Hospitals In Focus

Past is Prologue – Author John M. Barry on How Crises of the Past Lead to Reform in the Future


The Great Influenza and Rising Tide author and historian John M. Barry knows a thing or two about disasters and society. The Tulane School of Public Health and Tropical Medicine professor joined Chip to discuss not just the ramifications of great crises on society and politics, but also how we get there. What are the policy decisions that make or in some cases break the public response? And what can we learn for future policy making by looking at decisions from the past? All is discussed on this episode of Hospitals in Focus.

Speaker 1 (00:05):
Welcome to Hospitals in Focus, from the Federation of American Hospitals. Here’s your host Chip Kahn.

Chip Kahn (00:16):
I have been a fan of our guests for many years. His book, The Great Influenza, has been read by millions around the world since it was first published in 2004, and interest in it has been revived as we grapple with COVID-19. This book, and his other writings, are particularly important because they are not only a good storytelling, but because they help instruct us on how to prepare for the future. As Confucius said, “Study the past if you would define the future.” Unfortunately it is apparent some of our current leadership did not get the memo.

Today I would like to focus not so much on his 1918 book as another one of his titles, Rising Tide. This book is about the 1927 Mississippi River flood, that so well captures the root development and the result of a great crisis. It is a book I frequently buy for friends.

John’s writing both provides an origin story and brilliantly weaves together the policies and realities that explained how a crisis, and the response to it, could shape American politics in the 20th century. And it is this book, with its focus on the implications of a crisis, that I would like to discuss with him today.

I am so pleased to be able to welcome esteemed author, historian, and fellow New Orleanian, John Barry to our podcast.

John Barry (01:42):
Thank you, Chip, fun to be here, and a pleasure to talk about something other than COVID-19 or the 1918 pandemic, for at least part of the conversation.

Chip Kahn (01:54):
John, could you tell us a little bit about yourself?

John Barry (01:57):
Well, I went to Brown, went to graduate school in history, expected to be a historian. Dropped out of grad school. Coached football. Was a journalist in Washington covering politics for a little while. First book was on politics, called Ambition and the Power, really turns out to have been about the rise of Newt Gingrich, largely, back in the late eighties, the loss of democratic power in the house.

Wrote a book with Steve Rosenberg at NCI called The Transformed Cell: Unlocking the Mysteries of Cancer. Steve is the guy who really … one of the major pioneers in immunotherapy, developed the first therapies that I looked into, did the first gene therapy experiment.

And then I wrote Rising Tide, the book you are talking about, then the influenza book, then a book on separation of church and state where the argument began back in the 17th century, Roger Williams. I tell people I get bored easily, that’s why there’s a lot of different topics in there. Two of the books sort of involved me in policy, not sort of, did.

After the influenza book came out, I got involved with the Bush Administration in 2004, 2005, 2006, thereabouts, with the early meetings on developing pandemic preparedness plans, sort of conceptualizing them. And then after Katrina, I was asked to chair, by the Louisiana Congressional Delegation, a bipartisan working group on flood protection. And I ended up serving on the levy board protecting most of Metro New Orleans.

This was an unusual board, they required passage of the state constitutional amendment to create it. It was really a board of experts from North Carolina, someone who chaired the National Academy of Sciences working group on coastal risk reduction from California. We had the chief of floodplain management for the State of California. We had past President of the American Society of Civil Engineers. I mean, it was really an incredible levy board.

Then we kind of shook up the State of Louisiana when we decided to sue the oil industry over coastal land loss. Got pretty political. And then started working on another book, which I’ve just put aside.
Really I haven’t done anything on it in the last, I guess, four or five months, and been focusing on COVID.

Chip Kahn (04:32):
Great. So let’s talk a bit about one of your books. So one of the things I found most enlightening in the Rising Tide was this notion of how the fundamentals can impact crisis. As you well-described, in the late 19th century there was this competition for the future of the Mississippi River between James Buchanan Eads who favored floodplains and an engineer from the American Corps of Engineers, Edward Humphreys, who favored levees. Humphreys eventually prevailed, but Eads was ultimately proven correct.

