Notes: Pale Rider by Laura Spinney

This entry is part 6 of 6 in the series Book Notes

Concluding my pandemic-themed book reading binge for the year, here’s my summary of Laura Spinney’s Pale Rider (2017), perhaps the most comprehensive popular look at the Spanish Flu, among the many published to date.

There are several books on the topic, and the most popular is probably John Barry’s 2005 book, The Great Influenza, thanks to the now-widely-known-story of George W. Bush being inspired by it in the wake of SARS to beef up the United States’ pandemic preparedness. But I picked Spinney’s book partly because it is more recent (it covers research on the Spanish Flu that wasn’t available in 2005 when Barry wrote his book), and partly because it self-consciously sets out to paint a global portrait.

Here is the original thread on twitter (I read it in September-October). Now on to the cleaned-up notes.

Next pandemic live-read. Pale Rider, by Laura Spinney, about the Spanish Flu. I’m relentless.

Okay here we go. This will probably be the last of my pandemic reads. I picked this out of several on the Spanish Flu because it promised a global perspective. Let’s see if it delivers.

Basic facts well known by now: 50-100m dead 1918-20, 2.5-5%. Lost in footnotes of WW1.

WW1: 17m, WW2 60m, Black Death 75-200m (but much bigger in percent terms, 1/3-1/2). Bigger than WW1+2 combined, much bigger than COVID at least so far, smaller than Black Death. Most deaths concentrated in 13 weeks in 1918, “broad in space, shallow in time” WW1 was opposite.

We’re gonna get an African-women-narrative/Talmudic style story. Circling the subject with widening circles of context, weaving it into space and time. Sounds like fanfic. I’m down. Let’s go.

So apparently global perspective is recent scholarship. In Europe death rate from Spanish Flu was the lowest. WW1 took 2-6x as many lives. But elsewhere Spanish Flu was much bigger. So opposite pattern of Black Death.

Book has 8 parts with 2-5 chapters each. Part 1 is a history of flu viruses. They date to agriculture since they need higher population densities. More co-adapted to humans than malaria or leprosy, not as exclusively parasitic on us as mumps, measles, rubella.

So birds are thought to be the natural reservoir of flu viruses, and pigs an intermediate host. Makes sense that we’ve had avian and swine flus.

Discussion of how the flu was likely very deadly when it first appeared between 5-12k years ago and adapted to humans. Some discussion of native Americans getting wiped out by European diseases. Dry opening so far, but I appreciate the context setting. Will stop here tonight.

1580 was the first properly documented flu pandemic. 10% of Rome died: 8000. Two in 18th century. 19th century was peak of crowd diseases generally.

Industrial revolution cities “… were unable to sustain themselves— they needed a constant influx of healthy peasants from the countryside to make up for the lives lost to infection. Wars too brough epidemics in their wake.”

1830 and 1889, two flu pandemics in 19th century. So these things are not common.

Wonder if there’s been a coronavirus pandemic before SARS-COV-2 and -1.

1889 “Russian” flu — 3 waves, mild-severe-mild. 1 million. First one to be statistically profiled. It also attacked adults, not just elderly and children. Apparently Edvard Munch Scream was flu-inspired 😱

By early 20th century cities were self-sustaining thanks to germ theory of disease, vaccines, and sanitation. Wars became deadlier than epidemics and military doctors learned to control disease in conflict. But viruses still a mystery.

Even in the 19th century people thought of epidemics like earthquakes. Acts of god and beyond control. Hmm. Even with earthquakes today you can sort of manage risks by building on bedrock far from fault lines. I guess plate tectonics was like germ theory.

“In England [the plague’s] last visitation coincided with the Spanish flu” Infectious disease was still the big killer.

Antibiotics hadn’t yet been discovered. Modern germ theory was still pretty new.

Pasteur and Koch did their work between 1850-80. As new in 1918 as genetics today (which was unknown then)

Viruses were discovered in 1890. So as new then as the World Wide Web today.

Modernity is young.

March 4th 1918, guy named Albert Gitchell reported sick to the infirmary at Camp Funston in Kansas. Conventionally regarded as the start of the pandemic.

By May, all over Europe and starting in Africa, by end of May in India. by June/July in China, Japan, Australia. Unclear where it started, but war helped spread it fast.

3/4 of French forces and half the British forces fell ill. This was the milder first wave.

Longish tour of the spread of the second wave. Rather dry account of the complex pattern of spread. Peppered with a few anecdotes featuring Jung, Yeats, Kafka, Leo Szilard, etc. The war wraps and celebrations immediately cause crowd superspread events.

Second wave was deadliest and ended by December. Australia was the only major region that kept it out via quarantine. But third wave in summer 1919 got them too. So 3 waves of a few months each. Kinda different from the relatively continuous ooga-booga of Covid.

Now that we’ve surveyed the station-temporal contours, on to Chapter 4, about the disease itself. Mostly mild in first wave but deadly in second. Mutation? Most deaths due to bacterial pneumonia, Faces and extremities turned dark and they came up with a color-coded death watch.

