^B00:00:12 >> Carla Hayden: Hello, I'm Carla Hayden with the Library of Congress and welcome to our very first virtual National Book Festival presents. As we all, collectively, face the challenge of the pandemic, the safety of our staff members, our visitors, our scholars, is our first priority at the Library of Congress. And so, we are following the CDC recommendations and guidelines and all of our buildings are closed to the public until further notice. However, it is the library's mission to engage and connect with our users, and so we have been rolling out various programs virtually for parents, and teachers, scholars, students, and everyone who could benefit, we hope, from our resources online. And so, please visit our website, loc.gov, for more useful information, not only about what's going on currently, but also things that you could use during this time. Now to our event. We will be joined by bestselling author, John M. Barry, who will be discussing his book, The Great Influenza, the epic story of the deadliest plague in history. He will be joined in conversation by Mr. David Rubenstein, cochair of the National Book Festival and author of the American Story, Conversations with Master Historians. Please join me in welcoming Mr. John M. Barry and David Rubenstein in the first virtual National Book Festival presents. >> David Rubenstein: Right. We're here with John Barry. And, John, I want to thank you very much for agreeing to do this interview. I realize that, today, you are one of the more popular people in the United States because of the book that you wrote, The Great Influenza, which I highly recommend, we'll talk about this book. But what prompted you to write a book about The Great Influenza in 2004 when that was so long ago, how people weren't then focused on these kinds of things? >> John M. Barry: Well, that's too long a question for this show actually. But when I was a kid, I wanted to do two things, I wanted to be a scientist doing medical research, and I wanted to be a writer. I actually remember the moment in time I was 13 or 14 years old when I decided I would abandon science and become a writer. But -- so I always had that interest just I guess seemed like a good idea at the time. >> David Rubenstein: Well, I've read the book recently. As I told you the other day, I hadn't read it before I'm embarrassed to say, but I read it recently and I couldn't really put it down because it's an incredible story about what happened in 1918. And what I'd like to do is take us through that story and then see how that compares to what's going on now. So, let's go through the story initially. First, it's called, The Great Influenza, when did that title actually come about? Was it called The Great Influenza then or later? >> John M. Barry: [Inaudible]. It's probably the first title that I picked for any book or article that I've ever written in my entire life, I'm not very clever. We were searching for a title, I suggested that one, nobody had any better. It -- it was not called that at the time, it was referred to as the Spanish flu, as I'm sure you know that. >> David Rubenstein: Now let's talk about that. It was called the Spanish flu by many people but from the point of view of Spain, that's not very fair because it didn't start in Spain, so why was it called the Spanish flu? >> John M. Barry: Well, Spain was not at war, so it didn't censor its press. And the warring company -- countries all did, and -- and the U.S. was more self-censorship. And when the first wave came, which was actually quite mild in the spring of 1918, Spain was pretty hardhead, and the king, him-- himself, got sick, which of course, generated attention all over the developed world, so they began writing about it, and called it Spanish flu. >> David Rubenstein: So, let's talk about the time you took to write. This book this book has your obvious interest in science because it's very, very thorough in the scientific parts and the epidemiology parts of it. How long did it take you to research this and to write this book? >> John M. Barry: Seven years. >> David Rubenstein: Seven years. And did your publisher say, from time to time, it's taking too long, or he -- he didn't say that, or she didn't say that? >> John M. Barry: Well, my publisher is from New Orleans and -- and she liked one of my prior books. she gave me some -- she -- she was patient. The -- yeah, I did not think the book would take anything like that when I started it, I really believe that, at most, it would take two and a half years. But I got pretty deeply into it and it just kept going and going. >> David Rubenstein: So, as we talked today, you are in New Orleans now? Is that's where you live? >> John M. Barry: I am in the French Quarter in New Orleans, I'm very deserted. >> David Rubenstein: So, talking about The Great Influenza, as you called it, are [inaudible], known as the Spanish flu to some, how many people actually died -- to the best of our knowledge -- during that influenza? >> John M. Barry: Well, the best estimates on the first person to come up with it was a Nobel Laureate, MacFarlane Burnet. It's been confirmed by epidemiologists much more recently, it is 50 to 100 million people worldwide. If you adjust for a population, that's 225 to 450 million people today, so it was a very lethal outbreak in the United States. About 675,000 people died. >> David Rubenstein: So, when did it first surface in the United States? In