Spanish flu: the virus that changed the world

Spanish flu: the virus that changed the world

In spring 1918 a disease began to sweep around the planet – a lethal virus that infected a third of the world’s population and left upwards of 50 million dead. Laura Spinney explores the devastating impact and far-reaching legacy of the Spanish flu pandemic

A Red Cross worker in the United States wears a mask to stop the spread of Spanish Flu
This article first appeared in BBC World Histories, issue 4

On 28 September 1918, a Spanish newspaper gave its readers a short lesson on influenza. “The agent responsible for this infection,” it explained, “is the Pfeiffer’s bacillus, which is extremely tiny and visible only by means of a microscope.”

The explanation was timely, because the world was in the grip of the most vicious flu pandemic on record – but it was also wrong: flu is caused by a virus. Unfortunately, it wasn’t just one Spanish newspaper that had misidentified the causative agent of the disease. The idea that flu was caused by a bacillus, or bacterium, was accepted by the most eminent scientists of the day, who would find themselves almost entirely helpless in the face of the scourge. Between the first recorded case in March 1918 and the last in March 1920, an estimated 50 million people died, though some experts suggest that the total might actually have been twice that number. The ‘Spanish flu’ killed more than the First World War, possibly more even than the Second World War – indeed, perhaps more than both put together.

The pandemic struck at a critical juncture in the evolution of understanding of infectious disease. Well into the 19th century, epidemics were considered acts of god – a notion that dated back to the Middle Ages. Bacteria were first observed in the 17th century, but initially weren’t connected with human illnesses. In the late 1850s the French biologist Louis Pasteur made the connection between micro-organisms and disease, and from a couple of decades later German microbiologist Robert Koch furthered modern concepts of infectious disease. ‘Germ theory’ was disseminated far and wide, slowly replacing more fatalistic ideas.

By the 20th century the application of germ theory, combined with improvements in hygiene and sanitation, had made significant inroads against the so-called ‘crowd’ diseases that afflicted human communities, especially those inhabiting the great cities that had mushroomed in the wake of the industrial revolution. Throughout the 19th century, so many urbanites had been lost to such diseases – cholera, typhus and tuberculosis, to name but three – that cities needed a steady influx of healthy peasants from the countryside to keep up their numbers. Now, at last, they had become self-sustaining.

By 1918, then, faith in science was high, and some scientists had even adopted a certain swagger. Twelve years earlier, this had prompted the Irish playwright George Bernard Shaw to write The Doctor’s Dilemma, in which an eminent doctor, Sir Colenso Ridgeon – a character based on Sir Almroth Wright, who developed the typhoid vaccine – plays god with his patients’ destinies. Shaw was warning doctors against hubris, but it took an outbreak of another ‘crowd’ disease – influenza – to bring home to them just how little they knew.

When scientists thought about ‘germs’ in the early 20th century, they generally thought about bacteria. The virus was a novel concept; the first virus, discovered in 1892, infected tobacco plants and had been detected indirectly by its ability to transmit disease. Unlike many bacteria, it was too small to be seen through an optical microscope. Without having actually seen viruses, scientists debated their nature: were they organism or toxin, liquid or particle, dead or alive? They were veiled in mystery, and nobody suspected that they could be the cause of flu.

During the previous flu pandemic – the so-called ‘Russian’ flu, which began in 1889 – a student of Koch’s named Richard Pfeiffer claimed to have identified the bacterium that caused the flu. Pfeiffer’s bacillus, as it became known, does exist and does cause disease – but it does not cause flu. During the 1918 pandemic, pathologists who cultivated bacterial colonies from the lung tissue of flu victims found Pfeiffer’s bacillus in some, but not all, of their cultures, and this puzzled them. To add to doctors’ puzzlement, vaccines created against Pfeiffer’s bacillus seemed to benefit some patients. In fact, these vaccines were effective against secondary bacterial infections that caused pneumonia – the ultimate cause of death in many cases – but scientists didn’t know that at the time. They would realise their mistake too late.

