the book for sale out there, by four or five copies apiece. can we can give another round of applause? [applause] [background noises] : : his thoughts on how prepared we are for the next major outbreak. then a discussion about viruses from the 2016 brooklyn book festival featuring paul zimmer and eddie young, the later john berry describes in 1918 flu pandemic that killed 100 million people worldwide. enjoy book tv, now and over the weekend on c-span2. >> last november we mark the centennial of the end of world

war i. in november of 1918 the people of combat nation felt relief that the years of warfare and death were over. yet another threat to life was reaching across the nations into homes and schools and hospitals, the flu. influenza pin democrat 1918 killed more people worldwide then killed in combat in the war. many records housed in the national archives here in the washington area and many other field locations, documents this effort break in the united states and writers reports, books, telegrams show the reach of the 1918 influenza epidemic to all parts of the nation. these records opena a window oo the world of 101 years ago and show us the human and societal cost of the pandemic. they allow us not only to look back at times but perhaps also to look ahead. as thepa information may help

guide present inquiries and increase our understanding of the disease. doctor jeremy brown is an emergency physician and was a research director in the department of emergency medicine at the george washington university in d.c., he's now the director of office of emergency care research and the national institute of health and doctor brown is the author of articles and books including the oxford of american emergency medicine in the handbook on cardiology emergencies. he's recently received an nih director's award for his efforto supporting research and non-addicting methods of pain relief. jacob apple says brown is clearly a man who knows the flu, not just the physiology and virus or the epidemiologyt of illness but countless fascinating and fun facts about this. and in the wall street journal,

highlights brown's emergency room experience and in influenza he builds effectively on his clinical and scientific career making the virus itself central to the story he reads history contemporary urology clinical practice together, although his story is a somber one, his account has humor and advice. the best time to visit an emergency room for instance. please welcome doctor jeremy brown. [applause] >> thank you so much for those kind words, it's not every day you getou introduced by the archivist of the united states. so we are here to talk about influenza and the plague that struck us 100 years ago that

resonates all the way through to today, as you mentioned more people were killed in the influenza virus then in the wars, 50 - 100000000 people worldwide. here in the united states 675,000 deaths and of the 116,000 combat casualties, u.s. combat casualties killed in world war i, over half actually died from disease and that was the majority of that was influenza. it is a sobering thought to think of, if you take the statistics and multiply them by the current population of theti united states, the 675,000 deaths were turned out to be about 3 million deaths in today's numbers. put that into perspective and think what that would be like to live there such a thing. another way of thinking about it

was to put the calls of this, i'm going to come back to this but back in 1918 there was no known cause, viruses had not been discovered yet. so people were dropping from this disease called influenza but nobody really knew what ital was from and we will return to some of the thoughts that were behind it. i think about that and i think about the 1980 outbreak of hiv which was incredibly frightening and yet we knew that i had to be a virus, took it three years to identify but at least we knew what we suspected that we had a corporate right away. back in 1980 they had no idea. one other thing to put this into perspective, as you all know we are sadly living through an epidemic of a very different kind, the opioid epidemic which has claimed so many deaths in this country, the news over the last couple of years was the

death rate, it is so high that it has dropped the average life expectancy inso the u.s. and you may have seen that statistic. if you look at the average six presidency because a large number of death, the average life expectancy has dropped, that is shocking, how much has a drop by. >> if you look at the data ishe drop by one tenth over the year. that is a terrible statistic but it's one tenth of a a year. the 1918 epidemic cause such a loss of life that it dropped the life expectancy in the u.s. by ct12 years. 12 years, 120 times greater than what we have seen with the current opioid crisis. again putting in it to perspective as to what it really was, since were in the archives, i thought it would be fun to actually look at archive

material that actually affects and shows what happens here in the nation's great capital. so these in the following slides are from the washington post and i think it tells a brief story of a much complicated event, this is the washington post from saturday september 14 in 1918, not the front page and it tells us that the spanish influenza was spreading across u.s., was not reported yet in the papers in large numbers and in washington, d.c. but it had begun to spread across the u.s. now, the following day the washington post reported that 90 people had died of influenzape n boston and they seem to be sweeping from east to west, was actually started somewhere in the midwest but it was already

