tv 1918-19 Influenza Pandemic Lessons for Covid-19 CSPAN May 25, 2022 10:53am-12:18pm EDT
anytime at c-span.org/history. i'd like to introduce our guest speaker. who is christopher knight nichols of oregon state university. he is i would like to introduce our guest speaker, who is christopher nichols of oregon state university. he is a frequent collaborator of ours, a board member at oregon's historical society,
his youtube videos talking about comparing the pandemic to what happened in 1918 are some of our most popular online. he is very active in civics, citizenship, and we are thrilled to have him with us, a full vile is on our website. without further ado, professor? >> thank you so much, derek, thank you so much to derek olson and to the partners at the oregon historical society who have helped make this event possible. most importantly, thank you to all of you with the tremendous interest in this topic. that has been inspiring to me, excited to talk to you and walk through some of the questions that we have about pandemic exhaustion. pandemic to endemic latin's from the 1918 flu pandemic. so, i will now share my screen so we can see some of the amazing images from this era. as i do so i would like to
first consider our contemporary moment. it is the second here, we are about to turn into a third year of the pandemic. the truth is we are all one out more. this will help face how many questions we have today. the pandemic has challenges and changed us in ways we are not sure we fully appreciate. it has revealed the fractures and fissures within society that many of us knew where there, we had some sense of them, but quite a few of us chose to avoid them or ignore them, or not address them. most of all, if we are thinking about the pandemic today it is not over. that is a crucial insight that we have from those who are pursuing wishful interest and thinking into 1918 and 1919. many of us had longed for a end to this pandemic through 2020, 2021, and now in 2022. this pandemic has now also
reminded virtually every one of us at the importance of history. and, of understanding pass pandemics in particular. i have been variance fired by helen people have been learning about the pandemic of 1918 from journalists, business leaders, to citizens, to students, and others. comparisons abound. historical lessons have been the subject of a lot of sub conversations i have spread as rapidly as the virus itself. in particular the 1918 1919 pandemic has become a subject of interest. which survives us. for the first few moments of this talk we will discuss where we stand today, a historians perspective on where we stand today. first and foremost i think there is an optimistic element, something we all need to take a moment and take on board, especially in these troubling times where russia has attacked ukraine and there is a lot of uncertainty in the world.
in world historical terms we have arrived at the amazing moment, they fastest successful global race to effective vaccines happened in our lifetimes. everybody who is alive today and has witnessed this in some way, shape, or form and is not cognizant of that fact. increasing production, distribution, and vaccination by spring and early summer 2021. the resumption of some seemingly normal activities became something that a lot of us could hope for, and could pursue. and then in came the omicron and delta variance. first the delta wave overlapping with omicron wave. as they combined with the presence of blocks of our population, did this fundamentally alter the trajectory of the pandemic? is this something we have seen in the past or is this
something new? that is a question for us to star in, that is for public health scholars. i am a historian and not an epidemiologist or an empty. so, we have this quote that i am suggesting up there. absolutely remarkable in world historical terms. and the other hand the world health organization and others noting that even though the omicron sub variant is, perhaps, less deadly it is also more infectious. it is racing around the globe and coming to catastrophic numbers in total deaths in the u.s.. me in 1918 there was a race by scientists and others to try and push forward vaccinations. to try and figure out science for that. people long for better treatments and search of desperately for a fight of ways to deal with the pandemic. trains sprinted across the country with prototypes of the vaccines to try and get them into the arms of volunteers. i will talk a little bit about that.
and you think about the moment where and now it is a tale of two pandemics as i know it is here, what is astonishing is when you look at these numbers and broad perspective and not in fine grained analysis it is how badly u.s. global covid deaths have been in comparison to the u.s. as percentage of global influence us in 1918 and 1919. to put that in slightly better perspective with a population of roughly 105 million there were only the order of 675,000 estimated u.s. deaths in 1918. into 1919. today it was a population of over -- the u.s. is 930,000 estimated covid deaths and counting. one piece of analysis is that obviously the pandemic is not over in the sense of moving through omicron but also in the devastation it is living in its
wake. one of the historical lessons we have learned, my great colleagues like nancy bristo and others have emphasized in great work on the 1918 pandemic. we need to put forward lessons and insights about suffering and trauma. the people who survive pandemics often have what we call contagion guilt. gill related to the contagion themselves coming through it, perhaps surviving, perhaps not having too many effects. also guilt about conveying it to others, family members, loved ones, members of their community, when we think about these big numbers i would encourage us all think about the smaller scale numbers and the trauma, personal and private suffering and morning that you go through. locking into this set of concepts, then, i would suggest one of the first lessons that came out of the 19 1819 pandemic that was telegraphed and shouted for the rest of the public health officials in that period, and that's been something that we've heard pretty consistently from 2020
now to 2022, is that a viral, deadly pandemic is much easier to prevent than to clear. the case of preventative behaviors and measures, things like masking and distancing and closures, those are the best mechanisms for that. but, of course, easier to prevent than cure now, in our contemporary, moment unlike 18 1918, prevention strategies, safe we know to be affected through modern science, have really changed the game of how we may think about being easier to prevent than to cure. another element of this that i want us to pull out here at the outset of this talk, as we think about questions of what is the meaning of endemicity and how should we think about lessons from 1818 and 19 for today is that giving up on pandemic measures, or downplaying the significance, likely means paying a significant price. so, here's two examples. one from, denver one from birmingham.