So far I’ll admit this book is very dry relative to others. This African-grandmother circling narrative model is a little almanac-like. I think we’re going to go over the 3 waves with a dozen different lenses.

“The distress of the bereaved was compounded by the look of the cadaver: not just the blackened face and hands, but the horribly distended chest”

That’s Spanish Flu. Do Covid victims look as distressing?

Extended section on the symptoms. It’s interesting to compare this to the relatively limited descriptions of Black Death in the Tuchman book. Distant mirror vs proximal mirror. That came alive better but this feels more grimly real and less like aestheticized fiction.

“Delirium was common… [a doctor] described his patients’ anxiety-provoking sensation that the end of the world was nigh, and their episodes of violent weeping.”

Vignette in Rio, anchored by the story of a young man, Nava, living with middle-class uncle’s family. He fell sick.

Depressingly familiar tale of food shortages and closed schools. It was initially dismissed as an old-people-killer and elites didn’t want over-reaction.

Vaccines had only just been socialized. Ten years earlier smallpox vaccinations had led to vaccine riots in Brazil. By 1918 most were vaccinated but state public health was still unpopular.

Bodies piling up in street. A famous carnival reveller, Jamanta, Jose Luis Cordeiro, drove a tram up and down the streets collecting bodies and dumping them at the graveyard. The church bells rang continuously driving people living nearby nuts.

Shades of NYC under Covid.

“Terror transformed the city, which took on a post-apocalyptic aspect. Footballers played to empty stadia”

Err why? They didn’t have TV…

Color blindness was a symptom, so many accounts are shaped by the bleak colors. The book takes its title inspiration from one such, a Katherine Anne Porter story. Pale refers to the literal paleness. This pandemic was witnessed in black and white by many.

Chapter ends with the death of Nava’s pretty second cousin who he appears to have had a crush on.

This thing was very quick compared to Covid. In and out in 2 months but huge toll very quickly. Must have been like a horror movie.

Chapter 5. Extended riff on dangers of naming diseases poorly (eg swine flu is not spread by pigs but pork exports were banned by several countries anyway). Discussion of CDC naming guidelines which looks grim in light of Trump drumming on China/Wuhan virus.

Spanish Flu was of course not Spanish. It had been in US, UK, France for months before it arrived in Spain. Wartime censorship plus neutrality of Spain plus encouragement from the nations at war led to the name sticking.

This book is making me relive March/April in a deja vu way, and also re-frightening me, which is good. I might have been getting sloppy. Earlier this week, someone in my close circle died of Covid, much too young, and it was a sudden, sharp reality check. This is still very real.

“In Senegal, it was the Brazilian flu, and in Brazil, it was the German flu…”

Some progress. In 2020 we have more certainty around origins but at least largely call it coronavirus except for troglodytes like Trump.

Some evolution of a shared sense of humanity.

That was a short chapter on names that ended on a note of “sorry Spain, sucks to be you.”

Took a while for it to be recognized that there was one global pandemic on, not many local ones.

Again, progress. We knew pretty quickly. It was named, tagged, and tracked fairly early.

Now back to the medical story and a confused early understanding due to a misattribution of influenza to a bacterium by germ theory pioneer Richard Pfeiffer:

When history’s deadliest influenza pandemic began in 1918, most scientists believed that Pfeiffer’s bacillus caused influenza. With the lethality of this outbreak (which killed an estimated 20 to 100 million worldwide) came urgency—researchers around the world began to search for Pfeiffer’s bacillus in patients, hoping to develop antisera and vaccines that would protect against infection. In many patients, but not all, the bacteria were found. Failures to isolate B. influenzae (now known as Haemophilus influenzae) were generally ascribed to inadequate technique, as the bacteria were notoriously difficult to culture.[2]

The first blow to Pfeiffer’s theory came from Peter Olitsky and Frederick Gates at The Rockefeller Institute. Olitsky and Gates took nasal secretions from patients infected with the 1918 flu and passed them through Berkefeld filters, which exclude bacteria. The infectious agent — which caused lung disease in rabbits — passed through the filter, suggesting that it was not a bacterium.[3] Although the duo had perhaps isolated the influenza virus (which they nevertheless referred to as an atypical bacterium called Bacterium pneumosintes), other researchers could not reproduce their results.

People confused it with cholera, dengue, plague, typhus… most doctors would only have looked at surface symptoms like black spots on cheekbones. The most advanced practitioners would have made sputum bacterial cultures mistakenly following Pfeiffer’s theory.

This was just 102 years ago. All four of my grandparents were living through this 😰

Today we’re lucky enough to have political controversies about proper testing of the correct thing. The FUD in 1918 must have been mind-boggling. They were MINOs: Moderns in Name Only.

In Chile, elitist doctors thought it was typhus (spread by lice and apparently considered a disease of social decline), blamed the poor, and launched a misguided typhus campaign but didn’t ban gatherings. The 2 look alike except typhus spreads slower and ends in a rash.