What’s in a name?

The Russian flu had acquired its name because it was thought to have originated in Bukhara in Uzbekistan (at that time, part of the Russian empire). The pandemic that broke out nearly 30 years later will always be known as the ‘Spanish flu’, though it didn’t start in Spain. It washed over the world in three waves which, in the northern hemisphere, corresponded to a mild wave in the spring of 1918, a lethal wave the following autumn, and a reprisal in the early months of 1919 that was intermediate in virulence between the other two. The first cases were officially recorded in March 1918 at Camp Funston, a military base in Kansas. Within six weeks the disease had reached the trenches of the western front in France, but it wasn’t until May that the flu broke out in Spain.

Unlike the United States and France, Spain was neutral in the war, so it didn’t censor its press. The first Spanish cases were therefore reported in the newspapers, and because King Alfonso XIII, the prime minister and several members of the cabinet were among those early cases, the country’s plight was highly visible. People all over the world believed that the disease had rippled out from Madrid – a misconception encouraged by propagandists in those belligerent nations that knew they’d contracted it before Spain. In the interests of keeping morale high in their own populations, they were happy to shift the blame. The name stuck.

Understandably, Spaniards smarted at this calumny: they knew they were not responsible, and strongly suspected the French of having sent the flu across the border, but they couldn’t be sure. They cast around for a different label, and found inspiration in an operetta performed at the capital’s Zarzuela Theatre – a hugely popular reworking of the myth of Don Juan, featuring a catchy tune called ‘The Soldier of Naples’. The catchy disease became known in Spain as the ‘Naples Soldier’.

But though the Spanish flu didn’t start in Spain, that country did suffer quite badly with it. In the early 20th century, flu was viewed as a democratic disease – nobody was immune from it – but, even in the thick of the pandemic, it was noted that the disease struck unevenly. It ‘preferred’ certain age groups: the very young and the elderly, but also a middle cohort aged 20 to 40. It preferred men to women, with the exception of pregnant women, who were at particularly high risk.

These age- and gender-related patterns were repeated all over the world, but the virulence with which the flu struck also varied from place to place. Inhabitants of certain parts of Asia were a staggering 30 times more likely to die from the flu than those in parts of Europe. In general, Asia and Africa suffered the highest death rates, with the lowest seen in Europe, North America and Australia. But there was great variation within continents, too. African countries south of the Sahara experienced death rates two or even three times higher than those north of the desert, while Spain recorded one of the highest death rates in Europe – twice that in Britain, three times that in Denmark.

Dr Robert Koch (seated), influential in developing ‘germ theory’,
Dr Robert Koch (seated), influential in developing ‘germ theory’, and his student Richard Pfeiffer at work in the late 19th century. During the ‘Russian’ flu epidemic starting in 1889, Pfeiffer claimed to have identified the bacillus responsible – though flu is actually caused by a virus. (Getty Images)

The unevenness didn’t stop there. In general, cities suffered worse than rural areas, but some cities suffered worse than others, and there was also variation within cities. Newly arrived immigrants tended to die more frequently than older, better-established groups, for example. In the countryside, meanwhile, one village might be decimated while another, apparently similar in every way, got away with a light dose.

“Some indefinable horror”

The flu seemed to strike with an element of randomness, and cruelly so. Because adults in the prime of life died in droves, unlucky communities imploded. Children were orphaned, elderly parents left to fend for themselves. People were at a loss to explain this apparent lottery, and it left them deeply disturbed. Attempting to describe the feeling it inspired in him, a French doctor in the city of Lyons wrote that it was quite unlike the “gut pangs” he had experienced while serving at the front. This was “a more diffuse anxiety, the sensation of some indefinable horror which had taken hold of the inhabitants of that town”.

