Speaker 1:
From the library of the New York Stock Exchange at the corner of Wall and Broad Streets in New York City, you're Inside The ICE House, our podcast for intercontinental exchange on markets, leadership, and vision in global business, the dream drivers that have made the NYSE an indispensable institution of global growth for over 225 years. Each week we feature stories of those who hatch plans, create jobs, and harness the engine of capitalism. Right here, right now at the NYSE and at [inaudible 00:00:32] exchanges and clearing houses around the world. And how, welcome Inside The ICE House. Here's your host, Josh King of Intercontinental Exchange.
Josh King:
On Thursday, March 19th, I headed for the hills, literally. I'd spent the prior four days at the nearly emptied New York Stock Exchange, one of three people left on my floor. A few times a day maybe I'd go down to the trading floor, maybe for a media interview with NYSE President Stacy Cunningham. They were now connected by a remote camera, a far cry from just a few weeks prior when the floor was teeming, and Stacy sat at Post 9 with the anchors of CNBC's Closing Bell to reflect on the performance of market-wide circuit breakers. Now it was quiet, and getting quieter.
Josh King:
The media was all gone, headed to their homes and apartments to carry on their duties, equipped with what are now known as padcaster kits. The network acquired 40 of them for that purpose. You insert an iPad into the padcaster, which provides connectivity, camera, and lighting for effective remote shots. As Dan Colarusso, who's the Senior Vice President of CNBC Business News, told Broadcasting and Cable Magazine from a similarly depopulated headquarters in Englewood Cliffs, and I quote, "We always look for, one, good failsafes, and two, less expensive ways to go remote." And Dan went on, "We're going to give people a little peace of mind," he said. "The whole thing seems to be very random, so you try to cut out randomness wherever you can."
Josh King:
How true is that? What's your experience? For me, when I headed to the hills, the Catskills, 142 miles north of the NYSE, I didn't think I was cutting out randomness, but that's what it is. For over three weeks now, beyond the nonstop WebEx meetings and the Zoom cocktail hours, or checking in with Mom and Dad on the Amazon Echo show, I've been in regular person-to-person contact with no one, besides my wife, two kids, and our dog. A wave to a friend in the convenience store parking lot, a hike up, socially distanced with a few others, to the summit of one of the Catskills peaks. Finally, a dinner with one family who has similarly self-quarantined. Given the discipline we've imposed, we trust each other.
Josh King:
Trust, it was the key concept behind survival of the 1918 flu pandemic that killed between 50 million and 100 million people around the world. Applying that stat to today's population, it would equal 220 million to 430 million people. As John Barry, professor of Tulane's School of Public Health and Tropical Medicine, and author of The Great Influenza: The Story of the Deadliest Pandemic In History, wrote recently in the New York Times, "Cities like San Francisco avoided some of the worst effects of the pandemic by leveling with the citizenry, sort of the way New York Governor Andrew Cuomo is today.
Josh King:
As Barry wrote in the Times, 102 years ago in San Francisco, he wrote, "The Mayor and business, labor and medical leaders jointly signed a full page ad that read, in huge all-caps type, 'Wear a mask and save your life.'" They didn't know that masks offered little protection, but they did know they trusted the public. The community feared but came together. When schools closed, teachers volunteered as ambulance drivers, telephone operators, food deliverers. 102 years later, is the community coming together again? Let's find out. After this, our conversation with John Barry, author of The Great Influenza, for a look at the past, an analysis of the present, and a prediction for the future. That's right after this.
Speaker 3:
And now a word from Ron Delia, CEO of Amcor, NYSE ticker AMCR.
Ron Delia:
Today is a really good day for Amcor. We've been around for 160 years. After so much time takes a passion and dedication of our people around the world, and it takes resilience, and we have lots of that at Amcor.
Ron Delia:
Our aspiration is to be the leading global packaging company, and that means winning for our customers, our people, our investors, and the environment. We have a big pledge around sustainability and we really hope to change the world as we look forward.
Ron Delia:
Amcor, now listed on the New York Stock Exchange.
Josh King:
In 2005 the National Academies of Science named The Great Influenza: The Story of the Deadliest Pandemic In History, a study of the 1918 pandemic, the year's outstanding book on science and medicine. In 1998, Rising Tide: The Great Mississippi Flood of 1927 and How it Changed America, won the Francis Parkman Prize of the Society of American Historians for the year's best book of American history. Both the Bush and Obama administrations have sought John Barry's advice on influenza preparedness and response, and he was a member of the original team which developed plans for non-pharmaceutical interventions to mitigate a pandemic. Professor Barry joins us via Skype from New Orleans to talk about the similarities and differences between COVID 19 and the great influenza, and how the current pandemic may reshape society once we get on the other side.