The sanitary brigades invaded poor homes and ordered the poor to strip, wash, and shave hair. In some places they burned down poor tenements and the homelessness probably caused flu to spread faster.

All societal ignorance reliably hurts the poor first. 😶

Still true with Covid.

Now a vignette from Shanxi in China where a reformist warlord battles traditional Chinese medicine with the aid of American missionaries who were the only source of western medicine. The locals mightily resisted modern medicine and sought refuge in appeasing dragon gods.

Sadly I think this stuff is still potent. Indian WhatsApp is full of bullshit traditional medicine ideas and religious crap. Though to their credit, people seem to be treating them as a second line of defense rather than first.

Gotta admire the Christian missionaries who spread western medicine through the test of the world, as well as their politically courageous local sponsors, in the early 20th century. Double jeopardy: religious and lifestyle hostility.

This book is giving me a sense of civilizational memento mori. Modernity is so young and fragile. Just a hundred years ago the world was vastly shittier than it is today, yet we’re callously risking hard-won things for shallow vanities. Kudos to GWB for learning this history.

“Watson [one of the missionaries in Shanxi] measured the impact of the governor’s [Yen] modernization efforts by his own practical yardstick: how many villages spontaneously organized their own quarantine at the first indication of an outbreak.”

Worked well apparently.

Possibly, it’s not current state of knowledge but openness to new states that determines success in adaptation. These superstitious Chinese villages 100 years ago in Shanxi were more open to learning and change than many ostensibly modern parts of the US today.

People in Allied countries suspected biowarfare and wondered if Aspirin made by German company Bayer secretly contained more and whether German U-boats were spreading the flu. Today that would be suspicion of Russian or Chinese vaccines.

This chapter has a vignette about a devout but backward part of Spain, Zamora, that avoided mass gatherings but excepted church gatherings. Had a devout and anti-science bishop who catalyzed lots of masses and funeral parades. Ended up with the worst record in Spain.

Sad that religious congregations have been superspreading vectors from Black Death to Covid. It’s almost as though religion is a behavior like sneezing and coughing. Wear an atheism mask during pandemics people.

Alright back to this thing. I feel like this is my capstone read in a Covid-adaptation course.

Where were we? Ah yes. Religious people spreading death with their beliefs in Spain.

A chapter on how disgust-based distancing and burial practices are hygiene measures found beyond humans in nature and how these behaviors gave rise to distancing practices. Three big ones: cordon sanitaire, isolation, and quarantines. All 3 from times of ships and small towns.

With the rise of big cities and other forms of travel besides sea, these measures became less popular. Takes a small town where everybody knows each other for this stuff to work without external top-down authoritah.

Large cities = impersonal = defection behaviors.

Huh interesting, disease surveillance became a governance thing after the Middle Ages and by 20th century most western countries had systems for tracking spread of key diseases. The problem is, in 1918, influenza was not on the list. Slipped under the surveillance radar.

For modern disease control you need 3 top down things to work: detection, tracking of spread, and compliance with measures. In our case, testing, research on spread (droplets etc), and masking. Older control measures don’t scale to modern cities.

This point about historically cities and villages administering their own measures, often really harsh, is surprising. Town in England cordoned itself off and half the people died before it was lifted.

Makes sense. They had no good medicines. Containment had to do all the work.

Flu snuck under radar everywhere except a few islands, Australia being the major one. They had enough warning and got quarantine right to skip first 2 waves. New Zealand didn’t. American Samoa escaped because they figured out spread. Western Samoa, under New Zealand, didn’t.

Long discussion of epidemiology 101, social distancing, masks, vaccine controversies etc. All familiar now but would have read like science fiction when this book came out. It’s weird to read about this stuff covered with reference to 1918 with academic distance.

Feeling of not deja vu exactly but something like it. As in “omg they already knew all this stuff 100 years before Covid and we’re just learning it under live fire and relitigating 1918 arguments like they’re new?”

Must be weird for authors like Spinney to suddenly see their obscure interests take over headlines.

It’s like if 2x2s suddenly took over headlines and everybody started citing my 2×2 stuff.

This part is a bit boring but would have been interesting in 2019. Authoritarianism vs democracy, role of newspapers, minorities and marginalized populations suspicious of health measures. All stuff we’ve been through live.

One difference is that keeping schools open was a better bet then since kids otherwise lived in crowded tenements or ran around unsupervised.

Extended description of New York’s relatively good performance despite early fumbles. It was full of particularly vulnerable Italian peasants at the time, living in slums and already disproportionately suffering from respiratory diseases like TB. Pandemic led to improvements.

…Paired with similar extended description of events in Mashed, Persia, where things went much worse. At the time it was a medieval pilgrimage center and Persia was in a partial power vacuum due to the collapse of Tsarist Russia and the Great Game.

The British were filling the vacuum and doing their usual thing of simultaneously raiding the country (for troops) and trying to govern it. Two bad harvests and the people were already starving. It was set up to be a shitshow and it was.