It was only later, when epidemiologists zeroed in on the numbers, that patterns began to emerge, and the first elements of an explanation were put forward. Some of the variability could be explained by inequalities of wealth and caste – and, to the extent that it reflected these factors, skin colour. Bad diet, crowded living conditions and limited access to healthcare weakened the constitution, rendering the poor, immigrants and ethnic minorities more susceptible to infection. As French historian Patrick Zylberman put it: “The virus might well have behaved ‘democratically’, but the society it attacked was hardly egalitarian.”

Any other underlying disease made a person more susceptible to the Spanish flu, whereas prior exposure to the flu itself modulated the severity of a case. Remote communities without much historical experience of the disease suffered badly, as did cities that were bypassed by the first wave of the pandemic, because they were not immunologically ‘primed’ to the second. For example, Rio de Janeiro – capital of Brazil at the time – received only one wave of flu, in October 1918, and experienced a death rate two or three times higher than that recorded in American cities to the north that had received both the spring and autumn waves. And Bristol Bay in Alaska was spared until early 1919, but when the virus finally gained a foothold it reduced the bay’s Eskimo population by 40%.

Public health campaigns made a difference, despite the fact that medics did not understand the cause of the disease. Since time immemorial, whenever contagion is a threat humans have practised ‘social distancing’ – understanding instinctively that steering clear of infected individuals increases the chance of staying healthy. In 1918, social distancing took the form of quarantine zones, isolation wards and prohibitions on mass gatherings; where they were properly enforced, these measures slowed the spread. Australia kept out the autumn wave entirely by implementing an effective quarantine at its ports.

Exceptions proved the rule. In 1918 Persia was a failed state after years of being used as a pawn in the ‘Great Game’ – the struggle between the British and the Russians for control of the vast area between the Arabian and Caspian Seas. Its government was weak and nearly bankrupt, and it lacked a coherent sanitary infrastructure, so when the flu erupted in the north-eastern holy city of Mashhad in August 1918, no social distancing measures were imposed.

Within a fortnight every home and place of business in Mashhad was infected, and two-thirds of the city’s population fell sick that autumn. With no restrictions on movement, the flu spread outwards with pilgrims, soldiers and merchants to the four corners of the country. By the time Persia was again free of flu, it had lost between 8% and 22% of its population (that uncertainty reflecting the fact that, in a country in crisis, gathering statistics was hardly a priority). By way of comparison, even 8% equates to 20 times the flu-related mortality rate in Ireland.

Schoolgirls in Tokyo don protective face masks to guard against flu transmission during the outbreak. The use of such masks by the Japanese public boomed during the 1918–20 epidemic and subsequent disease outbreaks, and remains common in Japan today. (Getty images)
Schoolgirls in Tokyo don protective face masks to guard against flu transmission during the outbreak. The use of such masks by the Japanese public boomed during the 1918–20 epidemic and subsequent disease outbreaks, and remains common in Japan today. (Getty images)

Where disparities in rates of illness and death were perceived, people’s explanations reflected contemporary understanding – or, rather, misunderstanding – of infectious disease. When Charles Darwin laid out his theory of evolution by natural selection in On the Origin of Species (1859), he had not intended his ideas to be applied to human societies, but others of his time did just that, creating the ‘science’ of eugenics. Eugenicists believed that humanity comprised different ‘races’ that competed for survival, and by 1918 their thinking was mainstream in industrialised societies. Some eugenicists noted that poorer sectors of society were suffering disproportionately from the flu, which they attributed to a constitutional inferiority. They had also incorporated germ theory into their world view: if the poor and the working classes were more prone to infection, reasoned the eugenicists, they only had themselves to blame, because Pasteur had taught that infection was preventable.

Indian tensions

The terrible consequences of this line of thinking are illustrated nowhere better than in India. That land’s British colonisers had long taken the view that India was inherently unhygienic, and so had invested little in indigenous healthcare. As many as 18 million Indians died in the pandemic – the greatest loss in absolute numbers of any country in the world. But there would be a backlash. The underpowered British response to the spread of flu fuelled resentment within the independence movement. Tensions came to a head with the passing into law in early 1919 of the Rowlatt Act, which extended martial law in the country. This triggered peaceful protests, and on 13 April British troops fired into an unarmed crowd in Amritsar, killing hundreds of Indian people – a massacre that galvanised the independence movement.