Josh King:
John Barry, welcome Inside The ICE House.
John Barry:
Thanks. Those are large questions, not sure I can answer them.
Josh King:
Let's try and work through them. First of all, tell us where you are now and how you've managed through the last month. You were saying before we got on air that without the people on Bourbon Street the mice have taken over, or the rats have taken over New Orleans.
John Barry:
I wish they were mice. I'm in the French Quarter in New Orleans, and the rats have nothing to eat from the restaurants and the hotels, all of which are closed, and they have infested under my house and even made it into the house, so I'm not a happy camper.
John Barry:
On the serious level I'm doing pretty well, I think. My wife and I go for walks every day. It seems good.
Josh King:
It took until early March for many of us to get the message that we had to shut, largely, down the world. When did you get the sense that this was headed to a dark place, and what did you do when you first got that feeling?
John Barry:
By mid-January I think it was apparent to anybody who knew anything about viruses and epidemiology that this was going to be real and serious. I had written an earlier op ed for the Washington Post that ran in January originally titled This Virus Cannot Be Contained, and then I decided to hedge my bets a little bit, and it ran on the title, Can This Virus Be Contained, Probably Not. I guess I wrote that in mid to late January, ran it a week or so later. My conclusion was, it comes down to two things: how immunogenic the virus is, and how much compliance we're going to get from social distancing, which we will have to employ eventually. So those two questions are still out there.
John Barry:
If we can develop a very effective vaccine against the virus, we'll be in very good shape. If we can't, not so good, although I think natural immunity, once everyone or large numbers of people are exposed, will be extremely helpful. I would expect significant improvements in terms of natural immunity with or without a vaccine.
John Barry:
In terms of the social distancing, there are too many people not complying, but we seem to be making progress anyway. It would be better if more people did comply, we would make faster and better progress.
Josh King:
Talking about compliance, John, you are an old football coach. As a coach of young players, you expect compliance with what you're telling them in the locker room before they go out in the field. You dropped out of graduate school and history to become that football coach. Before we get to the topic at hand, tell us about that.
John Barry:
Actually I wrote a paper I put an awful lot of effort into, and very disappointed in the outcome. I thought I had great data, but didn't pull it together in the paper, and really got discouraged and left grad school in the middle of the semester. And as you said, ended up coaching football. Of course a couple years later I read the paper and did see any problem with it. I thought it was a great paper. But by then I had embarked on the rest of my life. I don't know if you can hear that sound, but that's a contractor trying to seal off some burrows that our rat friends have dug under the house.
Josh King:
So you've got the bona fides as a football coach. John, we are your team, we're in the locker room at half time, the latest stats as we have this conversation, to the extent that we can trust those stats, are about 1.4 million coronavirus cases worldwide, 76,000 deaths, 367,000 cases in the US, and about 11,000 deaths here, and those numbers will spike further before folks hear this conversation. Tell us coach, as we make our second half adjustments, what have we done wrong in the first half? What have we done right, if anything? And what adjustments do we have to make in the second half to win this game?
John Barry:
First, we've barely kicked off and run one series of plays. We're not ready for half time yet. Obviously in the United States, what we've done wrong is a lot. What we've done right is relatively little. Places like New Zealand and Germany, not to mention the Asian societies that are a little bit different culturally than us, Taiwan, South Korea, Singapore, have very much gotten ahead of the virus. Vastly better shape than we are. We had a White House that didn't take this seriously for weeks, we have a debacle in the testing, which we still haven't caught up with. Testing was key in all those other societies, all those other countries, and we're still behind the curve there. Right now, concerned about reagents, the chemicals make the tests work, and we're still behind the curve. Hopefully, once we catch up we will be able to get ahead of the virus, but we are nowhere near half time yet.
Josh King:
Before we get into the approach toward half time, let's go into history class. Professor Barry, I want you to tell us about one of the other great players on the field. It's 1918. Lieutenant Commander Paul Lewis, he deserves a place in the pandemic hall of fame. Why?
John Barry:
The book focuses on a group of scientists who confronted the disease. If you ask me what I write about, I may be the only person who sees it this way, but everything I do, I write about power. In the pandemic, I thought the people who were in a position to exercise some power were the scientists, so my focus was the scientific community. He was one of that generation, a brilliant man. He and Simon Flexner proved polio was a viral disease in 1908 and 1910, and that's still considered a landmark achievement in virology. They didn't even know really what viruses were there. By 1910 he had a vaccine almost 100% protective in monkeys against polio.