in 1918 into 1919, particularly in the late fall of 1919, after some weeks of what we call non-pharmaceutical interventions, and pei. like social distancing enclosure policies. after just a few weeks or months, people were eager to get back to their lives. they didn't like doing those behaviors very much, as we haven't, in fact. so, one challenge, particularly in the middle of november 1918, november 11th was armistice day, ending world war i, was that people gathered. they got, it they gathered, they partied. they were excited about this moment for the u.s. and the world and, therefore, as we would now think about it, you had enormous superspreader types of events and gatherings. even so, even as a thing for a feared, many health officials, politicians that business leaders who wanted to keep their businesses open, clergy members and churches wanted to
keep their places of worship open, pushed back against those non-pharmaceutical interventions. you end up seeing, in a number of places, uptakes of infections, deaths and disease. in some places, like all talk about a little while, like the city of denver, you saw a higher peak of deaths coming later in the deadly second wave of the pandemic. so, that's another key lesson here. it is one that you can't move away from those behaviors but that is critically important to take into account data and disease more than wishful thinking. so, that will lead us into thinking about this a bit. this is a glorious declaration in the city of portland, from the oregon daily journal. officials say the flu endemic is over, masks not needed. this is a sort of thing that we have been hearing in a number of blue states, in fact, in recent months. the state of oregon right now has said sometime ago that, by march 31st, masks wouldn't be
needed. and has now said that forward even to march 19th. these are the kinds of decisions that are either made led by data and disease or by public pressure. one of the things that we saw on the 19 1819 pandemic was a public pressure, to ease off on these kinds of restrictions, it was virtually omnipresent. it was an enormous and a lot of places, it didn't necessarily map on the politics are partisanship but people got tired of these kinds of behaviors fairly rapidly, much like we've seen in the last few years. one of the ways that this was manifest by public health, officials just eight days earlier, before that pronouncement was, and i think this is really salient to us and will resonate with a lot of you i bet, was this kind of accusation of individuals being careless. that the apathy of the public is the hardest thing officials have to fight, or that carelessness is the greatest
cause of spread. doctor sumner, of consolidated health in portland, made this argument that only until recently, in february 1919 -- in some, account some ways of thinking this would be in the midst of a third wave or in the case of portland, really, there is a large duration second wave of the influenza pandemic. he was arguing that finally people were changing their behavior, but the reality of this moment was that the city was rescinding some of these orders and mixed messages because of pushback as well. but this argument here is that it's about public responsibility and personal responsibility. one thing that is worth noting as we think of later stages of pandemics, like the one run today, is the ways in which individuals are -- the burden is placed on individuals. not always the collective. another, it's this accusation, here the set of comments, it's about people not wearing their masks, essentially, or gathering too much. that sort of thing. it didn't so much about what the city or the state owes to
those individuals. so, if you think about questions of who or what counts is an essential worker or the kinds of inequality that are exposed when a pandemic affects people who are, say, in businesses where they have to interact with a lot of individuals were in larger numbers at least. then, you could think about how this argument for personal responsibility may have some limitations, right? it's not as if people want to go into workplaces that they're forced to and interact in groups with those who may be carrying infectious diseases. now, things that change for us again with vaccines and boosters. but even today, less than 50% of adults who got their first or second vaccine have pursued a booster shot in the u.s.. which we know to be the best preventative measure. so, here's some headlines from the new york times, selected out from 1918-19. the new york times i would highly recommend you, it would be great to search. they cover the nationally at a local pretty well and thinking about the 1918-19 flu pandemic.
it gives you some sense of the kinds of mixed messages that individuals and groups were getting from public health officials and from politicians. the kind of wishful thinking of politicians and public health officials at different times. the sort of special interests that were invested in staying open or reopening. you also find in some of these cases a real fear about a return of the pandemic, in late 1919 into 1920. one of the key things, before i walk us through the whole pandemic very briefly get us to the endemic stage, is to know that there are four waves really. most historians track the first, three through the summer of 1919. but in the winter of 1920, that fourth wave, what's being worried about some of these notes of some of these headlines in the middle to late 1919, that fourth wave was worse than the first in the third. one of the truisms about pandemics is that, in fact, debate operate on three-year time scales.
this doesn't necessarily hold for all pandemics, it may not hold for hours today. it doesn't necessarily fit for 1918 and 19, but there is some truth to that. i've been a roundtable article with some scholars of this that will be out in april that talks about some of the kinds of time horizon that you can expect, based on past experience. so, let me walk you through a little bit of the overall ways in which the pandemic preceded, so that we can get a sense of how it developed and then where it went. what we can think about in the later stages, where there might be lessons for us today. i think it's incumbent on us to think very much about the human suffering, as i noted. and about how that affected risk assessment. so, one of the things that scholars often when they talk about the 19 1819 pandemic is the importance of historical memory. we've been puzzling for years about the fact that are the 1920s, and to the 1930s, there's a lot of small bits,
kernels if you will, of evidence of how the pandemic affected people. there was something called long flu, there is a brain encephalitis condition, there were psychological ramifications. fact, there was something like a seven times increase in hospitalizations due to psychological issues and diseases coming out of the pandemic. very much akin to long covid. and subsequent medical knowledge has suggested that viruses often increase the ways in which many individuals and groups have risk for other kinds of diseases. i want to thank, as we move through this, as historians emphasize, the personal suffering and private trauma often inform public behavior. one of the best examples of this is the doctor victor vaughan, he was dean of the university of michigan medical school, a former president of the american medical
association, founding member of the journal of lab in clinical medicine. he was serving as a colonel in the army when he let itself division of communicable diseases, when the influenza outbreak began. you can see in his memoirs, in his writings that the time and later, that as he travels to camp devins in massachusetts, outside boston, in september 1918 with a team of those appointed by the army surgeon general to look into the outbreak of the spanish flu, than so called, the influence of pandemic. he was pretty shocked. he said, i might say that i thought my eyes would never see such horror as i saw there. i went through the spanish american war, i saw thousands and thousands of cases of typhoid fever, but i never had anything so depressed me as the conditions that existed at camp devin's. as i have up there from his memoirs, even though he says in the introduction of his memoirs
he won't talk about his experience of the 1918 flu, he doesn't fact very much at the end of it talked a lot about it. poignantly. they are placed on the constant toll every bet is filled, what more come in. -- the bloodstain spewed in the morning that bodies are stacked up -- one of the things that are so essential to understand about that, pandemic unlike ours today, is that it disproportionately affected the most healthy amongst us. it affected the age bracket of 18 to 45, such that roughly half of all deaths of the 1918-19 flu pandemic came in that age range. , so it disproportionately affected the young and healthy, lead to extreme nursing shortages and medical caregiver shortages. it took people out of workplaces, it killed numerous parents and transformed the lives of orphans and all sorts of ways that historians have
documented and can only imagine. so, let me walk you through a bit more how the pandemic began and what is dignified. there are a number of origin stories about how the pandemic began our way began, epidemiologist are still tracing this. one origins tory is that it developed in vietnam, another is that it came from china. yet another tracks it to an outbreak in 1916 near the french lines in world war i. but as we track it over its global spread, in late winter, 1918, it looks to most scholars like it moves along the transmission lines of the u.s. military. moving from camp funds done in kansas. in march of february of 1918 and incubated of those perfect petri dish of large camps of young, healthy man, moving together, training together in very close proximity.