When the perfect storm came, the levies were a disaster and exacerbated the conditions that resulted in the great flood of 1927. One of the many interesting aspects of this first part of the book leading up to the flood was the public policy debate and the mistakes that were made. These failures didn’t just happen during the crisis, there was a lot that leads up to it. In your opinion, what were the big mistakes that resulted, frankly, in our disastrous response to COVID, and what can we learn from the lead up of the 1927 flood, where we now might’ve avoided things in terms of the pandemic today, if we had acted better in the past, if the fundamentals had been better arranged than we find them.

John Barry (05:55):
Well, those are questions I’ve never been asked. Let me start out by quoting another philosopher, you quoted one, I often quote Hegel who said, “What we learn from history is we learn nothing from history.” The flood book, Humphreys and Eads, I said one had genius, the other had power. Eads was a genius, and he was an extraordinary man, one well deserving of a dozen or two dozen biographies. It’s amazing nobody’s written about him. Humphreys had the army and the core behind him, and that was all ego.

In an op-ed in the New York Times a couple of weeks ago, the first sentence was, “When you mix science and politics, you get politics.” That’s what happened in 1927, or I should say in the construction of the flood protection system prior to 1927. Incidentally, that flood was an enormous event. As a percentage of GDP, it was 40% larger than Katrina and something like triple the impact of Hurricane Sandy. So it was just an incredibly large event.

But back to your question, when it goes to COVID, the plans were in place to respond reasonably well. I would say that the problem is, and it’s always a problem with a plan, that you need someone to execute it. I think the Bush Administration started a planning process that ended up with a pretty good product, and pretty detailed as to what triggers you should look at when you should pull them, what evidence.

Everything was in there, but either nobody read the plan, or certainly nobody followed it. The problem was at the top.

In fact, in all the talks that I gave after the influenza book came out, I routinely said, and I gave quite a few and participate in several pandemic games, and so forth. I always said the key issue is going to be getting somebody above the pay grade of a public health commissioner to heed the advice. And clearly we hadn’t gotten that in the United States. I don’t know how that relates to the Rising Tide, but.

Chip Kahn (08:35):
Well, you know, actually I think it relates directly to the Rising Tide. We have a situation now where the president has clearly passed on to the governors the responsibility and the decision making. And if we go back to the Rising Tide, we had President Coolidge appointing Secretary of Commerce Hoover to be in charge. Was that a model? I mean, did we need here to have a true czar, like Hoover was in 1927?

John Barry (09:09):
Well, that would have been a good model. Hoover actually did a great job in that, and it got him elected President of the United States. Compare that to basically every disaster that’s happened in the last 30 years, and pretty much all it’s done is damaged political figures. But Hoover was a logistical genius and a very, very smart guy, and if you give him a problem, he was an engineer, a very good engineer. Started out in poverty, made himself into one of the wealthiest men in the world. Very, very capable guy.

Coolidge did nothing with the Federal Government. The Red Cross was sort of the equivalent of FEMA, but didn’t get any direct money from the government, it raised it all privately. But it was a quasi governmental organization. So that would have been a good model. And as you say, Hoover was a czar, although he delegated a lot of authority to local people on the ground, which, in a fast moving disaster, you really have to do, you can’t centralize everybody. He gave them tremendous support and tremendous guidance from his central position. And he was actually put in the chain of command above the army so he could order the army to do something.

So in that sense, it would have been a very good model, but the law was very different then, or we didn’t have a Federal Government as we do today. The agency, everything, was much more informal. So you do have incidents of national importance and things like that, and whatever the exact titles are of these things. Certainly we could have centralized a lot better. Should’ve. Practically everybody else in the world has. So I guess you’re right, I guess that could have been a model

Chip Kahn (11:04):
During the Katrina period, I personally worked hard trying to help my hospitals during the rising waters. And one thing was clear to me that, in Katrina, it was every man or every organization for themselves. You could not depend on the government at any level at that point. If you didn’t have the capacity to take care of yourself, you were really in trouble, because the government response, in that Katrina context, was so lacking. Are we so culture bound as Americans that that is just the way it’s going to be? Because it feels like that way somewhat in the COVID situation. I mean, do you think this is a question of leadership, or maybe even a question of culture?

John Barry (11:52):
I think it’s leadership, 85%. Period. If you had someone who took charge, you know, Trump could have guaranteed his reelection if he had taken this seriously, addressed it. The only time in his presidency he’s cracked 50% was a day or two after he declared that he was at war, we were at war, with this virus. And people wanted to rally around him, and he could have taken charge, could have directed all sorts of things.