John Barry:
Influenza was a problem that was too difficult for them to solve back then scientifically. It did launch a whole bevy of scientific research that led to enormous progress later, but certainly not fast enough to prove effective during the pandemic itself. They did try everything, including some things that we're doing today. They did not know what caused the disease. They developed vaccines against several bacteria. A lot of people died of bacterial pneumonia, not directly from the virus, although the virus stripped the immune system of defenses, allowing bacteria. And even today, bacterial pneumonia after influenza has an 8% case fatality with modern antibiotics. Anyway, they had developed vaccines against what they thought were the targets, including the pneumococcus.
John Barry:
We've got a pneumonia shot and a vaccine today, it's a straight line descendant of what was developed in 1918. But again, those vaccines were not widely distributed. The pneumonia vaccine in particular only went to a few Army camps. So you were left with supportive care, which is basically all that we have today, and the supportive care back then was nowhere near as good as it is today. They couldn't administer even oxygen as we do now, much less a lot of the other things that you can get in a really high-grade intensive care unit. Today you can actually take the blood out of the body when the lungs aren't functioning, oxygenate it, and return it to the body, all while the lungs are recovering. There aren't many places that do this, and the number of beds where that's available is very limited, but if you're fortunate enough to be in one of those situations, you're a lot better off than somewhere else. Of course one of the biggest problems, that's why you want to quote flatten the curve, so the healthcare system doesn't get overwhelmed, so that you do have an intensive care bed available if you need it.
Josh King:
Talking about supportive care, John, Commander Lewis, when he looked at his gem, basically they were bloodied, but they weren't bloodied by bullets, they were bleeding from noses and ears, a wide swath of suffering. What exactly was afflicting then when he walked into these medical wards and saw these victims lying there?
John Barry:
The 1918 virus caused a lot of symptoms that are quite unusual for influenza. It was initially misdiagnosed as dengue, typhoid, cholera. The symptom you're talking about occurred, perhaps, in some studies, in military camps, as many as 15% of soldiers were bleeding from their nose. On rarer occasions you not only found nosebleeds and people bleeding from their mouth, but from every mucosal membrane, which includes your eyes and ears. Which would be very frightening for anyone, much less a layperson, if their neighbor or a spouse started doing that. Another symptom, people could turn so dark blue from lack of oxygen, I quoted one physician writing a colleague that he had one difficulty distinguishing African American soldiers from white soldiers because their pallor was so similar. That, of course, spread rumors of the black plague, or the black death of the middle ages.
John Barry:
In fact, the 1918 pandemic came in waves. The first wave was very hit or miss, most places didn't get hit, and it was mild where it did hit. It was largely unnoticed, except on the front lines. Ludendorff blamed it for the defeat of his last offensive, his last effort to win the war. But a lethal second wave hit, and the first outbreak of the second wave, apparently the virus changed in some way, became more virulent. Anyway, that was in Switzerland. Of course Switzerland was at peace, but US military intelligence sent reports back that they were calling it influenza, but it was actually the black death of the middle ages. There was obviously a lot of confusion in that, and a lot of fear.
Josh King:
So the pandemic stretched out over two years, but you write that perhaps two thirds of the deaths occurred over a 24 week period, killing more people that time than the black death killed over a century, or AIDS killed over 24 years. In your book you write how priests would drive horse drawn wagons down the streets asking for people to bring their dead relatives out into the street.
John Barry:
I know that occurred in Philadelphia, a good chance it occurred elsewhere. Philadelphia was one of the hardest hit cities. It was generally horrific. In fact probably two thirds of the deaths occurred in an even shorter timeframe than 24 weeks. Probably most of them were between late September and December 1918. The pandemic, there was a first wave in the spring, which was, as I said earlier, mild and not widespread. There was a third wave that was worldwide in the spring of 1919, and there was continuous sort of seasonal influenza after that, that's still considered part of the pandemic in 1920, but after that it petered out.
John Barry:
One of the things that made it most horrific, influenza normally kills people, as coronavirus does, the elderly. But in 1918 young people were the targets. The peak age for death was actually 28. Again, about two thirds of the deaths were probably between age 18 and 45. So regular influenza, in 1918, killed the very young. Children aged one to four died at a rate that would equal deaths from all causes over a 14 year period today. All cause deaths, 14 year period, compressed into a period of a few weeks in 1918. So imagine the impact if you were a parent. Then, many orphans created. As I said, the peak age was 28 for death. Pregnant women, a series of a dozen or so studies found case fatality among pregnant women from 21% to 71%.
