Quotes from John M. Barry

But how does one know when to persist, when to continue to try to make an experiment work, when to make adjustments—and when finally to abandon a line of thought as mistaken or incapable of solution with present techniques?

For if there is a single dominant lesson from 1918, it's that governments need to tell the truth in a crisis. Risk communication implies managing the truth. You don't manage the truth. You tell the truth.

Of developed countries, Italy suffered the worst, losing approximately 1 percent of its total population.

In most life forms, genes are stretched out along the length of a filament-like molecule of DNA, deoxyribonucleic acid. But many viruses—including influenza, HIV, and the coronavirus that causes SARS (severe acute respiratory syndrome)—encode their genes in RNA, ribonucleic acid, an even simpler but less stable molecule.

All training for war, for killing, ceased. Now men fought to stop the killing.

In a truly lethal pandemic, state and local authorities could take much more aggressive steps, such as closing theaters, bars, and even banning sports events—in 1919 even the Stanley Cup finals were canceled—and church services.

Mexico spent $180 million to fight the disease, but suffered $9 billion in economic losses because of the irrational response from trading partners—not exactly positive reinforcement if the goal is to encourage candor the next time.

Man might be defined as "modern" largely to the extent that he attempts to control, as opposed to adjust himself to, nature

Those in authority must retain the public's trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart.

Reassortment mixes some of the segments of the genes of one virus with some from the other. It is like shuffling two different decks of cards together, then making up a new deck with cards from each one. This creates an entirely new hybrid virus, which increases the chances of a virus jumping from one species to another.

In 1918 especially, this question of balance played a crucial role in the war between virus and immune system, and between life and death. The virus was often so efficient at invading the lungs that the immune system had to mount a massive response to it. What was killing young adults a few days after the first symptom was not the virus. The killer was the massive immune response itself.

Donohue's family operated a funeral home: "We had caskets stacked up outside the funeral home. We had to have guards kept on them because people were stealing the caskets. . . . You'd equate that to grave robbing." There were soon no caskets left to steal. Louise Apuchase remembered most vividly the lack of coffins: "A neighbor boy about seven or eight died and they used to just pick you up and wrap you up in a sheet and put you in a patrol wagon.

Those in authority must retain the public's trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best.

Closing saloons and theaters and churches meant nothing if significant numbers of people continued to climb onto streetcars, continued to go to work, continued to go to the grocer. Even where fear closed down businesses, where both store owners and customers refused to stand face-to-face and left orders on sidewalks, there was still too much interaction to break the chain of infection. The

Clifford Adams recalled, "They stopped people from communicating, from going to churches, closed the schools, . . . closed all the saloons. . . . Everything was quiet.

Even normal services such as schools were in short supply. Of the twenty largest cities in America, Philadelphia, the city of Benjamin Franklin and the University of Pennsylvania, spent less on education than all but one. In all of South Philadelphia, home to hundreds of thousands of Italians and Jews, there would be no high school until 1934.

Antigen drift can create epidemics. One study found nineteen discrete, identifiable epidemics in the United States in a thirty-three-year period—more than one every other year. Each one caused between ten thousand and forty thousand "excess deaths" in the United States alone—an excess over and above the death toll usually caused by the disease. As a result influenza kills more people in the United States than any other infectious disease, including AIDS.

Katherine Anne Porter was a reporter then, on the Rocky Mountain News. Her fiancé, a young officer, died. He caught the disease nursing her, and she, too, was expected to die. Her colleagues set her obituary in type. She lived. In "Pale Horse, Pale Rider

Avery soon solved this particular puzzle. He discovered that all the liquid in the laboratory bottles labeled "alcohol" was actually water. Soldiers had apparently drunk the alcohol and replaced it with water. When he got alcohol, the test results came in as expected.

It now seemed as if there had never been life before the epidemic. The disease informed every action of every person in the city.

For the virus had not disappeared. It had only gone underground, like a forest fire left burning in the roots, swarming and mutating, adapting, honing itself, watching and waiting, waiting to burst into flame.

in 1835 Harvard's Jacob Bigelow had argued in a major address that in "the unbiased opinion of most medical men of sound judgment and long experience . . . the amount of death and disaster in the world would be less, if all disease were left to itself.

But unlike other life forms (if a virus is considered a life form), a virus does not even do that itself. It invades cells that have energy and then, like some alien puppet master, it subverts them, takes them over, forces them to make thousands, and in some cases hundreds of thousands, of new viruses. The power to do this lies in their genes. •

Fear began to break down the community of the city. Trust broke down. Signs began to surface of not just edginess but anger, not just finger-pointing or protecting one's own interests but active selfishness in the face of general calamity. The hundreds of thousands sick in the city became a great weight dragging upon it. And the city began to implode in chaos and fear.