An Unfinished Lesson

[0] This is Hidden Brain.

[1] I'm Shankar Vedantam.

[2] About this time last year, I recorded an interview with a historian Nancy Bristow about the eerie parallels between the influenza pandemic of 1918 and the COVID -19 pandemic a century later.

[3] At the time, we didn't know how long the coronavirus outbreak would last.

[4] We didn't know then that more than half a million Americans would die.

[5] Since we spoke, we've seen multiple waves of infection.

[6] A first, followed by a second, then a third.

[7] And now, even as the country is rolling out vaccines to combat the virus, the number of new infections remains high.

[8] In many other countries, infection rates are also rising.

[9] A few weeks ago, one of the nation's top public health officials implored people not to let down their guard.

[10] At one point, she put aside the data and spoke directly to the public.

[11] I'm going to pause here.

[12] I'm going to lose the script, and I'm going to reflect on the recurring feeling I have of impending view.

[13] We have so much to look forward to and so much reason for hope, but right now I'm scared.

[14] That's Rochelle Walinsky, Director of the Centers for Disease Control and Prevention, speaking at a White House briefing on March 29th.

[15] Please hold on a little while longer.

[16] I so badly want to be done.

[17] I know you all so badly want to be done.

[18] About a century ago, after a year of dealing with social distancing mandates, many Americans felt the same way.

[19] The United States and lots of other countries around the globe had been pummeled by the deadly new strain of influenza.

[20] New variants constantly popped up.

[21] It seemed like the waves would never stop.

[22] And at a certain point, people just felt exhausted.

[23] They wanted the crisis to be over.

[24] They wanted to look away.

[25] This week on Hidden Brain, we revisited a moment that has been largely forgotten and overlooked, and we consider the lessons we can still take from a century ago if we only stop to listen.

[26] The parallels between the 1918 outbreak and the current pandemic have grown even more striking now than they were when I first spoke with Nancy Bristow.

[27] She's a historian at the University of Puget Sound and the author of American Pandemic, the lost worlds of the 1918 influenza epidemic.

[28] She began by talking about the scale of that outbreak.

[29] This was a massive event.

[30] Inside the United States, more than a quarter of Americans were sickened.

[31] By the time the pandemic was through, 675 ,000 Americans would die.

[32] And the estimates vary for the world for somewhere between 50 and 100 million people and a third of people on the globe were likely infected.

[33] I mean, that is simply staggering.

[34] You say in the book that the outbreak lowered life expectancy in the U .S. by 12 years?

[35] I mean, that's just horrifying.

[36] It's exactly right.

[37] And it was horrifying at the time as well.

[38] It was a scale of carnage, literally, that Americans were completely unprepared for.

[39] So this was not the first time the country had been affected by an influenza outbreak.

[40] What is it that made this strain so dangerous, Nancy?

[41] The influenza virus is a very clever virus.

[42] It's constantly changing, drifting through limited but frequent changes in its genetic makeup during the reproduction process.

[43] But sometimes there's a thing called antigenic shift.

[44] It's a much more dramatic transformation when a single cell hosts two separate and distinct strains of influenza and during the reproduction process recombines those two parental strains into a new hybrid virus, a virus for which, No one is prepared.

[45] No one has immunity.

[46] So, of course, because the virus sort of strikes with some regularity every year, people have developed some immunity.

[47] Your point is that when the virus mutates in this fashion, it essentially is striking a naive population.

[48] Exactly.

[49] So many people believe the 1918 outbreak in the United States first began at an army camp in Kansas.

[50] Tell me about Camp Funston.

[51] Well, Camp Funston was one of many places in the United States where American soldiers were training for the First World War, and that spring, they experienced a somewhat unusual example of influenza.

[52] And as it traveled through the army camps, a few pathologists noticed that there was something unusual.

[53] The post -morting exams of the victims showed a kind of soggy lung.

[54] But in general, most Americans didn't notice it.

[55] And this first wave, with its origins, including, Kansas would pass to the United States almost entirely unnoticed except by a few military epidemiologists.

[56] And so once it strikes in Camp Funston, soldiers presumably are moving about the country, they're moving from camp to camp.

[57] What happens to the virus?

[58] Well, the virus, of course, is continuing to do its work of infecting American soldiers and traveling with them, first all over the country, and then, of course, it will become more noticeable because it will travel with those American troops over to the European battlefields.

[59] By April, it spread to the British and German forces.

[60] By May, the French troops are infected.

[61] And then, of course, by that summer, Italy and Spain will also be infected.

[62] By June, it would infect Britain, and in July, citizens all over the continent of Europe would be infected with this first wave.

[63] So you mentioned a second ago, of course, that this pandemic is unfolding at a time when the world is engulfed in war.

[64] And the virus travels from the United States to Europe, to the countries of Europe, but it's also traveling to the theaters of war in Europe.

[65] Tell me what was happening on the Western Front, Nancy.