Josh King:
The story of the great influenza is a story of utter chaos, as you've described, but also, as you write, a story of science, discovery, and how one thinks, and how one changes the way one thinks, of how a few men sought the coolness of contemplation, the utter calm that precedes, not philosophizing, but grim, determined action. Tell us about the science and the discovery of that grim, determined action, and how the tables were turned.
John Barry:
When a scientist approaches a problem, he doesn't just dive in. He or she will lay out a plan, and it will be a logical plan. How to test a hypothesis, what do you think will work, how to get there. It's a complex system. In 1918, and for that matter today, you're doing this under incredible pressure, with very little knowledge. Today the unknowns about this virus are almost astronomical. What the right treatments are.
John Barry:
For example, people are dying from, their immune system is unleashing what is called a cytokine storm. These are lethal toxins that the immune system sends out to fight and to alert all the elements of the immune system to fight the virus. The battlefield is the lung, so it's largely destroying your ability to breathe while it's trying to kill the virus. Exactly the same thing was often happening in 1918, what's referred to as acute respiratory distress syndrome. Same thing then as now.
John Barry:
So there were multiple laboratories around the world that were all going through this process, coming to other conclusions, testing other hypotheses, and much faster than would normally be the case, trying them out in an actual patient. We didn't have the ethical concerns or the legal liabilities then that we have today. But of course back then, without even knowing the pathogen, there was little they could do. Most of the progress, in fact basically all of the progress, with the exception of the pneumonia vaccine, and the use of convalescent serum, those breakthroughs occurred after the pandemic.
John Barry:
In one case, probably the most important breakthrough was the discovery of DNA, that it carried ... dna was discovered in 1868, but nobody knew what it did. A gentleman named Oswald Avery came across this problem as a result of the influenza research that led him to discover that DNA carries a genetic code, which allowed the development of molecular biology. Of course that did not come until the 1940s, but it grew out of the influenza pandemic. You may have heard the saying, basic science, you shoot an arrow in the air, and where it lands, you paint the target. That was the case there.
John Barry:
There were other advances. Obviously the definition of a virus. Obviously, 1918, they weren't sure whether a virus was an entirely different kind of organism or just a really, really tiny bacterium. That was one of the problems in growing it, because you put bacteria in a Petri dish with the, essentially, food, and it'll grow, and they couldn't grow the pathogen because a virus needs living cells to replicate in. That discovery came in 1925, a guy named Thomas Rivers. And other things were tried, draining lungs, all sorts of things. Again, everything was tried.
Josh King:
Let's talk about painting the target slightly earlier than that medicine at the turn of the 20th century. My dad went to medical school, then served as a physician in the Air Force in the mid 20th century, but 50 years before that, you write that it was more difficult to get into a respectable college than an American medical school. You didn't even need a high school diploma, med schools would take any man willing to pay tuition. We were in pretty rough shape as we approached the 20th century, from a medical standpoint.
John Barry:
That's true. Practically every medical school, the faculty was paid by student fees, so they had every reason to accept a student, assuming they could pay, and no reason to decline, to reject one. None of these medical schools did you ever see a patient. Your training was exclusively in lectures. Very few medical schools had a microscope, much less used one, even though this is a period when in Europe, Pasteur was already making enormous advances. Robert Koch in Germany was making enormous advances. But at Columbia, at Harvard, there was no one on the faculty knew how to use a microscope. Harvard, if you passed five out of nine courses, all lecture courses, not one with a patient, you got an MD. You could flunk four courses. And Harvard initiated reforms after one of its recent graduates killed half a dozen patients in a row by not knowing the fatal dose of morphine. So that did force them to make some changes.
John Barry:
However, the real breakthrough came with the funding of Johns Hopkins Medical School, and its dean William Welch, who was arguably the most important and most influential figure in the history of American science. Hopkins forced Harvard to compete. The results were better than the system. As bad as the education was, many, many serious people who wanted to be doctors went to Europe for further training and came back knowing what to do, but the med schools were below par. So after Hopkins was established, it attracted such a huge percentage of the serious people that, just to compete, Harvard and Columbia and Penn and so forth also became much better schools.
John Barry:
Then in 1910 there was something called the Flexner Report. A guy named Abraham Flexner, who founded the Advanced Institute at Princeton, his brother Simon was the head of the Rockefeller institute for Medical Research, which is now Rockefeller University. Anyway, it was really a muckraking report about just how terrible medical education in the United States was. In the last handful of years more than half the American medical schools closed, or merged. Medical education in the United States became, almost overnight, much, much better, equal to anywhere in the world, and suddenly there was ... Today there's really no bad medical school. There are some that are better, but there's no bad one. The standards are very much enforced all over the country.