as john barry, historian, rights, a soldier told that of the 12 minutes left my squadron seven where he'll at one time. within just a few months, you find that -- within under a month, of march, 24 of the 36 largest you have camps are overwhelmed by flu cases. this is all in the context of world war i. one of the challenges for us, in trying to figure the lessons of that pandemic and how it transformed to the endemic, it's at the devastation of world war i and the transmission lines in the global connections of world war i have really overwhelmed how we can understand and desegregate the flu story of world war i. so, estimates are that perhaps as many as 50 million people around the globe in a global population of about 1.5 billion died of the 1918-19 flu pandemic. and some populations, it was as much as five or 10% of the population. in others, it was on the order
of one to 2%. it matched with the sort of lost generation kinds of concepts that fit observers from the 1920s and 1930s thought about the devastation of the war. effectively, the world was globalized in 1918. and so, as the flu spread in march and april from kansas, across the atlantic, across the port facilities where u.s. troops and material were headed in breast, france. moves around the world such that it's in algeria by june and only australia is able to keep it out by the end of the year, by very strict quarantine policy. then, eventually, six troops on troop transports bring it in at the end of 1918 and early 1919. so, just like in 2020, the virus traveled around the world through the conditions of the great war. as you see here, u.s. trading forces there in an induction camp in syracuse, new york and
french forces near the western front are near ideal kinds of configurations of human beings to help spread and to help enhanced mutation of viruses. if you think about this moment, another key element to understand about that pandemic and, in some of the ways that we've dealt with it in the u.s. and around the world, as to think of it in terms of patriotism and in terms of nationalism or other kinds of calls for bringing people together for communal or collective effort. so, you saw the world war i context first, a real attempt through organizations like here, the red cross, to manifest and operationalize a kind of patriotism, to turn that against the virus as the war was ending, as that deadly second wave was coming across and crashing across the u.s.. and red cross volunteers and others making gauze masks, where in the so-called fight against the virus.
as you see there as you see there on this line. if i fail he dies as a direct translation. there is a direct translation to end the war effort and in terms of care making and mask making, and other activities. there is another element of this, i will mention it briefly. which is that wartime censorship later big role in the information people could have. one of the lessons learned at that moment repeat future public health and you saw this in public health preparedness documents from the cdc and other organizations has been honest, clear, transparent communication. masha sensual in risk assessments for a infectious disease, in this case in 1914 in the uk we, you also see it in the 1918 espionage acts in the u.s.. which made it a crime for journalists to publish stories that might undermine the war effort. ostensibly this was about the
war and preventing people from undermining the war. it also got caught up in the undertow, journalists would have reported against those induction camps and barracks that were overwhelmed with cases of flu. even when it was a less lethal and less inspections disease. there was this effort to minimize the flu, they three-day favor as the u.s. public health service noted. that was the assessment in early 1918, and so there was little reporting on it. the censorship was also part of why i got a name spanish flu. because spain was neutral in the war effort and therefore it's journalists were able to report when the king of spain got the flu, and a number of
elites in the aristocrats got down with the flu. there was widespread disease. and, it then it was weaponized. very often anglo american press you would hear spanish flu used derisively to talk about a place and people that were much more prone to getting this disease. if you look at any of these documents you find that, in fact, american doctors and british doctors knew very well that the flu did not originate in spain. but, minimizing the risks, minimizing the flu itself was widespread even as the second deadly wave was spreading across the country. as you say this indications, here. no occasion for panic. . certainly in the u.s. of 2020 we saw this, but across many countries. we have heard it because of wishful thinking. before there was more information on the delta variant and omicron, wishful thinking that perhaps the virus was developing to be less
infectious or less deadly. more there is no reason or wishful intent of a virus except to self replicate. me. so as we think this through and talk through the whole of the pandemic, the second deadly wave really occurred and fall of 1918. when you look to the happening, the world scene is minimizing in the midst of the war, you need to look no further than what u.s. and british intelligence officers were saying as i saw a more infectious, far more deadly variant. secret and confidential documents like the disease that is now epidemic throughout switzerland is commonly known as the black played, although it is being designated as the spanish sickness. what they want, they waving the red flag of warning that this is going to affect the war effort.
, they are challenging they wilson and ministration. or at least the troops combative in a fundamental way. of course, the problem is the war effort. not wanting to undermine the war effort, and moving forward lewis things like liberty loan parades to support a case for the war, one of the things you say in september 1918, which i bet a lot of you smart folks in the audience have been thinking and heard about me. the superspreader event in philadelphia in september of 1918, local public health officials have been minimizing the risks of a flu, they said that they could be contained in the naval docks and in the military facilities, and it would not affect facilities. and then, as it began to encroach into the civilian population. there were warnings against it, it was the largest in
philadelphia. nevertheless it did move forward, and at the worst in the wake of the event you had as many as 700 died a day in philadelphia. it is more so devastating. . in some fellas there are none left to get care of the burying the dead, others are not able to bury them. they cannot get undertakers. husband an infant dead in a few hours any woman dying. as i noted before by the later stages of the deadly second wave a state like pennsylvania had 45,000 or fans. if the child lost the mother, the father is very often we were not culturally commissioned by their communities to take care more.
the devastation is massive in this moment, if you look at letters and correspondents me you often find out about the private devastation, sent off to live with relatives because of the death of parents. the ways in which that affected educational or career opportunities. the region people live in or grew up in me,, mark i think what is worth the movement of people on the private trauma and devastation of covid, i think that will be with us for quite a while. as we are thinking about the move across the u.s., that first wave went out from kansas across the atlantic, the second wave comes back. it comes into boston. it comes down the eastern seaboard and then moves across the country. one of the things that you can say when you track through the good faith efforts.