your book, it seemed to indicate that it came from Kansas, but is that clear that it was really originated in Kansas? >> John M. Barry: Well, I had that hypothesis when I researched the book, I thought I had may even have located its site of origin and even wrote a scientific journal article on that. And it still may have started in Kansas but a lot of sort of research has been done since my book came out, and I backed off that hypothesis myself. I think it's more likely China, but other hypotheses are Vietnam, and France, New York City is a possibility. We don't know where it started, and we will probably never know. >> David Rubenstein: Wherever it started, it surfaced initially in military barracks, is that correct? >> John M. Barry: Yeah. Well, it actually first surfaced in a small town, a county, rural Kansas, Haskell County, that was the first reported outbreak of lethal influenza anywhere in the world, January 1918. You could track people who went from that town to what is now Fort Riley and -- and they -- they -- people and their families had pneumonia, they arrived at Fort Riley, and 48 hours, just the intubation period of influenza, 48 hours later, Fort Riley largely erupted in a pretty serious outbreak. But it wouldn't compare to the fall outbreak, it -- it was still fairly mild. >> David Rubenstein: Well, on this outbreak, it began to -- to go from soldier to soldier, soldiers were transported and getting ready to go to Europe for World War I, was that how it spread from soldier to soldier who were in close confines? >> John M. Barry: It did, yeah. I mean it would -- it would have happened anyway. Pandemics have occurred -- influenza pandemics throughout history. In the 1600s, made it from Europe to North America, so the -- I don't think the war was a major factor, but it had -- it -- as I say, would have spread anyway. But the -- it did go from one army camp to another, infected more than half of the army camps in the spring. They carried it to Europe and spread from there. >> David Rubenstein: So, when the soldiers were going to Europe, they were going to large ships, very close confined -- the ships -- that probably helped spread it amongst the sold -- sailors and soldiers then, and then into Europe as well? >> John M. Barry: Yeah, and that became a really serious problem, the troop ships on the second lethal wave of the pandemic, those troop ships became horrific a place, almost floating coffins. >> David Rubenstein: Now did the military senior leadership begin to recognize that there were problems, that their soldiers were getting a kind of influenza, and some of them were actually dying from it. What did the senior military leadership do about this? >> John M. Barry: Pretty much nothing. You know, they were in conflict. The Army Surgeon General William Gorgas, who was really a terrific physician, scientist, public health person, he was almost at war with the army leadership over this issue. But they largely ignored Gorgas, so did -- so did Wilson, himself, the president. >> David Rubenstein: When did it go into the civilian population? What cities did it mostly go into? Large cities in the United States, in the East Coast more than the West? >> John M. Barry: Well, there was a spring outbreak in -- in New York City, which was actually -- at the time, it wasn't noticed, so it's been noted since then carefully epidemiological research that actually broke out in February and possibly late January, even before the occurrences on the troop in the military camps, that's why I say, it would have spread anyway. >> David Rubenstein: But the influenza that broke out, when people got this, in some cases, they survived obviously, but in many cases, they came down with such terrible pains and diseases that they died in ways that are horrific, as you described in your book. People were bleeding out of their eyes, their ears, what was that? >> John M. Barry: Well, we -- we have to distinguish between the first wave, which -- as I said -- was generally mild, and the second lethal wave, which began in September and most places in the world. And those symptoms were horrific. As you said, you could bleed not only from your nose and mouth, and in military camps, some sort of -- 15% of the soldiers were bleeding from their nose, but you could also bleed from your eyes and ears. You had -- the disease misdiagnosed initially as cholera, typhoid, dengue because of the symptoms have presented with, not normally associated with in -- influenza. People could turn so dark blue from lack of oxygen called cyanosis that I quoted one physician writing a colleague saying, he had difficulty distinguishing African American troops from white troops because their pallor was so sim -- similar. And that, of course, spread rumors of the black death. >> David Rubenstein: So, when this was going on, did -- did epidemiologists and other medical researchers say, this is something that we should solve with a vaccine? What kind of research was done? >> John M. Barry: Well, exactly what you said. They knew a lot about bacteriology, they didn't know whether a virus was just a tiny bacteria, or an entirely different kind of organism. It was a hypothesis that it was caused by a particular bacteria, which still has the name, Haemophilus influenza still has the name influenza associated with it, but of course, it wasn't. They were able to develop vaccines against -- although they did not get widely