[66] Well, of course, the Western Front is deep in the throes of this war.

[67] American troops are just beginning to arrive in large numbers in the spring of 1918, though the nation had joined the war in April of 1917.

[68] So the war is ongoing.

[69] It is deep.

[70] Millions of people have already died in trench warfare.

[71] And by the spring of 1918, the United States has entered and we're beginning to see a new round of assaults, a new round of battles.

[72] And so the opportunity for the virus, in a sense, is unlimited.

[73] You have a virus ready to attack the very people who are in those trenches, the target audience for the virus, young people.

[74] So across the Western Front, which is essentially the dividing line between the German forces and the Allied forces, you have these trenches and you have this very lengthy period of trench warfare unfolding in World War I. Conditions are pretty dismal.

[75] Health conditions, of course, are terrible.

[76] From the virus's perspective, of course, this is actually ideal conditions to spread and grow and mutate.

[77] Exactly.

[78] Not only do you have a number of people far too many close together.

[79] We know now that social distancing is the best thing we can do to prevent the virus's spread.

[80] But in 1918, you have large numbers of people, both in training camps and then on the battlefields themselves.

[81] And these are often people with compromised health already.

[82] They're living in horrible conditions.

[83] They may be undernourished.

[84] They're certainly not sleeping well.

[85] And so you have a large population that is simply an easy field in a sense for this virus.

[86] So the chronology here is that early in 1918, perhaps with the epicenter at Camp Funston, the virus starts to spread in the United States, primarily following the paths of soldiers.

[87] It goes to Europe.

[88] It mutates.

[89] It changes.

[90] It becomes more deadly.

[91] And then something really dramatic happens that August and in the fall of 1918.

[92] What happens, Nancy?

[93] Well, it's really an explosive moment.

[94] The virus emerges in this new form on three continents, almost simultaneously.

[95] in Freetown, Sierra Leone, in Brest, France, and in Boston here in the United States, where it arrives on August 27th.

[96] And then over the course of just two months, by the end of October, the entire United States will be a wash in disease.

[97] From Buffalo to Birmingham, from Pittsburgh to Portland, no one will be able to hide from this illness.

[98] And the same thing is happening worldwide.

[99] And of course, the picture you've painted is that the virus, having mutated and become in some ways more deadly in Europe, when it returns to the United States, presumably it's much more dangerous now?

[100] That's exactly right.

[101] At this point, it is both very, very contagious and also deadly.

[102] Probably about 28 % of Americans will be sickened by the virus, and in the end, as I mentioned, 675 ,000 people in the United States will die.

[103] The morbidity rates in the United States will range in different communities, sometimes as high as 40%.

[104] The mortality rate is also very high.

[105] between 2 and 2 .5%.

[106] To put that in perspective, seasonal influenza is at 0 .1%.

[107] So this is something like 25 times as lethal as regular seasonal influenza.

[108] So the second wave of the influenza epidemic runs through the fall of 1918, and as you've described, it's truly devastating.

[109] And then, almost incredibly, there is a third wave of the epidemic that strikes early in 1919.

[110] What happens here, Nancy.

[111] It's horrific for communities in many cases that are just coming off the second wave.

[112] Perhaps they've just reopened their schools.

[113] Stores are open again.

[114] Perhaps movie theaters and saloons are up and running once again.

[115] And then people begin to sicken all over again.

[116] And they suffer through a third wave, again, this time quite noticeable because Americans are on high alert, having just recovered from, or in some cases still in the throes of the second wave.

[117] So again, people are just beginning to breathe again, just beginning to relax, and suddenly the disease is back.

[118] Debt from influenza outbreaks tend to have what you call a U -shaped curve when it comes to the age of its victims.

[119] Most victims are very young children, very old people.

[120] Was that the case with the 1918 -19 -19 -epidemic?

[121] This was something else that made this particularly horrific.

[122] In 1918, the mortality chart had a W -shape.

[123] In other words, those between the ages of 20 and 40 were particularly susceptible.

[124] And so in fact, almost 50 % of the epidemic deaths in the United States were 20 to 40 -year -olds.

[125] The very people who are the mothers and fathers of young children, they may be the teachers in schools, they're the firefighters and the police officers, they're the people who are in a sense the guts of a society, the people who are keeping a place up and running.

[126] And that population was struck desperately by this particular virus.

[127] I'm wondering if this might be partly connected to the chronology that you unfolded a few moments ago.

[128] When the virus essentially traveled from the United States to Europe and spread in the theater of World War I, its primary victims were people, again, in the prime of their lives, young men in their 20s and 30s, and obviously for the virus to essentially acquire a foothold in the trenches required the virus to mutate so that it would be effective among people in their 20s and 30s, which might explain why when it returned to the United States, the victims were not just the very young and the very old, but people in working -age people, often in the prime of their lives.

[129] That's a really interesting theory.