the countries that work and did not work in this area, the subsequent infections, death, spread, and case fatality rates. one of the things you see is that across the u.s. with the time lag there is the development of different types of interventions. you end up finding more masking on the west coast and the southwest, because people have had a little bit more time to figure out that might be effective. or, at least that as a behavior that travels with other behaviors, like keeping more distance, abiding by closure policies. that is the sort of thing that may be useful. as it goes you see the effects of social distancing as well, i'm sure a lot of us are familiar with this. i will not be labor this point. it is clear from the data and applied immediately in 2020 was the effects of social distancing. in the city of philadelphia is
the best example. he was a sign of the union army soldier, he was obsessed with infectious diseases and control. he was armed with more capacity by the mayor to put on social distancing policies early and keep them on for longer. it is not like there was not infection, gas, and spread. if you look at st. louis versus philadelphia you see a much lower pig. you see a more affective overall total strategy. that is a clear lesson to learn, another lesson that we have learned that and something we saw with omicron is that health care structure can be overwhelmed. of course in 1918 and 19 the public health infrastructure was much smaller. citizens then, regular people living in communities really had far fewer possibilities or
opportunities to go to doctors, medical facilities, they did not have the same expectations of them that we have today. for instance, one thing that i have been thinking a lot about and do not have fully formed ideas about is that there is a double kind of privilege that we think about today. there are people that think it is perfectly fine to be unvaccinated or an boosted. and then, should they get very ill they also believe that if perfectly fine and appropriate to take advantage of and use all the tools at their disposal within the modern medical public health infrastructure. in 1918 and 1919 there were people who pushed back against restrictions, like masks and closures, but there was not the widespread sense that a hospital would be available for you, or modern medical treatment necessarily curio in the way that it does today. i will deepen that thought to suggest that the 1918 and 19 with the rise a professional
medicine. the gendering of the profession where women were nurses, making a case to be more professionalize nurses with training. there were more gendered male medical doctors and mvps. there were lots of promises made that modern medicine could help cure or deal with these kinds of infectious diseases and other concerns. one of the lessons that came out of the 1918-19 pandemic you see this and spacious and memoirs and letters. doctors and very sanguine and the doctors could not deal with the flu. the flu caught them by surprise and they did not have the tools at their disposal to grapple with it. the best they can do is palette of care, essentially. this is sort of what we were dealing with in 2020 before they were treatment strategies, before there was much known about covid. by the late 1920s, and this is a message i think you should
consider, by the late 1920s the lessons of the same doctors and medical professionals were putting forward was that this is a triumph of modern nursing. that modern nurses were able to deal with this overwhelming of the health care infrastructure. but these now nearly trained professional women nurses were doing a great job. if anything the may lessons and arguments to come out of the flawed strategies and medical treatments of 1918 and 1919 was that we needed more, essentially. the argument we made was that we needed more money for science and research, more money for vaccines, you see lots of studies in the early to mid 1920s of trying to figure this out. there was, of course, some pushback. but one of the things you saw with a non-pharmaceutical interventions coming to play was the most accepted. that is arguably the same case and story that we have seen throughout the pandemic. even though there has been even flow, fatigue and exhaustion,
even pushback and misinformation. the vast majority of people seem to have agreed to and supported and accepted the closure policies. whether it was schools, churches, businesses, limits on gatherings, limits on the number of people who could come into businesses like grocery stores. that sort of thing. you know, this is one good example where you see in washington d.c.. churches, protestant ministers at a meeting, they vote unanimously to a seed to the request the churches be closed in the city. so, when you saw sometime ago these battles over whether or not religious groups should have a special exemption to gather based on their fate. one of the interesting things you saw in 1918 was that religious groups generally agree. in fact, you see lots of innovative ways in which they attempted to do their teaching by correspondence courses. people coming, picking up letters, sermons, send in the back. that sort of thing.
then, like now there is bad information and incoherent messaging, the thing i tend to think about most is not the u.s. surgeon general, although it is the remarkable number of times that he said it was not cause for alarm as the second wave was spreading. rather, one of the things i most interesting think is this moment is a direct comparison between ours and theirs. woodrow wilson never once spoke publicly about the flu pandemic. he was far more concerned with world war i and you barely see references to the flu pandemic and his private correspondence. even though it seems very likely that in the paris peace negotiations to end the war in 1919, he in fact did come down with the flu. that flew case, even if it was not so bad, did seem to have backed his personality, even if you want to argue against that element it is very clear that we may have had effects on his vascular degeneration, that led to a stroke that he had later in 1919.
which undermined his ability to negotiate, not just about the piece but about the u.s. joining the league of nations. lots of repercussions in this moment, wilson did not mention it. lots of misinformation, questions about ethics vapor wearable, gargling by troops, you see on there also. volunteers getting a vaccine. places then, a number of other places, as they ease on and off, relax quarantine procedures, predictably places like billings, montana, they saw an order of a third to half of the county come down with the flu in the fall of 1919. so, it continued on throughout this period because of a flow of the disease and because of the ways in which peoples and groups work through the push back against them. i noted this race for vaccines, i wanted to suggest just how important that was and also how
much mixed messaging was there. as we think about our race for effective axioms and how important that's been a world historical terms, the race for vaccines and 1819 was a challenge for politicians at the local level. they didn't want to over promise and under deliver, and they were worried about possible side effects. and, as they see these first anti grip vaccines, influenza vaccine, they're hopeful. but actually, they find they don't work particularly well and the u.s. military and navy are the volunteers for quite a few of these studies, as our convicts. which is another part of a lot of these stories that comes up to the present. whether or not people are volunteering for testing and for medical testing and skepticism about the effectiveness of treatment strategies. as things move forward in the fall of 1918, there is an ongoing push and pull and messaging is a real problem.
when will things left? how will they left? we're seeing that now, in 2022. some promises about health commissioners and governors and mayors saying that things will change and be altered and yet, in some cases, following death and assailants bread and other cases following a push of special interest. one of the lessons we also know that this, moment one of the other things we should think, about whether we're business leaders or politicians or individuals in other kinds of institutions, if that fails reopenings arwa tend to work. that is, you reopen slowly, you keep on kinds of behaviors like masking or distancing and then you have to be prepared to slam the door shut. so, one of the ways the turn to endemicity endemicity can be thought of that it is over and there's a new normal but rather there is a phased opening back towards the new normal. there may not be a new normal for quite awhile, but i can
