Reddit reviews The Great Influenza: The Story of the Deadliest Pandemic in History

Spanish Flu, 3 to 5 percent of the world's population
I also read The Great Influenza and would recommend it to anyone, its not only about the flu itself but how the U.S. rose to be the medicine powerhouse of the last century, the gobsmackingly horrible conditions the survivors were left with and the absurd political reasoning behind some of the choices over the course of only 24 weeks perpetuating the problem.

Not a great example, as the most dramatic and obvious changes to the flu virus occurs via a process known as genetic shift which has no correlate in mammals.

In laymen's terms, two viral strains possessing different types of neuraminidase and hemagglutinin surface proteins (e.g. H5N1) can simultaneously infect a single host and exchange genetic elements and rapidly and radically alter their surface proteins in a single cell cycle. This is especially dangerous when humans become co-infected with avian- or swine-predominant strains of influenza, to which the population has little acquired immunity. The danger in such cases is mostly to the young, who possess robust immune systems capable of mounting very strong responses to previously unseen antigens.

If you're interested in learning more, The Great Influenza is a wonderful place to start reading.

Finally, take this piece of advice from someone older (though not necessarily wiser): unless you're a high school science teacher, debating evolution with people is a waste. Barring exceptionally poor school systems or upbringings, most doubting the existence of biological change in response to selective pressure lack the curiosity, reading ability, and/or motivation to educate themselves. Your intervention is unlikely to change this. If you're really interested in helping, read voraciously yourself and recommend a beginners' reading list to those interested in better understanding the world. To the others, a big toothy smile and "yeah, bro" will considerably reduce your blood pressure.

My answer to this question is largely based on my studies in public health, but also a book called The Great Influenza, by John M. Barry. If you’re at all interested about learning more about the 1918 pandemic, he provides a pretty thorough chronicle on the subject.

The 1918 flu pandemic, occurring when and how it did, was a pretty big eye opener for the United States public health programs, particularly because up until this time they were lacking and almost ignored, simply because an outbreak on this scale wasn't considered a major threat. Once it did hit the U.S., however, it became really clear really quickly that:
1. Science and medicine were not nearly as advanced as they needed to be to handle this sort of pandemic, especially since it was viral; and
2. Priorities of the federal government had been so focused on other matters that they didn't realize major gaping holes in their health policy or issues with their leadership.

As far as context was concerned, this flu was coming right in the middle of U.S. involvement in WWI. In fact, the outbreak was beginning to emerge amongst camps over in Europe just about the time the U.S. had decided to go all-in. Although the full-scale flu outbreak didn't happen in the United States until a bit later, right around peacetime, essentially all of the federal government's energy, money and focus were put into the war. President Wilson essentially placed all matters regarding the flu threat at the wayside, and as a result of this precedence, so did everyone else underneath him. The Surgeon General, a man named Blue, was in charge of the federal Public Health Service at the time and did the same sort of thing: disregarding any notions of an impending outbreak, even going as far as to undermine its severity in his public statements, referring to it simply as "the common grippe." When Blue did provide public health statements once the flu became impossible to ignore, they often followed the idea of "clean mouth, clean skin, clean clothes," citing this and three good meals a day as the way to prevent getting sick.

Anyways, long story short, the federal leadership was focused heavily on the war and the Surgeon General downplayed the severity. Thus, by the time the 1918 flu reached full-scale in the U.S. we had no doctors, no nurses, and no medical resources to handle it - so it essentially blew up in our faces. The federal government tried to provide assistance where it could, but really the majority of successes as far as infection control were due to locally based efforts. Philadelphia, which got hit pretty hard, had a public health director known as William Krusen who essentially single-handedly organized the campaign. Denied assistance from Blue and the PHS, a lot of his funding and resources came from the Pennsylvania branch of the Council of National Defense, run by George Wharton Pepper. Other towns, particular out west, installed extreme citywide quarantines, essentially blockading their borders and arresting anyone who tried to enter or exit.