Josh King:
You wrote that Hopkins would pursue the truth no matter to what abyss it led. Taking a broader aperture on the idea of truth, what's the importance of truth? In World War I, the papers called it the Spanish flu, and that moniker continues to this day, right up to what we're calling the China virus, or some people are calling the China virus. Maybe they'll be calling it the China virus 100 years from now. Talk about the truth, from that moment that Hopkins resolved to pursue the truth to what we're seeing today.
John Barry:
When Hopkins itself was founded, which was about 15 years before the med school, 1876, they were founded on, their endowment was all Baltimore and Ohio railroad stock, which later tanked, which delayed the opening of the med school. But at the founding ceremony Thomas Huxley, a British scientist and Darwin devotee, gave the lead speech. And in the entire ceremony that commenced the establishment of that university, God was never mentioned, which was extremely controversial.
John Barry:
Later, to talk more about the Spanish flu, Spain was not at war. It didn't censor its press. When the first wave came it hit Spain hard, and the king got sick. Relatively few people were dying, but again, the first wave was pretty mild. But the Spanish press wrote about it. The warring countries censored their press, or in the US it was more self-censorship, but there was a lot of pressure. They didn't want to say anything negative about anything. That was considered depressing to morale and the war effort. So it became known as Spanish flu.
John Barry:
When the lethal second wave arrived in September, national public, because we were at war, Wilson had created a propaganda machine designed to focus the country on the war effort. The whole plan of that, the architect of that machine, said truth and falsehood are arbitrary terms. It matters little if something is true or false. So they were prepared to lie. And consistent with the propaganda machine, national public health leaders were saying things like, "This is ordinary influenza by another name." Well people knew it wasn't ordinary influenza by another name. There was no Tony Fauci back then.
John Barry:
Local public health leaders almost universally echoed that message, "This is ordinary influenza by another name, you have nothing really to worry about." We talked earlier about the symptoms, talked earlier about, people could die in less than 24 hours. Obviously this was not ordinary influenza. People learned that they were being lied to, they learned that very, very rapidly. It got so bad in Philadelphia, when they finally closed schools, bars, gatherings, closed churches, no church services and so forth, one of the papers actually went so far as to say, "This is not a public health measure. You have no case for panic or alarm." Well how stupid did they think people were?
John Barry:
I think ultimately society is based on trust. Without that trust, society began to fray. Obviously they couldn't trust anyone in authority. And I think the imagination is more powerful than reality. People began imagining things to be even worse than they actually were, and they were pretty bad. Therefore society began to fray. Not only in Philadelphia, but according to the Red Cross reports, from rural areas where you expect community and family to be everything. Reports of people starving to death because no one's got the courage to bring them food.
John Barry:
A very sober, serious, scientists who headed the Division of Communicable Diseases for the Army, and before the war had run the University of Michigan Medical School, which was a good medical school, he wrote privately that if the rate of acceleration continues for a few more weeks, civilization could easily disappear from the face of the earth. That's a pretty powerful statement. He happened to write that just at the peak, and the rate of acceleration not only didn't continue to accelerate, but in fact bent downward.
John Barry:
We started the conversation, you were talking about San Francisco. San Francisco was one of the very few, very, very few, cities that did tell the truth. You were talking about that, "Wear a mask and save your life." In fact San Francisco was very hard hit. It was fourth or fifth highest attest mortality in the United States. But the city functioned. You didn't have people starving to death in philadelphia because no one had the courage to bring them food. That community came together. After the pandemic, despite having been very, very hard hit, the Chronicle wrote an editorial saying that in the whole history of San Francisco, as bad as it was, it would be one of the most glorious moments because of the way the community rallied. Very, very few cities could've said that in 1918.
Josh King:
How did it all end in 1918 and 1919? Cities like San Francisco, people like Paul Lewis, how did they construct the body of knowledge to eventually triumph?
John Barry:
Piece by piece. You read the medical journals, and an enormous amount of work came out of this. The same way that you do anything today, there was no single moment, no dramatic breakthrough. The disease itself worked its way through the population. People developed some natural immunity, the virus mutated toward mildness. That's my speculation on the virus. Between those two things, and became seasonal influenza for the next 50 years, until replaced by the virus in 1957, which caused a much more mild pandemic, although still a reasonably serious one.
Josh King:
After the break, John Barry and I talk about COVID 19 and what comes after. That's right after this.
