WEBVTT - COVID-19 Chapter 20: Looking forward by looking back 0:00:00.560 --> 0:00:03.120 Hi, My name is Carrie. I live in Colorado and 0:00:03.160 --> 0:00:06.200 work as a hospice chaplain. In that role, I provide 0:00:06.240 --> 0:00:09.320 spiritual and emotional support to some of the most vulnerable 0:00:09.320 --> 0:00:12.719 among us, those who are diagnosed with the terminal illness 0:00:12.800 --> 0:00:16.319 and expected to die within six months or less. This 0:00:16.440 --> 0:00:19.840 season of COVID has had an extraordinary impact on those 0:00:19.880 --> 0:00:25.640 who are already facing excruciatingly difficult circumstances. For those who 0:00:25.720 --> 0:00:28.560 receive hospice care at home, many have not had a 0:00:28.640 --> 0:00:32.680 chance to spend cherished time with children, grandchildren, siblings, and 0:00:32.720 --> 0:00:36.360 friends who are unable to visit due to travel restrictions, 0:00:36.960 --> 0:00:40.840 border closures, and the risk of virus exposure. This also 0:00:40.920 --> 0:00:43.879 means that family members who would ordinarily jump in and 0:00:44.560 --> 0:00:47.680 lend a hand with the intensive responsibility of twenty four 0:00:47.720 --> 0:00:49.840 to seven care for a loved one who is dying, 0:00:50.479 --> 0:00:53.519 are less available to provide the kind of practical and 0:00:53.760 --> 0:00:58.560 emotional support families need. Many who are terminally ill also 0:00:58.680 --> 0:01:02.920 receive hospice care in nursing communities, and that has proven 0:01:03.040 --> 0:01:06.720 especially challenging As a result of state restrictions to protect 0:01:06.800 --> 0:01:12.080 this population from devastating outbreaks, family members and hospice support 0:01:12.120 --> 0:01:15.959 staff are rarely permitted to visit nursing community residents in 0:01:16.000 --> 0:01:20.080 person right now, although family members are occasionally able to 0:01:20.120 --> 0:01:24.120 schedule window or outdoor visits, these are typically limited to 0:01:24.160 --> 0:01:27.399 thirty minutes or so. They are dependent on whether and 0:01:27.520 --> 0:01:30.919 difficult or impossible to coordinate for those who are bedbound, 0:01:31.800 --> 0:01:36.560 and unfortunately, window and outdoor visits are incredibly confusing for 0:01:36.640 --> 0:01:40.440 people who have dementia and frustrating for those with hearing 0:01:40.520 --> 0:01:45.160 and visual deficits. Telephone and video visits are typically not 0:01:45.200 --> 0:01:49.680 optimal or possible for the same reasons. So imagine that 0:01:49.720 --> 0:01:54.200 you're living in a nursing community. Anticipation builds as you're 0:01:54.200 --> 0:01:57.040 willed to an outdoor visiting area where your wheelchair is 0:01:57.080 --> 0:02:00.840 locked in place six feet away from your son or 0:02:01.040 --> 0:02:04.160 sister or best friend you haven't seen in six months. 0:02:05.240 --> 0:02:09.240 You can't hear what they're saying because you're too far away. 0:02:09.360 --> 0:02:12.359 You can't watch their lips because they are wearing masks, 0:02:13.400 --> 0:02:16.119 can't hug them, and aren't allowed to sit with them 0:02:16.120 --> 0:02:18.360 and enjoy your favorite lunch they picked up on the 0:02:18.360 --> 0:02:23.160 way to visit someone inside inners in community during the 0:02:23.200 --> 0:02:26.560 pandemic in the state of Colorado. Your loved one must 0:02:26.560 --> 0:02:32.600 be actively dying to qualify for what we're calling compassion visits. Occasionally, 0:02:32.639 --> 0:02:35.600 hospice support team members are permitted to visit during this 0:02:35.680 --> 0:02:39.639 short window of time. When people are dying, their greatest 0:02:39.680 --> 0:02:42.400 need is almost always to spend time with those who 0:02:42.440 --> 0:02:47.440 are closest to them, reflecting on memories, verbalizing expressions of love, 0:02:48.600 --> 0:02:55.040 offering forgiveness, seeking reconciliation, and sharing hugs and kisses. There's 0:02:55.080 --> 0:02:59.400 usually some level of fear about the dying process, concern 0:02:59.480 --> 0:03:03.919 regarding a finish business, and a desire to address these issues. 