In this episode, we seek to put the current COVID-19 pandemic into perspective by speaking with Dr. David M. Oshinsky, the director of the Division of Medical Humanities at New York University.
In this episode, we seek to put the current COVID-19 pandemic into perspective by speaking with Dr. David M. Oshinsky.
As the director of the Division of Medical Humanities at New York University, Oshinsky has a direct connection to the medical community in New York City, the epicenter of the coronavirus outbreak in the United States. And as the author of several books, including "Polio: An American Story," for which he won the Pulitzer Prize for History in 2006, and "Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital," he shares additional insight into how this pandemic compares with those of the past including one of the greatest stories of modern medicine, the roll-out of the polio vaccine.
[Podcast introduction with theme music in the background]
President Lyndon Baines Johnson: So it's all here, the story of our time—with the bark off.
Mark Updegrove: That was President Lyndon Baines Johnson upon the dedication of his presidential library in 1971. Since then, the library has played host to the biggest names and best minds of our day, who have helped to tell the story of our times through candid, revealing conversations—with the bark off.
This podcast delivers them straight to you. Welcome to “With the Bark Off: Conversations from the LBJ Presidential Library.” I'm your host, Mark Updegrove.
As we seek to put the current pandemic of COVID-19 in perspective, I talked to Pulitzer Prize-winning author David Oshinsky, the director of the division of medical humanities at NYU School of Medicine, whose books include “Polio: American Story” and “Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital.”
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Mark Updegrove: David Oshinsky, welcome to the program.
David Oshinsky: Thank you. Glad to be here, Mark.
Mark Updegrove: We're delighted to have you. As the director of the division of medical humanities at NYU, you're very close, obviously to the medical community in New York, which is currently ground zero for this pandemic in the U.S. How would you describe New York right now?
David Oshinsky: Well uhm, overwhelmed. I think, certainly from a medical point of view. Where I work, we have a number of hospitals. We have the VA and then the medical examiner’s office where the bodies are sent for autopsies. And then Bellevue Hospital, which is the great public hospital in New York City. And then all the NYU Langone Hospitals and the medical school as well. And we have just had hundreds and hundreds of COVID-19 patients. Uhm, we have turned each of the hospitals basically into a COVID hospital. I mean, we're just taking over floor after floor, ward after ward. It's an all hands-on deck where retired physicians are coming back, where medical students have graduated early so that they can help, doing nothing above their pay grade of course, but for everything they're qualified for. Uhm, we have volunteers coming from around the country, which is amazing to see from the military and otherwise. We're not hurting for equipment. We have everything we need to take care of the patients. It's really been an issue of the people on board have been swamped. There's just so many patients. It has begun to flatten, the curve has begun to flatten, the deaths are still very high, but the number of admissions has begun to decline. So we take that as a very, very positive sign.
Mark Updegrove: Does the virus have a possibility of resurging? What will it look like as it progresses?
David Oshinsky: That Mark is really the imponderable, that is the unanswered question. We would hope that within a short period of time, uhm, antivirals and then a vaccine, would help with this problem. I guess the only thing we have in terms of the size of the pandemic to measure it against is the Great Influenza of 1918-1919. And what many people may not know is that it came in several distinct waves. The first wave came in the Spring of 1918 and it was a relatively mild influenza and then there was a reassortment in the virus and the virus changed and came back murderously in the Fall of 1918 and that's when the vast majority of deaths occurred.
One of the things that is interesting is that as best we know, those who got the lesser flu in the Spring of 1918 tended to be relatively immune to the murderous flu that came in the Fall of 1918. I don't know whether that script will be followed again. I pray it won't. I think it's possible that COVID-19 or variant will return. Uh, but I think that unlike 1918, 1919, we will have antivirals. We probably will have a vaccine. And what was most remarkable in some ways about the 1918 flu was that most people did not die of the flu. They died of bacterial pneumonia. In other words, their lungs just filled up with all kinds of gooey fluid and dead cells and the like. And if that ever happens, certainly we have antibiotics. The antibiotics to take care of that.
Mark Updegrove: So in layman's terms, how does a virus morph? You said that that's the big fear and that's what happened in 1918. It came mildly in the spring and more virulently in the fall because the virus had changed. How does that happen?
David Oshinsky: Uh, it's a good question. Let me, let me start by saying that bacterium can live on their own. Viruses can only survive by moving from host to host and basically taking over the genetic role in the cells that they, uhm, capture. So they are very, very different. Viruses cannot live by themselves. That's why on the surface they will die in a certain period of time. Viruses, however, some come from birds, some come from pigs, some come from humans, uhm, and they're always being mixed and re-assorted so that you will have a virus that can start out as one thing and over time it could have what's called antigenic drift. And that means very, very slowly, it takes on the genetic material of other things. Then you can also have what is called antigenic shift, which occurred during the Great Influenza of 1918 where in a very, very short period of time that virus is re-assorted. The genetic material actually changes within the virus and you have something that your immune system is not at all familiar with because of that change. And what will happen is that your immune system, if, you know, one of the, one of the interesting points for the 1918 flu in the fall was that most influenza, like even COVID-19 today, most viruses will attack the very old and the very young. Those are the two groups that are most at risk.
