Governments Have Suppressed the Dangers of Epidemics Before, Only Making Things Worse
The mainstream American press has agreed – at the request of the government – not to report on suspected Ebola cases.
Let’s provide some context …
The U.S. National Academies of Science noted in 2005 (starting on the bottom of p. 64):
In the United States, national and local government and public health authorities badly mishandled the [1918 “Spanish Flu”] epidemic [which killed up to 50 million people worldwide], offering a useful case study.
The context is important. Every country engaged in World War I tried to control public perception. To avoid hurting morale, even in the nonlethal first wave the press in countries fighting in the war did not mention the outbreak. (But Spain was not at war and its press wrote about it, so the pandemic became known as the Spanish flu).
The United States was no different. In 1917 California Senator Hiram Johnson made the since-famous observation that “The first casualty when war comes is truth.” The U.S. government passed a law that made it punishable by 20 years in jail to “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the government of the United States.”
One could go to jail for cursing or criticizing the government, even if what one said was true. A Congressman was jailed. Simultaneously, the government mounted a massive propaganda effort. An architect of that effort said, “Truth and falsehood are arbitrary terms…. There is nothing in experience to tell us that one is always preferable to the other…. The force of an idea lies in its inspirational value. It matters very little if it is true or false” (Vaughn, 1980).
The combination of rigid control and disregard for truth had dangerous consequences. Focusing on the shortest term, local officials almost universally told half-truths or outright lies to avoid damaging morale and the war effort. They were assisted—not challenged—by the press, which although not censored in a technical sense cooperated fully with the government’s propaganda machine.
Routinely, as influenza approached a city or town—one could watch it march from place to place—local officials initially told the public not to worry, that public health officials would prevent the disease from striking them. When influenza first appeared, officials routinely insisted at first it was only ordinary influenza, not the Spanish flu. As the epidemic exploded, officials almost daily assured the public that the worst was over.
This pattern repeated itself again and again. Chicago offers one example: Its public health commissioner said he’d do “nothing to interfere with the morale of the community…. It is our duty to keep the people from fear. Worry kills more people than the epidemic” (Robertson, 1918).
That idea—“Fear kills more than the disease”—became a mantra nationally and in city after city. As Literary Digest, one of the largest circulation periodicals in the country, advised, “Fear is our first enemy” (Van Hartesveldt, 1992).
In Philadelphia, when the public health commissioner closed all schools, houses of worship, theaters, and other public gathering places, one newspaper went so far as to say that this order was “not a public health measure” and reiterated that “there is no cause for panic or alarm.”
But as people heard these reassurances, they could see neighbors, friends, and spouses dying horrible deaths.
In Chicago, the Cook County Hospital mortality rate of all influenza admissions—not just those who developed pneumonia—was 39.8 percent (Keeton and Cusman, 1918). In Philadelphia, bodies remained uncollected in homes for days, until eventually open trucks and even horse-drawn carts were sent down city streets and people were told to bring out the dead. The bodies were stacked without coffins and buried in cemeteries in mass graves dug by steam shovels.
This horrific disconnect between reassurances and reality destroyed the credibility of those in authority. People felt they had no one to turn to, no one to rely on, no one to trust.
Ultimately society depends on trust. Without it, society began to come apart. Normally in 1918 America, when someone was ill, neighbors helped. That did not happen during the pandemic. Typically, the head of one city’s volunteer effort, frustrated after repeated pleas for help yielded nothing, turned bitter and contemptuous:
Hundreds of women who are content to sit back had delightful dreams of themselves in the roles of angels of mercy, had the unfathomable vanity to imagine that they were capable of great sacrifice. Nothing seems to rouse them now. They have been told that there are families in which every member is ill, in which the children are actually starving because there is no one to give them food. The death rate is so high and they still hold back.3
That attitude persisted outside of cities as well. In rural Kentucky, the Red Cross reported “people starving to death not from lack of food but because the well were panic stricken and would not go near the sick” (An Account of the Influenza Epidemic, 1919).
As the pressure from the virus continued, an internal Red Cross report concluded, “A fear and panic of the influenza, akin to the terror of the Middle Ages regarding the Black Plague, [has] been prevalent in many parts of the country” (The Mobilization of the American National Red Cross, 1920). Similarly, Victor Vaughan, a sober scientist not given to overstatement, worried, “If the epidemic continues its mathematical rate of acceleration, civilization could easily … disappear … from the face of the earth within a matter of a few more weeks” (Collier, 1974).
Of course, the disease generated fear independent of anything officials did or did not do, but the false reassurances given by the authorities and the media systematically destroyed trust. That magnified the fear and turned it into panic and terror.
It is worth noting that this terror, at least in paralyzing form, did not seem to materialize in the few places where authorities told the truth.
One lesson is clear from this experience: In handling any crisis, it is absolutely crucial to retain credibility. Giving false reassurance is the worst thing one can do. If I may speculate, let me suggest that almost as bad as outright lying is holding information so closely that people think officials know more than they say.
Note: The above-quoted comment was made by John M. Barry, Distinguished Visiting Scholar at the Center for Bioenvironmental Research at Tulane and Xavier Universities at a scientific workshop entitled The Threat of Pandemic Influenza: Are We Ready?
Barry’s 2004 book The Great Influenza: The Epic Story of the Greatest Plague in History was a New York Times Best Seller, and won the 2005 Keck Communication Award from the United States National Academies of Science for the year’s outstanding book on science or medicine. In 2005 he also won the “September 11th Award” from the Center for Biodefense and Emerging Pathogens at Brown University. Barry has served on a federal government’s Infectious Disease Board of Experts, on the advisory board of MIT’s Center for Engineering Fundamentals, and on the advisory committee at Johns Hopkins Bloomberg School of Public Health for its Center for Refugee and Disaster Response.