people deserve what they’re getting. Really, really awful stuff.

S8: The stuff was said by very prominent public figures in the early years of that epidemic.

S1: So we’ve been through the first two acts of pandemic response, blame and denial. And now the U.S. is in the midst of the third act of the story.

S15: Mass mobilization.

S8: The responses that have been done in the past week are completely unprecedented in human history. They’re far more impactful on the general population than even what was going on during World War Two. At no point in human history has large chunks of the US population been told to stay inside, potentially for a six to eight week period. We’ve lost a third of the value of the stock market now that the costs of that are concentrated on a very small number of people, but it still dramatic. There’s going to be mass unemployment. I think they said in Massachusetts there were 20000 new unemployment claims in one day and one state. These responses are going to have a gargantuan cost.

S1: And that cost we won’t really know if it was worth it until long after the response is over.

S8: Is it appropriate? Is a very hard question to answer, because, you know, we’ll only really know in retrospect. People I respect greatly will say our models suggest that this is gonna be a huge epidemic and we will clearly overwhelm hospital capacity. And look what is happening in Italy. We don’t want to be like that. So therefore, it’s OK to wipe out the stock market, cause mass unemployment. We can do these things. We will survive. So we ought to do them. That’s a pretty good argument, I think. But then you can sort of push on the details. We’ve had a real struggle, but other cities in Southeast Asia have managed to contain the epidemic with much less dramatic responses than what we’re doing in the US at present. Some cities in Italy have clearly seen a fiasco of overwhelmed health care services, but not all cities in Italy. And so it’s a very mixed message about what this virus is doing to cities that it strikes. Precaution may still be the wisest response. If there’s something we can do and we can survive doing it. That is reasonably likely to prevent a bad outcome. It probably is worth doing so. On the social isolation bandwagon and we’ll see. But you know, as this goes on, week after week after week, I think we are going to have to ask hard questions. Have we killed more people in our response than. Either the virus has killed or even with the virus have killed, how do we not done this?

S15: There’s not really a satisfying answer to that question right now. The best we can do is look back to the last time there was a respiratory epidemic in United States. That’s 1918.

S9: The data collected from that pandemic offers clues for how this could all turn out, data is never a completely perfect or ironclad, but the clear trend that came out of it was that cities that were enthusiastic and responsible about social distancing or as some people are now saying, physical distancing had a milder experience with the epidemic than cities that ignored the problem. And milder experience in many cases meant fewer deaths. And everyone hopes that Corona virus is similar enough to flu, such that those sorts of responses will have that desired effect.

S4: In this case, you know, I want to I want to talk about this a little bit more because I talked to a doctor Sunday who is looking at that archive. And he was like, well, but look at San Francisco. San Francisco shot a lot of things down and they didn’t see the same flattening of the curve. And I I wonder if we know that for certain. But I’m curious how much we really know about this social distancing and how it worked.

S9: Yes, there are two things there. So. So one is, as I said, no data set is ever perfect. And you can certainly pull pairwise comparisons. You can find a city that was aggressive and had mild flu in a city that was lax. It is Ikle and had bad flu. But you can also find cities that seemed to respond in a robust way and didn’t. Have a great outcome. You know, the world is a messy place. Interventions are going to play out differently in different places, and you can’t always get decisive, consistent results when you’re looking at historical experiences in hundreds of cities.

S5: Now, some people will say, well, maybe San Francisco said it was doing all of these things, that it really didn’t do them well. But it could also be that there are other factors that are involved.

S4: Are there any historical lessons about how we’ve recovered from moments like this? Because if there’s anything that I take away from all of your research and all that we’ve talked about, it’s that we’ve been here before. But I guess what I’m really curious about is what happens now and what previous experience tells us about. What we should be doing and what we should be preparing for.

S8: So. We have been here before, but we don’t actually know where we are yet because we don’t know how bad of an epidemic this is actually going to be. So it could be that we’ve been here before. And by the time the dust settles, this will be more or less like SaaS or mild flu pandemics, where tens of thousands or hundreds of thousands of people will die. Deaths of hundreds of thousands of people is a big tragic deal, not trying to minimize that. An epidemic on the scale of two hundred thousand deaths like annual flu mortality is not a world up ending. Event. We will we will get back to business as usual relatively quickly. If this is more like the great pandemics of the past flu 1918 or bubonic plague in the 14th century, then that could precipitate really dramatic social changes. What happened after 1918? Well, that’s complicated because that was both the end of the pandemic and the end of a war in the 1920s, at least until October 1929, where a great time for this country. Prohibition aside, you know, the country boomed. And was there something about the post-war or post pandemic that had contributed to that boom?

S22: I don’t understand economic history well enough to know.

S23: Now, I very much wish I had said back in early January. Look, we’re doing it again. We’re ignoring this epidemic. It’s gonna spread out of China. We should really do what we can to prepare for when that happens. I didn’t say that, I don’t think anyone said that. Know, we were we were watching. You know, we were hopeful. People were complaining that China wasn’t doing enough. But no one was saying, America, get ready. Yeah. No, exactly. You sound like you feel almost a little guilty regret. The ad, certainly.

S20: These epidemics do end at some point. It just it fades away and never even isreally notice that there usually aren’t celebrations.

S22: Life slowly comes back to normal and people wake up one morning and say, Oh, that’s interesting. I wasn’t worried about plague or the plague didn’t disrupt my day yesterday. That’s interesting. And things get back together. And so everyone assumes that we will get there. But we don’t know is whether we will be there in two months or six months or two years and whether that will come at the cost of thousands or tens or hundreds of thousands or, God forbid, millions of lives.

S4: David Jones, thank you so much for joining me. Thank you.

S14: David Jones is a professor of the history of medicine at Harvard.

S24: Before we go, here’s a little bit about how your friends and neighbors are coping with this social isolation. You guys have been calling in and sharing your stories. I love to hear it because we’re all getting through in our own way.

S25: Hi, my name is Kathy and I live in Cleveland Heights, Ohio. One thing I’ve been doing is I’ve been scheduling virtual coffee dates with my friend where I’ll either get coffee or I might run down to the corner and buy a latte. We can still get carryout in restaurants and coffee shops. And then I sit in my kitchen with them and we have a little coffee date either on messenger or by phone or face time. I meditate. I miss a lot, but my favorite is connecting with my friends sitting in my kitchen drinking coffee.

S26: Hi, Mary. My name is Carl Hitler. I’m from South Bend, Indiana. I’m a pastor of a church that serves the homeless. And so I’m going to work because we’re part of the services that provide warm shelter for the homeless. In this case, mornings from Monday to first day and give them a hot meal, showers, laundry, clothing, mail, telephone services as part of a network that we have here in South Bend. So I’m continuing to go to work. Even though some staff are staying home. We’ve had to rely more on homeless guests to pitch in and take leadership roles. But we’re pulling through. Hi, my name is still Carolina.

S27: It’s my husband, my two and a half year old daughter and now three ducklings in the bathtub. I went and bought ducklings. I guess I thought it was a nice, cheerful thing to do. Don’t worry. I want to take care of them. But here we are. OK. They say, everyone, I share your story.

S24: Let us know how those ducklings work out. Tweet at me. I’m at Mary’s desk. Or just call 2 0 2 8 8 8 2 5 8 8. All right. That’s the show. What next is produced by Daniel Hewitt, Mary Wilson, Jason De Leon and Maurice Silvers. I’m Mary Harris. I’ll catch you back here tomorrow.