0:03:04.919 --> 0:03:08.120 When family members, friends, and support staff can be present 0:03:08.200 --> 0:03:13.760 to offer reassurance, calm anxiety, answer questions, and respond to 0:03:13.880 --> 0:03:17.919 unmet emotional and spiritual needs, the dying process is more 0:03:17.960 --> 0:03:20.400 peaceful for the person who is dying and also for 0:03:20.520 --> 0:03:24.960 family members and other companions during the process. It's important 0:03:25.000 --> 0:03:28.040 to know that when we're actively dying, that period of 0:03:28.080 --> 0:03:32.079 time when in person compassion visits are allowed, we can 0:03:32.160 --> 0:03:35.119 generally hear what's going on around us, but are minimally 0:03:35.200 --> 0:03:38.920 responsive and don't have the energy to engage in conversation. 0:03:40.080 --> 0:03:43.840 During this especially tender time, I encourage family members and 0:03:43.880 --> 0:03:47.120 friends to keep talking to their loved one and watching 0:03:47.200 --> 0:03:51.080 for subtle signs of response, usually a facial movement or 0:03:51.880 --> 0:03:56.480 eyes opening briefly. The difficult part of limiting family visits 0:03:56.520 --> 0:03:59.440 to the last few days of life is that most 0:03:59.480 --> 0:04:04.320 of us want opportunities to interact, to have important conversations 0:04:04.360 --> 0:04:08.320 before our loved one is actively dying and becomes minimally responsive. 0:04:09.320 --> 0:04:13.320 This is often not possible with current guidelines. That's heartbreaking 0:04:13.360 --> 0:04:16.760 for family members and friends, and also difficult for healthcare 0:04:16.800 --> 0:04:22.360 staff to witness. In fact, it compounds and complicates screeting process, 0:04:23.120 --> 0:04:25.640 not only now, but likely for years to come. 0:04:28.480 --> 0:04:30.640 My name is Clint and I'm a high school special 0:04:30.760 --> 0:04:34.320 education teacher in northeast Kansas. For most of the twenty 0:04:34.400 --> 0:04:37.159 twenty twenty twenty one school year, our district was going 0:04:37.200 --> 0:04:39.880 back and forth from fully remote to a hybrid schedule, 0:04:39.880 --> 0:04:41.960 with half of the students coming in the morning and 0:04:42.040 --> 0:04:42.720 half coming. 0:04:42.520 --> 0:04:43.240 In the afternoon. 0:04:43.839 --> 0:04:45.719 It was rough on all the teachers, but those of 0:04:45.800 --> 0:04:48.479 us in special education had a really tough time meeting 0:04:48.520 --> 0:04:51.920 our legally mandated service minutes for our students. Even when 0:04:51.920 --> 0:04:53.600 we were able to to connect with the kids on 0:04:53.640 --> 0:04:56.160 our caseload, it was often over zoom, which is a 0:04:56.160 --> 0:04:59.880 pay a limitation of actual student contact. All year, I 0:05:00.120 --> 0:05:02.600 been getting calls and emails from parents worried about their 0:05:02.640 --> 0:05:05.920 kids falling behind and expressing frustration at turning into their 0:05:05.920 --> 0:05:09.760 own kids de facto case managers and service providers. Each 0:05:09.839 --> 0:05:13.360 kid enrolled in special education services gets an Individualized Education 0:05:13.480 --> 0:05:16.640 Plan or IEP written for them every year. This year 0:05:16.680 --> 0:05:19.119 we had to amend every IP with a remote Learning 0:05:19.160 --> 0:05:22.799 contingency plan within the first month of school. During that time, 0:05:22.839 --> 0:05:25.120 the district changed their attendance plan and we had to 0:05:25.160 --> 0:05:28.159 adjust our servicemnts written on each IP as we rewrote 0:05:28.160 --> 0:05:31.240 our contingency plans. And the worst part for me and 0:05:31.440 --> 0:05:34.160 probably all of my colleagues as well, is that all 0:05:34.160 --> 0:05:37.040 this paperwork and bureaucracy comes at the expense of getting 0:05:37.080 --> 0:05:39.919 to actually spend time with our students. By far, the 0:05:39.960 --> 0:05:42.919 most important part of being a special education teacher is 0:05:42.960 --> 0:05:45.719 forming relationships with the students in our resource classes and 0:05:45.760 --> 0:05:48.280 our caseloads, but so much of our energy has been 0:05:48.320 --> 0:05:52.640 spent rewriting legal