[130] Not being an epidemiologist, I won't go too far on this, but certainly the war played a fundamental role in furthering the virus, in facilitating its mutation, and the opportunity provided by all of those soldiers.

[131] again, really was the groundwork laid out there for the virus.

[132] So some of the best accounts of the outbreak come to us not from doctors and scientists, but from writers.

[133] Tell me the story of Catherine Porter and the novella she wrote about the 1918 influenza epidemic.

[134] This is really a remarkable novel, one of the best sources we have on the influenza pandemic, because it's told from the perspective of a patient rather than the perspective of a physician.

[135] Catherine Ann Porter was a journalist living in Denver at the time, and she wrote a novella later, years later, in the 1930s, recounting her own experience with the influenza pandemic.

[136] She had sickened, and while she was sick, her dearly beloved, a young soldier named Adam, also sickened, and he died.

[137] And when she woke up, she came back to a world that was not the one she had left, and she was really quite tortured in a sense by the loss that she suffered during the moment.

[138] the pandemic.

[139] And she gives us a full account, almost a blow -by -blow, of what it was like to go through this illness.

[140] At the very beginning, she's not quite clear on what's happening, because again, the pandemic was new.

[141] And so she talks at first about not being able to smell or see or hear.

[142] She says, I must have a fearful cold.

[143] And then she begins to talk about something much more fearful, much more frightening.

[144] This is the beginning of the end of something.

[145] Something terrible is going to happen to me. I shan't need bread and butter where I'm going.

[146] I'll will it to Chuck.

[147] He has a venerable father to buy Hooch for.

[148] I hope they let him have it.

[149] Oh, Adam, I hope I see you once more before I go under with whatever is the matter with me. And she can't control going in and out.

[150] She keeps wishing that she can come out of her dream so that she can talk to him.

[151] I have pains in my chest and my head and my heart, and they're real.

[152] I am in pain all over.

[153] And you are in such danger as I can't bear to think about.

[154] And why can we not save each other?

[155] And at this point, she's not actually able to see Adam.

[156] He's been called back to camp.

[157] And by the time he tries to return to her in the novella, they will not allow him to see her.

[158] And so they never see each other again.

[159] And she goes off then into the delirium that was common with those who suffered deeply from this pandemic.

[160] At one point beforehand, she talks about loving to be She says to Adam, don't you love weather and the colors at different times of the day and all the sounds and noises like children screaming in the next lot and automobile horns and little bands playing in the street and the smell of food cooking?

[161] She seems to want to be alive, and then once she's really sick and goes into this very high fever and a delirium, a kind of dreamlike unconscious state, she doesn't so much give up as embrace what's coming, which for her appears to be the beauty of what comes after life, what death looks like to her when she is on the very cusp of it.

[162] So one reason that you've looked at novels and other cultural artifacts is, is that historians have noted that the great pandemic of 1918, even though it caused so many lives, was sort of quickly forgotten after the fact.

[163] Talk to me about this idea that in many ways, even though the effects of the pandemic were really horrific, it faded from public view, at least, relatively quickly.

[164] It did, and it's one of the things that I think historians have kind of puzzled over and even marveled about.

[165] Some people will simply dismiss it and say, well, this is what people do.

[166] H. L. Mankin wrote that the human mind always tries to expunge the intolerable from memory, just as it tries to conceal it while current.

[167] In fact, it seems to have been subsumed very easily under the memory of the war.

[168] It did happen concurrently initially, and the war was a much better story for the American people at this time.

[169] To remember the flu would be to admit to the lack of control that people had had over their own health.

[170] It would be to admit that the United States was not necessarily all -powerful, but was, like everywhere else in the world, subject as victims, to something beyond their control.

[171] You describe songs that have been sung about the flu, especially in the tradition of the blues.

[172] Yes.

[173] One of the rare places that we do see the story of the flu told are in blues lyrics.

[174] And I think it's because this was actually a genre that had space in it for the kind of message that this was a horrific event through which people had suffered and which left in its aftermath people lost, confused, and very frightened.

[175] Essie Jenkins had a remarkable song called the 1919 Influenza Blues.

[176] It was in 1919, yes, men and women was that with that stuff with the doctors.

[177] And another good one is Blind Willie Johnson Jesus is coming soon.

[178] And both of 19 and 18, God's sin of almighty tautzy.

[179] And both of these tell the story of people suffering and dying, and that this was really all part of God's plan, that this was God's way of speaking to the people about their having drifted from their faith or having acted in some ways that were either shameful or simply incongruous with their Christianity.

[180] When we come back, what the pandemic, what the coronavirus and the coronavirus pandemic of 2020 reveal about human nature.

[181] You're listening to Hidden Brain, and I'm Shankar Vedantam.

[182] Historian Nancy Bristow says the ferocity and virulence of the 1918 influenza pandemic caught the world by surprise.

[183] But in many ways, it shouldn't have been a surprise.