ramping up in the very next day they reported that 90 people in boston had died, these were deaths among soldiers and sailors. the plague built momentum and more and more people died in by october the second on the front page of the washington post we were told that the work hours were changed, that the federal data has been staggered to checa the influenza spread and the people have to take shifts, washington, d.c. was not the only city to do this by any means, in fact it happened in the most of the cities that were affected. the idea was if we could stop people from mingling although we did not know it was a virus that was causing this, we did understand somehow keeping away from people is probably a good idea. so theaters were closed down in some places, restaurants closed or staggered their hours, stores

had staggered hours, in an attempt to keep people space away from each other. the working hours of the federal government changed around the beginning of october. i talk about this piece -- this reporting in the book is a particularly sobering one and it comes a couple weeks after the announcement of closures. by october 13, 1918, the washington post reported on the headline the ghoulish coffin, the price of coffins had skyrocketed. and this was an example of people taking advantage of a terrible situation and in fact they write the confidence holding the people of the city of boston -- of washington by the throat and extorting outrageous prices for coffins and disposal of the dead. in the washington post goes on

to suggest that the department of justice should step in and instantly put a stop to the high prices of coffins. it cost more to bury your dead because the coffeemakers figured they could make amo buck. the middle of october in washington more people had died in a short amount of time and the crest was in sight, that was hopeful, there is no evidence but it was hoped that perhaps were nearing the end of it. throughout the epidemic both here and nationally people of course had various remedies, this is an example of a remedy that actually played throughout the fall and winter of 1918 and will come back and talk about this but i want you to remember these words, this is a remedy

that contains a laxative, will come back to that, thought to be very, very helpful in cases of influenza and a medicine that was the go to medicine forec malaria. it is now been superseded by others but it was thought to be helpful in influenza, people were making the laxative and i find it interesting if you look at the beginning as spanish influenza is an exaggerated form of grit, one of the words of influenza, it should be taken in large of those then prescribed an ordinary great, it's a really big epidemic so you better take a lot ofit this medicine. we will come back and talk about these particular remedies so

these and several others were advertised both to treat the disease and also of course to prevent it again, another marketing opportunity for businesses, laxatives and bruma- 1918 the washington post thought that we were coming to an end and they put this little piece that said spanish influenza is more deadly then war, that is indeed the case, we know that but what struck me here is the placing of this piece of journalism it's the back page, page 20 tucked in next to an ad for dining room chairs that the academic was more deadly than the war, why was this not front-page news. what had happened, these very

suggestions, some believe there was a passive agreement, not censorship the passage agreement between the newspapers and the government the play this thing down but if you're going to put a statistic like that the influenza cost more than the whole of world war i, putting on page 20 is really not going to get the attention. it's a little bit of a mystery and i'm sure will have very small that can shed more light on all this and other reports and tucked into the back. >> finally we hit a record, early reported that we were near the creston washington, d.c. and to note more destin sensor record of last october occurred, 16 deaths from the flu in a single day in the city of washington, again this was tucked away in maybe real estate

and legal record recording. again it was reported, it was not hidden but you have to look for this to understand what was going on. in the final slide i want to share with you of reporting from the washington post was on exactly the same march the fifth, 1919, exactly a century ago. exactly 100 years agoh today. this was a small report that was in the washington post that cited to washington boys who volunteered to go out to boston and to take part in an experiment that were trying to understand the cause and the methods of trump's mission, during the recentmi influenza epidemic we read men voluntarily submitted to experiments for doctors to determine the cause

and method of transmission of the disease and preventative measures. >> that is quite another remarkable side of the story that people would volunteer to be involved in research on this barely deadly epidemic that was not understood and for which there was no current than the tablets which i don't think people really look forward to to cure them. i think an example of everyday heroism of people putting their own lives to some degree on the line in order to understand what was actually going on, what was this terrible disease. these are just a few examples from the washington post that tell us a little bit about what happened in washington, d.c., i'm just going to switch to a second slideshow in this one will run itself.