documents and organizing legally mandated meetings. I 0:05:52.720 --> 0:05:55.480 have some students I haven't even met all year, Even 0:05:55.520 --> 0:05:57.360 now that our district has gone back to full time 0:05:57.400 --> 0:06:00.240 in person. I actually had to hold an IPU eating 0:06:00.320 --> 0:06:03.359 last week for a student I haven't met at all. Fortunately, 0:06:03.400 --> 0:06:05.680 that student's guardian was very understanding and was able to 0:06:05.680 --> 0:06:08.720 be a strong advocate for them. Any teacher can tell 0:06:08.720 --> 0:06:11.120 you that it feels like very little actual teaching and 0:06:11.200 --> 0:06:13.800 learning has been happening since about March of twenty twenty, 0:06:14.120 --> 0:06:17.839 but in special education it's been particularly difficult. We're now 0:06:17.880 --> 0:06:20.440 back to school all day, every day with masks and 0:06:20.480 --> 0:06:23.120 social distancing, and it's becoming more and more clear just 0:06:23.160 --> 0:06:26.800 how much we lost being unprepared for a pandemic. All 0:06:26.800 --> 0:06:28.640 we can do now is try to make up as 0:06:28.680 --> 0:06:29.880 much lost ground as we can. 0:06:32.720 --> 0:06:36.800 Hi, my name's Millie. I'm twenty three years old. I 0:06:36.839 --> 0:06:40.920 graduated last year in twenty twenty and I live in 0:06:41.000 --> 0:06:45.120 Northern England in the UK. Like many people my age, 0:06:45.160 --> 0:06:47.599 I've found it really hard to get a job, at 0:06:47.680 --> 0:06:51.600 least a job that I want because of the pandemic. 0:06:52.440 --> 0:06:55.520 So I took a job in a COVID nineteen test center. 0:06:57.400 --> 0:07:02.159 We do the lateral flow test, which is a form 0:07:02.200 --> 0:07:06.040 of asymptomatic testing. We don't test people with symptoms that's 0:07:06.080 --> 0:07:11.400 the PCR test. The idea is to catch cases of 0:07:11.440 --> 0:07:14.720 COVID nineteen that wouldn't have been apparent, you know, because 0:07:14.760 --> 0:07:18.360 they don't show symptoms. And we work in a school, 0:07:18.600 --> 0:07:22.000 so we test teaching staff and all the pupils twice 0:07:22.000 --> 0:07:26.000 a week now, although the government guidance changes pretty much 0:07:26.040 --> 0:07:30.040 every week, so sometimes we're telling people to swab their 0:07:30.080 --> 0:07:33.920 tonsils four times, sometimes it's five, Sometimes it's just two 0:07:33.920 --> 0:07:38.720 on each tonsil, sometimes it's just upper nostril. We're really 0:07:38.800 --> 0:07:42.640 playing it by ear and it seems quite inconsistent the guidance. 0:07:43.320 --> 0:07:45.880 So we're just learning to try and be as accurate 0:07:45.880 --> 0:07:50.360 as we can under the changing circumstances. And we're all 0:07:50.360 --> 0:07:53.640 absolute beginners. My own degree was in French. I have 0:07:53.680 --> 0:07:57.280 no medical background. The only people that are test center 0:07:57.360 --> 0:08:00.520 with a medical or scientific background are our labtape technicians, 0:08:00.880 --> 0:08:03.800 and they taught us to be really meticulous and careful 0:08:03.840 --> 0:08:08.120 when we process the samples. We've seen some hilarious things. 0:08:09.800 --> 0:08:13.520 Some of the kids have asked what the tonsils are. 0:08:14.560 --> 0:08:16.880 Some of them swab the outside of their neck or 0:08:16.960 --> 0:08:20.640 we handed them the swab. The kids are very resilient 0:08:20.840 --> 0:08:25.040 and they're adapting remarkably well to this situation. I think 0:08:25.040 --> 0:08:27.560 it's other people who are having a hard time here 0:08:27.600 --> 0:08:31.880 in the UK. The public sector is a big support 0:08:32.320 --> 0:08:36.400 network for people, especially in poorer communities. We need places 0:08:36.440 --> 0:08:41.400 like schools, ordinary state schools and libraries health centers to 0:08:41.440 --> 0:08:44.840 stay open, but it's difficult because of the pandemic and 0:08:44.920 --> 0:08:49.160 we have to turn people away who are actually quite 0:08:49.160 --> 0:08:52.800 lonely without those services. And in terms of our rollout 0:08:52.840 --> 0:08:58.920 of mass testing, it's focused on key workers, for example, 