[Previous] Discussion About Epistemology with doubtingthomas | Home | [Next] Apple Discussion

Comments on Prologue of The Great Influenza

The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry (2004) is about the 1918 flu. I started reading it today after enjoying his 2017 article How the Horrific 1918 Flu Spread Across America. Here are quotes and comments on the prologue:

In 1918 an influenza virus emerged—probably in the United States—that would spread around the world, and one of its earliest appearances in lethal form came in Philadelphia. Before that worldwide pandemic faded away in 1920, it would kill more people than any other outbreak of disease in human history. Plague in the 1300s killed a far larger proportion of the population—more than one-quarter of Europe—but in raw numbers influenza killed more than plague then, more than AIDS today.

The lowest estimate of the pandemic’s worldwide death toll is twenty-one million,

He says 21m is a bad estimate, the truth is likely more like 50m and could be 100m. And the world population was 1/3 as much back then as today.

And that this underestates how bad it was b/c it killed young adults, not just elderly and babies like the flu usually mostly kills. Roughly half of deaths were people aged 20-39.

Young adults dying is worse than the elderly dying because more future years of life are lost. Babies dying is also better than young adults because not many resources have been invested in a baby yet. (This paragraph is my own blunt comments, which are not representative of the book.)

And they died with extraordinary ferocity and speed. Although the influenza pandemic stretched over two years, perhaps two-thirds of the deaths occurred in a period of twenty-four weeks, and more than half of those deaths occurred in even less time, from mid-September to early December 1918. Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty-four weeks than AIDS has killed in twenty-four years.

Scary. And I had no idea this had happened. I'm pretty sure I'd heard the words "Spanish Flu" (misnamed) before, but had no idea what it actually was. By contrast, I've heard plenty about the black plague and AIDS.


He says it’s kinda the first time we (well a few ppl, but they had outsized impact) dealt with something like this with science instead of religion.

After humans do anything great, people think it’s dangerous and set up rules and institutions to harness, control and contain that human power. That’s what the FDA (U.S. Food and Drug Adminstration – other countries have similar agencies) now does to our medical pioneers. 100 years after the 1918 flu, with the COVID-19 threat scaring the world, I actually don't know, with confidence, that we're in a better position to face it. Yes science has advanced, but it's also more controlled now. Plus science has been mainstreamed and let in far too many mediocre social climbers and low-initiative, uncreative follower-types (too quickly, without enough cultural assimilation, and without enough requirement that they can actually achieve anything, paid for with mostly government funds with little accountability and no need for profit).

In a way, these researchers had spent much of their lives preparing for the confrontation that occurred in 1918 not only in general but, for a few of them at least, quite specifically. In every war in American history so far, disease had killed more soldiers than combat. In many wars throughout history war had spread disease.

I knew wars had a lot of non-combat deaths (from weather, malnutrition and other stuff too, besides disease) but didn't know the particular statistic that I've italicized in the quote.

Not until late—very late—in the nineteenth century, did a virtual handful of leaders of American medical science begin to plan a revolution that transformed American medicine from the most backward in the developed world into the best in the world.

William James, who was a friend of—and whose son would work for—several of these men, wrote that the collecting of a critical mass of men of genius could make a whole civilization “vibrate and shake.” These men intended to, and would, shake the world.

To do so required not only intelligence and training but real courage, the courage to relinquish all support and all authority. Or perhaps it required only recklessness.

I think Ayn Rand would have liked this even though it speaks of a small group changing the world instead of a single individual. The last sentence about recklessness shows the author's own mixed thinking: he's not really sure what side he's on or why. But he still managed to say something nice. Maybe he said it because it's true – and he knows it's true in a particular case in the field where he has detailed, expert knowledge – rather than because it's nice. (It can of course be both true and nice.)


Elliot Temple on February 28, 2020

Messages (9)

Chapter 1:

> In the South [in 1876, 11 years after the civil war ended which freed the slaves] a far more important but equally savage war was being waged as white Democrats sought “redemption” from Reconstruction in anticipation of the presidential election. Throughout the South “rifle clubs,” “saber clubs,” and “rifle teams” of former Confederates were being organized into infantry and cavalry units. Already accounts of intimidation, beatings, whippings, and murder directed against Republicans and blacks had surfaced. After the murder of three hundred black men in a single Mississippi county, one man, convinced that words from the Democrats’ own mouths would convince the world of their design, pleaded with the New York Times, “For God’s sake publish the testimony of the Democrats before the Grand Jury.”