if it all works fine, you will see some images as we talked through. today i would like to focus on three areas of research, one that i described in the book, the first looks at howard treatments of influenza have evolved. what do we do 100 years ago to treat this terrible deadly disease and what do we do today. and i think you will find that it has changed less than you would've hoped, the second focus is going to be howard understanding of influenza virus have changed over the last century. what caused it and what to be know about that same virus today and i think we can all agree that there has been an absolute remarkable evolution and understanding of what's going

on. finally were going to look at how we can prevent ourselves from catching the flu in the first place by looking h at vaccines, what vaccines were like back then 100 years ago and where we are today and will find that we still have a lot of work to do. so let's start with the treatments. the treatments were not terribly effective, they included mercury, free bark, and inhaling factory gases, that actually happened, people were reported in the soft of england to take their families and their children, munition factories where the fumes were thought to reduced the likelihood of getting influenza. it turns out not to be as crazy as it sounds because many of these contain chlorine, chlorine gases used during the war and we know chlorine is a great antiseptic, kills everything

including people. so very likely that chlorine and work that was done shows a factory work has slightly lower rates probably because yes they were inhaling little bits of chlorine and they hold atmosphere in the chlorine gas and that probably reduced the amount of free virus around, was not a complete crazy thing to take your children to inhale factory gases, there is upside of treatment back then, whiskey was extremely popular and was champagne, these are prescribed by senior physicians and so not everything was difficult, as we said enemas -- they were actually used to treat everything back thing, that was something you could do so that was thought to be to clean everything out, and enemas quite popular in one of the most remarkable thing is blood

blessing. it's a process by which blood is removed from the body and the thought with the removal of the blood you are taking out the bad thing in the blood causing the disease. it dates back to the 50 century d.c. and george washington was probably killed by this as he lay dying from a throat infection, his senior dr. suggested that we do this. the junior people were less into thiswe idea and there was a lite bit of resistance but as usual the senior people one and blood was taken from george washington as he lay dying on his bed and he passed out and within a few hours he was dead. sorry own president george washington underwent this procedure, the doctor then tried

to think about reanimating george washington -- i'm not making this up using cheap's blood at the time good sense prevailed and they decided enough is enough and they let him rest in peace. what is remarkable to me is bloodletting was used in 1918 and not just by what we might call quacks today, but this was described by mainstream physicians and in fact this was one of the things that spark my interest in the story of influenza in these report, one of the leading medical journals in the united kingdom and if you n think about it, the lancet is named after the device that you would take blood from, the medical journal today's call the lancet. in the report mentions in 1916, two years before the flu

pandemic, there was another pandemic, another epidemic in some of the military camps in great britain and the doctors tried everything including bloodletting, so it was 1916, this is the lifetime of my grandfather and in 1916 physicians were trying bloodletting on these poor patients and of course it did not work but the physician said it did not work but we think but it didn't work because we tried it too late. had we tried bloodletting a little sooner into curving soldiers, that maybe it worked, there were reports in 1918, the height of the epidemic of bloodletting and in fact the reports were sometimes bloodletting works for influenza. so you can see if it was not the

enemas that got you the bloodletting might get you and it was really quite an austere rate of medicines that we had to try to treat this. we saw earlier in ad for concoction and we said it was a useful drug for malaria but useless as a treatment for flu. because it's a useful drug malaria, and reduces the fever cycle and the idea was if it reduces fevers and malaria then it will reduce fevers and influenza obviously to quite different mechanismsin of diseae but that was the thought process behind it but completely useless drug and incidentally dangerous and inappropriate. as i said everyone was prescribed enemas and one of my favorite discoveries when i was researching the book was from a published paper from the grandchildren of a patient who

had influenza, not 1918 but in 1936, 18 years, almost two decades after the great influenza pandemic, the family had preserved the nursing records of grandfathers and found them in the attic and actually published in. i'm going to read a little bit of a passage that describes what this person went through. over a period of three weeks he was treated with a punishing battery of bombs, muscle blaster, a home remedy rubbed on the skin, aspirin, for fevers, coding for a period tree no sailing, a cancer-causing laxative, cough medicine, oil, seven enemas, seven, rectal tubes, don't ask, milk of magnesia, another laxative, god help them, a bloodletting intercepted, these were all