The Spanish flu prompted uprisings elsewhere. The autumn of 1918 saw a wave of workers’ strikes and anti-imperialist protests across the world. Disgruntlement had been smouldering since before the Russian revolutions of 1917, but the flu fanned the flames by exacerbating what was already a dire supply situation, and by highlighting inequality. Even well-ordered Switzerland narrowly avoided a civil war in November 1918 after leftwing groups blamed the high number of flu deaths in the army on the government and military command.

There were still parts of the world where people had never heard of either Darwin or germ theory, and where the population turned to more tried-and-tested explanations. In the rural interior of China, for example, many people still believed that illness was sent by demons and dragons; they paraded figures of dragon kings through the streets in the hope of appeasing the irate spirits. A missionary doctor described going from house to house in Shanxi province in early 1919, and finding scissors placed in doorways – apparently to ward off demons “or perchance to cut them in two”.

Even in the modernised west, people vacillated. Death often seemed to strike without rhyme or reason. Many still remembered a more mystical, pre-Darwinian era, and four years of war had worn down psychological defences. Seeing how ill-equipped their men of science were to help them, many people came to believe that the pandemic was an act of god – divine retribution for their sins. In Zamora – the same Spanish city whose newspaper stated with such confidence that the agent of disease was Pfeiffer’s bacillus – the bishop defied the health authorities’ ban on mass gatherings and ordered people into the churches to placate “God’s legitimate anger”. This city subsequently recorded one of the highest death tolls from flu in Spain – a fact of which its inhabitants were aware, though they don’t seem to have held it against their bishop. Instead they awarded him a medal in recognition of his heroic efforts to end their suffering.

This exemplifies how responses to the flu reflected gulfs in understanding. The 1918 pandemic struck a world that was entirely unprepared for it, dealing a body blow to scientific hubris, and destabilising social and political orders for decades to come.

Laura Spinney is an author and journalist. Her book, Pale Rider: The Spanish Flu of 1918 and How it Changed the World, was published by Jonathan Cape in June 2017

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A mission ‘you’re willing to die for’: Michigan man shows up in Chicago ER after getting shot in Syria

A mission ‘you’re willing to die for’: Michigan man shows up in Chicago ER after getting shot in Syria

The emergency room at Northwestern Memorial Hospital was packed with flu patients when Caleb Stevens hobbled through the doors on crutches one evening in January, his leg pulsing with pain from a week-old gunshot wound.

The clerk at the intake desk was unfazed when Stevens said he had been wounded in Syria. She took his passport and told him to join the rest of the people in the waiting room.

So he sat with his mom for 20 minutes, his right leg wrapped in a cast, a splint and bloody bandages. He was still wearing a red-and-white Christmas sock someone pulled over his foot when he was rushed to a Baghdad hospital for surgery.

As he looked around the ER, Stevens, 23, said he thought some of the other patients “seemed more at risk than I was.”

A week before and 6,200 miles away, Stevens was on the roof of a house in the small town of Abu Hamam near the Euphrates River, he said, battling Islamic State as a volunteer fighter with a Kurdish militia group. The Tribune confirmed much of Stevens’ unusual account through travel documents, medical records, emails and interviews with others who said they fought with him. The militia did not respond to inquiries.

On the day he was shot, Stevens was running to retrieve a rifle, he said. A sniper’s bullet tore into his calf. “There was blood spurting out. I definitely knew I had been shot but a part of me refused to believe that.”

He underwent several surgeries at military hospitals in Syria and Iraq before arriving at O’Hare International Airport, records show. As doctors at Northwestern examined the jagged wound, word made its way to Chicago police that Stevens was somehow connected to Islamic State. The next morning, three officers walked into his room, he recalled. Four more waited in the hall.