>

> Voting returns had already begun to come in—there was no single national election day—and two months later Democrat Samuel Tilden would win the popular vote by a comfortable margin. But he would never take office as president. Instead the Republican secretary of war would threaten to “force a reversal” of the vote, federal troops with fixed bayonets would patrol Washington, and southerners would talk of reigniting the Civil War. That crisis would ultimately be resolved through an extra-constitutional special committee and a political understanding: Republicans would discard the voting returns of three states—Louisiana, Florida, South Carolina—and seize a single disputed electoral vote in Oregon to keep the presidency in the person of Rutherford B. Hayes. But they also would withdraw all federal troops from the South and cease intervening in southern affairs, leaving the Negroes there to fend for themselves.

This author doesn't seem to be an SJW know-nothing parroting that all Republicans are racists and always have been!

I'm no expert on U.S. history and am unfamiliar with the Hayes/Tilden election stuff. Comments/info welcome. I knew some stuff about racist, pro-slavery Southern Democrats from Ann Coulter and some other sources.

Also the comment about the popular vote is odd because that's not how we elect presidents.


curi at 6:35 PM on February 28, 2020 | #15681 | reply | quote

> After humans do anything great, people think it’s dangerous and set up rules and institutions to harness, control and contain that human power. That’s what the FDA (U.S. Food and Drug Adminstration – other countries have similar agencies) now does to our medical pioneers. 100 years after the 1918 flu, with the COVID-19 threat scaring the world, I actually don't know, with confidence, that we're in a better position to face it. Yes science has advanced, but it's also more controlled now. Plus science has been mainstreamed and let in far too many mediocre social climbers and low-initiative, uncreative follower-types (too quickly, without enough cultural assimilation, and without enough requirement that they can actually achieve anything, paid for with mostly government funds with little accountability and no need for profit).

Since writing that I've seen specific examples. Apparently the CDC is more of a problem than the FDA here:

https://twitter.com/toad_spotted/status/1235691794895187969

> Nurse sick and quarantined after caring for a COVID-19 patient is still *waiting for permission from the federal government to be tested* after her doctor and county health department ordered the test.

> The USA is really outdoing itself these days

> When pressed, the CDC a) pretends she couldn’t really be positive if she were wearing the proper equipment (demonstrably false given prior health care worker infections) & b) assigns her a low priority on getting tested because her illness is mild and they are rationing tests

And the nurse's statement referred to says:

https://act.nationalnursesunited.org/page/-/files/graphics/NU-Quarantine-RN-press-conf-statement.pdf

> Statement by a quarantined nurse from a northern California Kaiser facility March 5, 2020

>

> As a nurse, I’m very concerned that not enough is being done to stop the spread of the coronavirus. I know because I am currently sick and in quarantine after caring for a patient who tested positive. I’m awaiting “permission” from the federal government to allow for my testing, even after my physician and county health professional ordered it.

>

> I volunteered to be on the care team for this patient, who we knew was positive. I did this because I had all the recommended protective gear and training from my employer. I did this assuming that if something happened to me, of course I too would be cared for. Then, what was a small concern after a few days of caring for this patient, became my reality:

>

> I started getting sick.

>

> When employee health told me that my fever and other symptoms fit the criteria for potential coronavirus, I was put on a 14-day self-quarantine. Since the criteria was met, the testing would be done. My doctor ordered the test through the county.

>

> The public county officer called me and verified my symptoms and agreed with testing. But the National CDC would not initiate testing. They said they would not test me because if I were wearing the recommended protective equipment, then I wouldn’t have the coronavirus.

>

> What kind of science-based answer is that? What a ridiculous and uneducated response from the department that is in charge of our health in this country.

>

> Later, they called back, and now it’s an issue with something called the “identifier number.” They claim they prioritize running samples by illness severity and that there are only so many to give out each day. So I have to wait in line to find out the results.

>

> This is not the ticket dispenser at the deli counter; it’s a public health emergency! I am a registered nurse, and I need to know if I am positive before going back to caring for patients. I am appalled at the level of bureaucracy that’s preventing nurses from getting tested. That is a health care decision my doctor and my county health department agree with. Delaying this test puts the whole community at risk.

