BOOK REVIEW: Pale Rider by Laura Spinney

Pale Rider: The Spanish Flu of 1918 and How It Changed the WorldPale Rider: The Spanish Flu of 1918 and How It Changed the World by Laura Spinney
My rating: 5 of 5 stars

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Before the present-day COVID-19 pandemic, the Spanish Flu of 1918 seemed to be a largely forgotten historical footnote. It was overshadowed by its more explosive, if less lethal, co-event, World War I – the war that was fallaciously believed to hold the promise of ending all wars. Furthermore, Spanish Flu never achieved the mystique of the Black Death. In fact, among the fascinating questions this book examines is why such a world-changing event isn’t more diligently studied. Of course, these days there is a sort of grim desire to understand what happened in 1918 and what – if any – lessons can be learned.

[Which isn’t to suggest that that Influenza virus pandemic was perfectly analogous to the present Coronavirus pandemic. In 1918, science was still at a state in which there remained debate about whether the disease resulted from a bacterium or a virus, and — in some sense — it didn’t matter because they didn’t have good treatments for either. For COVID, we had accurate tests in short order, and will no doubt have a vaccine at some point in the coming months. That said, I’m not dismissive of COVID-19. As I understand it, COVID’s R-nought (reproductive ratio), and the fact that both pre-symptomatic and asymptomatic transmission occur make the current pandemic serious business. Furthermore, while scientific understanding has increased radically, human psychology is surprisingly similar and some of the same conspiracy theories and wishful thinking that made things worse a hundred years ago may prove to do the same today.]

The strength of Spinney’s book is that it takes global perspective. It doesn’t fixate on the United States (where the 1918 Flu was first understood to its own, new disease) or Europe (where it was inexorably linked to the fighting, and got its fallacious name of “Spanish Flu.”) In addition to these locals, Spinney’s telling visits and revisits China (one of the alternative candidates for ground zero,) India (which suffered tremendous fatalities from the disease,) Brazil, and a number of other countries around the globe.

The book’s twenty-two chapters are arranged into eight parts. While these divisions are topically organized, emphasis is given to the stories being told and so said topics aren’t in one’s face but are, rather, background that is subtly presented in narrative form. Chronological consideration is tertiary. The penultimate part (Part VII) does explore the world in the wake of the Spanish Flu, but discussion of attempts to find the true index patient (a.k.a. patient zero) don’t take place until chapter 11 [Part V.] [To clarify, the acknowledged patient zero was a soldier at a US military base in the middle of America, but there are widely divergent thoughts about how long the disease might have been infecting people before that – masked either by the war or by the lack of data collection and reporting throughout the world. The only thing that is widely agreed upon is that the “Spanish Flu” didn’t originate in Spain.] I’m certainly fine with meandering on chronology in order to serve a more appealing narrative.

A lot of the subjects covered are interesting, but are what one would expect, e.g. what was it like to live in the midst of Spanish Flu. Therefore, I want to focus on a few topics that I found particularly interesting because they were illuminating, but weren’t necessarily what I anticipated. One set of topics addressed sheds light on just how different a time 1918 was. I suppose different people have different ideas about how modern the early 20th century was — relative to today. To me it was interesting to hear about church leaders calling upon people to attend services because there was an idea that the Flu was a result of god finding humanity’s “lack of faith disturbing.” [I quote Darth Vader, not this book’s author.] I’m sure there are priests and preachers saying the same these days, but I also suspect those voices are so far into the lunatic fringe as to not merit much attention, but not so in 1918 (and, thusly, many went to sit in high-density churches only to spread the flu more effectively than any virus could hope for.) Another interesting insight into the level of modernity was Spinney’s explanation of the fact that medicine, as we know it, had not yet risen to a favored spot above approaches like homeopathy and shamanism. Lest it sound like I’m engaging in the outhouse fallacy; I will say that people are falling in many of the same holes despite more advanced understanding of viruses – particularly as regards to people’s desire to impose order and purpose on a natural event.]

The other discussion that I found unexpected and revelatory was about the dearth of art and literature on the subject of the 1918 Flu. Spinney describes the effects of Spanish Flu on many major artists of the time, but goes on to discuss how few of those who survived the flu in 1918 brought it into their works. She does also discuss some of the works that did come about, as well.