permit kinds of new normal activities or old activities that you want. you see this again and again in city after city across the u.s.. but there is some cautionary tales. so, one of the key elements at work here is the case of denver, i highlighted this before as we began. denver, in late november, there is something that i tend to think of him that callers call the amusement lab. businesses and leaders who invested in keeping theaters, movie houses, pool halls and other venues open. they successfully pressured the mare and public health officials to rescind and then revise a closure order. and this, in turn, generated what the rocky mountain news called, quote, almost indescribable confusion followed by widespread public defiance of mask and other public health prescriptions. add into that the fact that, in november, i foreshadowed this with that early warning about
gatherings, by the middle of november you have armistice day and people gathering to honor the end of world war one. he's only have a second a much higher peak of deaths in the city of denver. so, one of the ways to think about that is think about how these flu mask issues that came up to places like in utah, salt lake, the board of health were being pressured by local interests. if you think about how this is proceeded at other local levels, for instance mask battles at the school board level, you can imagine the kind of pressure being exerted on individuals and groups. in the case of the city of denver is on the mayor in the public health board, but in other places it's on the board of public health or on commissioners of schools. in san francisco, where resistance was generally at last successful that a denver, there was significant buy in from the sacramento bat getting. so, they had a first round of masking in the fall of 1918 and
then a second round of public health mandates and masking in early 1919 during a new surge. this is what led to lots of you know something about, but one really organized and all large-scale pushback organization in the u.s. on masks, the anti mask lead in san francisco. they claimed a number of 4 to 5000 total individuals within the group. it's always good to be skeptical about what numbers a group claims are its membership. but in any case, this was an organized lobby, they did lobby hard, they argue that of liberty was undertaken also that utility or efficiency and functionality of mask that steak. of course, they also argue to some extent against the kinds of penalties that were put in order to ensure that people would wear their masks would behave in those ways. so, you saw these famous cases in that moment. refuses to don a mask and a shot by a mask, held on a
charge of disturbing the peace. most of these people that were fined where man, many of these women who are recent immigrants or second generation immigrants, working class men in many cases. so, there is reason to believe that policing of anti masks or people who are refusing to wear masks was also skewed by inequality and racism. and, so that's important for us to note as well as we think about this moment. as this pushback happened in the second round of mandates the 1919, and the reason the mask mandate was put back on with other health measures, was because there is rising cases and deaths. the anti mask leak had formed, public defiance became more pronounced and, eventually, anti mask presented improving epidemic situation combined to end the so-called masked city's second mandate. one of the things i'm pulling out here is that january 17th as when they put back in that mandate, and you can see some
of the lower numbers of deaths there on a daily basis coming out of. that so, for the mayor and other public health officials that meant success that men they could pull back. keeping us moving, as the flu burned through vulnerable populations by late winter and early spring 1919 deaths and infections drop rapidly. shifting towards an addict moment. but the flu would remain present and other things that disrupted the country took the floor. you had a readjustment of the economy coming out of the war, you had racial violence and massacres, you had the largest strikes in u.s. history, the greatest real strike and others. he sought global tumult as well in 1919, the red scare, these are the ongoing civil war in russia. and, so efficient surprise was too much that at this moment in our pandemic we are seeing global tumult as well. and tumult in the u.s., you might say, as you think about the kinds of pushback we've
seen from both the left and the right. as i bring us back around to a conclusion, here is, courtesy of the center for disease control, a very basic chart thinking about that flu pandemic. so, you have here that first, wave much more modest. you headed to a second, wave quite enormous, significant numbers of death. the month of october 1918 alone, you have almost 200,000 americans die. in a third, wave which is that we tend to think about this pandemic, you see another significant uptick. it's not as if this is gone away. but when i want to emphasize it's from another, where detailed chart by one of the major statisticians working on this issue in this era, solomon collins, and i wish the 1920. this is that fourth wave that i, mentioned this is wet people, when we tend to think about the 1918 pandemic as being, quote, endemic, when we tend to think of that you fact in fact five very high death rate in the
late winter and spring in 1920. so it's, worth as we think about how catastrophic this was, just how important those later waves were in suffering and death, the human stakes and polls. i also wanted to know, again, if you're looking at and thinking about that in trade, the each practice of those being affected. again, really salient an important thing that i wonder if we'll see in years to come is how much of this younger age bracket, you see at the lower part of the age range, the 1918 pandemic is taking lots of younger people. 1919 waves taking lots of younger people. 1922 still taking lots of younger people. it's not until 1924 that we think about the seasonal flu is now more affecting the older age demographics. one of the speculation that epidemiologists and public health historians have is that the older groups and 18 have had exposure in a flu pandemic of 1889 to 1890, and their
previous exposure to something that was perhaps somewhat similar had led them to have at least a partial immunity. a little bit akin to what we've been talking about a lot lately. so, at least the worst outcomes of death didn't befall them. as i wrap up to a conclusion, i want to give you one political cartoon because i always love these. and one set of overall takeaways. this is the chief objectors, from the sentinel in 1918. people going, out doing their holiday shopping, one of the things i love about this is how it suggests that there were, in fact, objectors and society then. does anti-maskers type people, those folks not following the rules. here, giving you a sense of germ theory, giving you a bit of an insight even into injections and how people would be thinking about those. you see here, the chief objectors and this moment with a group of people still close together but masked is that they're saying i thought this holiday shopping would be our
chance, but then infernal mask spoil it all. we can't get through and everybody is safe. this is public health messaging through political cartoons that you saw that era, as one of many efforts, especially late in the period, to try and get across the message. so, here, let me give you a few pandemic to endemic insights. for as long as there is a deadly infectious disease spreading at scale in a community or across nations, there is no such thing as business as usual. or business has before. this is something that you see in the historical, record people longing for, and it's a good thing for us to just jettison as a concept or a term. better to think that you can return to new normal is or that you can develop new behaviors. but, that in fact, a return to business as usual is just inappropriate, frankly. not when there are people who are immunocompromised in our population, that one is a large population of unvaccinated people. not when there is people who cannot be vaccinated, according to the fda, in terms of under
five are at risk individuals. so, that is one piece of thinking about how this push back and push and pull of 1918 into 19 provides an insight for the president. another one, as i know spot is always worth keeping clear, on, it's clear communication, even the bad news and uncertainty, is best. if you think about efforts by state governments recently to talk about ending mask mandates, they've promised dates but without a lot of information as to why. so, you would want to think, if you're following this communication strategy, that we should know why. not just because people want to be unmasked or have different behaviors indoors, but what is the evidence for that? one of the arguments that we've seen, for instance, from the cdc last year and in late 2021 about quarantines with that they thought that people could go back to work earlier and they wanted to keep businesses open. one of the things you saw in that 1918-19 we see today is a kind of fast i'll pitting against each other of the health of business or public health.