In 1918, the group that was most at risk were 20 to 40 year olds, which was really fascinating. And everyone thought, well, maybe it was in the middle of World War I, troops were very close together. They were on troop ships. They were in the trenches. But what we also found out was that as many women were getting influenza in 1918 as men, as many civilians in the age of 20 to 40, were getting it as soldiers. And what actually happens is that that virus was so new that the immune system, the strongest immune system you have is when you're 20 to 40, the immune system, these people to try to fight off this invader that they had never seen before, that the immune system had never seen before, went into overdrive. And…it-it-it had such an enormous reaction to the incoming virus, a new virus, this new virus that had changed over the summer of 1918 that basically the battle that took place in your body caused such severe swelling and killing in your lungs, cells dying, mucus being formed, that you basically had a kind of bacterial pneumonia that just swallowed you up. And it was, it was just absolutely amazing that you had this one group, it's called cytokine, uh, the cytokine storm where your body just so overreacted and over-produced, in terms of immunity that you were really at the mercy of this virus.
Mark Updegrove: So you mentioned that viruses tend to attack the young and the old. The young seems not to be as vulnerable to COVID- 19. What are the reasons for that?
David Oshinsky: We don't know. That's, you know, basically Mark, what you think about is that it attacks the young because their immune systems are not fully developed and it attacks the old because their immune systems, like mine, are a bit over the hill. So when I get a flu shot, I need a much stronger antigen than someone who was younger than I.
The belief appears to be that young kids have had…they're always around germs, they're around other types of influenza, they're around colds. Uh, that sort of being together in this network where there are endless viruses and endless germs has actually been a help to them. That's the best we can figure out at this point. But you're absolutely right. It has not affected the young to any great degree.
Mark Updegrove: In “Polio: An American Story,” for which you won the Pulitzer Prize in 2005, you write: "Polio hit without warning. There was no way of telling who would get it and who would be spared. It killed some of its victims and marked others for life leaving behind vivid reminders for all to see." Talk about America when the polio epidemic swept through the country in the early 1950s.
David Oshinsky: I, I am old enough Mark to remember the days before the polio vaccines came in, and polio was a summer plague. It would come every summer. Uhm, when you were in New York City, the newspapers had like, uhm, charts, uh almost like the stan… baseball box score where the numbers of kids in public hospitals would rise in June and get higher in July and still higher in August, and then around Labor Day the numbers would begin to come down.
And because of polio, what I remember most is we couldn't go swimming, they would close swimming pools and beaches with the belief that water, uh, transmitted polio. My mother gave me a polio test every couple of days. Could I put my chin to my chest? Could I touch my toes? The slightest bit of stiffness, um, a… a parent would absolutely panic. My parents had very little money yet they would take me out of New York City and we'd go into the mountains north of New York. It didn't help at all. And polio, the virus was everywhere, but they thought it helped. You couldn't go to the movies. You had to stay out of crowds. You had to rest.
And then I remember coming back every fall to school and you'd see kids in leg braces, you'd see kids in wheelchairs, you'd see kids on crutches and you'd see the occasional empty desk where you knew the child had not survived. Uhm, and that I think to me is probably the emotion that sears most deeply into me is just the missing children.
Polio, Mark, is a very visual disease. Uhm, if you walk into a restaurant, you may know who, you won't know who has a heart condition. You may not know who has cancer, but you know who has polio. You just saw it everywhere. Uhm, and…and as I wrote in the book, uhm, parents could not protect their kids. There was just no, there was no protection, there was no prevention, there was no cure. Every kid was equally at risk for this disease.
Mark Updegrove: And, and it was scary because it was this silent killer. It-it came out of nowhere and it, to some degree, uh, there are analogies to COVID-19. I,I…I wonder, but ultimately we triumph over polio. Jonas Salk creates a vaccine. What did the process by which we found a vaccine for polio look like?
David Oshinsky: Polio is remarkable in that the government played absolutely no role in the development of either the Sabin oral polio vaccine or the Salk killed virus injected polio vaccine. This was all done privately and voluntarily. It's really one of the great stories in American history, and certainly in the 1940s and 50s.