Weird time machine aspect here. 1918 was around the beginning of global synchronized time. Local stories ranging from medieval to modern. Governance systems with similar range of vintages.

Mashed appears to have been somewhere between Shanxi and South America in development terms. New York comes off most modern so far.

As in Shanxi, Christian missionaries played a significant role. Targeting a Shiite holy spot for evangelism and being tolerated for medicine.

We interrupt this thread to note that Trump and Melania apparently just tested positive. Well our own shitshow just got worse so I’m glad to read about even worse shitshow in Persia 102 years ago 💀😖

That Mashed vignette was interesting. A sense of modernity arriving alongside missionaries and medicine. Persia modernized shortly after in 1921 under Reza Khan.

Seems like Spanish Flu triggered a lot of modernity arrivals. Covid might trigger a lot of anthropocene arrivals.

We stop here tonight. Gotta check on what the Discourse is saying about Trump having Covid. This seems like an awful development to me. He might win on sympathy votes or die and trigger a civil war from the grave. Ugh.

BoJo, Bolsanaro, and now Trump. Hmm.

We return to 1918, and the next chapter, titled The Placebo Effect.

Conventional medicine had just recently been privileged by law over alts like naturopathy and faith healing. There were no antibiotics or antivirals. Drugs were artisan. No double-blind or animal trials, no QA.

Aspirin was the big deal and heavily overprescribed in unsafe doses, which may have caused some deaths. Quinine too which may have caused some of the reported loss of color vision as a side effect. Digitalis, strychnine… sounds like an Agatha Christie medicine cabinet.

Arsenic, Epsom salts, castor oil…

Some doctors fell back on older techniques. Bloodletting etc.

Galenic “humors” medicine was still strong.

Medicine was closer to astrology than astronomy in 1918.

Temperance movement was big so alcohol was controversial as a treatment. Some thought cigarette smoke killed the virus.

Le Corbusier “retreated to his rooms in Paris” drinking and smoking and reflecting on how to impose Modernist Authoritah on the world. Gee thanks Spanish Flu. Wonder what bad ideologies are taking shape in Covid domestic cozy retreat right now 🤔

I’d better get Raoism codified.

Lots of dubious patent medicines flourished since there was no regulation. Dr. Kilmer’s swamp root was one.

Traditional home remedies also thrived. Mustard poultices and stuff. This stuff is living memory even for me.

When I was sick with coughs and colds and bronchitis as a kid in the early 80s (often), I was often administered Ayurvedic remedies like Starbucks turmeric lattes.

So basically all treatments being tried were placebos at best (hence the chapter title). Many were nocebos or actually harmful. The only worthwhile advice was to stay hydrated.

Section on fate of Odessa, which had been curiously unaffected by Bolshevik revolution and the only city to even detect the flu. Couldn’t do much with knowing because it kept changing hands through the war and revolution.

The city was half Jewish and a prominent Jewish doctor/bacteriologist Yakov Bardakh led what efforts could be undertaken. The city was reeling under a flood of refugees from the revolution. It was apparently a famous cosmopolitan city of its time, known as Marseilles of Russia.

The Russian silent movie star Vera Kholodnaya retreated to Odessa and died of the flu there at age 25.

A Jewish “black wedding” was held in a cemetery to ward off the flu. Between beggars. Apparently many such were held around the world.

Next chapter, titled “Good Samaritans” begins with observation that your best strategy was to to be selfish and isolate yourself and hoard food. This would starve the flu and it would die out. Then as now, people mostly didn’t do that.

Generally adaptive strategy of “social resilience” (coming closer together in a disaster) is maladaptive in a pandemic. Apparently there’s lots of theories why. Force of habit, fear of ostracization later for bring antisocial, all-in-this-togetherism, expanded sense of self…

With few exceptions people generally pitch in to help each other. Notable exceptions were in colonial conditions (Africa, India) where the colonized had learned to distrust white behaviors in crisis and deserted.

“At some point… group identity splinters and people revert to identifying as individuals. It may be at this point — once the worst is over, and life is returning to normal — that truly ‘bad’ behavior is most likely to emerge”

Ah shit. The assholery hasn’t even really started.

Rio carnival in 1919 was more out of control than before and there was a spike in rapes it seems.

And reports of a related ‘sons of flu’ baby boom (“hard to confirm”).

Spinney cites Decameron for similar effects after Black Death.

Long bleak account of ravages of flu among Yupik of Alaska. Already dwindling from other European diseases, the Spanish flu hit them hard, wiping out entire villages. Relief ships found dogs eating bodies in some. Weird subplot of Russian orthodox vs American Protestant missions.

300 orphans were brought to town of Dillingham of population 200. Today most inhabitants claim descent from flu orphans.

This was a messy story, hard to summarize. Weird mix of Russian-American-native history, transition to modernity, decidedly mixed role of relief ships that appear to have done some looting of dead villages, but helped others… there’s an Oscar-worthy movie in this episode.

Next chapter, “hunt for patient zero”.