administered to this patient in 1936 and actually in the paper that was published you can see thawhere the various things are given. the patient described five doses of whiskey, there's at least that in 14 doses of cost o costl coding suppresses coffee but also causes constipation. but that's what life was like we had influenza back 100 years ago or so. what about today. well, for the vast majority, influenza is an inconvenience, not life-threatening and it's something that we generally deal with at home, the friends of the

family come down and give us hot soup in a couple of days in bed and usually that's it but of course some of us in the emergency department, we got to treat many, many possibly hundreds, maybe thousands of patients within influenza over the many years and there we have things that we did not have 100 years ago, we had an emergency department, we had blood test that can tell us what is happening, x-rays so we can get a real good look at the lungs and see if there's any evidence of pneumonia, we can get fluids. -- sorry we can get people intervened as fluids. in treat them in that way. and of course, we have antibiotics today. let's be very clear, antibiotics should not be given to patients with influenza. they do not work, we all know

this even though the prescribed unnecessarily often for today, they do not work but they do work to treat the secondary infection in the ammonia that comes as a result of the primary viral influenza we have vira antiviral today and they were not available until the 30s and it's remarkable thing that today that we believe that the majority of deaths that occurred in the great flu epidemic were caused by secondary a ammonia that we would be able to treat today. that is good news. we also have medications to treat fevers, we have medications like aspirin, motrin or tylenol but i came across a very interesting study that suggested perhaps we should not be giving medications to people fevers quite as often as we do,

this was a study out of the university in canada and they looked at the modeling and said what happens if you give tens of thousands of people with the flu some medicine to reduce the fever. while, many of them would feel better quicker. having a high fever in shivers and shakes and chills, that is miserable, the feel better quicker in the get out of bed quicker, what will happen, they will come downstairs and talk to their friends and their children and go to work and the suggestion from this group from the university, by treating a fever for patients in the emergency department, you might increase transmission rates by 1% and given the norman t of this disease, they suggested you might get an additional 500 deaths per year in the united states as a result of treating peoplpeople fevers. if you come to the emergency department with influencer today, and your doctor sees that

you have a fever of 103 and she suggest that you probably should not get something for your fever because she says there is a paper from the university that is b theoretically, this could increase the death rate, you would probably say doctor, please give me the medicine -- i know i would and i know it's prescribed and we continue to prescribe something for people fevers in the presence of influenza, there is another way of thinking about what were doing locally and how that might affect transmission and spread. so we have those medications as well to help us. then there are specific medications that treat the flu and those are mainly like tamiflu and the new kid on the block call block severe, these are direct antiviral medications going into the strictly right

now, perhaps we could talk about them later but they are also out there. they probably don't work anywhere near as efficiently as they should but we will leave that for later. so that is the treatment, enemas, bloodletting, laxatives, whiskey, 100 years ago today, the emergency department will stay at home and connected to the emergency department is the intensive care unit where the sickest of the sicko. i opened the book with the young lady and a young mother of two who came down with influenza extremely quickly, she ended up in a matter of hours being medevac from her small town to pittsburgh where she was put on a machine for several weeks until she recovered from the flu. that is the miracle ofer medicie today that clearly was not around 100 years ago. so the treatment, let's think

about the cause of influenza, what do we know about the cause today and what did they know 100 years ago. so i think in many respects, this is the most frightening aspect of the great influenza pandemic, they just did not know what it was called. there were so some justin's, among the suggestions included the conjunction, that's where we get the name influenza. from the italian meaning influenza in the earliest thoughts were in the 1600s that this disease was in and entity that you could identify it was caused in the stars, there was a theory going around and we still have this. in the history when we refer to influenza today, perhaps

conjunction, animal carcasses were thought to be an explanation. earthquakes and volcanic eruptions were suggested as possiblele causes. a fluvial discharge into the air from the bowels of the earth and people really did not know what it was, and other meeting that occurred in chicago with public health officials in the early influenza epidemic of 1918, one public health official said the following, we may as well admit and call it duramax, we have no idea with the meeting of public officials will anoint your causes and where we are. an example of a that was not a cause was a discovery in 1892 in berlin by a microbiologist and they found a bacteria on the samples of people who had died from the flu and they said this