“They kind of barged in the hospital room,” Stevens said during a recent interview with his mother in their Michigan home. “One of them began aggressively and suspiciously asking questions. They asked me the same questions over and over and over.

“That was kind of my welcome back to the U.S.,” he said. “‘We think you’re a terrorist.’ I’m like, ‘No, no, no, no, no. I was fighting the terrorists.’’’

According to a Chicago police report, Stevens told the officers he was shot “in an exchange of gunfire with unknown offenders” while conducting a “military style offensive with YPG militia.” The report says the FBI was notified, but the federal agency did not respond to Tribune inquiries about the incident.

A handful of Americans have joined People’s Protection Units, also known as YPG, and other Syrian militia groups allied with the United States in recent years, according to experts and the federal government. Most of those who sign up are young adults, idealists and those with a military background who sympathize, and perhaps romanticize, the groups’ stated fight against Islamic State and oppression in Syria, Turkey and Iraq.

Stevens had spent two years at the U.S. Military Academy at West Point when he started getting restless to join the conflict. “I didn’t want to do two more years of college and job hunting to do something to improve the world,” he said. “This felt like something intense and meaningful and something I could jump right into.”

A seed is planted

When Stevens was in grade school, a guest speaker for a group called World Vision spoke to the students about philanthropy and helping needy children overseas. That night, Stevens said, he couldn’t sleep and decided to use his allowance to support Renaldo, a little boy in Mexico.

His passion for “the cause of justice” grew as he got older, Stevens said.

Stevens was a top scholar and athlete at Pioneer High School in Ann Arbor, Mich., and graduated in June 2012. He dreamed of becoming a soldier. He was interested in what was going on in the Middle East and was looking for more from his college experience than frat parties and dorm life.

Stevens considered joining the U.S. Army, but the war in Afghanistan seemed to be winding down and he had misgivings about how meaningful the Army would be for him. He applied to West Point and headed to New York in 2012.

By that time, Syria was in the midst of civil war. In the United States, the conflict was seen as a battle between the pro-government forces of President Bashar Assad and resistance rebels. But Syria had become many battlefronts involving an array of militias with different objectives. The YPG, a Kurdish militia, was dedicated to protecting Rojava in northern Syria, which is near the Iraq and Turkish borders and has become a home region for Kurds.

Stevens became aware of the YPG in 2014 from news reports of a mass killing in the region. He left West Point that August, according to the academy.

“YPG was the only military force that went into Mount Sinjar and fought off Islamic State. That really got me thinking. Maybe this is something that I could do,’’ Stevens said. “I wish more people would put more on the line for the cause of human dignity … Not just having something to live for but having something you’re willing to die for.”

He was eager to do something, but it would be three years before he set foot in Syria.

After leaving West Point, Stevens worked at a horse ranch in Indiana, a ranch in Australia and taught English and computer science in Mali in Africa, he said. Then he enrolled in Deep Springs College, a tiny school on the California-Nevada border that focuses on service and working the land. It was there he studied agricultural policy and infectious diseases. He also learned Kurdish.

Meanwhile, Syria sunk deeper into war. Russia threw its support to the forces of the Assad regime, while the United States backed rebel groups. Elements from each side clashed with Islamic State in the east. Militias battled for territory. Millions fled the country seeking refuge.

It wasn’t until February 2017 that Stevens learned through a Rolling Stone article about YPG accepting foreign volunteers. “I started thinking about it and talking about it with people. Running it by my friends and mentors and my mom,” he said. “And enough people were saying, ‘Yeah, this makes sense for you. I could see you doing this,’ that I thought, OK, I’m not crazy. This is something I could actually do.’’

But Stevens’ mother had reservations.

“We discussed it, kind of, in theory,’’ Deborah Stevens said recently as she sat near her son, his wounded leg propped up. “I expressed my concerns. But as it became clear that this was your aspiration, I got on board with it.’’

His mother began learning about the warring factions in Syria and the ideals of the Kurdish cause. Over time, she offered her support.