We stop here tonight. This is an oddly choppy book. Lots of jump cuts and impressionistic dabs. It’s not as enjoyable as Tuchman’s more classical renaissance-painting tale of 14th century but in some ways more effective and comprehensive.

The origins of the Spanish flu are uncertain. We begin with the hypothesis that it emerged in Manchuria in 1910 when China was weak and sick. The mandarins appointed the first western educated Chinese doctor, Wu Lien-Teh, to try and do something.

That appears to have been pneumonic plague and looked similar to the another in 1917 that Wu thought was also plague but is contested. Hard to do autopsies due to tradition.

300k men from this region served as a labor force in the European theater the following year.

This region = northern provinces hit by the thing that might have been either plague or flu in 1917.

This is the modern Chinese-origin hypothesis, not the speculation during the Spanish flu itself, which was more Yellow Peril mindset than a hypothesis.

So Hypothesis A is Chinese laborers brought the flu to WWI. Hypothesis B is that it broke out on the western front of WWI (and infected the Chinese labor contingent after it arrived).

Case for both is circumstantial, since there were not tests for the virus and records are poor. So it’s a case of a time-space jigsaw puzzle of outbreaks in 1917 that presented vaguely like the pandemic proper a year later.

Hypothesis C is similar — it came from Kansas.

These 3 are the most likely hypotheses. Apparently the one thing that’s nearly certain is that Spain is not a candidate.

Next chapter on death toll. Already in the 1920s the best estimate 21.6m, 20x the Russian 1890s epidemic of 1 million. Revised up to 30m by 1990d, but likely still an underestimate especially for Russia and China.

We circle back to Odessa, this time with an epidemiological lens, to cross check the Russian estimate of 450k/0.2%. Odessa data as a better documented Russian refugee zone suggests 1.2% and 2.7m instead of 450k.

China was similarly undercounted. Probably 4-9m, though an estimate via different method landed on just 1m. India was likely 18m.

So modern estimates are between 50-100m. 2.5-5x initial estimates.

This is all extraordinarily shaky. Literally data as plural of anecdotes.

Next: story of how multiple people converged on conclusion that it was not a bacterium but a virus. One of the first to publish, Rene Dujarric, had himself injected with filtered blood of a patient (thereby eliminating bacterial causes) and getting sick.

His conclusion was flawed because influenza cannot be transmitted via blood apparently. Right answer, wrong method. Other research pair, Nicole and Lebailley, got it right. FUD of pandemic+war.

So to peek ahead, modern theory is that Spanish Flu was a member of what is known as the H1N1 virus today (Though I did hear alt theory that it was actually a coronavirus).

So methods were generally sloppy then, so people believed what they wanted to. Richard Pfeiffer, of the incorrect bacterial theory of influenza, stuck to his theory. Others tried and failed to replicate the filterable infectiousness result.

Antibacterial methods seemed to work (likely because they addressed secondary infections). All in all, general confusion like today, leading to strong opinions.

Took till 1930s to confirm viral theory and connect to swine flu. 1950s to figure out origins in species crossover, via a ferret sneezing on a British researcher named Wilson Smith.

So of the 3 kinds of influenza A, B, and C, only A causes pandemics apparently. There’s also a 4th kind added recently.

It was hard to prove because viruses can’t be cultured like bacteria, in a Petri dish. Only inside living cells.

In 1931 Alice Woodruff and Ernest Goodpasture (solid names) figured out how to grow viral cultures in fertilized chicken eggs. I guess that’s why flu shots are grown in eggs and also why we get flus via birds. Very enlightening factoid.

Russian dude Smorodintsev created first attenuated flu vaccine in 1936. Many eggs were needed.

Aside: as a baby I had a bad reaction to a Russian-made smallpox vaccine (I’m old enough to have received that) that parents say almost killed me. So I have an extra large badass vaccine scar. As a teenager I used to tell other kids I got it in a knife fight. Some bought it 😎

The attentuated vaccine was risky since the virus could regain virulence. Russia continued to use the older tech viruses for 50 years. So 1986. Hmm… I wonder 🤔

Inactivated polyvalent vaccines were invented later and by 1944 American troops in WW2 were receiving it.

Jonas Salk apparently worked on the early flu vaccine in 1940s. Alexander Fleming helped prove viral origin in 1918. This story has interesting cameos.

Viruses weren’t actually seen till after 1943 when the electron microscopes were invented. Spinney compares them to Higgs boson before then. Quasi mythical and not entirely believed in.

The H and N of HxNy naming scheme refer to Haemaggluttinin and Neuraminidase, which help virus break into and out of cell apparently. Now you know. This is what the villain of this story looks like btw. Bastard.

Because flu viruses are single strands of RNA, they are not as stable as DNA and make lots of replication errors. This is why they drift 2% a year and vaccines have to be updated every covfefe. Shit, viruses are liek twetes. Taht’s why their hard to fihgt.

So pandemics apparently happen when 2 different virus strains meet cute in a human cell and have virus sex. Results in novel immune resistant strain. Especially bad if human and animal flus meet. You get human-adapted alien virus.