must be the cause of the flu because it is everywhere, they called this bacteria, they called it the influenza bacillus. the problem was that it was not the cause of the disease, it was a secondary pathogen that was found, it was a secondary bacteria in that thought that they found of the bacteria and it turned out not to be correct, the happen in several different instances in the history of flu. the bacillus was later changed its name, it was not called bacillus influenza but am off list influenza. some of you may have heard of this, it's a nasty bug, fortunately we now have good vaccines against this but for many years i had noisy a physician, why am i looking are treating this person with h flu, has nothing to do with the flu, it turns out 100 years ago it was thought to been the cause of

the flu and inappropriately named, one of thehe historians f the great flu called this discovery bacillus influenza and authority of sign pointing in the wrong direction. so that was bacillus influenza, the second pathogen. 1889, there have been a small epidemic but still a severe one in great britain, it was so severe that actually parliament commissioned a report on academic and this was reported in 1889 by henry parsons, he was a very, very smart person. we will see w why. he spoke about various theories that may have caused the 1889 epidemic, one of the theories at the time, i am not making this up was painted russian oats.

the suggestion was that the russians were bringing their disease from the east through europe and the painted russian boats, every society blame the outsider for this. but it struck me as weird that today when were still blaming the russians for everything back in the great flu epidemic in earlier perhaps the russians were behind as well. but parsons was smarter than that and he dug a little deeper. he suggested, he said it could be the weather, perhaps there is something floating around in the air, and that is of course personally true, there is something in the air although its person-to-person contact and he suggested that maybe it's a nonliving particulate matter which is actually a remarkably accurate description of what a virus turned out to be, a nonliving particular matter.

so that was describing the possible cause of the flu. it could be russian tainted oats, could be a poison in midair, then he suggested one of its person-to-person contact, it's not spread by oats or volcanoes but one person gives into another in here i think henry parsons really showed the right way for us to think about things, he said let's get some data, if its person-to-person, he looked at thess illness rates on the british railway system and he compared the rates of the engineers who were feeding the steam engines in the coals who worked outside before we from people any compared those real s and how many people reported sick and he compared those to the rates ofheat influenza among those inside selling the tickets, there inside but there

in constant contact with people. andy said he compared the two. he said he found it was the clerks who had an increased rate of influenza illness because they were in contact with people in the railway engineers driving the train standing outside feeding the coal into the steam engine, their rates were much lower than the clerks even though they were outside exposed to who knows what from volcanoes pre-here he suggested it's really probably nothing to do with the atmosphere but more to do with person-to-person contact. so from a simple look at records this guy figured out that were probably on to something with the person-to-person. and then he said the following. he also suggested perhaps animals have something to do with it and here he was really on the money, he suggested that perhaps birds or horses or dogs has something to do with the

spread and he goes into detail on the report. and of course we know today that there is intimately related to the spread of influenza in new strains. so back in 1889 henry persons was onto something when he discussed the possibility that birds were involved. so there is an example of people trying to think this through in a logical way and almost coming to the right conclusion. today of course we know what causes influenza, there's no doubt, a viral particle which is many, many times smaller than a bacteria, were able to take microscopes of this when the microscope was developed and able to be used around 1839. so we have pictures of influenza, we have diagrams intact scientist today no that

the genetic code of the influenza virus, how it's eight viral genes work together, what viral coat looks like, the proteins on the viral coat, what those proteins do and how they make it thick. to the degree of the advances from the suggestion that it's in oats to something we can see and identify and know a lot about is really a remarkable example of enthe progression of science. over a century. now we can identify the viral genetics down to the makeup, it's a genetic instruction. in that respect i think we've come a long way in understanding the cause of the disease. which brings us to the last part which is the way that we change in terms of vaccines and prevention. so there were attempts to

produce early vaccines to influenza, back in the 1880s he developed his own set of vaccines, most famously to rabies and that does not necessarily mean he knew what the virus was he had a suggestion that it was something in the nervous tissue and he managed to propagate nervous tissue and take samples and make them weaker and weaker and so he figured out what they had was a beacon thing, a virus and that's how he produced his rabies. so we know that people were producing vaccines back then. but of course what they were using were bacteria that was pathogen's and not the primary pathogen which was influenza. so for instance in early 1919 edward isolated five different types of bacteria from patients in a mixed them all together and he managed to inoculate over 100,000 people with his vaccine.