[184] The pandemic hit a world engulfed in war.

[185] We've seen how the movement of soldiers were a powerful vector for the virus, but it went deeper than that.

[186] Nancy, how did the conflict between nations change how they responded, especially when it came to taking steps to limit the spread of the virus?

[187] The war, again, really facilitated the virus's work.

[188] In the United States, for instance, President Woodrow Wilson would never, and I say never, speak publicly about the pandemic.

[189] Even as more than half a million Americans are dying of influenza, the President of the United States, refused to speak of the crisis that was underway precisely because he was worried about the war effort.

[190] He was so preoccupied with the prosecution of the war that he feared that people would lose sight of the most important business at hand, which was for the United States to win the war.

[191] I understand that this was not limited to the United States.

[192] The same thing was happening in Germany where people didn't want to communicate the idea.

[193] that the epidemic was basically going to harm Germany or undermine the war effort?

[194] That's exactly right.

[195] And of course, what we need most in the midst of a pandemic is good, sound, direct information from public health experts.

[196] And that's what many governments were fearing to share with their people.

[197] And in fact, that's how we end up with the misnomer Spanish influenza.

[198] Spain was not participating in the First World War.

[199] And so they were actually willing to share the reality of what was going on in their country quite publicly.

[200] And so there was this assumption that Spain was sick when no one else was, and people came to call it the Spanish flu.

[201] Quite unfairly, in fact, it may well have been an American flu.

[202] So I want to better understand the connections between the epidemic and human behavior by zooming in on what happened in one place, Kansas City.

[203] You write that when the second wave of the epidemic hit in the fall of 1918, this was the deadliest wave.

[204] How did the leaders of Kansas City respond?

[205] In fact, Kansas City had a relatively common response.

[206] Public health experts asked for there to be social distancing measures, and the city followed through closing public amusements and prohibiting large public gatherings.

[207] Again, that social distancing, that now is a term that's become so familiar to all of us.

[208] But as happened in many, many cities, as the numbers of people being infected would begin to slow a bit, people would relax.

[209] eventually they would overturn those requirements or those restrictions.

[210] But of course, there's another wave coming.

[211] And with the arrival of another wave, the government wants to put back in place these same kinds of public health restrictions and the people are much less compliant, much less interested in following the rules.

[212] They figure if it didn't stop it when we tried it last time, why should we bother to try it again?

[213] So there's a kind of turning away from the public health expertise precisely because the virus came back.

[214] But again, that's what viruses do.

[215] It was no failure on the part of public health that the virus could return.

[216] But it's so understandable, isn't it, which is that, you know, you're trying to follow the public health guidelines, and then the virus comes back, and you start to question how good are these guidelines, and then perhaps you follow some of the social distancing requirements that are put in place, and you do that for a couple of months, and it's difficult because schools are closed and businesses are closed, and everyone's itching to get back to normal.

[217] and then the third wave hits.

[218] And at this point, when people say, let's go back to social distancing, it's not surprising that people would say absolutely not.

[219] It's not surprising at all.

[220] And I think it's a really important idea to put out in our minds that even if we follow the social distancing practices, people will continue to sicken and people will continue to die.

[221] That doesn't mean that it's not working because those figures are going to be substantially lower than if we move forward without social distancing.

[222] But people get frustrated.

[223] Again, partly because it's really inconvenient.

[224] It is not that fun to be quarantined.

[225] It's not that fun to not be able to leave your homes.

[226] And so people are anxious to get back to regular life.

[227] And there's this suspicion that somehow, well, none of this is really working because people are still getting sick and dying.

[228] But that's not how we measure the success when we're in the midst of a deadly pandemic.

[229] So it's a really tricky thing, isn't it?

[230] Because the counterfactual, which is the number of people who might have died otherwise, that's something that a model is telling you.

[231] You have to sort of in some ways trust the math over how you're feeling at that point.

[232] That's right.

[233] And in 1918, they didn't have that mapping available to them.

[234] They couldn't look at models that would tell them how many would have died.

[235] In fact, our assumption that the social distancing worked is based on really careful research that has been done by epidemiologists and social who.

[236] historians who've looked at what took place in different communities and have been able to realize that places like Milwaukee, Wisconsin, or St. Louis, Missouri, that followed the rules and really maintained their restrictions for the longer period of time, just were more successful in keeping the death rates down.

[237] You talk about the distinction between the city of Philadelphia and you just mentioned Milwaukee.

[238] These cities had a very different response to the outbreak.

[239] Tell me what happened in those cities and then what the outcome was in terms of mortality as a result of the epidemic.

[240] In Philadelphia, they have a somewhat corrupt political situation at the time.

[241] Philadelphia's health commissioner, Wilmer Cruzen, decides that even though the disease was spreading, that the war was important and he'd allow the fourth Liberty Loan parade and event to take place on September 28th.