>

> I have the backing of my union. Nurses aren’t going to stand by and let this testing delay continue; we are going to stand together to make sure we can protect our patients—by being protected ourselves.

Another example:

https://www.statnews.com/2020/03/03/washington-state-risks-seeing-explosion-in-coronavirus-without-dramatic-action-new-analysis-says/

Lots of worrying things in the article. Particularly, again, that the CDC mostly won't test people:

> Frustrated by the lack of testing resulting from the problem with the CDC-developed kit, the Seattle Flu Study began using an in-house developed test to look for Covid-19 in samples from people who had flu-like symptoms but who had tested negative for flu. That work — permissible because it was research — uncovered the Snohomish County teenager.

The CDC apparently says what is and isn't permissible with science, testing and medicine, and they only got to do this by making an appropriate excuse about categorizing it as research not e.g. medical care.

https://twitter.com/iheartWallSt/status/1235595431565856770

This guy's uncle got tested and was positive for coronavirus. So they told him to stay home for quarantine ... while his wife could go grocery shopping, etc., she just had to keep her distance and wear a mask (even though a major way it spreads is tiny liquid droplets on surfaces around the home).

Broadly health authorities around the world don't seem to understand how quarantines work. And they don't seem to be offering anyone reasonable guidance about how to self-quarantine effectively. E.g. there's stuff like a cruise ship being quarantined for 14 days then they let people off. But that's trapping a bunch of people with an infected or possibly infected person. They infected a bunch of people doing this and killed some of them. And what for? 14 days is an appropriate quarantine for a single person. But if you have a second person, they could get infected on day 5, say, so you'd need at least 5 more days of quarantine. If you have hundreds of people, most healthy, and you're just going to wait until everyone is done getting infected it could take months. You have to isolate people to do quarantines or at least isolate very small groups like nuclear families (28 days must be enough for a childless couple, maybe a bit less. they could have guidelines for different family sizes. the most for N people would be N*14 days given that 14 days is long enough with one person. and it may well be less.)


curi at 5:34 PM on March 5, 2020 | #15759 | reply | quote

#15759 More on how fucked up things are today with the focus on social status in the form of credentials, licenses, being the government, etc.

https://www.macrumors.com/2020/03/05/apple-cracking-down-coronavirus-apps/

> Apple Rejecting Coronavirus Apps Not From Health or Government Organizations

Meanwhile Amazon would prefer people don't have hand sanitizer at all than have it at prices they're willing to pay:

> Amazon has banned coronavirus products and sellers attempting to price gouge on items like face masks and hand sanitizer.

https://abcnews.go.com/Business/amazon-cracks-million-misleading-price-gouged-products-amid/story?id=69357582

> Amazon removes 1 million products for misleading claims, price gouging amid coronavirus outbreak

Amazon has problems with counterfeits and fraud, and should police and remove that. But they're mixing in price gouging removals – meaning demand is up, supply down, and so the market clearing price is significantly higher than it used to be during normal times. So Amazon prevents the supply from being allocated to people who believe they would benefit from paying for it.


curi at 9:13 PM on March 5, 2020 | #15766 | reply | quote

More from the book.

> Influenza pandemics generally infect from 15 to 40 percent of a population; any influenza virus infecting that many people and killing a significant percentage would be beyond a nightmare. In recent years public health authorities have at least twice identified a new virus infecting humans but successfully prevented it from adapting to man. To prevent the 1997 Hong Kong virus, which killed six of eighteen people infected, from adapting to people, public health authorities had every single chicken then in Hong Kong, 1.2 million of them, slaughtered. (The action did not wipe out this H5N1 virus. It survives in chickens and in 2003 it infected two more people, killing one. A vaccine for this particular virus has been developed, although it has not been stockpiled.)

> An even greater slaughter of animals occurred in the spring of 2003 when a new H7N7 virus appeared in poultry farms in the Netherlands, Belgium, and Germany. This virus infected eighty-three people and killed one, and it also infected pigs. So public health authorities killed nearly thirty million poultry and some swine.

> This costly and dreadful slaughter was done to prevent what happened in 1918. It was done to stop either of these influenza viruses from adapting to, and killing, man.