the reality, one of the lessons of the pandemic to endemic stages, is that you can have both. but you can't have both as fully. there's good studied by economic historians and economic in general is that putting on or putting on later non-pharmaceutical interventions to save people suffering and death actually has positive economic benefits. another element of this, if you think about 1918-19 and risk assessment, is that we have to be of succumbing to fatigue but also honor it. if you like the cities that were doing well in 1918-19 their thinking okay, we have to get back to some new normal, we can't have all this enclosure policies. and this was before vaccines, of course, they don't have them. so, honoring that but not succumbing to it. in other words, not doing what denver, did not reopening and having second peaks. one other element that historians offer a lot is the question of how private trauma and suffering get translated to the public is very hard. when you're at numbers like
940,000 dead in the u.s., they are impossible to grapple with. but we all know some people who have suffered, and many of us know people who have suffered tremendously, including ourselves. and so, part of that is how to get that into the public narrative. historical memory of the 1918-19 pandemic is very limited, it appears an art and literature but sporadically. is that going to be the case of the suffering from this pandemic? my hope would be that it wouldn't be. but if it is the case, then you're unlikely to see the kind of substantive changes to public health that you might want. another element that i said, at the outset, that pandemics expose inequality. the question about equality for all of us is how good public health moved forward at an endemic stage if we also know that people are unequal in whether or not they're vulnerable to the disease. and, so part of that is thinking about the structures of government that might make it possible for people to work from home or to have a better
social safety net. and another element of that is thinking about how we can all, in our own behaviors, consider grocery store workers and delivery workers as essential workers, and that old sensibility of an essential worker for the war effort. in a patriotic sensibility. now, as we finally conclude thinking about this pandemics are political but they are also psychological. one of the things we need to think about when we think about this shift to the endemic is that most public health policy is local, and so is most endemic stage thinking. it is local, risk assessments that i have and you have, and for some it is the days with constancy, it is always there. on a lower level, for others it means one that concentrates on specific geography so it will be located in a particular place. for others still it is still in the technical definition. that is about a state over which a year or several years
each person who catches the infection will transmit it to one other. something like that. but, in the end endemic diseases can be innocuous or severe. and, just like in the case of seasonal flu you can learn to live with them. so, this 2020 moment. there is 1920 moment i want to emphasize for us is very important to understand the long term health consequences. so, in 1920 with all of those new deaths. more than the first and the third waves. one of the long term consequences was the long flu. you find references to it in the literature and the medical sciences, in the arts of the 1920s and you see it in all sorts of walks of life. as we think about the endemic insights and stages to come, grappling with long covid and the longer term vulnerabilities of the populations around the world, patients that have not had full vaccinations have not had access to vaccines at all. a whole another part of
thinking about the global public health policy. one lesson here is a close relationship between the local and global. one that i would like to emphasize for worldoregon is thinking about public health policies as they move in construction circles from local to global. and from individual choices, to other practices. there are final way of thinking about this is there is no such thing as sheer, certain, endemic stages. the 1918 pandemic, some scholarship between 19 1918 pandemic into the 1920s, others say that after 1990 and you see easing of restrictions and localities are ready to put on restrictions but they go wide open. in that sense it is the eye of the beholder when he moved to a pandemic stage. these insights help us to map a menu of options moving forward. thank you so much for being
here, i hope we have a good time for some q&a to follow. >> great, thank you so much, chris, this is tim director of programs for world oregon. as always it is a pleasure to hear you expound and throw down on such a fascinating topic. we have a lot of good questions from folks in the audience. i am going to jump straight in, certainly this was news today. they state department of education and the away jay an ounce that they are moving up the dates to and masking in schools and indoor public spaces to march 19th. do you see an echo of the past in this decision? caving to public pressure that in hindsight may have been hasty? is there an object lesson for us? >> that is a great example of precisely what i was trying to tease out in that brief anecdote from denver, colorado, in november of 1918. that as special interest, as
individuals lobby for particular public health outcomes that they want you are more likely to see precipitous public health measures taken by localities or from every level. now, again, they are not necessarily wrong. this is a question of trying to figure out an appropriate balance and strike an equilibrium. when some of these measures, it strikes me as an observer and a scholar of this, some of these measures are not that onerous. i do not think that masking, although i do not enjoy lecturing and spending 4 to 12 hours in a mask, is pleasurable. i do not enjoy it. i do not think it is particularly onerous. so, that, as a kind of particular issue for school age kids who have not been vaccinated. or, other kinds of things is striking me as less important of a battle. and, therefore one where you could draw a former line in the sand. this sorts of things that would happen in the setup of
decisions statewide is about opening indoor facilities. having maximum numbers of people inside. and, that doesn't seem like it should be led by data and not by lobby groups or other groups pushing for the outcome they want. i think the lessons from 1918 and 19 are pretty clear. places that open precipitously, even when there was increasing and significant transmission in the communities. they did worse. they had higher peaks of deaths or longer series of infections. or, they had a longer duration of total infections. that is another thing that happened in cities and states. so, i absolutely hear those residences and i think the insight for us and thinking about our role in this is that we all need to make our own assessments but also push for our collective best interest. i think one of the things that gets lost when we look at this historical literature is that pushback, i wanted us to start their early on. by public health officials against individuals, saying it
is the apathy that is the real problem. that may be true in some ways but if you look at the historical record you could flip it around and say it is really about public health officials making a tough decision. really standing up to those special interests, school board members, or others. you see that in a few places in oregon, new bern for instance. one of the people in our school board said they would resign if you rank off the mask mandate right away. he was able to get people to keep it on, at least for a little while longer. >> a couple of questions about lessons from that period, or models from that period. were there any innovations that arose during the 1918 to 1920 pandemic that helped enable society continue to function, similar to us being able to use zoom, for instance? >> it is fascinating, when you read the personal accounts of people see in news stands, magazine subscriptions. people were ravenous lee
rating. and interested in all kinds of literature. you see a real expansion of purchasing, reading, correspondence courses. sermons by mail or part of what people did. that, of course, there was nothing like zoom. there was no ability to work from home, in fact, economic scholars had made a really strong case that the economy was so fundamentally different between then and now that it is a little different for us to compare as an apples to apples. what i mean is we live with a service economy, with certain kinds of expectations about the ability to get food or deliveries. all kinds of essential items, and the ability to use the internet. remote working possibilities for a lot of times of jobs in ways that were not possible then. so, i think the short answer is it was an expansion of some of those practices of the correspondence courses and reading, people repeat being far more board if you look at
memoirs and diaries from the era. one of the things that they weren't was scared, and board. they stayed at home, people like john barry, the historian has emphasized that society would be rending because people would not even help their relatives and friends. they were so worried because so many healthy young people were dropping dead within 24 hours. there were not opportunities for any kinds of gatherings. another thing you see in the newspapers and advertisements of the era is people buying on credit pianos, layer pianos, other kinds of musical instruments. learning instruments, things that we would call picking a pandemic hobbies, something that was pretty common back then. >> you talk about that, there was a shift in terms of looking inwardly at homegrown talent. looking at jazz, the culture that was being produced here. we are also coming out of world war i where there was a lot,
you mentioned inequality but there was a lot of other as a shun going on in this period. there is a lot of anti german anti italian things. hinting around the red scare. we saw a similar thing to this with the early days of covid. very strong anti asian statement. i just do not know if there is a question in here. but, do we ever learn and do we learn the natural inclination? could we point fingers? are we trying to otherize anything like this? >> that is a great question and observation. the early stages of this pandemic saw the trump administration weaponize the rhetoric of the china flew, they will han flu, and very much nationalizing racist terminology. like i said, you saw something similar from the anglo american press suggesting that the
spanish climate or hygiene, you can google this in the newspapers of the era. those were the cause of the spanish flu, and then we saw othering and weaponizing of this national racialized language. where the spanish think of it as the french flu and they worry that the french wore workers were the ones who brought it into spain. the germans call at the russian past, the russians blame the german and the chinese in this period. there is a lot of that, absolutely, i think one thing that has troubled me and where a lot of other historians. as i was alluding in several ways is when you see this global turmoil, you see this turn inward by a lot of nation states coming out of the war and the pandemic. in 1919, in 1921, and especially 1924 or three of the most draconian immigration laws in the u.s. history. the national origins act in 1924 limits immigration to the u.s. to virtually a trickle.