Speaker 3:
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Josh King:
Before the break, John Barry, author of The Great Influenza: The Story of the Deadliest Pandemic In History, and I were talking about the history of the 1918 pandemic and lessons it left us. We turn, now, our attention to the current pandemic, COVID 19, and what it will teach us about how we live our lives now and in the future.
Josh King:
John, in the earlier part of our conversation we reflected on the men who sought the coolness of contemplation as they used this grim determined action to fight the 1918 pandemic. As you've watched the last few weeks play out, and based on your following of those stories long before they became household names, reflect on the coolness of contemplation of people like Dr. Anthony Fauci, you mentioned him before the break, and others whose names we don't yet know, at least in popular culture, spanning the last decade and a half since The Great Influenza was published, preparing for what we're facing now.
John Barry:
I know Tony. I have very high regard for him. Must be very difficult for him. I don't know that he has too much opportunity for coolness and contemplation, but I know he's trying to get that space for himself to figure out the right things to do. A lot of this was predictable. A lot of this was planned for. Not specifically coronavirus, but the idea that an influenza pandemic was going to occur. I'm sure you're aware there were several bird viruses. All influenza viruses, actually, originate in birds, but they clearly can infect mammals, in fact pretty much every mammal. So when two different bird viruses began infecting people, H5N1 back more than 15 years ago, initially in, I guess, '96 or '97. Then another outbreak, right after SARS, then H7N9 more recently threatened to become a really lethal pandemic that would rival 1918, or conceivably even exceed it, most developed nations began to prepare.
John Barry:
I was part of the early planning in the United States under the Bush administration, at least conceptually. The Bush administration did get legislation passed in the bills of dollars to create a national stockpile to improve vaccine manufacturing technology, to build some vaccine manufacturing facilities, fund planning processes. Every state developed a plan modeled after the federal plan. They began with, because I know I pushed this in every meeting I participated in and never really got anybody disagreeing with me, that you start out by telling the truth, and absolute transparency. After that, you get into various social distancing measures while you're working on vaccines and drugs. This is obviously not influenza, but it's a respiratory virus, and you handle it in terms of so-called non-pharmaceutical interventions, what you do when you don't have any drugs, in exactly the same way that those plans were laid out for.
John Barry:
We were very slow to act, certainly testing has been a debacle in the United States. Ordering additional supplies of masks and things like that has been very sluggish and very disappointing. There are many countries in the world that have done so much better than we have. New Zealand, Germany, of course the Asian countries like South Korea and Taiwan, Hong Kong, Singapore, most of which had the experience with SARS, so maybe they were more sensitized than we were. But Germany didn't have that SARS outbreak, and the German response has been light years ahead of ours, starting with taking it seriously at the beginning. Which we did not do. Or, the White House did not do. I mean certainly Tony Fauci, I'm sure, knows a lot more than I do, and if I could figure out by the middle of January that this was going to be a very serious problem, I'm sure Tony knew. I'm sure the CDC knew. Again, they know a lot more about this than I do. And yet here we are.
Josh King:
You live in New Orleans; did you see a train wreck coming when you saw the spring breakers arrive and Mardi Gras take full flower on Bourbon Street?
John Barry:
At that point, no. I was concerned because CDC was saying there were so few cases, but they weren't testing anybody, so we didn't really know. And as it turns out, there were. But it did seem pretty early to me. I knew that it was going to get here. At the time of Mardi Gras there was, I forgot the exact number, but I don't think there had been a single death. If there had been, it was one in the United States, and there had not been any cases in Louisiana, supposedly. Obviously there were actual cases, but there was so little testing, nobody knew that. So I thought at that point we did have time. I was mistaken on that. But Mardi Gras did not actually concern me contemplatively. Although I live in the French Quarter and I'm not really a Mardi Gras person anyway.
Josh King:
To what extent do you see history repeating itself when we hear about the hope people have for things like hydroxychloroquine? You think back to your book, where you note that in Illinois, for example, 18 different vaccines were used because, for example, quinine was effective against malaria, it was employed too, doctors prescribed codeine, morphine, heroin, you threw the book at this thing.
John Barry:
They did throw the book at it. As I said earlier, you didn't have the ethical standards and you didn't have the liability issues, so they were trying everything that, logically, they thought might make sense based on this symptom or that symptom. The evidence on that particular drug right now that Trump keeps pushing is very, very mixed. There are studies that show it having no effect, there are studies suggesting that it does have effect. The side effects are potentially very serious and in fact life threatening. I wish that he weren't throwing that drug around. Obviously I hope it does work. Whether you support Trump or not, you certainly support saving people's lives. But that one, again, the studies are very, very mixed as to whether or not it's beneficial.