“Caleb has a really big heart and I could see this as a way for him to utilize that aspect of his character together with his skills and really make a difference in the world,’’ she said.

Finding out how to join the YPG in its fight in Rojava was surprisingly easy, Stevens said.

The Kurdish fighting forces in Syria have a robust online presence and use Facebook and social media threads to recruit foreigners, including Americans, through provocative postings and photos detailing their efforts. On the Lions of Rojava page on Facebook, several Americans have posted inquiries and expressed interest in joining the cause.

Stevens did a quick Google search and sent a Facebook message to the group, then followed up with an email. In early April 2017, he sent a message that began, “Hello, I’m a leftist from the United States interested in fighting for the cause in Rojava.’’

The group sent him a lengthy application, including an exhaustive personality questionnaire, an essay portion and general information about volunteering. The Tribune reviewed the email exchanges between Stevens and the YPG. Messages left with the YPG via email and social media were not returned.

“Rojava is not a place for exotic holiday trips or for adventures,” the application read. “Supporting the YPG is not a game and no fun activity for bored people. … You are not going to join a football club or get a new job in a company: you are going to take part in a revolution.”

A questionnaire began with basic inquiries about education and family and ended with 70 very specific yes-or-no psychological questions. “Do you have difficulty trusting people? Do you tend to avoid social relationships? Do you believe you have special extra sensory abilities (ability to “sense” a person’s presence)? Do you occasionally or often dress or act provocatively to gain attention?”

Stevens filled out the application, clicked send and waited.

He received a short, curt reply: “We have received your ticket and your photo. Please email us again 3 days before your arrival. You will then be given final instructions and a contact number,” according to YPG emails reviewed by the Tribune.

Stevens bought a one-way ticket and in July 2017 boarded a plane to fight with rebel forces.

The draw of a foreign war

YPG is part of the Syrian Democratic Forces, which has been fighting Islamic State in the east of Syria and, more recently, Turkish forces in the north.

Rojava is viewed as an oasis for certain groups of people in the region fleeing persecution, according to Melinda McClimans, assistant director of the Middle East Studies Center at Ohio State University.

Many of the militia’s soldiers are women, she said. Some of them have fled Islamic State and taken up arms against it.

“I think part of the reason why Americans might be attracted to it is that idealistic concept of people being free,” McClimans said. “There’s definitely romanticism around it.”

Because YPG is aligned with U.S.-backed forces trying to defeat Islamic State, there do not appear to be legal ramifications for Stevens and others upon returning from overseas. No charges have been filed against Stevens.

The State Department referred questions about whether Americans are legally allowed to fight for YPG to the Department of Justice, which did not respond to inquiries.

Americans who join or support groups and forces designated as terror groups by the U.S. government, on the other hand, chance arrest on federal charges. Officials estimate there may be a few dozen Americans who have joined Islamic State fighters in Iraq and Syria.

McClimans said there hasn’t been much academic research on the various fighting forces because the area is difficult to access.

But one thing is clear: The fighting has torn the region apart. More than 400,000 people have died in the Syrian conflict since 2011, according to the World Bank, with 5 million seeking refuge abroad and more than 6 million displaced internally, according to U.N. agencies.

The State Department said it strongly warns against traveling to Syria to join the conflict. The State Department has no consular presence in Syria, and a department official said its ability to provide consular assistance to individuals who are injured or kidnapped, or to the families of people killed in the conflict, is extremely limited. “A small number” of Americans have died after traveling to Syria to take part in the fighting, according to the State Department.

“U.S. citizens who undertake such activity face extreme personal risks, including kidnapping, injury, or death,” the State Department said. “The U.S. government does not support this activity.”

Taking up arms

With minimal military experience and few instructions, Stevens arrived in Iraq alone and unsure of what was ahead of him, he said.

“They leave you in the dark. I put together a bag of stuff I thought would be useful. A bunch of socks and underwear. A bunch of semi-military equipment, mostly outdoor stuff.’’