In combination with the lack of strength within the Public Health Service was the incomplete understanding of what influenza was, how it worked/spread, and how to treat it. In fact, the common notion at this time was that the disease was caused by a bacteria, which they called Bacillus influenzae; a perception reinforced with the presence of pneumococcal secondary lung infections in flu patients. Many groups tried to develop flu vaccines at the time, however with an incomplete understanding of the pathogen, they were widely unsuccessful. Physicians tried crazy remedies, even going so far as to bleed their patients, but in the end all that really worked was the treatment of symptoms.

By the end of the pandemic, the U.S. had been hit pretty hard, and as a result, decided to change some policy. Recognizing a failure, the public health community took this opportunity to assess and reform their policies through the light of “lessons learned.” In 1918, they created a Committee on Statistical Study of the Influenza Epidemic comprised of leading epidemiologists. This began a shift towards using case studies and analysis as the basis for preventative public health measures. Various success stories nationwide (like those crazy quarantines out west) emphasized the importance of isolation measures in controlling spread, which was already known but now strongly affirmed as an essential step of outbreak control. Around the same time, the medical communities went into full swing as the federal government began supporting research of the flu pathogen to really figure out what it was and how it spread. As the years passed, the federal government started to place more emphasis on its public health community, wanting to avoid such an event from reoccurring. They now recognized a need for the assurance of proper medical resources, both in staff and supplies, at all times. Although it would take a few decades for science to advance to the level needed to really combat the flu virus, the 1918 flu sparked a movement for medical research that led to a number of developments that make modern medicine what it is today.

So, the answer to your question – the 1918 flu served as a motivator for a shift in the public health culture. As a result, the federal government policy towards public health refocused to incorporate increased medical research, increased epidemiological studies (particularly statistics-based), the formation of preliminary national prevention & response strategies, which incorporated both necessary actions and resources. Although these were in no way as elaborate (or even correct) as what we see today, they provided the foundation, which would later be built upon as our knowledge of infectious diseases grew.

No - one of the ironies of modern medicine is that hand hygiene and isolation of infected patients was probably better in 1918 than it is now. Modern doctors have come to rely on rescue meds/equipment/antibiotics that their counterparts did not have back then. But 1880-1920 was the first golden age of evidence-based medicine, and doctors then knew very well what was killing their patients.

A truly excellent book if you're interested is The Great Influenza by John Berry.

This is a really good book on the influenza pandemic

The Great Influenza

I'd recommend The Great Influenza

Yeah if just one isn't you have an outbreak that is spreading fast. People need to go to work, get food, go to the doctor ... it's just not realistic to expect normal people to uphold their own little quarantine. Your "solution" has already been tried, If you are interested read this: http://www.amazon.com/The-Great-Influenza-Deadliest-Pandemic/dp/0143036491

I recently read this book and learned that one of the reasons that the 1918 flu was so terrifying is that it struck down healthy young adults incredibly swiftly -- going from healthy to dead in less than a day. This particular flu managed to drive these healthy, strong immune systems into dramatically overreacting, and they destroyed the victims lung cells. So yes, many people died from other things like pneumonia, and in fact that may have been the majority of the deaths (nobody really knows), but there's no doubt that millions died from "just influenza" (a phrase repeated through the book to drive home the irony) alone.

BTW, the 50 million figure is also open to debate. In much of the world no meaningful records were kept, so the total death toll may be far higher.

I love reading about disease!


The Demon in the Freezer and The Hot Zone are fictionalized accounts of real events, and very good reads. The Hot Zone is about Ebola, and The Demon in the Freezer is about anthrax and small pox.


A fantastic historical account of the 1918 flu, and how it changed the United States is The Great Influenza. This is a nonfiction book that mostly discusses the reaction to the flu on a national level, and also by the scientific community.