0:08:58.960 --> 0:09:04.400 those who work in factories for food production, supermarkets, healthcare 0:09:04.760 --> 0:09:09.599 and education. But it's mostly run by volunteers and redeployed 0:09:09.600 --> 0:09:14.199 council workers. So sometimes we worry that we're not really 0:09:14.320 --> 0:09:19.160 qualified to be conducting tests and giving people these very 0:09:19.240 --> 0:09:24.040 crucial test results. And recently, the most striking thing that 0:09:24.120 --> 0:09:27.880 I've found is that older people who I work with 0:09:27.920 --> 0:09:31.960 in the test center, who guide our students through the 0:09:32.000 --> 0:09:37.200 swabbing process, have been comparing the effort we're all making 0:09:37.480 --> 0:09:43.160 collectively against COVID nineteen as a war effort. And you 0:09:43.200 --> 0:09:45.480 know that these are the people who they can remember 0:09:45.520 --> 0:09:48.600 their parents being involved in, you know, the war effort 0:09:48.600 --> 0:09:53.280 of the Second World War, and they're right you know, 0:09:53.440 --> 0:09:58.560 much like how women during war time moved to working 0:09:58.559 --> 0:10:03.360 in factories elements they never worked in before. Those of 0:10:03.400 --> 0:10:05.400 us who work in the public sector in the UK, 0:10:05.840 --> 0:10:09.680 who are employed by the local councils have been sent 0:10:09.720 --> 0:10:13.640 to deal with this crisis. We test people, We try 0:10:13.679 --> 0:10:17.760 and pick up on asymptomatic cases of COVID nineteen. We 0:10:17.840 --> 0:10:22.920 have jobs now where we're responsible for maintaining health and safety, 0:10:23.040 --> 0:10:28.359 avoiding cross contamination, and so much like a war effort, 0:10:28.720 --> 0:10:33.600 what I've seen here in the UK, especially among teachers 0:10:34.320 --> 0:10:39.480 and ordinary low level government workers, the wonderful ways in 0:10:39.520 --> 0:10:42.480 which ordinary working people can really pull together in times 0:10:42.480 --> 0:10:46.040 of crisis. And it's been amazing to see how it's 0:10:46.080 --> 0:10:48.640 brought people together, even though of course there's a lot 0:10:48.640 --> 0:10:54.119 of hardship. Ultimately, just like with a war effort, everybody 0:10:54.200 --> 0:11:00.079 has pushed their limits and found something to do. I 0:11:00.120 --> 0:11:02.559 love working in the test center. It's actually really good 0:11:02.600 --> 0:11:04.360 fun and it makes me feel like a scientist. 0:11:50.320 --> 0:11:53.920 Thank you so much to everyone who has shared a 0:11:53.960 --> 0:11:57.520 first hand account with us for this series, for this episode, 0:11:58.120 --> 0:12:00.760 for just filling out the Google everything. 0:12:00.800 --> 0:12:02.040 We really appreciate it. 0:12:02.400 --> 0:12:06.439 Yeah, thank you so much. Hi, I'm Erin Welsh and 0:12:06.480 --> 0:12:08.640 I'm Aaron Allman Updike and. 0:12:08.559 --> 0:12:11.079 This is this podcast will Kill You. 0:12:11.200 --> 0:12:19.880 Welcome everyone to episode twenty twenty twenty episodes in our 0:12:19.960 --> 0:12:24.240 Anatomy of a Pandemic series covering the COVID nineteen pandemic. 0:12:25.480 --> 0:12:28.960 It's been a lot, it's been a lot, very much. 0:12:29.640 --> 0:12:35.040 This is tentatively our final episode in this series. We 0:12:35.120 --> 0:12:39.280 have come a very long way since our first episode 0:12:39.679 --> 0:12:42.319 of this series, and we've covered. 0:12:42.360 --> 0:12:47.800 So much ground, so much ground. When we started this 0:12:47.960 --> 0:12:52.439 COVID nineteen series back in early twenty twenty, I don't 0:12:52.600 --> 0:12:55.920 think that we had any idea how many episodes of 0:12:55.960 --> 0:12:58.800 this we were gonna do and how many different lenses 0:12:58.840 --> 0:13:02.280 we would use to like examine the impacts of the pandemic. 