A copy of his airline ticket shows he set down at Sulaimaniyah International Airport in Iraq on July 23. He was told someone would pick him up, but the man never showed up and Stevens said his luggage was lost somewhere between Jordan and Iraq. He finally made contact after finding a hotel with an Internet connection and checking in.

“My first day was kind of stressful,’’ he said.

Stevens was soon joined by a classmate from Deep Springs College, Grayson Scott. “It was a pretty wild experience,’’ said Scott, who left the YPG months before Stevens was wounded.

“Caleb is an incredible person,” he said in a phone interview. “There isn’t anybody I’d rather fight fascism with.”

Scott and Stevens trained on old Soviet weapons: AK-47s, a PK machine gun, a rocket-propelled grenade launcher and a Dragunov sniper rifle.

It was about 90 degrees during the day but cooler at night. Stevens said he was paid a small monthly stipend. They lived on the rooftops of abandoned buildings. They drank a hot sugary tea constantly, even on the front lines.

Women and men had separate living quarters but fought together. Their operations took place mostly in the countryside, helping take villages and buildings where Islamic State may have been camped out.

One of Stevens’ closest friends during this time was a French recruit in his 30s who said he has been with the YPG for more than two years. Reached by phone in Syria, he said he wanted to be identified only by his Kurdish name, Hogir.

“We have a similar way of thinking,’’ Hogir said. “Many of the people who come to fight with the YPG do not adapt well to the environment. Maybe they complain many times for small things. (Stevens) was very disciplined. He was very eager to fight. He knew why he was here and, since he was one of the commanders of the unit, we had to meet every day to discuss a lot of the organization of the unit.”

It was five months, Stevens said, before his unit saw serious fighting. In early December, the unit moved to the city of Abu Hamam. News reports describe fighting in the area around that time.

“It was surprisingly Western,” Stevens said of the town. “Rich and well-developed. It was kind of a weird mix of really nice, tall homes, almost mansions, and then farmland and smaller houses.”

Stevens said he began to engage in serious battles. The YPG changed its operations from nighttime assaults to “sniper work’’ during the day, covering for other groups that were pushing at the front line.

“There were times when I was afraid for my life and there were times when it felt like it was just a matter of time before I died or got wounded,” Stevens said. “But I think being with people that you care about and having a mission that you care about, that does a lot to make you feel like even if you’re afraid, you have a reason to get over it.”

For eight days, Stevens’ unit moved from building to building, close to the front line, as other units moved forward and took new positions. He said he was on sniper duty on a roof Jan. 6 when his unit came under fire.

“We heard something,” Hogir said. “You don’t hear the shots, you hear like something breaking. Then you see there’s a hole in the wall and they are shooting at you. You hear the bullets going through the wall. You hear the wall breaking and the pieces of stone going to the floor. You don’t hear the shots.”

Everyone ran to a small shelter, but Stevens said he went back for his rifle and was shot. “I fell and I was on my back, so I scooted or crab-walked back into the shelter about 15 or 20 meters away. I was in instant survival mode. There was muscle hanging out and a lot of blood spurting out.”

After a tourniquet and bandages were applied, Stevens said he leaned on Hogir and other soldiers as he hopped down a flight of stairs and was laid on a stretcher. “My friends grunted and sweated for a kilometer until I could get to safety.”

Hogir said he and three others carrying the stretcher faced sniper fire on their way to an armed vehicle. The last time he saw Stevens was near a Syrian field hospital.

“He was lying in an armed vehicle with Americans around him,’’ Hogir said. “I just said OK, keep in touch, we will see each other very soon.’’

Stevens then began a medical journey that he said included stops at hospitals in Syria and Baghdad, treatment by U.S. doctors and five surgeries, four of them in eight days.

Medical records provided by Stevens show he was admitted to the 47th Combat Support Hospital in Baghdad on Jan. 7 for a gunshot wound to his lower right leg that fractured a bone, damaged nerves and tore his Achilles tendon.