I think the institutions are there, they have quite a bit of power under emergency circumstances, for FEMA or CDC, and so forth. I think the opportunities were there and people were begging him to do it, and he wouldn’t do it.

Chip Kahn (12:35):
Let’s take a different tack now, underlining problems are frequently exacerbated in crises. Whether it was the great flood or the pandemic today, the socioeconomics related to race and class came out in both. In terms of the treatment of black people in Mississippi, or the poor people of Plaquemines Parish downstream from New Orleans, there clearly were class and race issues in 1927. And clearly those class and race issues have been exacerbated in the context of COVID today. Can you make comparisons and where do you think these impacts of the crises, both of them, one led and the other could be leading?

John Barry (13:18):
Well 1927, they sort of made a point of perfecting the exploitation of people without political power, whether they were African Americans or poor whites outside New Orleans. And this time around it’s more the situation itself, the context in which people live their lives, has directly affected outcomes and mortality. But nobody’s aimed a gun at whether African Americans or Latinos whose socioeconomic situation makes them vulnerable.

Just the circumstances in the way our whole lives are set up. Someone has to take a bus to work somewhere where there are a lot of people, then obviously they’re at higher risk. In 1927, it was much more direct. African American sharecroppers who wanted to leave the area, and we’re talking about hundreds of thousands of peoples, that simply wasn’t allowed. They were penned in, refugee camps, with guns pointed at them, as if they were in a prison camp.

So obviously we’re not in that situation today, thank God. But the effects are pretty dramatic. Obviously the differences by race, and particularly I’m living in New Orleans right now, you’re from New Orleans, and Louisiana is one of the worst places in the country for that disparity.

Chip Kahn (14:53):
Looking to the future, your books showcase the importance of the fundamentals. What big changes in American society and politics do you foresee coming from this COVID-19 experience? I know it’s hard to prognosticate in the midst of it, but from your view, what do you think the future holds from what we’re experiencing right now?

John Barry (15:16):
There’s sort of two competing currents running through things right now. Number one is I think people understand the need for a strong government response. And number two, the government’s not going to have any money. Every state government, and the Federal Government, the budgets are under unbelievable stress. But I think there’s a recognition that this is something governments should have handled much better. And so the political will would be there, or at least desire. I don’t know about will, to shore up the government.

We’ve had, since Reagan, 40 years of people saying the government’s the problem. Well, the government’s the problem because people run it have said the government’s the problem. And obviously Trump has the denoted administration of tremendous amount of skill and expertise, purposely. So there’ll be a strong desire to rebuild that, but where will the money come from?

The most obvious thing to predict would be that public health would get a lot more investment than it has had in the last several decades when it’s eroded rapidly. And that’s an easy prediction to make, but I’m not going to make it, because once you get more than a couple of years out from this pandemic, I mean, certainly immediately in the post pandemic phrase I think there’ll be investment, but once you get a couple of years out, people have very short memories, and given the pressure on the federal and state budgets, which is probably be the highest in our history, including right after World War 2, I don’t know what’s going to happen.

I think the scientific establishment has certainly gained enough respect and prestige. I think the scientific community has reacted extraordinarily well. I mean, people who normally compete are cooperating, interdisciplinary. Everybody has come together around the world to try to solve this problem, and that’s certainly a plus. How long that will last, I think there might be some long lasting impact from the cooperation in the scientific community, which probably won’t really be noticed by the average person, but I think could have significant impact in terms of things, everything from architecture to office space.

I think ventilation’s one of the most under appreciated things that you can do to alleviate, dilute virus, and so forth and so on. But most of the new buildings that have been built in the last several decades, can’t open the windows. Will that change? Maybe. Will there be fewer office workers? Maybe. I think that depends on how quickly and how effective a vaccine gets here.

If you have a highly effective vaccine that gets here pretty quickly, I think returned to normal may come a lot faster and a lot closer to the pre pandemic normal than most people expect. But if it’s not that effective and we really have to essentially live with this for an extended period of time. And I mean by that, more like 18 months or longer, with face mask and social distancing and so forth. Then I think there would be changes.

I think the people who are anywhere from say eight years old to early twenties right now, I think this will mark that age group, just as I’m old enough that Vietnam and the Civil Rights era sort of imprinted itself on my psychic. But I think this event will probably be big enough that kids and teenagers and young adults who are living through it, that this will be somewhat of a defining part of their life.