0:13:02.760 --> 0:13:05.800 No, you, it was supposed to be one episode, Eric 0:13:06.160 --> 0:13:07.720 at first, and then. 0:13:07.600 --> 0:13:10.479 I talked you into six, give me six. 0:13:10.360 --> 0:13:12.480 And then it was like, well we should probably do 0:13:12.559 --> 0:13:15.600 some more. Well we should revisit okay. 0:13:16.040 --> 0:13:20.280 I mean, I've loved putting this series together. I think 0:13:20.280 --> 0:13:24.560 it's been really interesting and really has like allowed us 0:13:24.600 --> 0:13:27.839 to kind of feel out just how many ways there 0:13:27.840 --> 0:13:30.800 are to look at like this massive, massive thing of 0:13:30.800 --> 0:13:32.480 course that's impacting all of us. 0:13:32.720 --> 0:13:34.679 Yeah, and there. 0:13:34.480 --> 0:13:38.679 Are still so many unasked and unanswered questions. There are 0:13:38.720 --> 0:13:42.640 still many lenses that we haven't explored, and lots of 0:13:42.720 --> 0:13:46.440 ground that we still have left to cover. And I 0:13:46.480 --> 0:13:49.000 think that, you know, like I said, that's just part 0:13:49.080 --> 0:13:52.240 of the nature of a global pandemic, one that I'm 0:13:52.280 --> 0:13:57.560 sure will inspire or already has probably inspired a field 0:13:57.600 --> 0:13:59.400 of study all of its own. 0:14:00.120 --> 0:14:03.920 So we're not entirely ruling out the possibility of picking 0:14:04.000 --> 0:14:06.680 up the series sometime in the future to kind of 0:14:06.760 --> 0:14:10.000 cover some more of that uncovered ground, but for now 0:14:10.040 --> 0:14:13.360 we are putting a pin in it. We are tentatively 0:14:13.400 --> 0:14:18.280 concluding the series with an episode imagining what the future 0:14:18.360 --> 0:14:22.080 might hold for us by looking back in time to 0:14:22.160 --> 0:14:25.560 what is possibly the closest comparison to what we've experienced 0:14:25.560 --> 0:14:30.400 with COVID nineteen of course, the nineteen eighteen influenza pandemic. 0:14:31.080 --> 0:14:35.320 Yes, but before we get to that, we have some 0:14:35.520 --> 0:14:36.720 business to take care of. 0:14:37.080 --> 0:14:37.800 We sure do. 0:14:38.440 --> 0:14:39.640 What time is it? 0:14:39.640 --> 0:14:42.160 It's quarantiney time eronre Is. 0:14:43.240 --> 0:14:45.400 It always is on this podcast. 0:14:45.280 --> 0:14:50.080 It always is. We thought that for this last episode 0:14:50.240 --> 0:14:52.920 in the series, and especially for the topic that we're 0:14:52.920 --> 0:14:58.040 covering that the Corpse Reviver number one would be a 0:14:58.080 --> 0:15:00.000 good choice, an appropriate choice. 0:15:00.240 --> 0:15:04.480 I absolutely love it. So if anyone doesn't remember or 0:15:04.680 --> 0:15:09.720 hasn't listened, our very first quarantinie of all quarantinies, that is, 0:15:09.960 --> 0:15:13.160 from our very first episode, was Corpse Survivor number two, 0:15:14.560 --> 0:15:19.680 which we called the H one Drink one yep, from 0:15:19.680 --> 0:15:22.760 our first episode on the influenza pandemic. I love erin. 0:15:22.800 --> 0:15:25.280 When I saw that you suggested the corp Survivor number one, 0:15:25.280 --> 0:15:26.800 I was like, that's phenomenal. 0:15:27.120 --> 0:15:30.320 I mean, I was like, what was popular during nineteen eighteen? 0:15:30.400 --> 0:15:33.320 And then I was like, duh, there's Corpse Survivor number two, 0:15:33.360 --> 0:15:36.240 which implies there must be a number one, So let's 0:15:36.320 --> 0:15:38.680 do that one. It's going to be interesting to do 0:15:38.760 --> 0:15:41.560 a non alcoholic version, but that's okay. 0:15:42.400 --> 0:15:44.280 So what is in this quarantini? 0:15:44.720 --> 0:15:48.080 Ah, yes, so it is. I've just found this recipe 0:15:48.200 --> 0:15:51.520 on the internet. It is one ounce Kognak, one ounce Calvados, 0:15:51.600 --> 0:15:54.720 and half an ounce of sweet vermouth. But if you 0:15:54.760 --> 0:15:57.360 don't remember that or write that down, don't worry. We 0:15:57.400 --> 0:16:00.200 will post the full recipe on our website. This podcas 0:16:00.200 --> 0:16:02.880 will kill you dot Com and all of our social 0:16:02.920 --> 0:16:05.360 media channels, and that's also where we will post the 0:16:05.640 --> 0:16:09.040 non alcoholic version, whatever that will look like. 0:16:12.280 --> 0:16:14.840 If you go to our website, what you'll also find 0:16:15.280 --> 0:16:18.680 is so much other stuff, like a link to our 0:16:18.720 --> 0:16:22.560 merch and our Goodreads list, and our bookshop dot org 0:16:22.640 --> 