A private philanthropy started by Franklin D. Roosevelt called the March of Dimes, uhm, basically, said to the American people “you give us your dimes and we will find you a vaccine.” And they made that promise and they made good on that promise. And what was really extraordinary about this particular philanthropy was that in the old days, if you wanted to have a charity, you got a couple of rich people together and they gave, uh, money for, uh, home for unwed mothers or something like that.
What polio did with the March of Dimes was to turn fundraising on its head. They didn't want big donations from the few. They wanted millions of donations, small donations from the many. Uh, no person was too poor to give a dime to help a kid walk again. And because there were so many millions involved, they also became involved in raising money. My mother was a March of Dimes volunteer. And what the March of Dimes did at a time when there was no CDC, the NIH was very small, there was no big pharma, the March of Dimes started probably the greatest medical research program of that era, bringing together the best young virologists like Jonas Salk to try to develop a vaccine.
March of Dimes didn't care if you went to Harvard, they didn't care if you were Jewish, they didn't care if you were a woman. Some of—you know-- the biggest, uhm, uh, the most money in fact went to two Jews at a time when there was enormous anti-Semitism in the medical profession, Jonas Salk and Albert Sabin.
Two of the largest, uhm, grants went to women who did remarkable work in trying to find out how polio traveled through the body. Um, Jonas Salk was at the University of Pittsburgh, which was a great medical center today, but it was a backwater in the 1940s. Albert Sabin was at the University of Cincinnati. The March of Dimes wanted young, ambitious researchers who would follow the program. And what they did with private money was basically to give us two extraordinary vaccines that have largely eradicated polio around the world.
Mark Updegrove: So, it's one thing to get a vaccine. It's another thing to roll it out. How did, how did that happen?
David Oshinsky: The polio rollout is one of the great stories in modern medicine. More than a million kids, and I was one of them, were lined up in 1954 for the Salk polio trials, the largest medical trials in American history. And they remain the largest. And what happened was that half of us were given the real vaccine, half of us were given a lookalike placebo, and then you had some controls as well. It was a double-blind study. No one knew. No, no one knew whether he knew or she was getting the real vaccine and neither did the person giving the vaccine. So, by double-blind meant nobody knew this, Mark, was in the pre-computer era, so all of this had to be coded by hands. We got three shots. One for each strain of the polio virus. It took a full year. It took a full year basically to determine whether the vaccine worked. Can you imagine lining up a million kids today for experimental vaccine? It would be— it would be absolutely impossible.
Mark Updegrove: That's astounding.
David Oshinsky: And the reason was risk versus reward. You know, people like my mother understood that the risk of polio was far greater than the risk of taking the vaccine, an unknown vaccine. They saw what polio did to children. They saw the damage. It was, it was visual, it was everywhere. And then, after one year, basically of studying at the University of Michigan, all of these millions of pieces of coated paper, the word came down, the vaccine worked. It was potent and safe and effective. And they literally declared a national holiday, you know, church whistles tolled factory whistles…I'm sorry— church bells tolled, factory whistles blew off. People ran out of school, hugging each other in the streets. It was one of these remarkable moments for science, where everything came together. And as you may know, President Eisenhower invited Jonas Salk to the White House, where for the first time in memory, Ike broke down in tears as he thanked Jonas Salk for saving the children of the world. I mean, what a remarkable moment. Uhm, it really, it was almost like V-J Day, you know, it was the end of a war essentially.
Mark Updegrove: And it provides, uh, an example and inspiration for today. So, what does the…what does the vaccine process look like now, David? What's happening across the world, uh, as scientists try to determine, uh, the-the, the right way to combat COVID-19?
David Oshinsky: Well, I think that there are vaccine– there will be vaccine trials, uhm, of various types going on all around the world. Uhm, one of the models that was used recently was Ebola, uh, where in a very short period of time, more than one Ebola vaccine, uhm, was tried and found to be very, very successful. I think that, uhm, there will be much smaller vaccine trials in the United States, in Europe, and elsewhere; and I think a successful vaccine will be found. The difference is that unlike the great polio experiments of the 1950s, this will involve billions of dollars from the government, the WHO, uh, the Gates Foundation. Uhm, there will be this gigantic consortium of brain power and money that will go into what will undoubtedly be, uh, a process that will lead to a successful vaccine. A larger question is whether people will take it in numbers to produce herd immunity. And I think the answer is they will.
Mark Updegrove: We keep hearing, uh, that we're 18 months or two years away from that. Why so long?
David Oshinsky: When you have a vaccine, uhm, you… even-even the Salk trials took a year, and this was with no government regulation whatsoever. Um, when you have vaccine trials, you have to have stage one trials. You-I mean, we will speed this process up dramatically. The first thing you have to do is to try to figure out a vaccine to get the antibodies right, get the antigens right and to sort of pack it into a vaccine that is safe. And for that to happen, you basically need time. Uhm, this is not something that can be done two months or three months. It has to be rolled out in a process. And at each stage of the process you have to make sure not only is the vaccine effective, but the vaccine also must be safe.