There have been a series of major influenza outbreaks throughout history because it's good at mutating. It'll take over a cell, create 100k to a million new viruses, and 99% of them will be broken due to mutating. But it gets some good mutations that way. And 1% not broken is 1k to 10k per cell, which is apparently enough.

Flu kills a lot of people even when there's no outbreaks. Tens of thousands per year in the US. People sorta ignore it like they ignore the large numbers of car accident deaths, but I think they ignore flu even more, maybe because it mostly kills old people (and maybe infants, not sure how much that happens in developed countries) while car accidents kill all ages which means killing more people who are valued more.


curi at 2:13 AM on March 6, 2020 | #15767 | reply | quote

> #15759 More on how fucked up things are today with the focus on social status in the form of credentials, licenses, being the government, etc.

> https://www.macrumors.com/2020/03/05/apple-cracking-down-coronavirus-apps/

>> Apple Rejecting Coronavirus Apps Not From Health or Government Organizations

> Meanwhile Amazon would prefer people don't have hand sanitizer at all than have it at prices they're willing to pay:

>> Amazon has banned coronavirus products and sellers attempting to price gouge on items like face masks and hand sanitizer.

> https://abcnews.go.com/Business/amazon-cracks-million-misleading-price-gouged-products-amid/story?id=69357582

>> Amazon removes 1 million products for misleading claims, price gouging amid coronavirus outbreak

> Amazon has problems with counterfeits and fraud, and should police and remove that. But they're mixing in price gouging removals – meaning demand is up, supply down, and so the market clearing price is significantly higher than it used to be during normal times. So Amazon prevents the supply from being allocated to people who believe they would benefit from paying for it.

ebay has banned the sale of some items people want cuz of coronavirus

https://arstechnica.com/tech-policy/2020/03/ebay-bans-sale-of-masks-and-hand-sanitizer-over-gouging-concerns/

:-(


Justin Mallone at 2:08 PM on March 6, 2020 | #15776 | reply | quote

https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/

This advice is not good enough to prevent disease spread.


curi at 3:02 AM on March 7, 2020 | #15793 | reply | quote

From the book:

> By the first decade of the twentieth century, Welch had become the glue that cemented together the entire American medical establishment. His own person became a central clearinghouse of scientific medicine. Indeed, he became the central clearinghouse. As founding editor of the Journal of Experimental Medicine, the first and most important American research journal, he read submissions that made him familiar with every promising new idea and young investigator in the country.


Today there are too many potential submissions to read, so they filter/gatekeep on credentials and social status, which is a really bad filtering method.


curi at 12:32 PM on March 8, 2020 | #15811 | reply | quote

From the book:

> The Los Angeles public health director said, “If ordinary precautions are observed there is no cause for alarm.” Forty-eight hours later he closed all places of public gatherings, including schools, churches, and theaters.

People are bad at learning from history. Many reactions to the wuhan coronavirus are dumb and deadly.

> Chicago Public Health Commissioner John Dill Robertson violently rejected that suggestion as unwarranted and very damaging to morale. In his official report on the epidemic, he bragged, “Nothing was done to interfere with the morale of the community.” Later he explained to other public health professionals, “It is our duty to keep the people from fear. Worry kills more people than the epidemic.”

No, viruses kill people more than worrying does.


curi at 12:47 AM on March 16, 2020 | #15984 | reply | quote

I'm near the end of the book. A quote about bias:

> What it came down to was that nearly all investigators believed their own work. If they had found the influenza bacillus in abundance, they believed it caused influenza. If they had not found it, they believed it did not cause influenza.

>

> Only a very few saw beyond their own work and were willing to contradict themselves.

By contradict themselves, the author means go against their lab results: that is, say that even though they found X in their lab, X doesn't cause flu. That's not really contradiction though because X could have been present in their lab (no errors in lab experiment) and still not cause flu.

X here is "influenza bacillus" which is a bacteria that people thought might cause flu. The guy who found and named it was really confident it caused flu. (He was wrong; a virus causes flu.) So the name is confusing but there was an ongoing debate about whether it caused flu or not. And the quote is saying people who took samples from flu patients and found X thought X caused flu. People who took samples from flu patients and found no X thought X did not cause flu. Almost everyone went by the result at their own lab.


curi at 12:01 PM on March 17, 2020 | #16009 | reply | quote

(This is an unmoderated discussion forum. Discussion info.)