John Barry:
There are dozens of clinical trials underway on all sorts of things right now, that are being accelerated, but also are being done the right way. So if we do end up trying the drugs, we'll have good reason to think that they might work, not one or two very iffy studies. You've got to realize that even if something reaches a 95% level of certainty in a study, that means there's a 5% chance that your results are actually completely random and not reproducible. And even if it's 99% level of reliability, there's still a 1% chance that it's not reproducible. Even if you did the study right, and the results are as reported, there's a 1% chance that you're wrong. That's why you need multiple studies. Particularly when a drug has potentially life-threatening side effects.
Josh King:
Back in 1918, scapegoats could be found everywhere. You write the Germans, of course, were targeted, and the Bayer drug company because of its German origins. You talk about the health commissioner of Denver pointing his finger at the city's Italian immigrants. Again, as you think about where we are today as a society, do you see history repeating itself in terms of looking for scapegoats?
John Barry:
I think that the Trump administration made a conscious decision to try to call it the Chinese virus. It was consistent with his political game plan. Although he seems to have dropped that lately. Interestingly, I was on Breitbart Radio, very good interview with very well informed hosts, and I noted, however, they referred to it as COVID 19. They did not take the bait even on Breitbart to call it the Chinese virus. I don't really care what it's called, frankly. COVID 19's fine with me. The main point is, let the scientists work and let's get a solution. And we are all in this thing together.
John Barry:
In those early planning meetings I referred to 15 years or so ago, when we were trying to figure out what to do if a pandemic should strike, we thought a spokesperson was very, very important, because we knew we would recommend things like social distancing, and people needed to heed that advice. The groups were unanimous that it should not be any politician, not a president, not a Health and Human Services secretary. Because we felt any politician, no matter how honest or truthful, even if that politician followed 100% of our advice, was completely transparent, there would still be a very significant portion of the American public who would pay no attention to him or her.
John Barry:
We felt that the perfect spokesperson would be somebody just like Everett Coop, Reagan's surgeon general. Tony Fauci was not a member of any of these groups, but he was a name that we all said should be the spokesperson. And here he is 15 or 16 years later, we have a pandemic, Tony is out there. It would be much better, I think, for the nation if he were out there by himself.
Josh King:
The military is on the front lines of this, whether they are on the USNS Comfort in New York City or on the USS Theodore Roosevelt tied up in Guam. We've watched the story play out about the USS Roosevelt. First a few cases, then 150, then Captain Crozier is relieved of command for publicly sounding the alarm. Back in World War I the US had 120 training camps; how did they deal with it, versus what we're seeing today?
John Barry:
The Army Surgeon General William Gorgas, who was a very, very capable man, allowed the Panama Canal to be built by controlling yellow fever. Great admirer of William Welch, the Hopkins Deans Welch, became a colonel, and Welch's desk was actually in Gorgas's office. They initially tried to keep influenza out of the camps. They failed in doing that. They recommended isolation, quarantine, things like that. Some camps, they would examine soldiers twice a day for symptoms, take their temperature, look for any other symptoms. If one soldier was symptomatic he would be isolated immediately. If two soldiers in the same unit were symptomatic, the entire unit would be quarantined. This is not in every camp but in a lot of them. Others just did it once a day, a few didn't do it at all.
John Barry:
A very good epidemiologist named George Soper later did the first epidemiological studies of cancer and then head of the American Cancer Society, looked at what happened in the camps. He discovered that 99 camps had done some kind of quarantine, or the isolation, examining soldiers and so forth, and 21 did not. And there was zero difference, none. Not just not statistically significant, there was no difference in the camps that quarantined and the camps that did not.
John Barry:
That sounds discouraging, but he didn't simply look at the numbers, he did a qualitative analysis as well, and went inside the camps, see what they did. And discovered that most of the camps ended up leaking, very leaky. They did not rigidly enforce their own rules. And the very few camps that did, they had significant benefit in terms of flattening the curve at any rate. But there were so few of them in this larger mass, sample size of 2 million people, 2 million soldiers roughly in those camps, they didn't show up statistically.
John Barry:
That's actually sort of encouraging to us, and a lesson. For one thing, it's much easier to social distance in a civilian community than it is in an Army barracks. Very, very difficult in an Army barracks to do that. And what it showed us was that, if it could work in an Army barracks, if you rigidly enforced it, then we have a real opportunity to affect the course of the disease in a civilian society.