we are not sure what the outcomes were but he certainly tried to do something. in boston at the top medical college, doctor timothy leary made a vaccine. he made a blended vaccine using the chelsea hospital, the naval hospital, a nurse's nose from the hospital in the infected of kim devon not far from boston, he made a concoction and give them to people and actually his vaccine ended up being sent to san francisco were 18000 people were inoculated with his vaccine, that is timothy leary, you're wondering, the answer is the same doctor timothy leary and in fact this is the uncle of the famous doctor timothy leary and boston, he who wanted us to turn in and

dropout, it's his uncle who created this vaccine 100 yearstt ago. so that is attempt at vaccines back then, what do we have today. we do have vaccines against the flu. many of us in this room will take them every year and those of us who have healthcare have to get the flu vaccine, it makes sense to try to prevent the transmission but it's really not a very good vaccine. when you think about it, mumps, measles, rubella, polio, you get once or twice had a kid and you'rere done. you're done, you're finished, that's it, you're good to go, you will not get the diseaset, ever. but in terms of flu, were told that we need to get it every year, new flu shot i just had it last year in the year before. we are dealing with a vaccine that is really not on the same

level of effectiveness as the others and in a good year with the wind blowing in the right direction the flu vaccine is about 50 - 60% affected at best. last flu season it was less than that was in 20 - 30% range. so why is this, why is a flu vaccine so hard to create. the answer is that we have this hollow wall that creates -- that contained the 18th of the flu virus and it makes these proteins on the surface and against the proteins of the virus that the vaccine is creating. the problem is the flu is such a disguise or, a master of disguise that it changes the makeup of the service proteins very quickly. very, very quickly. and it mutates from one kind to another, when we think we have what kind of flu is going to be

around, it turns out that species a mutates and the vaccine is no longer effective against species a and by the way we did not realize species b and c were going to ben' the one soe did not include those in the vaccine and therefore we were not vaccinated against those. which is the reasonat incidentay that some of us get the flu vaccine and end up with the flu. it is not because the vaccine did not work in that particular strain but they were either others drains that we were not vaccinated against or the original when changes in surface structure just that bit so it's like changing an overcoat from a brown overcoat to a black overcoat in the immune system did not recognize it and that's what's going on the flu vaccine, it stays one step ahead all thev time. and there's a similar story with hiv, the promise of an hiv vaccine -- we would have it any in 1980. still not there. these viruses are very clever at

changing their surface and hiding from the immune system so we still don't have a good influenza vaccine. the way that we make the vaccine that we have 120 or so across the world with the world health organization, they look at samples that are sent to the lab and try to figure out exactly the kind of flu species that is prevalent, we look at australia on what they had in their most recent influenza outbreak because it's in their winters in our summer, we try to figure that out and incidentally they do the same for us. and we look and seend what happened in the northern hemisphere and adjust themselves to the oncoming flu season in the summer. and then doctorsom make the best educated guess that they can. they say best enter based on the

evidence that we have the most likely species that will be this and this and this and we will make the vaccine. to this day the majority is produced using eggs in the vaccine is very hard to grow so it's grown on eggs which is the same thing used a century ago, there is some vaccine made using cell technology and that allows us to have a vaccine that is not on eggs but still those are simply the message that we have today that are left over from us 100 years ago so the majority of the vaccine still to this day has something to do with eggs and needing to be grown. in many respects, we are really at the beginning of the fight against influenza by preventing it in creating a vaccine. while that is all true and not a very effective vaccine, you must remember that inme certain grous

it is extremely important to get the vaccine, the high risk people. so those are children,e the elderly, those with immune compromise conditions, people who is taking steroids and undergoingha chemotherapy, pregnant women, extremely important for pregnant women to get the influenza vaccine, the heart is an increased risk of complications from influenza. and so those are some of the high risk fruits that should certainly be vaccinated, no questionro there. in terms of everybody else, the data out there is an harder to find an effect on the flu and for in fact, united kingdom, high-risk groups are targeted and everybody else says if you want one, you can get one but there is no campaign. here in the u.s. we have a campaign, the cdc says everybody over the age of six months should get a vaccinated.

