John M. Barry: 'The Great Influenza'

A lot has happened in the last month as COVID-19 has spread from China to the world and roiled financial markets.

I like to turn to history to better understand the present and map the future.

I've typed up some notes from “The Great Influenza” by John M. Barry, an account of the 1918-1920 influenza pandemic, which I hope will give readers another mental model with which to assess the current situation.  That pandemic killed an estimated 35-100m people, more in absolute terms than any other outbreak in history. It had three waves, spread over a period of roughly 18 months.  The second wave was the most lethal and young adults were just as affected as the rest of the population, if not more so.  The poor were worst hit, and poor countries worst of all. Ultimately, the pandemic burned out naturally when the surviving population developed some immunity and the virus eventually mutated into a less lethal form, i.e. it did not end when a vaccince was produced.

Notes - "The Great Influenza" by John M. Barry

Several factors seem to have exacerbated the pandemic, at least in the United States (on which the book focuses):

• Cities and barracks were crowded and unclean;

• News of the pandemic was initially suppressed to protect morale and the war effort;

• Despite some local quarantine efforts, the virus continued to circulate throughout the pandemic as troops moved around the country and the world;

• Public health institutions were inadequate and quickly overwhelmed;

• The scientific community’s response was misdirected by the specious hypothesis that influenza was a bacterial infection, not an (airborne) viral one;

• Antibiotics had not yet been discovered and so were unavailable to treat secondary infections; and

• There was virtually no policy intervention or fiscal support from the federal government.

How does this help us navigate today’s pandemic? On the one hand, we are acting radically different: there has already been a rapid and massive response by society, governments and medical scientists around the world. Better late than never.

But on the other hand, the odds of a large scale loss of life and protracted global recession seem high given how far the virus has already spread and the way shut-downs are bringing economies to a halt. I also think the assumption that this lasts just two months is too optimistic given how the previous episode struck in three waves.

I am sorry about what is likely going to happen in the next few weeks in Europe, North America and elsewhere. Hope you all are safe and keeping yourselves isolated as much as possible.