distributed -- against pneumococcus. If you get a -- a pneumonia with a vaccine shot today, it's a straight line descendent to what was developed back then. And they basically tried everything that they could think of. Obviously, since it was primarily a viral disease, and the -- even the bacterial vaccines here -- any bacterial vaccines did not get widely distributed. None of the -- those therapeutics worked. They did try things that we're doing right now, such as convalescent serum that probably had some effect. None of the scientific studies were well done, they knew that at the time, they weren't -- weren't well-controlled because they were in the same chaotic situation that we are today, and they were more concerned with saving somebody's life than the controlled study. ^M00:12:59 >> David Rubenstein: In the first wave, as you described, it wasn't quite as bad as the second wave. But what was the theory about why the second wave was so much more lethal? Was it just that the virus had become stronger and mutated in that way? >> John M. Barry: That would be my theory. I don't really see another explanation. You know, the two ways were so different, there is a small minority virologists we think that they were actually different viruses, but I think the evidence is absolutely overwhelming that they were the same virus, and that's a consensus view among virologists. >> David Rubenstein: Now it turns out that in -- the virus from 1918, it -- it seemed to affect younger people more than older people. Why would that be the case? >> John M. Barry: In -- in those cases, oddly enough, people's immune systems were largely responsible for the overreaction that when you're younger, you have a stronger immune system. The virus, if it was getting into the lung, the immune system was throwing every weapon it had at the virus. The battlefield was a lung -- the lung was being destroyed in that battle. Even on the bac -- bacterial pneumonias, the virus is stripping the defenses of the body in ways that are unique, not an entirely unique [inaudible]. >> David Rubenstein: Now, as this was going forward, did the press in the United States say, this is a terrible thing, and we got to worry about this, and do something about it? Or did the press not really cover it that much? >> John M. Barry: Well, because we were at war, and because it was this infrastructure for the war effort that had already been created to give out nothing but good news, the press echoed National Public Health. There was no Tony Fauci back then. National Public Health leaders were saying things like, this is ordinary influenza by another name, you have nothing to worry about if proper precautions are taken. Local city officials were routinely echoing that, so they were minimizing it. In addition, the press also echoed that, for example, in Phoenix, they wrote a little bit about it when it was in Boston, which was the first American city hit by the lethal second wave. They wrote less about it when it was in New Orleans. When it was actually in Phoenix and you read the Phoenix newspapers, there's not a word about it, hardly any mention. Again, they -- the whole attitude was depressing anybody would hurt the war effort so that focus on the war put a lid on any press comment. >> David Rubenstein: But as the bodies are -- are very -- are kind of growing more and more dead bodies, where are they going? And people recognize there a lot of dead bodies coming around, where -- where -- how do they explain that? And where did they get buried? >> John M. Barry: Well, it's funny your -- it's not funny. But to give you an example, in Philadelphia, at a time when they were actually digging mass graves, and when they finally belatedly close schools, theaters, saloons, and so forth -- churches, one of the newspapers actually said, this is not a public health measure, you have nothing -- no cause for alarm. But people knew, obviously, they're digging mass graves, they're closing everything, they're -- their neighbor is dying 24 hours after the first symptom, sometimes with horrific symptoms, they knew perfectly well, this was not ordinary influenza, and that led to a real fraying of society. >> David Rubenstein: Okay, and let's talk about -- you mentioned earlier, President Wilson. Did President Wilson actually make any statements about this? What did he say about it? >> John M. Barry: Not one word. Never did he make a single public statement about this pandemic. As far as he was concerned, it was a -- a distraction from the war. >> David Rubenstein: And the reason he didn't do it was because he wasn't convinced there was a problem, or he did want to detract from the war? >> John M. Barry: It was a -- he was obsessed with the war, an -- he's a strange person. He would focus on something and that would be it, dog with a bone, the war was all he -- all he cared about. >> David Rubenstein: Now he went to Paris to help -- help resolve the war. He spent, roughly, six months there. Did he contract the virus when he was there? >> John M. Barry: He did and one of the unusual complications of the 1918 virus was mental disorders, even to the extent that the people that all the Sachs wrote about in the awakenings hypothesize that they -- where that was a result of the 1918 pandemic. Wilson had 103 degree fever, clearly had influenza. Everybody around him commented how disoriented was. He had held firm to the principles that the U.S. had gone