Mark Updegrove: What do you think will be the long-term ramifications of this pandemic? Will society as we know it move to a new normal?
David Oshinsky: That… [laughs]… uh, uh… it's a counterfactual question, which I like because you can never be wrong…
Mark Updegrove: [laughs]
David Oshinsky: …On. But, but-but I would say that, uh, if you use 1918 as your example Mark, you know this as well as I, if you read a history textbook today, you will have an entire chapter on World War I, you'll have an entire chapter on the Treaty of Versailles and you'll have one sentence on the great epidemic or the pandemic that killed 50 to 70 million people, and in other words, it killed 10 times as many people as were killed during World War I. So we have short memories, I think— when you talk about it in those terms. Uhm, the world, it was subsumed by World War I, but the world moved on I think very, very quickly after that.
What I will say is that this may be different. And by that, I mean that I think the handshake has gone. I think that people are going to have to kind of get over a big hump before they go to crowded restaurants. I think you going to see waiters with gloves and masks on for a while. I don't know myself, although I’m a big New England Patriots fan, whether I go to a Patriots game, whether it's 60,000 other people shouting and screaming in my face. I think all of those things have to be determined. I think what also has to be determined is whether issues like, uhm, safe distancing, uh, really sort of remain in effect, or, or – or whether we go back to exactly the way we were.
I think another thing that may happen Mark, is that the young people I talk to all want to stay in New York City or Los Angeles or Chicago. One of the things we found out from this pandemic is that density played an enormously important role. So it's very possible that cities will be different places. Um, I am a subway rider. I almost never drive in New York City, but I— even I in the back of my mind now realize that maybe it's safer to be in a car than it is to be on the subway, at least for the next year or so. Whether that will last into the future? I honestly don't know. I hope not. I don't know what the new normal will look like, but I think it will be somewhat different than the world as we know it today.
Mark Updegrove: What, what is the greatest lesson that we can learn from the success of combating polio 65 years ago?
David Oshinsky: I think the greatest lesson from polio was one that if we unite even voluntarily that we can be very, very successful. The other is that we've got to have a continuing faith in science. My greatest fear, Mark, is that with the anti-vaccine movement that with climate denial, that those who have always set the medical agenda and the research agenda no longer hold the trust of large parts of the population. Some of that is the Internet. Everyone's his or her own expert now, you know, you can find any prejudice you want on the Internet. Some of it is, you know, you know as a historian may come out of the Vietnam War, where we just felt that we were not being told the truth by elite people that we had believed in simply were telling us falsehoods, and we became much more skeptical of what we heard.
My feeling is that science is a different baby. And by that, I mean that, that is the one thing that we really must have trust in. Uhm, and I think that that trust to some degree has been lost. Uh, when in the 1950s if my pediatrician told my mother to do something because it was beneficial for me, she did it. That was both good and bad. But she understood that there were people who were trained, who had gone to school, who had spent years as interns and residents and fellows and had worked in laboratories and they actually knew more than she did. And they accepted that it was simply part of, uh, a kind of belief in a system that seemed to be moving in incredibly important directions. Antibiotics rolling out, vaccines rolling out. Uhm, I think we have lost that now. We— I think we have lost our way in terms of the trust we have in medical research and in science. And to me, uhm, if I could sort of go back to where we were in the 1950s, I would certainly stress volunteerism, but I would also stress, a kind of faith in educated elites, particularly in science and medical research that were working for all of us.
Mark Updegrove: Do you think, uh, when we defeat COVID-19 and we certainly will get past this, that it will bring us closer together and restore our faith in science?
David Oshinksy: I think, you know, we are now, uhm, at a time when we realize that nature will always be one step ahead of us. And it's really a time, I think when we need to rally as a nation, both voluntarily and uhm, really backing science, uhm, as best we can, whether it be with vaccines, uh, with antivirals, with, uh, controlling the earth and the climate. Uhm, I’m not certain that's going to happen. Uhm, the divisions over this, I find very depressing, but I think on the whole, I do have a kind of optimism that, uhm, light will, uh, come through and overshadow the darkness. Uhm, and I think you have to live like that, uhm, as a human being that, uh, you— you just have to think in terms of what are the best options, uhm, who can provide the best solutions and to provide all of the support to these people, uh, to make life better for all of us.
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Mark Updegrove: My thanks to David Oshinsky, to our sponsors, the Moody Foundation and St. David's HealthCare, and of course, to you for joining us. Subscribe to us on Apple Podcasts, Spotify, or wherever you listen to your podcasts.
I'm Mark Updegrove. See you next time.
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