which does not change until 1965. we see in the 1920s the rise of the klan. a very inward oriented set of policies that is a very much scapegoating people and groups that do not fit a dominant paradigm and society. that is white, anglo-saxon, protestant in the last. that is an enormous and challenging problem, scholars had talked about this, a literary scholar talked about it in the book called viral modernism. this viral language is something that in facts and influx our minds and how we think. and then, matches up with this sentiment for scapegoating. it is a very worrisome thing to think about in this moment. we are seeing war around the world, potential for a recession, we have seen anti asian hate crimes in the u.s. go up. and, other kinds of conflicts. i wonder to what extent the pandemic is a causal force and that, we cannot be sure because
it is not probably a 1 to 1 thing. but, it is the kind of crisis that leads people to potentially escape ace capable and alienate others. i think you put your finger right on it, it is very troubling, seems to be something that has been repeated in other areas and is certainly going around today. >> many voices, your own included, and many of the great op-eds you have done say the great dangers and the security and complacency after living with the pandemic for nearly two years. but, i do wonder, are way too polarized to be able to find agreements on this? do you think as a country a galvanized sense of unity or a wee is really possible coming out of this? >> you know, that is also a great observation, thinking about the 1918 and 1919 moment yes there were political dimensions to it, both republicans and democrats in the midterm election of 1918 talk about the ways in which
public health intervention policies suited one policy or the other. what did not happen was it did not map onto party politics. there was not a party more in favor of proactive public health measures, non-pharmaceuticals. what is really striking 100 years later is how much that has mapped on and whether or not people take a lifesaving vaccine or boosters. even how much they care about fellow measures of their communities. i think there you are talking about something fascinating, i read a piece on what has happened to sacrifice as a political rhetoric in the u.s.. and, what has happened to sacrifice as a concept. there was the concept of a draft draft slacker, americans who dodged the draft were not patriotic. many of them were in jail. they were sought out at the
state level. that turned to the mask slacker concept. which i think is a great way of understanding it in the fall of 1918 into the spring of 1919. saying, hey it is a patriotic act for your fellow members of society to wear a mask. just like it is to serve and be drafted in a time of war. we do not have that today. it is surprisingly absent for a fairly large but still minority part of the population. that is important for us note as well on the optimistic side. the vast majority of americans and the vast majority of those in countries that have put forward a non-pharmaceutical intervention to stop spread and death, and you help fellow measures of their communities. the challenge is there is too large of a percentage of people who are not buying into it. that is a real challenge for how to create that we. is there a week that could gather in some more of those folks? what kind of messaging strategy, as i was talking about, would help get us there? how can you do that moves that i was suggesting, beware of
coming to fatigue. how can we do that while honoring it? you have done your best, maybe you do not have to do masking at this point. maybe this summer is a less risky time for infections, go within range and and do the things you want to do. but, for the collective weight is there a way to message and being ready to clamp on those measures? like i was saying, in the phase reopening strategies in late 1918 into 1919. is that possibility? i would add one other we question, if i had even longer to give this top and have this q&a i would've brought this in. in 1919 there was an effort in congress to put a whole lot of money into the u.s. public health service 5 million dollar. it's they wind up getting almost none of it. overtime, that gets whittled away and whittled away. one of the challenges that comes from getting through a pandemic is thinking of how to stop the next one and had to be responsible and ready in the endemic stages when, not if, a
worse mutation comes on the scene like omicron. it was shocking to be how poorly prepared we were for omicron. i knew it was coming, we saw with modern medical science, sequencing this out of south africa, and yet the u.s. wasn't prepared with this modern public health infrastructure and potential for great public health capacity. for it. that's the kind of thing like a nation-state like the u.s. needs to be leaning on and also helping other countries with, that don't have the full capacity. i think that's what part of the we should be, also collective in global if possible. i don't forget, there i'm not optimistic on that. one but one of the clear lessons i have 1918-19 is that america's peculiar propensity for going it alone prevented the u.s. from joining the -- operations [inaudible]
[inaudible] [inaudible] why isn't the u.s. leading adjust on vaccine policy but really distribution as well as production? countries are haul thing vaccinations in some places, not because they don't have a vaccine now, but because they don't have the people to deliver it and the tools and techniques. the u.s. can help deliver those things, wow, you'd really be getting somewhere. so, that is a move from the we in the u.s. all the way to the global we. and as we're thinking about, because there was no real global we after the 1918-19 pandemic. >> so, speaking of the, we you brought up at the end all those great points and all the things to consider, inequality was one that keeps coming to mind. we have seen an increase in wealth concentration at the top during this pandemic. and is there any equivalent that occurred during the 1918-19 pandemic? >> yeah, so, i recently
challenge my students, actually last month, to think about this. the relationship of 1918-19 the pandemic in world war i with the inequality that rose in the 1920s, that eventually was part and parcel of the great depression. and it strikes me that there isn't any direct connection. historians have tried to explore the ways in which the economy of the 1920s was related to the pandemic, and one of the ways they talk about it is simply that a significant part of the u.s. and western populations of working age were cut down in their prime. and so, there were a lot of adjustment problems for the economy. but that said, which isn't a direct reference there. the exposure of inequality that i would point to in the moment that, which wasn't acted on, which i would hope we can act of more, is this question of essential workers. so, in 1918, while the war was
going on, the language beneficial worker came from the military itself. and the argument was they had to be involved in steel production, ammunition production, textile production. and yet, you see in the fall of 1918, sometimes 50% of people not showing up to work in october, that deadly much. not because they're sick because they're taking this risk calculus and saying i can't afford to get sick, to take care of my family and that sort of thing. i thought that was a very similar, strikingly, eerily similar parallel to what we are seeing in 2020 and 2021, before the vaccine was more widely distributed. that is to say, we saw people who were doing the essential operations to keep society open, in some cases being forced to work and getting infected. and in other cases, not showing up for work, because the society had not prioritize them, had not truly made those essential workers essential in the sense of higher, pay higher esteem, capacity to stay at work when they're sick. those sorts of things. so, that is a piece of taking
tibetan equality. another element in 1918-19 this heart rending and worth noting is how badly some indigenous communities were affected. in alaska for, instance there's accounts of several villages of indigenous folks where you had fatality rate of 80 or 90%. and it wasn't because they all died of the flu but rather because there's no public health infrastructure left, no caregivers left to take care of those folks. and they died of famine and other kinds of diseases, and they died partly of racism because of white patriarchal views of not taking care of those populations. to some extent, we've seen marginalized groups and indigenous populations certainly disproportionately affected by death and disease in this pandemic. that is expose the kinds of ways that society is structured to disproportionately push down risk on those groups. and that is a direct correlation with the upper and, where people who can work from home, as you're noting, with higher amounts of wealth are