I found this book fascinating from cover to cover. The fact that it covered so much ground geographically as well as topically was part of that intrigue. Learning what changes occurred in the wake of the 1918 Flu has certainly helped me consider what to expect in our future. The similarities and differences between then and now also surprised me. Just like today, there were a lot of wildly bizarre conspiracy theories from people who had to make sense of both the randomness of the Flu’s action and the fact that it put such a nasty a crimp in their lifestyle. It’s also interesting to consider some of the more intellectually stimulating theories – e.g. that part of the reason for the lethality of Spanish Flu is that in the theater of war, the virus didn’t benefit from the internal restraint usually shown (because people were dying so rapidly) and so mutations that favored a quick and harsh influence made gains. [For those who aren’t aware, it was the second wave of the Spanish Flu that was really nasty. The first wave was like seasonal flu for almost everyone, and by the third wave the virus didn’t have much of a reservoir of those without acquired immunity and so petered out relatively quickly.]

If you want to learn more about Spanish Flu, I’d highly recommend this book – particularly if you are interested in the global story and the after-effects of the disease.

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Thoughts of a Traveler Traveling Amid the COVID-19 Pandemic

I just returned from a week of traveling in Rajasthan and Punjab for Holi and Hola Mohalla, respectively. Because my trip involved only domestic travel within India, there were no formal disruptions, but evidence of concern about the virus was widespread.

The first thing one notices is that instead of a few East Asian tourists protecting themselves against the poor air quality of megalopolises, at least a third of those traveling were wearing masks. Some unknown percentage of these travelers presumably have sound, medically-directed reasons for donning the masks (e.g. they have some sort of infection, they have compromised immune systems, etc.) but for many they are merely a security blanket. I suspect the reason that “wear masks” isn’t a part of the advice of public health experts has to do with the two types of masks that one sees:

First, the type that are to keeping out virus as a chain-link fence is to keeping out mosquitos.

Second, the type that will keep out virus (if worn / changed as directed,) but which — because they are expensive and hard to come by — are worn far too long, such that they become a nice warm, moist petri-dish pressed up against one’s face.

I don’t begrudge anyone a security blanket. In fact, a lot of what I’m suggesting herein are ways to maintain a confident and positive attitude so your immune system can be its awesome self — whatever that takes. My worry about the mask phenomena is that some people seem to believe that if one little viral agent makes it inside their body they are doomed. That’s simply not the case. If a viral marauder gets into your body, its chances of being escorted right back out by your body’s mucosal bouncers, swallowed whole by a macrophage, dissolved in your stomach’s acid bath, or otherwise being discovered and destroyed by your body’s sentry force is quite good.

In short, a mask isn’t your last line of defense. It’s a first line of defense that’s followed by an immune response that is swift and deadly to foreign invaders. It should be noted that nose-breathers already have a kind of mask, in the form of the nose and nasal passages. When you breath through your nose, your natural filtration system is at work. If you tend to breath through your mouth (particularly during inhalation) you have a lessened defense.

If you have trouble maintaining nose-breathing under all circumstances, I’d recommend a pranayama (yogic breathing exercises) practice. I don’t know how well it’s established by study, but I’ve found that I breath much more effectively and consistently through my nose since I’ve regularly practiced pranayama. Another helpful yogic tool is kechari mudra, which has helped me to even run without mouth breathing. (Kechari mudra involves curling the tongue so that the bottom of the tongue rests against the soft palate at the back of the roof of one’s mouth. This seems to reduce turbulence that would be created by air swirling in one’s oral cavity, and makes more of a direct line of travel for the breath in and out through the nasal passageways. At a minimum, it focuses one’s attention on the area the breath is passing through, and makes one aware of the breath.)

All this talk about one’s immune system keeping one safe may seem a bit pollyannaish or over-optimistic. Don’t get me wrong, I follow and would recommend others follow all the basic precautions regarding washing one’s hands and minimizing hanging out in high density environments — particularly high density environments with high-risk individuals. (i.e. for the asymptomatic [or alternatively-symptomatic individuals, i.e. those who have something but probably not COVID-19] who think they absolutely must be tested to have peace of mind, realize that you are likely walking into a high-risk environment and increasing your chance of self-fulfilling prophecy. Just sayin’. If you are able to rest comfortably, you might want to consider doing so.)

Back to the issue of being irrationally optimistic or a Pollyanna. My response is: fair enough. But there is an upside to being overly optimistic (if cautious) but none-whatsoever to being a worrier. Again, by being “a worrier” I’m not talking about taking precautions, I’m talking about obsessing or being needlessly pessimistic about the bodily systems (e.g. your immune system, your lymphatic system, your digestive system, etc.) that are keeping you safe all day and everyday.

