Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata

Just finished Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  In some ways an awkwardly written book but in others, revelatory.  Lots of passages worth quoting, which is always a good mark.  

I have more than a passing interest in the history of disease and have at least half a dozen and probably closer to a dozen books on the Spanish Flu of 1918, one of the great tragic mysteries of history.  

This book was published in 1999 and so now has quite a bit of value as it paints an independent picture untainted by the epistemology or the politics of Covid-19 in 2020.  

I learned a great deal from Kolata's account but there are probably two primary take-aways.

The first is the near exact replication of failure in terms of the Public Health response to the Swine Flu outbreak of 1976 and the global Covid-19 pandemic in 2020.  In both instances there is a pattern of almost always making the wrong decision in a sequence of decisions and there is a shared deficit in basic project management skills.  Simple things like defining the disease of concern.  Measuring it in a fashion that excludes similar diseases.  Failure to anticipate mass deployment issues, especially the challenge of monitoring responses to the vaccinations and confounding illnesses.  The failure to have a measurement mechanism in place which could distinguish between deaths from the disease, deaths from the vaccination, and deaths misattributed.  

The 1976 Swine Flu is just on the edge of my adult memory.  It first showed up at Fort Dix in roughly central New Jersey in January and February of that year.  I arrived from Sweden in August to attend the Lawrenceville School in August, my first time of living in the US.  I remember reading a few references to the Swine Flu outbreak but the news was actually dominated by the first deaths in late July from what would become known as Legionnaire's Disease from a convention of Legionnaires held in Philadelphia.  

So I knew of the 1976 Swine Flu outbreak but little more than that it had occurred and that there was a massive nationwide effort at immunization that petered out before it reached even the majority of the population.  

Kolata's account was new to me, revelatory and gripping.  Just as with Covid-19, it caught the CDC by surprise, they didn't know what to do, they had a knee-jerk fear of being held accountable for doing too little in the face of a virus which they anticipated might be highly contagious and deadly.  

Bad definitions, bad planning, bad measurements, bad estimating, bad forecasting, bad communication with decision-makers and the public, inadequate evidence-based decision making - everything that went wrong with Covid-19 was already in evidence in 1976.  You have to wonder where the CDC institutional knowledge was because the 1976 Swine flu was a huge professional black eye which wasted money, sullied reputations and achieved no success.  

The second take-away is our continued incapacity at a societal and institutional level to settle on established norms for assessing appropriateness of response when dealing with uncertain knowledge in the context of multiple chaotic, loosely couple, power-law driven, dynamic and evolving complex systems.  With the 1976 Swine Flu, the CDC quickly settled on the need for a nationwide mass vaccination campaign despite never having any real experience in this kind of preemptive vaccination under the time clock or good scientific foundation to justify the actual risk, the real costs, or the magnitude of possible consequences.  The Public Health response to Swine Flu in 1976 look like just as much a clown show as did the Public Health response to Covid-19 in 2020.  The experts seemed to have learned absolutely nothing.  

Lots of other good knowledge tidbits and insights in the book.  I enjoyed the read.