able to do that much more safely. so, one takeaway here would be perhaps society needs those essential workers, but why don't societies value that more? >> so, i know all of our minds are on -- the title of this program is pandemic exhaustion. we've both been inspired, we've been exhausted, it's also hard to look away. but right now and today, in the last couple of days, ukraine is on our minds. so, i think it brings up a lot of different questions. we're seeing citizens in the ukraine crimea to subways to avoid shelling. we're looking at a region that is really not dealt well with covid. there is still very much a lot of uncontrolled response to the virus going on. so, with this being the case,
i'm curious if you can talk about the correlation or the parallels with the disruption that world war i created and how that played a role in how the u.s. and the world with the pandemic. and, if we were to walk into something that was hopefully not the extent of what world war i was for everyone, the great war, what would that do? do you have any thoughts on this, as a historian? >> yeah, so, one of the things that i'm interested in studying the pandemic of 1918-19 was the politics of world war i. as i noted just in passing, i've read these documents elected them closely. american intelligence, officers british intelligence officers are seeing in the summer of 1918 this more deadly, more infectious mutations as we now think about it. it knocking out as many as 80%
of combat effective, now combat ineffective troops. not that they're dying at that rate, the worst rates of troops dying was like 5%, but still that's catastrophic if they're out and unable to man their post on front lines for a war effort. and that is precisely because of the conditions that you're describing. whether you're gathering in subways, gathering barracks, gathering in trenches. it's very easy to transfer viruses back and forth. and those individuals are also like petri dishes in terms of generating imitations. so, that's another challenge there. in the late stages of the war, one of the things that i often know is that when u.s. troop transports landed in france and places like breast, where lots of troops arrived, they would be met by ambulances and horses, because so many american troops were dying and needed immediately to get hospitals from the virus. i wonder in this moment, when we're looking at a roy laying, large invasion and conflict, large disco dislocations of
individuals, likely refugees, likely peacekeepers and humanitarian relief, all those people mixing. they're mixing across, borders are mixing in large numbers, they're mixing in close quarters. that is the perfect recipe for generating mutations, generating widespread disease and discomfort, probably deaths, lots of suffering. but it's also that conflicts can change, right? there are arguments that the mutinies in germany, as german and french mutinies, chairman late offensive was in 1918 get stopped eventually. that part of what's topping them is also the flu. on top of everything else, the flu is really undermining morale if not full combat effectiveness. so, to what extent will covid be part of that process? even if it doesn't undermine the conflict or peacekeeping very much, it's in our minds, at least for many about who
care about infection and death. it also will likely be in the minds of those moving through spaces, trying to go back to family members, coming back for instance for birthdays or death or to see sake relatives. we have all the other complications of how human beings will be transmitted diseases on the front lines of a conflict or a refugee situation with this infectious disease. we're hearing reports now of other mutations that are kicking around, you can only imagine that another mutation might well appear in some of these places that have not had good vaccine distribution programs or uptake or have had worse, frankly, vaccines that are less effective trotted out there. so, there is a lot of development here and i think there is some distant echoes of the past, in terms of the war, in terms of refugee crises. and that is deeply worrisome to. also, in terms of the comments you made before about the ways that this power dynamic tend to
float downhill. so, this is more likely to affect the refugees and those that lower status, lower socioeconomic status. it's likely to be potentially more racialized violence related to this, certainly you saw this with friends of ethnic cleansing to our world war i and in terms of the public policies and proactive policies of immigration restriction after world war i it inward looking kinds of orientations of nationalism and racism of that era. so, all of this is a witches brew of terrible things with the pandemic on top of conflict on top of inequality, atn of people in a globalized world where viruses can travel all the way around even faster than in 1918-19. and so, it's deeply worrisome. as we're thinking of the legacies of endemicity however, part of that is learning to live with the uncertainty of having seasonal mutations of a virus, right? so, it is simply impossible to
imagine a constant cycle of significant closure policies. they did not envision that in 1918 and 1919, but they prepared to be ready for closure policies, to have limits, to have re-masking, all that kind of stuff. that is a direct lesson, all that kind of thing. we need to jettison the idea of a new normal, business as usual. and rather think of new normals that involve being ready to throw on a mask, being ready to limit possible indoor gatherings of large sizes. but the potential for travel disruptions because of closures or because of border questions and that kind of thing. and to always be on the lookout. i think, potentially, there will be new generational behaviors to look at for the next pandemic on the horizon. many of us on this, watching this, talking about, this thinking about this, know about mers and sars and avian flu, we've had a lot of scares in recent years. we've been living with one of the biggest rolling pandemics in recent history, which is the
aids crisis. so, they're all there, you just need to open your eyes to see those kinds of dimensions of pandemics that are around us. i'd add one more behavior question. in 1918 and 1919, the only behavior that could serena definitively after that is something that they called the common cap, that people regularly at schools are businesses or restaurants would share a cup. that's about the only behavior that entirely is gone, in terms of western culture in the u.s.. masking doesn't stay on, limits don't stay on, when seasonal sleeves get bad of the late 1920s you don't see masking, you don't see significant limits. so, my question to everybody in the audience, everybody listening to this and thinking about this concept is if there are pandemic to endemic lessons, one of the behaviors we want to actually embrace and keeping on? for our own reasons, personal reasons, immune compromised family members, lessons learned
from suffering private trauma. for what kinds of behaviors do you think our best to be kept on another spheres of life. in businesses, schools, public gatherings on planes, trains, transports. remember in 1918-19, and lots of cities are acquirement that you had to wear a mask on public transport. that could serve the window in 1990, that's come on a virtually any place on i-20 and, by the late 20s, it's totally forgotten. so, will we still be masking in public places than a decade? will we be prepared to do so? those are big questions for us. there are, again, like i, said there in the high of the bold, or psychological, not clearly public health answers to that. does not necessarily clear political answers to that. they are about how we feel, our own personal health risk assessments. you see that other records of 1819, and how we interact with our community. that's a great point about the we, the collective. what behaviors are we going to continue to help others, even
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