[242] At this point, we're already a month into its having arrived in the United States.

[243] Some 200 ,000 people showed up.

[244] for that march.

[245] And by the end of the flu season, in fact, some 12 ,000 residents in Philadelphia had died.

[246] Now, in some other cities, they moved much more quickly, they prohibited those parades, and they were, in fact, able to cut the death rate in some cases by half.

[247] Was it partly because the residents in places like Milwaukee were much more cooperative, much more likely to listen to public health officials?

[248] That's part of it.

[249] In Milwaukee, they have a very well -established health board.

[250] and Health Commission.

[251] They're very familiar.

[252] This is a city that has during the progressive era really embraced the idea of experts and the possibilities of reforming our communities and moving towards healthier, cleaner, safer lives by way of following sort of what science can teach us.

[253] And so Milwaukee had a very robust public health system.

[254] People were familiar with it.

[255] And in turn, because they had a good health board in place, they were able, I think, politically to do the work that needed to be done, to get those restrictions in place, to keep them in place for the longer period.

[256] And in fact, do more things.

[257] In Milwaukee, for instance, they use quarantining as well as closing spaces, prohibiting meetings, and asking about the possibilities of public masking.

[258] They went all the way to enforcing quarantine as well.

[259] It really speaks to the importance of public institutions and the trust that people have in those institutions when catastrophe strikes, doesn't it?

[260] Absolutely.

[261] And that's one of the things I worry about right now is the faith in government is a little bit shakier in 2020, and it's going to be very important as we go forward to listen carefully to those public health leaders, in particular, the experts who really know what they're talking about.

[262] And in 1918, in those communities where people did that, it really did make a difference.

[263] You describe how in Roanoke, Virginia, people with mild cases of the flu or people who had had the flu and recovered decided that quarantines really weren't for them anymore.

[264] And this is, again, totally understandable.

[265] People were starting to chafe after a few days or a few weeks of enforced, you know, restrictions.

[266] And they said, all right, I've sort of come out the other side.

[267] I'm fine.

[268] I can go about my daily business.

[269] Again, completely human, but potentially really dangerous.

[270] Very dangerous not only for the individual who may have a relapse, may not in fact be fully healthy yet, but also for those around them.

[271] Their families would become ill or those whose shops they went to, the people who might sit next to them in a movie theater.

[272] So extraordinarily dangerous to assume that one is healthy before one is verifiably over these illnesses, because you can continue to shed the virus even after you begin to feel healthy.

[273] I want to be cautious about one point.

[274] You know, when we hear about Roanoke or the difference between Philadelphia and Milwaukee, you know, we know the people in Roanoke who are breaking quarantine were making a mistake.

[275] We know that Milwaukee got it right and Philadelphia got it wrong.

[276] But in some ways, Nancy, I'm wondering if we know this because we know now how the pandemic turned out.

[277] We have the advantage of hindsight.

[278] There have probably been dozens of other disease outbreaks where the Philadelphia response might have been just fine.

[279] What I'm trying to get at is that there are huge social and economic consequences from shutting down schools and businesses, and those can harm people's lives too.

[280] And I guess what I'm trying to say is that policymakers, when something is unfolding, when an epidemic is unfolding, it's really difficult to actually know exactly what the right thing is to do because there are potentially devastating consequences regardless of which choice you pursue.

[281] That's so true.

[282] And it's one of the things I was worrying about on my way into work this very morning.

[283] were closing schools, those hundreds of thousands of children who rely on school, breakfast, lunch, and in some cases, even dinner.

[284] So policymakers in 1918 did not have the benefit of hindsight that we have as we look back at them.

[285] So you're right that in some ways the critique of the policymakers really does have to be softened a bit.

[286] In many cases, they really were doing the best they could.

[287] Now, in some cases, I think we have corrupt politicians in some communities that are really thinking more about their political futures than the health of their communities.

[288] In those cases, I think it is a little easier to point a finger.

[289] But again and again and again, we have to remember how difficult this is when you don't know where the pandemic is going.

[290] And that is something that I think I've never understood as well as I have in the last week.

[291] I'm wondering if one of the deeper lessons here is not so much that some people were right and some people were wrong, but that, you know, as the catastrophe was unfolding, many people really didn't change their behavior.

[292] It's really difficult to get people to change their behavior for any length of time.

[293] That's right.

[294] And in 1918, we have to remember that the notion of germ theory had certainly caught on and was certainly fully embraced by the vast majority of health providers.

[295] But for the general public, there were still a lot of questions out there about how disease was transmitted.

[296] So the idea that washing your hands was important or that you wouldn't all drink out of the same drinking cup was relatively foreign for some people.

[297] In fact, it's during this pandemic that most American cities finally ban the common drinking cup at places where people would gather to get water.

[298] So again, it was hard for people because on the one hand it's inconvenient and on the other they were asking for new habits, things that they had always been allowed to do before and suddenly you're not allowed, for instance, to spit on the street.