Excellent book is The Great Influenza, but reading it will really freak you out. The main theme is that medical care was actually BETTER in the early 20th century because they weren't so reliant on antibiotics.

If this particular virus hit today, we would likely see greater morbidity/mortality.

polio was a good one. And The Great Influenza , while not specifically about vaccines has some vaccine info and is really good history as well.

There's a pretty good book about this topic that I recommend to anyone hoping to read more about flu pandemic of 1918 => https://www.amazon.ca/Great-Influenza-Revised-John-Barry/dp/0143036491

There were numerous factors that contributed to the outbreak's ferocity, including having millions of soldiers in tight quarters. Throughout the United States, officials knew that public events of all kinds, like sporting events, etc., should be cancelled, but didn't do so. They knew quarantines should be observed, but failed to do so.

But the bottom line is, the flu transmits very very easily and travels all around the world on its own accord. The flu of 1918 is though to have originated in China, yet it killed 600,000-1,000,000 Americans and god knows how many Chinese.

If you want to to know more, read The Great Influenza by John Barry. It's a thorough overview of both the virus itself and the politics that in many ways dictated the course of the disease's path.

> Do you have any books you'd recommend that are in the same vein? I have also read about how we ended Smallpox and ebola.

The Great Influenza

Have you read John Barry's book about the 1918 influenza? I love it so much. I love reading about diseases! I know too much about the bubonic plague for my own good.

While I'm not an expert at all, I would think that finding something about the Spanish Flu that hit around 1918 would prove interesting. I think it was a global pandemic, and killed millions.

Example

Disclaimer: I have not read this book (but am adding it to my wishlist).

This book: http://www.amazon.com/The-Great-Influenza-Deadliest-Pandemic/dp/0143036491 is a great primer on development of medicine towards the end of the last century.

A fantastic read, but TL;DL: you wouldn't want to live then. Anyone could call themselves a "doctor", the state of medical education was atrocious (basically, the equivalent of modern "Get a PhD in C programming by mail correspondence course"), etc.

But, of course, if enough people die after going to one practitioner, others would stop going to him/her, so the market will sort this out. Right?

Ironic you say "plagues" your mind. That's probably closest to what will actually happen. Read this if you're interested in knowing more about the history of a pandemic. We can't catch them all in time.

Another awesome, grimly terrifying read: The Great Influenza, the pandemic "Spanish Flu" (it actually started in Kansas) that circled the world in the closing days of World War I.

It killed as many as 100 million people worldwide, over five times the number of people killed in the war itself.

If you want to know why CDC and WHO spend so much time and energy tracking novel flu viruses every year, recommending vaccinations and the like, it's because they know that the emergence of another pandemic flu virus -- highly contagious and because it is completely new to human immune systems, rapidly lethal -- is just a matter of time.

Pandemic flu is an entirely different monster from ordinary seasonal flu. Seasonal flu affects primarily the very young, the very old and the immune compromised (chemotherapy patients, HIV patients, etc.). Your body gets worn down by fever, muscle aches, and metabolic depletion as your immune system fights off the virus. A pandemic flu instead affects healthy adults (18-25 year old soldiers were some of the prime victims in 1918). In fact the stronger your immune system, the more dangerous the infection can be as your body produces what pathologists and immunologists refer to as a "cytokine storm." Essentially, your immune system kills you.

Some of the autopsies of 1918 flu victims revealed that vital organs had been partially liquefied by immune overreaction. Death for some victims occurred less than 24 hours after onset of symptoms.

People who are worried about Ebola and smallpox should have the bejeesus scared out of them if a novel, pathogenic H1N1 virus or a swine flu emerges next winter.

Jonas Salk did some amazing vaccine work (polio is the big one but his work with the flu is important). not sure if that counts but in my mind vaccines and semiconductors are the two biggest life changers science has produced. there were many, many doctors involved but Salk was pretty key. if you are remotely interested this book is really informative on both the science side and practical side.