but the advice given the united states, it's worth pointing out this is not the advicee given overseas and we can talk about why that might be another time but it's an important difference in the way that we think about the flu. so for high risks groups is very important, otherwise healthy adults, the evidence is influenza vaccine does not really do a whole lot. so what we need instead, we need a universal flu vaccine, vaccine that will your work year to year without having to get againin eh year, vaccine that will work in all age groups in a vaccine that will work in all geographic areas, regardless of what specific strain of flu is running rampant in your area. so that is the goal of the universal flu vaccine. and to do that we have to target that flu virus which we understand very well and find a

bit of it that does note change, find a bit ofe the flu virus tht we can target and then our immune systems will recognize and latch onto and will kill the virus no matter what strain of influenza it was. it sounds easy, it's a very hard thing to do in reality and were still not there yet, but i will say the national institute of health where i work and i want to pause and let you know that i'm not here representing the federal government on the great influenza epidemic of 1918, mureau my own time and these are my own personal views but the nih where i work is very, very focused on trying to find a universal flu vaccine they porn a lot of money in research, time and effort into that. there is a trial of a possible candidate produced by company called by him back from israel and other companies out there doing this that is underway right now from the nih and who

knows, will this work, will i not work, will we fear universal vaccines, i do not know. i don't know if we'll see when soon but that is certainly the goal of what were trained to do with vaccines, so we certainly have a long way to go. so if we look at where we were 100 years ago and where we are today, the treatment is very different thankfully pre-but we ststill have lack of treatment r influenza pre-we understand the virus ended remarkable and deeper profound way in a way that was unimaginable a centuryw ago. are we able to use the knowledge and build a vaccine, not quite yet, were not quite there although that's where the research is going. my hope looking forward is that we really will be able to see influenza, not just the story of the past but a disease of the past and the way that we think about smallpox a disease of the past that was eradicated. it is important to move towards

theve goal, cdc estimates anywhe between 30 - 50000 people die from influenza, it's a soft number, not an extremely accurate number but it's a ballpark figure so a lot of people still get this disease and die from it, it's in the high risk group weather happens so we really have to try toou think about ways that we can improve our own vaccinations so we will be able to make a one-day influence at the thing of the past. thank you for your time. [applause] any questions, i would be happy to take them. >> thinking. somebody made a lot of money with facemask back then, we see those today in this culture we don't see them as commonly in asia when they get a cold or don't want to give a call to somebody else. my question is, how effective

are those because there was a train picture you showed that spit causes death, they can spit in your eye i would assume that to be uncomfortable potentially dangerous, can you talk about that perspective in regards to the filtering, it's just a comfort on olivers and back then, the use of masks or reality to prevent the spreading of that. >> that's a wonderful question thank you. of course masks do something. the cheap mass that you can buy the local pharmacy have a filter mesh so if you cover it you'll be breathing through the mesh but that mesh is going to stop something, the question is what is it stopping. it might be stopping your secretionng if you cough in the mask catches what your coffee not. does it stop the viral particles that someone else has coughed

out from creeping out of the mask almost only not. the other thing about facemasks is after certain amount of time they become clogged and they're completely useless and not doing anything. i think what we're seeing is an interesting idea in other words don't sneeze on other people please. don't cough over people, that makes sense. but this is josh and that we are going to stop this by wearing a facemask, i think you might've seen the picture of the happily married couple husband-and-wife hugging each of the wearing facemask. that is a pr example of something that probably does very, very little. but what we do know is one of the most important things that you can do to d prevent flu is t to go out and get a antiviral medicine from your doctor, it's to wash your hands if you're helping somebody look after 70pi with the flu and not to cough on people. so it reminds us of what we need to do and when we have the flu

but in terms of intervention, the small paper masks almost certainly doing very, very little. >> thank you for the talk. i'd be curious to hear you say more -- you mention the cultural differences between where the u.s. encourages everyone to get vaccinated where in europe sometimes theyed don't. so why is on which one do you think is correct. >> i go into some detail. to be clear, and the united states is cdc's recommendation is that everybody over the age of six months get vaccinated in the uk and parts europe in high risk groups only -- you can if you want but is not being pushed. i think that the difference of how we approach, if you look on the cdc website for example, you will read the influenza -- and