[299] to share a drinking cup, that you had to cover your cough and sneeze in your elbow.

[300] These were new things people were being asked to do in 1918.

[301] One of the things I found really interesting is that you cite a number of letters in your book.

[302] These were letters written during the time of the 1918 pandemic.

[303] One of them was written by the avatrix, Amelia Earhart.

[304] Others were written by men.

[305] What did these letters say?

[306] And what do they reveal?

[307] It's very interesting, the ways in which the reactions to the pandemic, were actually somewhat gendered, we find that in the midst of this catastrophe, as people are wrestling with something so new to them, that there's a great deal of sort of looking for security in how things are commonly done, in grabbing hold of our traditional patterns and behaviors.

[308] And so for women, it was much more common for them in their letters to talk about what they were seeing, how frightened they were, giving detailed outlines of who in the family or who in the friend groups.

[309] were ill and what was going on and really admitting up front how frightening it all was.

[310] And again, it feels so typical because you sort of see some of the same things happening today.

[311] I feel like you have people reacting in fairly predictable ways.

[312] Some people saying we really have to be anxious and other people saying, nah, it's going to blow over in a couple of weeks.

[313] I think that's right.

[314] What's interesting is the ways in which in 1918 it is so profoundly about being male and female so that someone as well -known, known as Amelia Earhart, as she will become known, right, as a great avatrix, said of the flu, I hate and fear it somehow more than a little.

[315] Having seen so much of it, I suppose, has prejudiced me with the very uncertainty of treatment adding to the prejudice.

[316] She was working in an influenza ward, knew what it looked like, and was sharing this with one of her dear friends.

[317] And meanwhile, men are worrying about not getting into the office and sending notes to one another, apologizing for missing another day of work in the midst of the war.

[318] You also note how gender in the form of social norms played a very powerful role.

[319] You interviewed a survivor of the 1980 epidemic when she was 85 years old.

[320] Can you tell me the story of Lillian Kansianich?

[321] I can.

[322] This is a lovely woman lived in Tacoma when I interviewed her several years ago, and she had lost her mother when she was only three months old.

[323] And in her community, it was felt that men shouldn't live alone.

[324] with daughters, that they could not adequately raise children on their own.

[325] And so she and her sister were sent away, her sister to live some ways away with family.

[326] And Lillian was actually traded between members of the family for a couple of years before she finally was able to move in to a permanent situation with relatives in the same town as her father.

[327] But she remembered for the rest of her life that this had cost her something.

[328] She didn't remember her mother, but she remembered that she was somehow different from others.

[329] She knew that she and her sister had lost valuable years together during their youth, and she felt that her life had been changed.

[330] She said that it had changed my life completely.

[331] It had to.

[332] At one level, a virus is a biological organism.

[333] It's a creature of natural selection.

[334] It follows rules that have been studied for decades by epidemiologists.

[335] But at another level, a virus is a social organism.

[336] It detects fissures in societies and exposes fault lines between communities.

[337] That's when we come back.

[338] I'm Shankar Vedantam, and you're listening to Hidden Brain.

[339] Nancy Bristow is the author of American Pandemic, The Lost Worlds of the 1918 Influenza Epidemic.

[340] She has studied the lessons of the deadly outbreak a century ago, and she sees historical parallels with our own battle against the coronavirus.

[341] Nancy, you describe how the Red Cross once went into a world.

[342] a rural and disadvantaged part of Kentucky to help residents affected by the 1918 epidemic.

[343] How did volunteers relate to the patients?

[344] Well, in the case of Kentucky, not very well.

[345] As was common often with visiting nurses, as they would enter homes or communities that were not like their own middle class upbringing, they would look down their noses somewhat disparagingly at the conditions that they found.

[346] And in the case of Kentucky would say terrible things, in fact.

[347] They talked about them being desperately poor, but they would also go on to say things like they were ignorant of the simplest principles of sanitation and hygiene, that they were living in crowded quarters, and they would almost make it seem as if the poor were responsible, in fact, for their own situation and that they were in fact causing the very epidemic conditions from which they were reeling.

[348] You would imagine it would be difficult for the volunteers to truly play a helping role when they had such attitudes about the people they were trying to help.

[349] I think that's right.

[350] In some cases, they could be useful, and it was usually, I think, especially those who had a much more compassionate and empathetic approach to those who were not just like them, who could enter a home and recognize that the reason it was dirty was because both parents were working.

[351] The reason that there wasn't as much clothing or as clean of clothing was because the family was strapped.

[352] The reason it was cold was because perhaps they couldn't afford to buy coal.

[353] And so, again, those who could recognize difference as coming not from innate human lacking, but rather from circumstance, from actual social conditions.

[354] Those were the people, I think, who had the most opportunity to facilitate good health and to actually help people move forward out of this pandemic towards health.