John Barry:
The second lesson is that these measures have to be sustained. You not only have to comply with them, but you have to sustain them. Pretty much all these camps, initially, started doing a good job, but over time they simply relaxed. It became tedious and so forth and so on, they had to maintain these measures for a month or more, and it became so lax, or lax enough, not necessarily so lax, because you don't need a lot of leakage to ruin the effect of the social distancing. So that's it, the measures can work, but you have to do it.
John Barry:
At the very first meeting, 15 or 16 years ago now, on trying to develop a pandemic preparedness plan and recommend pharmaceutical interventions, the very first meeting, we had in attendance the infection control person from the Hong Kong hospital that had the fewest number of healthcare workers die. As you may recall, a lot of healthcare workers died during SARS. And he was here to tell us what he did right. It's not like his hospital knew more about infection control than anybody else, those are standardized procedures. Everybody knows that, every hospital.
John Barry:
He just said, to get back to football ... Well he didn't say it, my paraphrase was blocking and tackling. He made sure that his people did it right every time, all the time. In other hospitals, maybe they did it right 95% of the time, or 98% of the time, or 99.9% of the time. But that little bit of slippage meant that healthcare workers were dying elsewhere around the world in large numbers. And they didn't die in his hospital. So we all know what to do. If we do it, we can get ahead of the disease. If we don't, we are in for a long, long hard road.
Josh King:
There was news out this morning that major league baseball could start next month in Arizona with 30 teams playing to empty parts with television cameras. But based on what 1918 has taught you, might today's problems in New York be tomorrow's problems in Phoenix?
John Barry:
Yeah. This virus is going to get everywhere. There's no question about it. It's going to get everywhere in the world, so we will see. I would think next month for baseball would, I think, be pretty early. I'm not sure the players would be too keen on that themselves. I'm sure the players association might have something to say about that. I didn't know that news, you just told me something I didn't know. There are ways to do things like that with reasonable safety. They all, of course, involve testing. We are still way behind on testing, we're running out of reagents. Testing is the key, continued testing and managing populations, and doing some pretty sophisticated studies. I'm not a quantitative person, I'm not exactly sure how I'd approach that, but there are people who are pretty good at those kinds of things.
John Barry:
I remember, when the first recommendations for controlling things came out, the federal government was talking about 250, limit your numbers to 250, and frankly I asked somebody at the CDC, where did that number come from? Was that modeled? No, it wasn't modeled, it was a political number to minimize disruption. In other words, it was nonsense. You need to pay some attention to the numbers. There may be ways to start sports back up without crowds.
Josh King:
Yeah, without crowds. I have a friend who's the CEO of a major sports team in a major city, John. His business model is not based on not having crowds, it's predicated on cramming 18,000 people in a building to watch a game. Even with an eventual vaccine, will those business models ever return to normal, or have we as a society become spooked to the idea of mass assembly?
John Barry:
I think they'll come back. And there's no reason they don't, particularly with a vaccine.
Josh King:
The first story of yours that you ever saw published was in a coaching magazine, about a way to change blocking assignments at the line of scrimmage. So we're at the line of scrimmage, Coach Barry. How do we change blocking assignments to the line of scrimmage against a nemesis called COVID 19 and the pandemics that will surely follow?
John Barry:
Obviously the line of scrimmage is the healthcare system, which is right now incredibly stressed. Healthcare providers don't have N95 masks. Number one, let's get the appropriate protective equipment to the healthcare workers. That's the number one priority, period, end of story. That's the line of scrimmage. After that, the testing, which we've already discussed. Therapeutic drugs, which we haven't really talked about too much, but hopefully we'll ... I mean there's a lot of optimism about a few of them. At least there are dozens, literally dozens, of trials going on on different drugs. And then of course the vaccine, at least a year away.
Josh King:
That will give us plenty of time to talk again John. Thank you so much for spending the time that you have with us, and best of luck to you and everybody else in New Orleans.
John Barry:
And to you also. Thanks very much.
Josh King:
That's our conversation for this week. Our guest was John Barry, professor at Tulane's School of Public Health and Tropical Medicine and author of The Great Influenza: The Story of the Deadliest Pandemic In History.
Josh King:
If you liked what you heard, please rate us on iTunes so other folks know where to find us. And if you've got a comment or a question you'd like one of our experts to tackle on a future show, email us at [email protected], or tweet at us, @ICEHousePodcast. Our show is produced by Pete Asch, Kent Abel, and Ian Wolff. I'm Josh King, your host, signing off from the remote library of the New York Stock Exchange in the Catskills of upstate New York. Thanks for listening. Stay safe and socially distanced, and we'll talk to you next week.
Speaker 3:
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