I’d say if there is an upside to the pandemic, it was in reminding me to practice gratitude toward my body, my immune system, my gut bacteria, etc. — all of which keep me feeling excellent 99.9% percent of the time. Does that mean I think I can’t catch infection? No, it doesn’t, but it does mean that if I catch one my body will be much more effective at defending itself.

So when people ask me why I’m not worried about traveling, it’s because my immune system is awesome and I’m thankful for it every day.

A couple of post-scripts:

– I’ve been seeing the swarm of memes about toilet paper shortage in the US. Having moved to a part of the world that recognizes that wiping one’s backside with dry paper isn’t the height of sanitary practice, all I can say is: “You might want to look into what most of the world does most of the time.”

– I understand that there is a desire to curtail a wider spread of the virus, but this easily tips into a form of xenophobia — “a your COVID-19 is worse than our COVID-19.”  If a person is without symptoms, being Chinese (or from any other country with many cases) doesn’t mean that they are Typhoid Mary.

BOOK REVIEW: A Stranger Truth by Ashok Alexander

A Stranger Truth: Lessons in Love, Leadership and Courage from India's Sex WorkersA Stranger Truth: Lessons in Love, Leadership and Courage from India’s Sex Workers by Ashok Alexander
My rating: 5 of 5 stars

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In 2003, Ashok Alexander left a prestigious job at the advisory firm McKinsey and Company to head up the Gates Foundation’s HIV/AIDS prevention program for India. He had no experience in public health and faced an HIV prevention challenge on a scale and of a nature that hadn’t been seen before. This book describes his experiences — and sometimes those of others in Avahan (the Indian HIV Prevention program.) However, the emphasis isn’t on patting himself and his team on the back so much as pointing out the lessons they learned from the high-risk populations they served – mostly sex workers, but also their clientele, as well as intravenous drug users.

The nineteen chapters of this book are arranged into two parts. The first part (Ch. 1 thru 11) explores Alexander’s travels around the country to meet with various high-risk groups and learn about their needs. The second part (Ch. 12 thru 19) takes a deeper dive into the building of Mysore’s program, Ashodaya, which became a global educator on HIV prevention.

Part one offers insight into bits of India that most of us never see. When I mentioned that the problem in India wasn’t just it’s large size, but also the peculiar nature of the environment, that can be seen throughout these chapters. What do I mean by the peculiar nature? In India, not only is prostitution rarely practiced in brothels, but sex workers are largely indistinguishable from the general population. The biggest portion of the group is women in saris who look like much of the female population. Also, the societal stigma is great, which creates all the more incentive to not let your work be known. For these reasons, just finding the at-risk population was challenging, they were dispersed and hid in plain sight. There were also problems of thinking that ranged from politicians who wouldn’t admit there was potential for massive HIV / AIDS in India because they insisted that Indians don’t engage in any of the “immoral” acts seen elsewhere in the world, to johns who honestly believed that drizzling lime juice on one’s manhood would prevent infections.

Among the most intriguing chapters in part one are those that reveal the issues with long-haul truckers (the single biggest demand-side high-risk population), intravenous drug-users in the golden-triangle adjacent states of the Northeast (i.e. Manipur and Nagaland,) and one that explained the unique cultural traditions of the transgender populations in India. There’s also a chapter (Ch. 6) that discusses the leadership traits that were found among the sex workers.

Part II, which dealt with the Mysore program, also had its fascinating elements. Two of the chapters discussed the life stories of two particular sex workers (one female and the other male) who worked in the Ashodaya program. There was also a chapter that dealt with the discussion of violence. That might seem like a diversion, but apparently violence and lack of prophylaxis go hand-in-hand, and had to be dealt with together.

The book has an Appendix of general information on HIV / AIDS and its occurrence in India. Other than that, a few maps and annotations are the extent of the ancillary matter.

I found this book fascinating — if heartbreaking in places. As someone who’s lived in India for over six years, there was a great deal of insight offered into segments of the population of which I had little awareness. Even learning about the trucking industry (divorced from the sex work / HIV angle) was intriguing. I’d highly recommend this book if one is interested in the topics of: leadership, public health, or the unseen side of India. The author uses a narrative approach throughout to great effect.

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