[355] How did these class divisions and class attitudes shape the way people reached out to others in terms of charitable donations, in terms of being willing to extend a helping hand?

[356] Did people in general, in the public, see the poor?

[357] is essentially being somehow responsible for their illnesses?

[358] At this time, there really was a lot of distinguishing by those in the middle and upper classes that among the poor, there were those who were worthy and those who were not.

[359] And to be worthy meant a few very particular things.

[360] One, it meant that everyone in the household was working.

[361] In other words, if you're going to pull yourself up by your bootstraps, everybody better be helping with the pull.

[362] In other cases, if families didn't adhere to certain American traditions, they might have have a different spiritual system.

[363] They may have come from a different part of the world and not speak English yet.

[364] Anything that made them seem somehow different would also sometimes categorize people as the other, in a sense, and make them somehow more suspicious, not quite as, quote, worthy of the kind of care that charitable organizations were happy to give to some people.

[365] I'm thinking of some of the fissures that are already emerging in the present day in the United States in the context of the coronavirus.

[366] You know, if you're a white -collar worker who can work from home on your computer, it's an inconvenience to stay home, but it's not really devastating to you.

[367] You're still getting paid.

[368] You still have your health benefits.

[369] But if you're an hourly worker, a gig economy worker, a contractor without health insurance, this can actually be a disaster.

[370] That's exactly right.

[371] And it was true in 1918 as well.

[372] The Associated Charities of Minneapolis worked with a family listed only as the, quote, D family.

[373] But they tell this story of a man who had done everything right.

[374] had been working hard and then was stricken by the pandemic.

[375] By the time they reported in for charitable aid, they already needed groceries.

[376] They'd used all of the money that they had saved.

[377] He was trying to return but was too sick.

[378] His children were getting ill. And by the time they visited his home, they were absolutely without coal.

[379] He borrowed a pailful from a woman downstairs from his apartment.

[380] The groceries were completely gone and he could not get any credit at the grocery store.

[381] At this point, Mr. D, as they refer to him, simply broke down and cried, saying everything was against him.

[382] It wasn't his fault.

[383] His problems didn't originate, in fact, with the epidemic, but in his insecure situation, which was then made much worse by the bout with influenza.

[384] And I fear we're going to be seeing the exact same thing right now.

[385] Native Americans have long been affected by infectious outbreaks in a way that's often different than white people in the United States.

[386] And you tell the story in the book of a young girl, named Edith Potter.

[387] Tell me her story, Nancy.

[388] Edith Potter was a young woman from California, and her father had passed away.

[389] They were living on a reservation in California, and her mother decided to send her off to Salem, Oregon to the Chamawa Indian School.

[390] She arrived there on September 12th, and not long after, when the pandemic hit, she would become sick.

[391] On September 18th, they first noticed that she's sick and send a notice to her mother by way of the Indian agency to please advise her that your daughter has a very bad case of the grip, but was in no danger as yet.

[392] She was just one of some 500 cases of Spanish influenza suffered by the kids at the Chamawa Indian school that fall.

[393] And her case was one of those that was deadly.

[394] Within two days, a final telegram would go to her mother saying that everything possible was being done for her, but the next day she would die.

[395] Her mother wanted desperately to bring her home to do proper burial of her, according to her own traditions.

[396] But every effort of her mother to have her daughter's body returned were, of course, met dead ends in the midst of a pandemic.

[397] And so she was left without her daughter and even without her daughter's body.

[398] Even the next year, she would attempt to bring her daughter home.

[399] And it was said that it was simply too unlikely, it would be foolish to take it up at the present time, the superintendent told her.

[400] I'm wondering, you know, when I'm thinking about the present moment, how this might play out here where people, you know, you talk about sort of the mortality rate of the coronavirus.

[401] But that mortality rate is likely to be very different in different places, is it not?

[402] I mean, if you're wealthy, if you're living in a part of the country that has excellent medical care, if you have access to health insurance, your mortality rate is likely to look very different than somebody who is poor or living in a rural part of the country or living in a part of the country where they don't have access to health care.

[403] I think that's right.

[404] And again, I'm not an epidemiologist, nor am I a physician, but it seems that this particular crisis with COVID -19, it is going to matter who has access to health care.

[405] For instance, the availability of a ventilator is going to be really crucial for those in really critical condition, so that there's going to be a really inequitable landing of this virus and of this illness, depending on one's social position, one's economic position, one's place in the racial hierarchy of the country.

[406] all of these things will be playing out, I fear, as people have inequitable access to health care.

[407] You mentioned the racial hierarchy a second ago, and of course this was true in 1918 as well.

[408] You tell the story of how in Richmond African Americans were allowed access to a hospital where whites were being treated, but there was a catch.

[409] Yes, they could certainly visit this new emergency hospital at John Marshall High School.

[410] The problem is that they were only allowed to be treated in the basement, where a separate, space had been opened up.

