"It’s really remarkable to me that the flu of a century killed 675,000 Americans out of a population of 110 million, meaning that roughly works out to the 2.2 million upper range guess of projections for COVID-19 by proportion of the population. And yet, the cultural response to it was primarily to shrug our collective shoulders and get on with our lives. It wasn’t total ignorance that created that situation. Some communities did engage in effective quarantining, for instance, and there were real death rate differentials between them. But to my knowledge anyway, sports weren’t cancelled. The World Series went on as normal (and quite famously in 1919!). There was no effective government response at the federal level."One point I will take issue with, however, is this:
"Basically, what has changed is us. We see ourselves as something closer to immortal today." (emphasis mine) "The only two health crises even close to the flu between then and now were polio and HIV and those are very different types of events. Polio’s transformation into something much more powerful than in the past definitely scared lots and lots and lots of people, but what could you really do? AIDS certainly frightened many, but it was also classified as gay cancer early on and Reagan was happy to let them all die until his buddy Rock Hudson fell to the disease.I think this confuses correlation with causation.
We have a culture of immortality. That’s not a bad thing. Science has advanced so far. We think we can protect ourselves from the outside world through eating and exercise and medicine. To an extent, we can. Even though COVID-19 has hit very old people in nursing homes and those with co-morbidities much harder than most people, it’s seen as an unimaginable tragedy to lose these people in a way that the deaths of thousands upon thousands of young parents and workers was not a century ago. To an extent, this is a reminder that human beings are incredibly fragile animals who have bodies where germs and bacteria pass in and out of all the time. We just don’t think about it. Our seeming indifference to climate change is related to this as well. We simply think we will figure it out, just like we figured out polio or the ozone layer or how to make a good television comedy."
Yes, we do think we'll "figure it out". But that's because we are accustomed to the - when you think about it - astounding advances in medical practice over the past century.
I mean...the docs in 1919 understood the germ theory of disease and the nature of influenza. They weren't stupid. They did what they could.
But.
At the time inoculation and vaccination was just beginning to become widespread. The notion that "oh, sure, we'll get a vaccine for that" was not just remote, it was nearly unthinkable in many cases. People died all the time from diseases we've more-or-less removed from our experience; typhus, cholera, diphtheria, measles, smallpox. That simply doesn't happen anymore.
So it's not that we "see ourselves as...immortal" or have a "culture of immortality". It's that we have internalized that what is going to kill us is a heart attack, or cancer, or an auto accident, or a random nutter with a firearm. The notion that a simple contagious disease - a sort of superflu - can kill or maim us?
THAT's insane. That's fucking creepy. That's...something that shouldn't be happening.
So we ARE not really treating this plague the way we did a century ago, but not because WE'VE changed.
It's because our fundamental baseline for medical competence and medical success has changed.
We don't expect we're going to die of cholera anymore.
So we're really pissed off and really frustrated and really afraid that this thing has become, despite all our knowledge and skills and learning, the pestilence that stalks in the darkness
2 comments:
Umm .. actually, they didn't understand the nature of influenza.
That mistake had ugly long-term consequences too.
Truth be told, it was a reasonably honest mistake. American epidemiologists took their cue from the work of Richard Pfeiffer, who'd isolated a bacterium from the lungs of influenza fatalities back in 1892, and duly reported his findings.
And sure enough, when they had some 1918 pandemic cadavers to examine, they found Pfeiffer's bacillus in their lungs too.
They actually worked up a vaccine for Pfeiffer's bacillus, and, of course, it did absolutely nothing to prevent influenza.
It didn't really help matters any that the electron microscopes that would even allow you to see an influenza virion were still almost 20 year away.
And since nobody knew how DNA worked, to say nothing of RNA, they wouldn't have had a clue about the rapid mutation rate of the influenza virus even if they'd somehow tumbled to its role.
It also didn't help that techniques for validating vaccine candidates were still so immature they needed diapers in 1918.
So the odds they'd have been able to work up a vaccine that would have made any difference were so close to zilch, you would have needed an electron microscope to see them.
But their failure gave a serious boost to the pseudoscience and outright bullshit that still infects our culture and our public discourse more than a century later.
Good article discussing your man Pfeiffer and his colleagues (especially someone named Leichtenstern) here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862332/
Apparently the whole question of bacilli, etiology, and transmission was fairly complex and poorly understood, as often as not because the standards of epidemiological study at the time:
"While the experience of the great pandemic of 1918–1919 had given American medical researchers a heightened appreciation of the dangers of pandemic influenza, and while it permitted epidemiologists to enlarge the fund of descriptive information on influenza outbreaks, it had done little to unlock the mysteries of the disease. If anything, the experience of 1918–1919 served to deconstruct existing biomedical knowledge.
This void in fundamental knowledge would not be filled soon. When Jordan published his massive, 500-page authoritative synthesis of the influenza literature in 1927, the most basic and fundamental features of influenza were still unexplained. Jordan told his readers that influenza could only be defined by its pattern of occurrence—its epidemiology. Its cause was unknown, and its pathology was indefinite. It was uncertain whether there was acquired immunity for influenza, and, if there was, how long it lasted. Why pandemics occurred when they did and why they spared some places were also unknown. It was also uncertain whether the disease called influenza that occurred every year in sporadic cases and small outbreaks was the same disease that circulated in the pandemics. He continued the practice of distinguishing “influenza” from “epidemic influenza.”73
Jordan did suggest that changes in virulence of the still unknown agent of influenza might be important and that this agent might be filterable, but in 1927 these were still speculations for which there was no direct evidence. In short, the three decades that had passed since Leichtenstern published his major synthesis had seen remarkably little addition to the fund of basic scientific knowledge of influenza, in spite of concerted efforts by researchers employing the best available research tools."
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