Chip Kahn (19:29):
John, it was such a pleasure speaking with you today, I just really appreciate you taking the time and joining us.

John Barry (19:36):
It was my pleasure.

Speaker 1 (19:43):
Thanks for listening to Hospitals in Focus, from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @FAHhospitals, and follow Chip @ChipKahn. Please rate, review, and subscribe to Hospitals in Focus. Join us next time for more in depth conversations with healthcare leaders.

John M. Barry, Author, Professor, Tulane School of Public Health and Tropical Medicine 

John M. Barry is a prize-winning and New York Times best-selling author whose books have won multiple awards. The National Academies of Sciences named his 2004 book The Great Influenza: The story of the deadliest pandemic in history, a study of the 1918 pandemic, the year’s outstanding book on science or medicine. His earlier book Rising Tide: The Great Mississippi Flood of 1927 and How It Changed America, won the Francis Parkman Prize of the Society of American Historians for the year’s best book of American history and in 2005 the New York Public Library named it one of the 50 best books in the preceding 50 years, including fiction, nonfiction and poetry. His books have also been embraced by experts in applicable fields: in 2006 he became the only non-scientist ever to give the National Academies Abel Wolman Distinguished Lecture, a lecture that honors contributions to water-related science, and he was the only non-scientist on a federal government Infectious Disease Board of Experts. He has served on numerous boards, including ones at M.I.T’s Center for Engineering Systems Fundamentals, the Johns Hopkins Bloomberg School of Public Health and the Society of American Historians. His latest book is Roger Williams and The Creation of the American Soul: Church, State, and the Birth of Liberty, a finalist for the Los Angeles Times Book Prize and winner of the New England Society Book Award.

His books have involved him in two areas of public policy. In 2004, he began working with the National Academies and several federal government entities on influenza preparedness and response, and he was a member of the original team which developed plans for mitigating a pandemic by using “non-pharmaceutical interventions”– i.e., public health measures to take before a vaccine becomes available. Both the Bush and Obama administrations have sought his advice on influenza preparedness and response, and he continues his activity in this area.

He has been equally active in water issues. After Hurricane Katrina, the Louisiana congressional delegation asked him to chair a bipartisan working group on flood protection, and he served on the Southeast Louisiana Flood Protection Authority East, overseeing levee districts in metropolitan New Orleans, from its founding in 2007 until October 2013, as well as on the Louisiana Coastal Protection and Restoration Authority, which is responsible for the statewide hurricane protection. Barry has worked with state, federal, United Nations and World Health Organization officials on influenza, water-related disasters and risk communication.

His writing has received not only formal awards but less formal recognition as well. In 2004 GQ named Rising Tide one of nine pieces of writing essential to understanding America; that list also included Abraham Lincoln’s Second Inaugural Address and Martin Luther King’s “Letter from Birmingham Jail.” His first book, The Ambition and the Power: A true story of Washington, was cited by The New York Times as one of the eleven best books ever written about Washington and the Congress. His second book The Transformed Cell: Unlocking the Mysteries of Cancer, coauthored with Dr. Steven Rosenberg, was published in twelve languages. And a story about football he wrote was selected for inclusion in an anthology of the best football writing of all time published in 2006 by Sports Illustrated.

A keynote speaker at such varied events as a White House Conference on the Mississippi Delta and an International Congress on Respiratory Viruses, he has also given talks in such venues as the National War College, the Council on Foreign Relations and Harvard Business School. He is co-originator of what is now called the Bywater Institute, a Tulane University center dedicated to comprehensive river research.

His articles have appeared in such scientific journals as Nature and Journal of Infectious Disease as well as in lay publications ranging from Sports Illustrated to Politico, The New York Times, The Washington Post, Fortune, Time, Newsweek and Esquire. A frequent guest on every broadcast network in the US, he has appeared on such shows as NBC’s Meet the Press, ABC’s World News and NPR’s All Things Considered, and on such foreign media as the BBC and Al Jazeera. He has also served as a consultant for Sony Pictures and contributed to award-winning television documentaries.

Before becoming a writer, Barry coached football at the high school, small college and major college levels. Currently Distinguished Scholar at Tulane’s Bywater Institute and a professor at the Tulane School of Public Health and Tropical Medicine, he lives in New Orleans.

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