[411] And was the treatment quality different in the basement than it was in the main hospital?

[412] One has only to imagine.

[413] I have no way of knowing for certain, but again, we know that segregation had made two very distinct health systems and African Americans were routinely under -treated.

[414] In 1915, the life expectancy for white Americans was 55 .1.

[415] While for African Americans, it was only 38 .9 years.

[416] So a huge differential in life expectancy prior to the pandemic.

[417] So we certainly have to assume that in the midst of the pandemic, the kind of care that was creating that differential was also happening.

[418] What's odd in 1918 is that there's no evidence necessarily that access to health care changed the death rate particularly.

[419] It certainly changed how comfortable people were, however.

[420] I understand that some black pastures offered sermons that use the 1918 outbreak as a way to argue for social justice and social change.

[421] That's right.

[422] There were those who resisted this clinging to the status quo who saw in the epidemic actually an opportunity to shake up the hierarchies, to call out that which was unjust.

[423] My favorite example of this was the Reverend Francis Grimke.

[424] He was an important advocate for African -American rights.

[425] and worked at the 15th Street Presbyterian Church in Washington, D .C., his church.

[426] And he really believed that God was trying to awaken Americans to the sacrilege of the caste system.

[427] He said, what ought it to mean to us, this pandemic?

[428] Every part of the land has felt its deadly touch, north, south, east, and west, in the army, in the Navy, among civilians, among all classes and conditions, rich and poor, high and low, white and black.

[429] And he concluded, God has been trying in a very pronouncedly, conspicuously, vigorous way to beat a little sense into the white man's head has been trying to show him the folly of the empty conceit of his vaunted race superiority by dealing with him just as he dealt with the people of darker hue.

[430] He was convinced that the epidemic scourge was actually God's work and he was trying in a sense as he said it to teach the white man the quote folly of his stupid color prejudice end quote.

[431] One of the things that strikes me as you're describing these various responses is how little people actually changed from what they believed or thought before the outbreak began.

[432] And what I mean by that is, if you're a black pastor and you're advocating against white supremacy, the outbreak becomes a mechanism for you to argue against white supremacy.

[433] If you're fairly high up in the class hierarchy and you look down on poor people, the outbreak becomes a vehicle for you to express your class prejudice.

[434] If you're interested in prosecuting a war, then the virus becomes a way for you to say, you know, fighting the virus is a way to win the war.

[435] And I'm seeing actually some curious parallels with the present moment as well, which is as soon as the coronavirus outbreak began, you saw people from different parts of the political spectrum, different interest groups, all sort of essentially using the outbreak to basically say, Look, the point of view that I had before this actually happened, all this does is confirm everything that I believe to be true.

[436] I'm afraid that's what I'm seeing as well, whether it's the xenophobia that we saw expressed against people who appeared to be of Asian descent or this willingness to say that actually we have everything in hand because our government knows what it's doing, these kinds of tendencies to simply rely on what we already believe is not actually going to help us.

[437] us effectively manage what is not just a national crisis, but an international crisis.

[438] For Americans, many of whom I fear, think of us as somehow exceptional.

[439] This is a moment to step away from that kind of belief and to recognize ourselves as citizens, in fact, of a world that is wrestling with this pandemic.

[440] And my hope is that maybe this time around we can be a bit more sensitive, a bit more culturally aware and perhaps embrace that sort of world citizenship because that's the route, I think, to handling this scourge in the most effective way.

[441] Nancy Bristow is a historian at the University of Puget Sound.

[442] She's the author of American Pandemic, The Lost Worlds of the 1918 influenza epidemic.

[443] Nancy, thank you for joining me today on Hidden Brain.

[444] It's been an honor and a pleasure.

[445] Thank you so much.

[446] Hidden Brain is produced by Hidden Brain Media.

[447] Our production team includes Bridget McCarthy, Kristen Wong, Laura Querell, Ryan Katz, Autumn Barnes, and Andrew Chadwick.

[448] Our executive producer is Tara Boyle.

[449] I'm Hidden Brain's executive editor.

[450] Our unsung hero this week is Kelly Rudin.

[451] I met Kelly many years ago after I finished writing my book, The Hidden Brain.

[452] Kelly eventually began working with me to help coordinate speaking events.

[453] She's invariably thoughtful, organized, and kind, and gently pings me on.

[454] on my cell phone to remind me of something I need to do or somewhere I need to be.

[455] She has saved me on a number of occasions, for which I'm truly grateful.

[456] Thank you, Kelly.

[457] If you'd like more stories that build on our podcast, be sure to check out our newsletter.

[458] You can also find out what I and the other members of the team are reading and thinking about, and we always end the newsletter with a moment of joy.

[459] You can subscribe at news.

[460] that's n -wes .hiddenbrain .org.

[461] That's n -w -s.

[462] dot hiddenbrain .org.

[463] I'm Shankar Vedantam.

[464] See you next week.