to war over before he got sick. After he got sick, he -- he couldn't remember anything. As I say, he was disoriented and he ended up caving in to Clemenceau, whose nickname was the Tiger. >> David Rubenstein: So, in other words, the positions that Clemenceau wanted were more punitive towards the Germans than what Wilson had wanted. Those positions prevailed. And how did that work out in the end? >> John M. Barry: Well, you -- you had it exactly right, that's what -- you know, Clemenceau won on practically every point. John Maynard Keynes called Wilson the greatest fra4ud on earth after the peace treaty. >> David Rubenstein: Yeah, and of course, the Second World War probably came about because of some of those punitive things against Germany. But let's go on to the next subject, which is what are the lessons that you took away from the work that you did? What lessons would be applicable to today from what you did in your research and writing? >> John M. Barry: Well, there were two lessons, the first is, the best way to handle an outlook -- break like that it is for the leadership to tell the truth. Transparency was absolutely crucial. And the second lesson sort of grows out of the first and it's kind of impossible to get without the first, and that is, most of the cities in the United States did a lot of what we're doing today, social distancing, closing the schools, and so forth. But the ones who did it later, after the virus was already widespread in the community, was too late to have any significant effect. The cities that did it earlier before the virus really got widespread had a much better circumstance during the pandemic. Certainly, the phrase, flatten the curve, which we all are too familiar with almost now, it definitely flattened the curve in those cities. And in some cases, the deaths were actually less possibly because of that. >> David Rubenstein: Now epidemiology is more advanced presumably than it was in 1918. Have people gone back, who have modern skills and techniques, and looked at what happened in 1918 and said, it wasn't of influenza, it wasn't a virus, it was something else? What had they learned by going back with modern skills and -- and analyzing what happened then? >> John M. Barry: Well, you know, exactly what I said earlier on on the lessons. You know, when -- about 15 years ago, the Bush administration, after bird flu surfaced, and many other governments around the world launched a major effort to prepare for a pandemic, and I was asked to participate. And you know, there was a pretty detailed analysis of what cities did in 1918 and the conclusions were what I articulated a moment ago. You do it early, before the virus is widespread, and you can have impact. If you wait until a lot of people start dying, it's too late, the why -- the virus is already so deeply seeded in your community, the impact is much less. >> David Rubenstein: So, the main message that somebody would take away from your book -- and you'd like them to take away is, you know, we need government officials to recognize it's a problem and be honest with people, is that your main point? >> John M. Barry: Yes. Unless you do that, when you finally close down schools and businesses and ask for people to heed your warnings and advice, they are not going to do it if you haven't been up front with them at the beginning. >> David Rubenstein: But back in 1918 and today, still, social distancing is probably the most effective thing that somebody can do, is that fair? >> John M. Barry: Absolutely. Without a doubt. >> David Rubenstein: Now you are -- as we talked about -- in New Orleans right now, what are you doing to socially distance yourself from this problem today? >> John M. Barry: Well, I'm -- you know, we do go for walks outside, that's quite safe. Other than that, really don't do much of anything. You know, fortunately, with what I do, I work at home, although right now -- you know, I'm involved in a couple of groups, one on messaging to try to get people to comply, groups that are not compliant, the other is an international group of scientists and epidemiologists, I'm spending a lot of time on that. We don't really do anything, you know? I'm over 70 so I'm at risk. I -- fortunately -- have some younger friends who volunteered to even go to the market for me, so I'm -- I don't even have to do that. >> David Rubenstein: So, I don't want to make it sound like your next book, it might also be indicating a future disaster that might arise, but what is your next book? Should we assume that you're going to predict some other great crisis that might happen by writing another book now? What are you working on next? >> John M. Barry: Well, I was working on a book on the Louisiana Coast, everything that has gone into making the Louisiana Coast a disaster. We've lost roughly 25% of the Louisiana, close 2,000 square miles, about the size of the state of Delaware. And what has helped create that land loss, it includes everything. You know, it starts more than 2,000 miles upriver on the Missouri there. It ends at the things that are going on right now on -- onsite. And of course, then you have global warming, and sea level rise, so I sort of see it as a narrative history that also is a narrative of global warming. >> David Rubenstein: Well in The Great Influenza book, we have a few questions that have been sent in by email and before we conclude, let me just give you one or two of them if you