paraphrasing it but influenza is a serious disease with complications that include death. since that is the case, everybody over the age of six months to get the vaccine. if you go on the website, i was looking at some of them recently from the national health service in england, it basically says the following, influenza is a bit of a nuisance. you're going to feel unwell for a couple of days, you don't hava to go see her primary care doctor about it because there's probably not a whole lot she'sre going to do but if you need to you can, stay indoors and you will be fine. that is basically what the national health service view of influence is. if you have these two very different approaches to describing a disease, it's a potentially dangerous disease that can kill you versus a bit of a nuisance but you'll be all right. those are two very different ways of approaching what we should do about the disease.

if it's a potentially deadly disease even though the influenza vaccine isn't terribly good, and the united kingdom they say let's use it where we need to use that but most people will not need it. which of those two is correct, they both are right. influenza is indeed a potentially deadly disease, that's only for .001% of the people that would get it in those tiny number of people that are going to get it, unfortunately it's not who get sick as those increased risk from the disease, those high risk populations. in the united kingdom approach is a bit of a nuisance, that's about it, that's also correct. which of these two messages drives us is going to decide how

we respond to the vaccine, we decided in the united states is cdc decided this is the enter best public health approach. i think the data as far as i read it and this is purely a personal observation, the data is in high risk groups people should get it, it's not terribly effective but it does something, and everybody else, let's talk about that group is a young healthy middle-aged adult probably does very, very little. and yet as you know beginning of august you will see signs in your pharmacy saying were ready to get the flu vaccine, come and get it. we will give you a coupon. or something like that. so two very different approaches, it's a potentially deadly disease in a nuisance and that drives how we look at the vaccine and of course this is a larger discussion with the question if it kinda works, we should use it, that's the approach for many aspects of the market health system, if it works put it out there.

even though it might not work terribly well, even though there's problems, it works, get it out there, in the united kingdom -- at talk to the chief medical officer of the vaccine program who leads a discussion and he said in the united kingdom they think about things beyond how well the vaccine was, doesn't make sense economically and if you add up the numbers, it does not make sense economically to have aes big campaign for healthy adult to get the influenza vaccine when so few of them proportionately are going to end up getting sick and taking time off work. so we will just leave it at a very different approach to these in the cultures. yes, sir. >> good afternoon doctor brown, i'm a history graduate student at george mason university. i'm quite a stickler on sources. so i c was just curious at what sampling of sourcessa you use, i know you had mentioned newspaper

articles and some medical diaries but i was more specifically interested in your use of secondary sources to bolster your own medical knowledge that you already have. >> it's a question that i might get in trouble because there's a historian in the room. the truth is, i use both, obviously i began whatever secondary sources that he could, i read everything posted in the last decade or so, there's very good books onhe influenza. and i was actually talking just before i came in, now you have the resource of the thing called the internet and i don't know this was available to the good degree but it is with the other books that came out, you can do

a search for hundreds of hundreds of new papers with the keyword influenza coming to dubai state, city, by time and you can get these gems of information like i should you g just now, those are primary source but i don't think anybody is really the fact that the washington post reported that the death rate for influenza was greater then the death rate in world war i, it's in the back page of the washington post, i've never seen that the reports, it's observation, it tells us wha how we approach the flu. thankfully and you're also grateful for this and here we are on the remarkable national archives, jim of history where we have a lot that is available to us in relatively simple tools, the nice thing is when historians discover something that no one else has found hidden away in a box in a course as a historian you and others are great team to find that. but a lot of primary sources going back reading the original articles teasing ou the medicine from the earlier

reports in 1916, they were mentioned but when you go back and read the primary, you can get this. thank you for thea question. we are out of time ladies andnd gentlemen, thank you very much for your time and attention and i hope each and every one of you will stay healthy as we in the flu season. [applause] . . . . [applause] book,

influenza. [inaudible conversations] [inaudible conversations] thank you all for coming. you are on a panel called viruses and destiny. this is a discussion in which we will reveal how microbes are the secret puppet masters and i should first start off by pointing out viruses are