This is awful. I’m never taking off my mask or going near animals again. How did we ever think we could win this arms race long term? It’s like our microbial interface is full of fast adapting little trumps crossing the wall from bird snot.

Anybody think about how Trump’s wall idea is just a country scale mask against people he thinks of as diseases? Some 4d irony there that I don’t have the energy to unpack.

Wear masks, don’t build walls.

So flu equilibriums last about a human lifespan. Once populations get “immunologically naive” another pandemic can happen. 1968 Hong Kong flu was possibly 1890 Russian flu, and 2009 H1N1 was apparently 1918 Spanish Flu.

There’s an eerie echo here in outbreaks of totalitarianism. Despite “never forget” culture re Holocaust, 2010s had become immunologically naive to perils of totalitarianism. Even though Trumpism mind flu is an attentuated strain, it’s descended from Hitlerism mind flu of 1933.

There are apparently 18 kinds of H and 11 kinds of N. So you could potentially have a flu called H18N11🤔.

And that’s not even counting strains.

We should just give up and stop living in dense cities. This doesn’t seem very winnable long term.

Yeah I’m a bit defeatist.

Ok that’s 13 chapters done. Next one ominously titled “beware the barnyard.”

Bedtime horror story resumes tomorrow. Try not to pet bats and ferrets and chickens ok.

Footnote to tonight’s notes… defeatism here is not just me. I’ve heard a popular theory that the century of gains against infectious disease was entirely based on temporary victories. Individual battles are won but the war overall gets harder and we are steadily losing ground.

Well, let’s get back to this grim fairy tale. The story of crossover. Apparently duck guts are the natural reservoir of flu viruses and that’s been known since the 1970s. I’ll never look at ducks the same. Wonder what species stores coronaviruses 🤔

They used to think flus needed to go from birds to humans by way of pigs (which would make the French origin hypothesis the likeliest for various reasons) but H5N1 in 1997 in Hong Kong showed it could jump direct. Could that have happened in 1918? 🧐

After partial sequencing from rare preserved samples in the late 90s, researchers managed to get better permafrost-preserved samples from Alaskan mass graves. In 2005 Ann Reid and Jeffrey Taubenberger finally sequenced the full genome after 9 years of detective work.👏👏👏

Damn 87 years later. Gotta love the deep historical detective work.

They resurrected the virus in the lab and showed it was very bird-like. No pigs needed in transmission chain.

1918 flu was exceptionally good at blocking interferon, which is the immune system’s first responder that blocks virus protein synthesis. This is like a SIM card hack to get around sms-based 2FA or something.

If this first line fails, second line defense kicks in, immune cells and antibodies. Blood flow increases to infected cells, nearby cells are killed to prevent spread… this is inflammation. Like a control burn around a forest fire I guess?

The immune cells released cytokines to do this stuff. If this response is overzealous you get a cytokine storm, which seemed present in 1918 based in reports. Replicated in lab rats after the sequencing.

Note that we’re already into the story past the point GWB got missionary about this stuff in 2004 or so.

In 2011 they figured out that the virus mutated slightly by the second wave to adapt better to humans, which is why it was deadlier. Could happen with SARS-Cov2 as well.

Btw it seems like H1N1 identifies a class of viruses based on H-N topology. Not a specific strain. I guess the genus/species type Linnean binomial nomenclature is too coarse for viruses.

So the mutation was possibly favored by wartime conditions on the western front. Normally viruses get more moderate to spread better but if everybody is dying faster from bullets, the more aggressive strains might be favored. Also mustard gas is mutagenic so might have nudged it.

So if there’s a second winter wave of Covid and there’s a civil war after the election, we have a mutated worse strain to look forward to. Yay.

This story just gets relentlessly gloomier as a precedent for 2020.

More detective work. Drift rates in the virus suggest the North American origin story is most likely. Research by Michael Worobey of U. Arizona in 2014 showed 7 of 8 1918 H1N1 genes resembled flu genes found in North American birds.

This is fascinating. Apparently horses rather than birds used to be the main flu reservoir. There’s a chance mechanization/cars and the retreat of horses from human life made birds the reservoir. Very circumstantial evidence but I like the story.

There is some tricky inside baseball here about 8th gene and the W shaped mortality curve. I’m not going to try and follow the intricacies here. But the level of detail that detective work uncovers is astounding. I didn’t know flu research was so broad deep. Good work Science!™

2 more flu epidemics in 20th century, 1957 Asian flu H2N2 and 1968 Hong Kong flu, H3N2, both share a lot of genes with H1N1.

Apparently humans gave the flu to pigs, not the other way around. Swine flu should be called long pig flu.

We stop here for tonight and reflect on the grim fact that coronaviruses are not flu viruses so a lot of this does not apply. But we have a sense of the learning curve involved.

Chapter 15: the human factor. Apparently there was a lot of variation in who died across age and time. Age mortality had a W shape with a peak for adults and also very young and very old, already covered in previous chapter… complicated. Now geographic.