could answer them. One of them is from Rockville -- Rockford, Illinois. What individual or group provided the biggest positive effect amid the 1918 pandemic? Was there some group or individual you would like to cite as having done the best job, the Tony Fauci of his day? >> John M. Barry: Well, there was no Tony Fauci, but the American Red Cross certainly behaved admirably in the healthcare system. All the medical workers risked their lives, many doctors and nurses died, as unfortunately, may happen to -- today. >> David Rubenstein: So, another question we have is from -- from Florida. What were some of the newspapers saying about the virus that turned out to be sensationalized? What kinds of fears were spreading through the population? And how did the media respond? >> John M. Barry: Well, as I said earlier, the media really said almost nothing about it. They completely minimized it, which turned out to spread more fear. I think the unknown is the scariest thing. If you go to a monster movie, it's much more frightening when your imagination is at work than when the mad -- monster appears on the screen. >> David Rubenstein: Right. >> John M. Barry: So. >> David Rubenstein: Okay, from Arlington, Virginia. My great grandmother, a young mother at the time, died in the 1918 pandemic in a very small village in the Adirondack Mountains of New York. What are likely scenarios of how it got into the Adirondacks? >> John M. Barry: I mean that virus, like this virus, is going to get everywhere in the world, there really is basically no escape from it. >> David Rubenstein: Thanks. And from Oregon, the question is, I would like to know how Congress actually worked during that time? Did congress work through this endemic? And what -- the members of congress ever comment on or do very much about it? >> John M. Barry: Well, again, Washington was focused on the war. They did pass an appropriation in the -- for public health, and -- and so forth, and so on. That was about all they did. >> David Rubenstein: So, today, if somebody has the time to read your book, which I highly would recommend, they will -- you know, learn a lot more detail about it, but let me just mention -- ask you about one of the unsung heroes -- or one or more of the unsung heroes, the epidemiologists that you talk about in your book, those from Hopkins, and the Rockefeller Institute, now Rockefeller University. These people worked slavishly to come up with a vaccine, but why did it not succeed? Why did they not come up with a vaccine? And how come we don't have a vaccine yet for the current pandemic? >> John M. Barry: Well, number one, they didn't know what caused it, so you can't develop the vaccine, unless you know what the pathogen is. Number two, as we have learned, since we still don't have a great vaccine against influenza, because it's one of the most rapidly mutating viruses in existence. It is very difficult to develop a vaccine. I think there's been actually a lot of progress in the last 10 years or so towards a vaccine that will work against all influenza viruses, or almost all of them, so you won't have to get a new vaccination every year. There's been enough progress that that goal is likely to be achieved, but it's -- it's still out there. >> David Rubenstein: Now you are a person who I presume who gets a flu shot every -- every season. >> John M. Barry: Yeah. >> David Rubenstein: And you highly recommend those as well? >> John M. Barry: Yes, because even though they're not tremendously effective, like a measles vaccine or yellow fever, it's like 100%, or close to it, influenza is much less than that. But even if you still get sick, have -- after getting vaccinated, it is much more likely to be a much more mild attack than would otherwise be the case. >> David Rubenstein: The final question is, Dr. Fauci has said that it is likely when this receeds a bit, it is likely to come back in -- in the winter, perhaps. Do you have any views on whether that's likely to happen and it's likely be more virulent than -- than today? >> John M. Barry: I see no indication that it would be virulent, I mean I'm looking for that. In 1918, even though the first wave was generally mild, there were always hints and -- you know, that you could see in retrospect, and even at the time, that there was tremendous virulence in that virus. There isn't the slightest hint anywhere in the world that this virus has that capacity, thankfully. In terms of the timing, I'd say this virus is going to be here forever, it will be a new human disease. It's certainly going to come back. I do think that we have a very good shot at getting a vaccine for it, a good vaccine. It's a -- it's much more stable than the influenza virus and therapeutic drugs and then when it's going around a couple of times, people's immune systems will provide much more natural protection that is -- than is the case right now. >> David Rubenstein: John, I want to thank you very much for helping us understand better what the current situation is and what the situation was in 1918. And again, I really enjoyed your book and I look forward to reading your next book. Hopefully, it won't predict another problem that arises. Hopefully, it will be a lesser problem when that arises on -- about the book you're -- you're working on now. Thank you very much for your time. >> John M. Barry: Well, thank you very much, I certainly enjoyed it. >> David Rubenstein: Thank you. ^E00:29:17