They were energized, just as the scientific community today is energized and extremely focused, but they did not know what the pathogen was. They developed vaccines, but they were aimed at the wrong targets, although many people — probably most people who died — died of secondary bacterial pneumonia following influenza. Even today, that's got a case fatality rate of eight percent when it follows influenza, because influenza does so many things to your immune system which make bacterial pneumonia more dangerous.
They did develop vaccines against several bacterial pneumonias. If you get a vaccination against pneumococcus today, that's a straight-line descendant of what was developed in 1918. They tried convalescent serum, of course, which we're trying today. But there wasn't a lot they could do. Basically, all they could do was supportive care. Of course, they didn't have the tools that a modern ICU unit has, so the supportive care was much less than can be given today. They could not even administer oxygen, at least not in the ways where we're doing it today. Forget about ventilators.
In terms of the public health measures, eventually — but in most places, too late — cities issued closing orders and advised social distancing. By that time they didn't really have to advise social distancing, because people were pretty terrified and kept away from each other.
OR: Woodrow Wilson himself suffered from it — how does the response to that fit in with the propagandistic approach of public officials you just described?
Barry: Wilson did not get sick until April in Paris during the peace negotiations. Wilson was so focused on the war, he never even issued a public statement about the pandemic. Not one, never. But he did get sick in Paris. I think it had consequential repercussions. Well noted at the time, every scientific assessment summary after the pandemic concluded that second only to pulmonary problems, the disease affected the mind. Wilson was disoriented. Everyone around him commented on his inability to focus, his lack of mental sharpness, that he was nothing like what he had been. Prior to his getting the disease, he had been adamant in the peace negotiations that the principles he had articulated as reasons why the U.S. was entering the war be incorporated into the peace treaty. He got sick, as I said, in the middle of the negotiations. Some of the negotiations actually occurred in his sick room with the British and French heads of state, and he caved in. Clemenceau, the French prime minister, was nicknamed “the Tiger.” Here is Wilson, mentally disoriented, unable to focus, physically weakened and tired out by the disease, trying to negotiate with the Tiger. The Tiger won and got the peace treaty the French wanted. The only thing Wilson got out of it was the League of Nations.
It's conceivable that he would have caved in on everything to get the League of Nations, even if he had remained well. We don't know for sure. But he did get sick. He was disoriented. His mind was affected. He was physically weaker, and he caved in, to the great distress of many people in the U.S. peace delegation. In fact, quite a group of his young aides, about ten or so, met in secret, including two people who subsequently became Secretary of State and others who became Assistant Secretaries of State. Walter Lippmann and Lincoln Steffens were also among this group of young aides. They all debated whether they were going to resign in protest, and a couple of them did resign. Others did not, but they were all enormously discouraged and disgusted by what Wilson had given away. John Maynard Keynes called Wilson "the greatest fraud on earth" afterwards.
OR: There are paradigmatic case studies coming out of Philadelphia and out of St. Louis that demonstrate the very different approaches of those cities. Can you talk a bit about those?
Barry: Philly was archetypal, in terms of lying to the public and not doing much. They had a Liberty Loan parade on September 28th. But by then, in Philadelphia, the disease was circulating. The medical community urged the health commissioner and the mayor to cancel the parade. They refused. This was patriotic. They had to help support the war effort. It's a huge parade. Hundreds of thousands of people pressed close together. Like clockwork, 48 hours to 72 hours later, the disease just exploded in Philadelphia. It was not until after that in Philadelphia, quite a while after that, that they finally closed schools, banned public gatherings, and so forth. In fact, to illustrate just how there was fake news back then — because the news media was complicit with the government in trying to promote morale and not saying anything negative — after the city finally issued these closing orders, with people dying all over the city, one of the newspapers actually said the closing orders "are not a public health measure. You have no reason for panic or alarm." Of course, everybody knew that was a lie.
In St. Louis, by contrast, the public health commissioner had some power and exercised it, or at least convinced the mayor to go along. They did close down. In the phrase we use today, they did succeed in flattening the curve. The healthcare system in St. Louis was not overwhelmed. So you compare the curve in Philadelphia — a very steep peak and a more gradual drop off — with the curve in St. Louis — there's a much, much flatter peak, and it lasts a lot longer. This is what we're trying to accomplish with our public health measures today.
OR: What were the economic ramifications of the pandemic, and why do you think it is such an underdiscussed subject in mainstream history given its massive death toll?
Barry: For clarity here: the death numbers now are generally considered 50 to 100 million, although there are some people who think it was less than that. In terms of why it hadn't been written about, I think historians, until maybe 30 years or so ago, tended to only write about what people did to people and ignored what nature did to people, as a general rule. There were some exceptions. In fact, I would recommend one of my favorite books. It’s by a Nobel Laureate, Macfarlane Burnet — the first person to come up with the 50 to 100 million estimate. He wrote The Natural History of Infectious Disease. It's a great book. Probably out of print. There's also a very good book called America's Forgotten Pandemic by Alfred Crosby, who's a terrific historian. So the bigger question is: how come there's so little in literature about it? That, I don't understand. John Dos Passos is one of my favorite writers. He got influenza himself on a troop ship, which was like a floating coffin, on his way to Europe, and he barely mentioned influenza in his entire body of work. I don't have an explanation for that.