0:16:26.640 affiliate account, our Patreon. You can find transcripts. You can 0:16:26.640 --> 0:16:29.360 find a list that Aaron Welsh put together of all 0:16:29.360 --> 0:16:32.080 the promo codes that we say on this podcast, so 0:16:32.320 --> 0:16:35.520 you can save some money if you're buying things. So 0:16:35.600 --> 0:16:37.600 many things, check it out. This podcast will kill you 0:16:37.640 --> 0:16:38.240 dot com. 0:16:38.480 --> 0:16:43.800 Yes, okay, Now let's get to the actual meat of 0:16:43.920 --> 0:16:49.480 this episode. Over one hundred years ago, the world experienced 0:16:49.760 --> 0:16:55.120 one of the deadliest, if not the deadliest pandemics in history. Yeah, 0:16:55.240 --> 0:16:59.360 a highly virulent strain of the influenza virus rapidly spread 0:16:59.360 --> 0:17:02.680 around the globe, killing an estimated fifty to one hundred 0:17:02.720 --> 0:17:06.880 million people. And if you've heard of the nineteen eighteen influenza, 0:17:07.080 --> 0:17:09.680 there's a good chance that it was in the context 0:17:09.800 --> 0:17:13.520 of the current COVID nineteen pandemic. With so many articles 0:17:13.560 --> 0:17:16.840 and podcasts and books and news programs and so on 0:17:17.240 --> 0:17:21.600 making comparisons between what's happening today and how things transpired 0:17:21.600 --> 0:17:25.320 in nineteen eighteen, and many of these comparisons are apt 0:17:25.640 --> 0:17:28.840 in some ways. What happened in nineteen eighteen is eerily 0:17:28.880 --> 0:17:31.960 reflected in the events of twenty twenty and twenty twenty one, 0:17:32.960 --> 0:17:35.800 and neither of us has gotten up the nerve to 0:17:35.920 --> 0:17:39.080 re listen to The very first episode of this podcast, 0:17:39.400 --> 0:17:42.879 and We Never Will Never Will I was released in 0:17:42.920 --> 0:17:46.560 twenty seventeen on the nineteen eighteen influenza So pre COVID, 0:17:47.160 --> 0:17:49.520 and several listeners who have listened to it have pointed 0:17:49.560 --> 0:17:52.280 out just how spooky it is to hear in light 0:17:52.359 --> 0:17:53.840 of this current pandemic. 0:17:53.960 --> 0:17:56.240 Oh, I'm sure, especially because at the end we talk 0:17:56.320 --> 0:18:00.560 about what could come next, and so it was us 0:18:00.600 --> 0:18:04.679 thinking about the nineteen eighteen influenza that inspired the topic 0:18:04.720 --> 0:18:08.240 of this episode. We have, over the course of the 0:18:08.320 --> 0:18:11.800 last year and a half or so, learned so much 0:18:11.880 --> 0:18:15.480 about the virus that causes COVID nineteen and the widespread 0:18:15.480 --> 0:18:19.280 impacts of the pandemic. But one of the biggest questions 0:18:19.320 --> 0:18:26.000 that remains unanswered is well, what happens now right, And 0:18:26.040 --> 0:18:29.320 of course we can't actually answer that question, and we're 0:18:29.320 --> 0:18:33.240 not really going to, but we can do the best 0:18:33.320 --> 0:18:35.920 that we can by looking at what happened in the 0:18:36.000 --> 0:18:40.280 nineteen eighteen influenza pandemic. Granted, the world was a very 0:18:40.280 --> 0:18:43.399 different place back then compared to today, but there are 0:18:43.520 --> 0:18:46.480 key lessons that we learned from the nineteen eighteen pandemic. 0:18:47.160 --> 0:18:49.639 So how well did we apply them to this current 0:18:49.680 --> 0:18:53.320 COVID nineteen pandemic. And if we use the aftermath of 0:18:53.359 --> 0:18:56.720 the nineteen eighteen influenza pandemic as like a rough roadmap 0:18:57.000 --> 0:19:01.240 for a post COVID future, what are the limitations in 0:19:01.320 --> 0:19:04.400 those kind of comparisons? And what can we learn from 0:19:04.440 --> 0:19:08.200 the similarities between these two pandemics and from their differences. 0:19:09.200 --> 0:19:12.639 Yeah, and to help us wrap up this Anatomy of 0:19:12.680 --> 0:19:16.680 a Pandemic series by answering these questions and many more. 0:19:17.080 --> 0:19:22.040 As always, we are extremely excited to be joined by 0:19:22.280 --> 0:19:26.880 John Berry, Award winning author of several acclaimed historical books, 0:19:27.160 --> 0:19:32.440 including The Great Influenza, The Story of the deadliest pandemic 0:19:32.520 --> 0:19:36.399 in History, which is just an absolutely fascinating read on 0:19:36.440 --> 0:19:40.720 the nineteen eighteen influenza pandemic. And I talk with John 0:19:40.880 --> 0:19:44.280 on May twenty fifth of this year, and we will 0:19:44.359 --> 0:19:47.120 let him introduce himself right after this break. 