Asia and Africa had the highest death rates. Some areas 30x the west. Persia seems to have had the highest rate at 22%.

Undivided India highest absolute numbers, 13-18m at 6% fatality rate. Possibly higher than WW1. I’m guessing some of my great grandparents generation got it.

Mostly boring survey here of patterns similar to Covid, correlated with wealth, class, caste, bring immigrants etc. Eugenicists casting aspersions at “inferior” races being weaker etc. Interestingly blanks in the US appear to have been less susceptible in 1918 unlike 2020.

Mask wearing and banning of mass gatherings cut death tolls by up to 50% in some cities and the US was better about this than Europe.

Woodrow Wilson vs Trump would be an interesting comparison. Has anyone done one?

Mostly men died at greater rates except of course in India where these things always flip. TB was a big comorbidity. It’s weird to think about how TB was such a huge thing back then. Like diabetes today.

It’s kinda grim that so many segments of this book are boring through no fault of the author. We’ve all learned this stuff more directly. We’re in the reboot of this movie.

Well that’s it for tonight.

Here we go again. Chapter 16, “the green shoots of recovery.”

Bad news: took between 1922-26 for the Spanish Flu to truly recede, basically culling the population of the weak.

Sorta good news? there was a baby boom after as the healthier ones went for the demographic dividend.

In general the world got healthier from the cull. Especially men. But babies conceived during the flu, and exposed to it prenatally were weaker, and had poorer life outcomes.

Many adults who got it had chronic conditions after, just as already seen for Covid.

Darwinian 💀

We’re only now seeing Spanish Flu effects erased as the last of those born during it die.

The acute phase of the disease often had anxiety attacks and suicidal behavior. The chronic phase often had lingering depression. 💀💀💀

In Norway, 7x higher asylum admissions related to flu every year in the 6 years following the pandemic.

It’s going to be 7x the fun till 2026 people.

Tanzania had a famine because people were too depressed to plant stuff.

General high incidence of “sleepy sickness” encephalitis lethargia, EL, 1917-25. War+flu I guess. A third died within weeks, a third recovered, a third went on to develop Parkinson’s-like paralysis.

The causal link is unclear but it seems these were the Oliver Sacks’ L Dopa patients in Awakenings. Damn.

We end this chapter with the story of a Xhosa woman, Nontetha Nkwenkwe, who started a religious movement out of her Spanish flu visions and ran afoul of the white state that saw her movement as subversive, and kept putting her into an asylum till her death.

This chapter rhymes the most witch Black Death aftermath. Mental illness, long-term social malaise, cults…

Not pretty.

The core of it seems to be extended post-viral fatigue syndrome and complications, compounded by unraveling societies where the toll was high in % teens.

We stop here tonight. That chapter totally bait-and-switched. “Green shoots of recovery” my ass. That was more “red veins of long-term damage.” Repent ye sinners.

7 years of pain are upon us.

This is the least entertaining of the books I’ve read do so far, but the most reality checking. It’s like reading a travel book about a country by a foreigner after being blind-teleported there. She’s the expert, but all of us now know more than she did when writing this.

This chapter is about what-ifs of interrupted lives. Survivor lives that turned out different due to someone close dying. Insurance companies paid out $100m ($20B today).

One death was Trump’s grandfather. The real estate slumpire started with his Spanish Flu insurance payout 😬

Due to prime-of-life fatalities many breadwinners died.

In Sweden, for every death, four people ended up in the poorhouse.

Do we have poorhouses anymore?

Countries like a France and UK passed adoption laws soon after the flu, possibly due to flu orphans. 500k orphans in South Africa alone 🤔.

Black ones didn’t do so great.

20 languages went extinct in Vanuatu which apparently now still has 130.

Some Alaskan tribes crippled.

Baby boom + orphans in 1920s. States with highest death rate had highest growth in per capital income after 🧐

Yupik word: nallunguarluku, “pretend it didn’t happen.” Apparently elders advise young people to do that to their recent history. Looks like the Spanish Flu was the last of several epidemics that destroyed their way of life completely. Welfare-alcohol spiral.

A lot of people are going to have to nallunguarluku 2020.

Not me I think. The flu culled not just physically vulnerable individuals but demographically vulnerable cultures and languages.

Wonder if it happened in civilizational core. Like music or literary scenes culled.

Next chapter, science and anti-science. The flu caused backlash against germ theory triumphalism, and alt medicine types claimed higher cure rates and grew in popularity and legitimacy after.

Le sigh.

Expecting an anti-vaxx spike myself, post-Covid.

That was a quick chapter. Back to nature movements, loss of faith in Victorian science but rise of more modern ethos. Kinda weak connection to flu as one of the causes. Medicine regained credibility with ruse of virology, antibiotics etc. Overall the flu created postmodernist.

Next chapter a whistlestop tour of rise of universal healthcare and modern public health surveillance in the wake of the Flu. The Soviets pulled it together first. Socialism and public health got all mixed up and the US got set on its death-before-socialized-medicine course.

Naturally, eugenics was also invented alongside in both left and right editions.

