Coronavirus and the Spanish flu: A historian reflects on key lessons

“We have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.”

That was President Trump’s response when asked by a CNBC reporter on January 22 whether he was worried about the coronavirus. Almost two months later, with the threat too large to ignore, the president’s tone has shifted dramatically (even as his press briefings continue to be models of incoherence and inaccuracy).

The contradictory messages about the virus, and the dishonesty motivating them, is dangerous right now. Refusing to tell people the truth will cost lives because it undercuts our efforts to flatten the epidemic curve with practices like social distancing. It also erodes the public’s trust in government — and that’s a huge problem.

The biggest lesson of the 1918 influenza epidemic, according to historian John M. Barry, is that leaders have to tell the truth, no matter how hard it is to hear. Barry, who wrote an influential book on the 1918 pandemic, says that lying about the severity of the crisis in 1918 created more fear and more isolation and more suffering for everyone.

“Trust in authority disintegrated, and at its core, society is based on trust,” Barry wrote in a recent New York Times column. “Not knowing whom or what to believe, people also lost trust in one another. They became alienated, isolated. Intimacy was destroyed.”

I spoke to Barry by phone about the costs of lying to the public in 1918, if he thinks we’re repeating the mistakes the government made back then, and how leaders should balance the tension between telling people what they need to know and trying not to induce mass panic.

A lightly edited transcript of our conversation follows.

Sean Illing

Is the coronavirus the closest thing you’ve seen to the 1918 influenza pandemic in your lifetime?

John M. Barry

Nothing else even begins to approach it. At the beginning of the 2009 H1N1 outbreak, there were real fears that it could be bad, but of course it turned out to be fairly mild. If it weren’t for molecular biology, it would never have been noticed at all. So nothing we’ve seen since 1918 even comes close to what’s happening. If this is merely a once-in-a-generation virus, we’ll be lucky.

Sean Illing

How is our situation today different from the situation we faced in 1918?

John M. Barry

The biggest difference is the target demographic. In 1918, the overwhelming majority of people who died were 18 to 45. Maybe two-thirds of the deaths were roughly in that age group. Back in 1918, well over 90 percent of the excess mortality was in people younger than 65. So obviously the elderly in 1918 had experienced a mild virus in their youth that was close enough to the 1918 virus that they had a lot of protection against it from natural immunity.

Another difference is the incubation rate. Influenza’s average incubation rate was two days, almost never longer than four. The average for the coronavirus is more than twice as long and can stretch quite a bit longer than that, which is both a good and bad thing. The good thing is it allows time to contact, trace, isolate, and things like that, which was almost impossible during the influenza epidemic. The bad thing is that that means this virus may stretch out over a much longer period of time and infect more people. It seems to be considerably more contagious than influenza.

Here’s one positive difference: Despite the contagiousness of this, the case fatality rate seems much lower than the 1918 influenza. The fatality rate in 1918, in the West at least, was about 2 percent. In other parts of the world it was much, much higher. Something like 7 percent of Iran’s entire population died. Perhaps as much as 5 percent of Mexico’s population died. [Author’s note: There’s some scholarly debate about the actual fatality rate of the 1918 flu.]

That’s how we ended up with 50 to 100 million total deaths in 1918.

Sean Illing

What would you say was the biggest, most consequential mistake made in 1918 — by governments, by local communities, by individuals?

John M. Barry

The government lied. They lied about everything. We were at war and they lied because they didn’t want to upend the war effort. You had public health leaders telling people this was just the ordinary flu by another name. They simply didn’t tell the people the truth about what was happening.

Sean Illing

How long did it take for reality to explode those lies?

John M. Barry

Not long. People noticed pretty quickly what was up when their neighbors started dying 24 hours after symptoms first appeared. People were in the streets bleeding out of their noses, bleeding out of their mouths, bleeding out of their eyes and ears. It was horrific. Everyone understood very quickly that this was not an ordinary flu.

Sean Illing

And what were the consequences of all that lying?

John M. Barry

It was a disaster. People lost faith in everything — in their government, in what they were being told, in each other. It just isolated people even further. If trust collapses, then it becomes everyone for themselves, and that’s the worst instinct in a crisis of this scale.

In most disasters, communities come together. And that was the case in some places and cities where the largest social structures were fraying. But in my book, I wrote about the gradual disintegration of trust at every level of society and cascade of breakdowns that resulted from it.

But there were also practical consequences. For example, the lack of trust made it harder to implement critical public health measures in a timely way, because people just didn’t believe what they were being told. And by the time the government was forced to be transparent about the situation, it was mostly too late. The virus was already widely disseminated.

So the lying and the lack of trust cost a lot of lives.

Sean Illing

You quote a scientist at the time who said we were a few weeks away from civilization “disappearing from the face of the earth.” How bad did it get on the ground?

John M. Barry

Bad. Some places managed much better than others, of course. But the Red Cross reported instances of people starving to death in rural communities because everybody was afraid to bring them food — the panic and the fear was that intense. It stretched society to the absolute brink.

Sean Illing

After researching the 1918 pandemic, how do you think about this difficult tension between telling the public what they need to know and trying not to induce mass panic?

John M. Barry

Well, that’s always the question. I don’t have scientific studies confirming that I’m right, but my own view is that people can deal with reality and the truth a lot better than they can deal with the uncertainty. If you’re watching a horror movie, your imagination always makes the monster more scary. Once the monster appears onscreen, no matter how horrible, it’s less scary once it’s concrete.

This is why I hate the phrase “risk communication,” because it implies managing the truth. In my view, you don’t manage the truth. You tell the truth.

Sean Illing

President Trump’s initial response to this crisis was to downplay its seriousness, dismissing criticisms as a “hoax.” Fox News continued to downplay it until fairly recently. I think everyone’s tone has basically shifted at this point, but did these early missteps cost us dearly?

John M. Barry

Absolutely. There’s no question whatsoever that it cost us. And the bizarre thing is that it was always in Trump’s self-interest to be candid. There’s no doubt he was being told the cold, hard truth about the situation behind closed doors. But he minimized it publicly, and that cost us in ways we can’t really quantify yet.

Sean Illing

How does our collective response to this moment measure up to the response in 1918?

John M. Barry

Well, in 1918, you couldn’t really say there was a collective response. It varied so much from city to city. But, look, we had people here essentially saying this virus was a Democratic plot to undermine the presidency. Nobody’s saying that now, of course. But it remains an open question whether we will collectively meet this challenge. We’re only at the beginning of this thing.

We’ve botched the early testing, and it’s not clear the public has responded seriously enough to the calls for social distancing. But things are changing quickly. What the public does moving forward, how much it complies with the recommendations of public health experts, is going to determine how bad this gets and how fast. Countries like South Korea have managed to beat this back pretty effectively. I don’t know if we’ll have the same success.

It’s just too early.

Source link

Leave a Reply