0:20:20.680 --> 0:20:25.560 I'm John Barry. Consider myself a writer before anything else, 0:20:25.640 --> 0:20:29.080 but a couple of my books have ended up involving, 0:20:29.080 --> 0:20:34.640 I mean policy. I got involved in pandemic preparedness planning 0:20:35.800 --> 0:20:40.520 with the Bush administration, actually the very first meeting from 0:20:40.560 --> 0:20:45.239 which the plans on non pharmaceutical interventions and pis so 0:20:45.359 --> 0:20:47.080 called in other words, what are you doing you don't 0:20:47.080 --> 0:20:50.200 have any drugs? Then worked a little bit with the 0:20:50.240 --> 0:20:53.240 Obama administration during the two thousand and nine pandemic and 0:20:53.280 --> 0:20:58.679 so forth. So I stayed involved in the area, you know, 0:20:58.720 --> 0:21:02.879 pretty regularly. I was on a federal government's Infectious Disease 0:21:02.920 --> 0:21:05.720 Board of Experts as the only non scientist on EDAM, 0:21:06.760 --> 0:21:10.080 and currently I have a title of Distinguished Scholar at 0:21:10.080 --> 0:21:13.560 the Tulane University School of Public Health and Tropical Medicine. 0:21:14.119 --> 0:21:17.159 Wonderful, Well, thank you so very much for taking the 0:21:17.240 --> 0:21:20.800 time to chat with me today. I'm very excited to 0:21:20.840 --> 0:21:23.760 hear your thoughts on sort of COVID nineteen versus the 0:21:23.840 --> 0:21:28.880 nineteen eighteen influenza. So we'll just dive in. So over 0:21:28.920 --> 0:21:31.240 the past year and a half, as I'm sure you're 0:21:31.320 --> 0:21:35.040 very familiar, there have been many comparisons made between the 0:21:35.080 --> 0:21:40.040 COVID nineteen pandemic and the nineteen eighteen influenza pandemic. But 0:21:40.320 --> 0:21:44.200 these are two very different pandemics caused by two very 0:21:44.240 --> 0:21:47.560 different diseases. So can you remind us of some of 0:21:47.600 --> 0:21:51.080 these similarities as well as some of the differences, things like, 0:21:51.160 --> 0:21:53.880 you know, the groups affected, the backdrop of World War 0:21:53.960 --> 0:21:57.560 One and what influence that had, case fatality rate, duration, 0:21:57.880 --> 0:21:58.399 et cetera. 0:21:59.359 --> 0:22:02.680 No. Number One, they're both, you know, viruses jump from 0:22:02.760 --> 0:22:07.040 animals to humans. Number two. The mode of transmission is 0:22:07.080 --> 0:22:13.119 absolutely identical, respiratory droplets and airborne. There may be there 0:22:13.200 --> 0:22:17.080 is very little foamite transmission for COVID. There's probably a 0:22:17.119 --> 0:22:22.359 little bit more of that from influenza. They bind two 0:22:23.600 --> 0:22:28.359 different binding sites, once a cialic acid for influenza and 0:22:29.200 --> 0:22:34.680 so called these two for Sarus kobe two. Both viruses 0:22:35.119 --> 0:22:38.320 could bind to cells deep in the lung, which is 0:22:38.600 --> 0:22:44.120 unusual for influenza and doesn't happen with the common cold 0:22:44.200 --> 0:22:47.879 the other coronaviruses that we're familiar with. It. So you 0:22:47.920 --> 0:22:50.600 can start off with a very serious condition if you 0:22:50.680 --> 0:22:52.960 have a heavy load of virus deep in the lung. 0:22:54.080 --> 0:22:58.560 Both viruses buying to cells in the upper respiratory tract, 0:22:59.080 --> 0:23:03.200 which is why they are easily transmissible stars. COVID two 0:23:03.240 --> 0:23:07.679 is much more transmissible than influenza. Ordinary seasonal flu is 0:23:07.760 --> 0:23:10.520 going to a reproductive number about one point two eight. 0:23:11.320 --> 0:23:15.199 The nineteen eighteen pandemic was about one point eight. COVID 0:23:15.280 --> 0:23:18.280 nineteen is about two point five to three, And in fact, 0:23:18.480 --> 0:23:22.560 the variants that have developed or higher than that, or 0:23:22.640 --> 0:23:25.439 would be if you didn't do anything to stop transmission. 