International Red Cross was founded and global public health became a thing.

Rockefeller foundation was the main non-socialist catalyst of public health and was of course suspected of a neocolonialism agenda. The Bill Gates conspiracy stuff today is spectacularly unoriginal.

Rockefeller was tarnished by involvement in Nazi eugenics. The era’s public health ideas had openly eugenicist flavor, but that had become not-PC by the time League of Nations collapsed so WHO was founded on non-eugenics principles. Of course socialists continued with it into 60s.

We stop here tonight. Big lesson: science had made big leaps since Black Death and has made more big leaps to 2020. But people stay the same. And they suck.

Everything social/cultural/political happening today has clear rhymes in 1918 and 1348.

Long science, short people.

The purpose of science is to make the world suck less despite the fact that humans on average suck exactly the same in 1348, 1918, 2020.

Chapter 20, war and peace, is kinda weak and all over the place. Starts with a good account of why Spanish Flu might have swung the war in the allies favor (it hit Central Europe harder due to malnutrition etc), then unravels as it surveys global post-flu geopolitics.

Wilson got the flu, Gandhi got the flu, dealing with the flu was part off the story of political leadership everywhere obviously. But it’s unclear if it was decisive anywhere. The flu was big but other big stuff was going on too. It probably accelerated slide to WW2 though.

Chapter 21, melancholy muse, is about why the flu didn’t inspire much art though it did create a huge break from past tradition. No major creative of the lost generation really tackled the subject though all were personally affected by it.

So in romantic tradition that preceded the modernist tradition (?), disease was a boring everyday reality and mainly used in symbolic ways in literature like in Thomas Mann’s Magic Mountain where it represents Europe’s decay. After the flu/WWI it was a literal central concern.

Virginia Woolf consciously pioneered this shift. Though the Spanish flu wasn’t a special focus, disease and illness generally took center-stage. She wrote an essay On Being ill in 1925. Hadn’t heard of it.

This was another rushed, whistle-stop tour chapter. Unsatisfying. Again there’s a vague pattern here globally. A shift away from romanticism to unsentimental realism plus introspective orientation. But it just sort of gestures at Spanish Flu accelerating existing artistic trends.

I do think we’ll see an equally sharp acceleration of artistic trends and it will be similar in tone, from expansive neoliberal romanticism of 1997-2015 to a post-Covid unsentimental interiority. And an equally studious avoidance of explicit and direct engagement.

Spinney mainly surveys literary fiction and poetry around the world as indicator species. From T. S. Eliot outwards. Freud thrown in (clever to include him and his death drive theory in art chapter). Plausible case that mood shift was sharpened by flu. Today I’d track memes+TV.

Interesting insight into Hindi literature of the period (Premchand, Nirala) of the progressive movement of the time as a break from Tagore romanticism. Not something I expected to see in a book by a British writer. She reads it right but again I doubt flu was a decisive driver.

In general this chapter and the previous one could both be full books. They read like speculative teasers of richer possible treatments that leave you looking for closure/resolution of the hypotheses being casually floated.

Finally close to the end of this book.

A retrospective from modern view.

2016 report by Commission on Global Health Risk Framework (GHRF) estimated 20% chance of >4 pandemics in the next century, 1 being flu.

Well 1 down, 3 to go. Hopefully this is last big one in my lifetime.

The big flu candidates are H5N1 and H7N9. They’re under surveillance. I guess viruses are like terrorist orgs. Gotta monitor them.

One 2013 model estimated if something like Spanish Flu emerged today, there’d be 21-30m dead. Relatively lower, but absolutely higher.

If the exact same strain of H1N1 emerged today, she says it would likely be mild.

I wonder how you get to that conclusion. Most people exposed to it are now dead. How are the rest of us immune primed? I still don’t get some basics here. 🤔

This conclusion and afterword is mostly forgettable speculation in light of Covid. Comments on WHO and CDC that seem charmingly simplistic in 2020. Still some interesting thoughts on using social networks for surveillance etc. Just… obsolete.

Afterword has interesting insight that pandemic memories take longer to develop and stabilize than other historical memories. 80,000 books on WW1 but only 400 on Spanish Flu. But latter are recent/exponential increase.

Spanish Flu is finally entering popular memory. 3 characters in Downton Abbey got it and 1 died. Black Death wasn’t even called that till the 16th century. It was called the blue death before. First works on it from 19th century.

That delay effect is over I think. Covid has been live-blogged and tweeted vastly more broadly and deeply than anything in history. I bet there will be a crop of solid books within a decade.

Alright done. I skimmed the last 5 chapters rather fast because the book was beginning to drag tbh. But it’s overall a very well done heavy lifting that does its global multi-level spiral South African grandmother storytelling shtick well. The diverse anecdotes help a lot.

This concludes the pandemic reads live-tweeting book club.

Series Navigation<< Notes: The Marshall Plan by Benn Steil

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About Venkatesh Rao

Venkat is the founder and editor-in-chief of ribbonfarm. Follow him on Twitter

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