0:23:26.480 --> 0:23:30.480 The target audience you might say, or target victims. In 0:23:30.560 --> 0:23:33.320 nineteen eighteen, probably two thirds of the dead were people 0:23:33.400 --> 0:23:38.440 aged eighteen to fifty. Obviously, COVID nineteen is primarily people 0:23:38.480 --> 0:23:44.040 over sixty five. The difference in age groups it has 0:23:44.160 --> 0:23:47.600 certainly had tremendous impact in terms of the public response 0:23:47.720 --> 0:23:51.199 and the politicization of the disease. If most of the 0:23:51.280 --> 0:23:54.560 deaths two thirds of the deaths were people eighteen to fifty, 0:23:54.840 --> 0:24:00.000 you wouldn't hear anybody talking about let's try herd immunity, 0:24:00.480 --> 0:24:04.639 heard immunity I wouldn't work anyway for a variety of reasons. 0:24:04.680 --> 0:24:07.879 But I'm getting off the subjects. So let's say, uh, 0:24:08.720 --> 0:24:12.920 both viruses in terms of similarity. Both of them, in fact, 0:24:13.480 --> 0:24:17.800 affect virtually every organ, quite literally from the testes to 0:24:17.840 --> 0:24:20.800 the brain. If anything, in nineteen eighteen there was even 0:24:20.840 --> 0:24:25.600 more neurological complications. And we're seeing today the two biggest 0:24:25.600 --> 0:24:31.119 differences other than the one I already mentioned, virulence, The 0:24:31.240 --> 0:24:35.520 nineteen eighteen pandemic was much much, much more virulent. People 0:24:35.560 --> 0:24:38.760 could die in less than twelve hours. They could die 0:24:38.760 --> 0:24:41.520 with horrific symptoms. Now, most of the deaths were secondary 0:24:41.560 --> 0:24:46.000 bacterial pneumonia infections, which antibiotics would help with today. But 0:24:46.600 --> 0:24:51.160 even today, the case fatality rate for bacteria in pneumonia 0:24:51.200 --> 0:24:55.919 following influenza is about center eight percent, So that's roughly 0:24:55.960 --> 0:24:59.680 a quarter of what it was back in nineteen eighteen. 0:25:00.320 --> 0:25:04.160 It's still quite high for that disease. That aside, there 0:25:04.160 --> 0:25:06.919 were many many deaths that were directly caused by the 0:25:07.000 --> 0:25:11.520 virus so called long covid. That same phenomenon occurred in 0:25:11.600 --> 0:25:16.119 nineteen eighteen. You know, worldwide, nineteen eighteen probably killed fifty 0:25:16.119 --> 0:25:18.720 to one hundred million people. If you adjust for population, 0:25:18.840 --> 0:25:20.719 that's sequel to two hundred and twenty five to four 0:25:20.760 --> 0:25:24.199 hundred and fifty million people today. So even if we 0:25:24.320 --> 0:25:28.439 did nothing with COVID nineteen except just let it run loose. 0:25:29.080 --> 0:25:31.520 The projections would not come up with anything like that 0:25:31.600 --> 0:25:36.280 kind of death toll, thank god. And another very important 0:25:36.280 --> 0:25:41.800 difference is duration, which you mentioned. Influenza just moves much quicker, 0:25:41.880 --> 0:25:46.359 but much much faster in every area. Incubation period, how 0:25:46.440 --> 0:25:49.280 long you're sick, how long your shed virus, how long 0:25:49.320 --> 0:25:52.760 to recovery, all those things are much faster in nineteen 0:25:52.840 --> 0:25:57.439 and influenza, whether it's seasonal influenza or nineteen eighteen. In 0:25:57.440 --> 0:26:01.000 that sense, nineteen eighteen was just like ordinary infla, it's 0:26:01.119 --> 0:26:06.440 just much faster. So in nineteen eighteen, probably as much 0:26:06.480 --> 0:26:10.040 as two thirds of the dead died in a period 0:26:10.080 --> 0:26:14.199 of really weeks, maybe fourteen weeks or so in the 0:26:14.240 --> 0:26:19.199 fall of nineteen eighteen, And in any particular place it 0:26:19.240 --> 0:26:23.040 was faster than that, because influenza then would go through 0:26:23.040 --> 0:26:25.040 a community in six to ten weeks, it would peak, 0:26:25.119 --> 0:26:27.600 and when it was gone, it was essentially gone. So 0:26:28.320 --> 0:26:32.600 there were waves in nineteen eighteen, but they were very discreet. Obviously, 0:26:32.680 --> 0:26:36.000