He was initially admitted under the name “Marauder” until officials could confirm his identity, according to the records. Stevens’ name, Social Security number and date of birth were later added.

Stevens underwent surgeries that he was told saved his leg. “The DOD (Department of Defense) and the U.S. Army started taking care of me. It was nice of them.’’

Neither the Army nor federal officials would respond to questions about Stevens’ whereabouts, care or treatment or the involvement of American troops, doctors or equipment.

The return home

After Stevens was discharged from the combat hospital, he was flown to Amman, Jordan, where he was scheduled for a flight to O’Hare. He said he lost his passport after being shot and was given a provisional one that was issued for just one year, according to a copy he provided.

At the airport in Amman, security officers searched his backpack and found the bullet that doctors had pulled from his leg, Stevens said. They thought this “very suspicious’’ and Stevens said he had to check the backpack with his pain medication inside. That meant a 14-hour flight to Chicago with no relief from the pain.

At O’Hare, “a bunch of Border Patrol police took one look at me and my passport and said, ‘You’re going to have to come with us,’” Stevens said. After two hours, they let him grab the bag so he could take something for the pain, he said. Then they let him go.

Sitting in a wheelchair, reunited with his mom, Stevens said the return to a big American city was jarring. Everything looked “lit up and expensive.”

“I felt totally out of place,” he said. “Not just with the people but with the environment — how everybody’s lives seemed disconnected from what is going on in Syria. It was jarring, kind of. A feeling of not exactly belonging.”

After his stay at Northwestern, Stevens said he has been at a hospital closer to his home for continued treatment for his leg. “I can put weight on it now. Even though the fibula is broken, I’ve started my first baby steps on the road to recovery. But it’s kind of a wait-and-see kind of thing.’’

In the month since Stevens came home, alliances in Syria continue to shift. Incursions by Turkey could force the YPG to unite with Syrian government forces to fight a common enemy.

Last weekend, Stevens posted on his Facebook page a picture of a former comrade who he said was recently killed while fighting the Turkish army in Syria.

“There were times when I couldn’t stand him, and times when I couldn’t stand to see anyone but him,” Stevens posted. “And one unexpected homecoming when he made me feel as much at home as I’ve ever felt. And his death mixes all those together into a tangle that won’t come undone … Martyrs never die. We remember them when we remember the ideals they died for.”

As his leg heals, Stevens considers finishing college, maybe at the University of Michiganor Yale. Once he can walk again, he plans to travel with his mom. They want to go to Scandinavia.

He might even go back to Syria.

Chicago Tribune’s Madeline Buckley contributed.

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In the end, Exxon made the Kurdish deal.

In November, 2013, Tillerson travelled to Washington, D.C., to meet with Nuri al-Maliki, the Prime Minister of Iraq. Maliki was hoping to persuade Tillerson to change his mind about a sensitive political matter. Exxon was then negotiating a multibillion-dollar deal with the government of Iraqi Kurdistan, a semi-autonomous region in the northern part of the country, which has long sought independence. Under the deal, Exxon would explore for oil in some eight hundred and forty thousand acres, potentially providing the Kurds with a steady stream of revenue that was independent of the government in Baghdad. In Maliki’s view, giving the Kurds their own revenue would hasten a breakup of the country.

Maliki was not alone in objecting; President Obama opposed the deal, and his aides had prevailed upon Exxon executives to drop the Kurdish project. “We were concerned that this would further embolden the Kurds to strike out on their own,” Tony Blinken, Obama’s deputy national-security adviser at the time, told me.

The meeting, held at the Willard Hotel, ended in acrimony. Exxon had previously made an agreement with Maliki to undertake two drilling projects in southern Iraq, and Maliki, a former dissident and guerrilla fighter, threatened to cancel them if Exxon pursued the Kurdish deal. Tillerson refused. Maliki argued bluntly, “You’re dividing the country. You’re undermining our constitution!” But Tillerson held firm. “It was one of the worst meetings of my career,” a senior Iraqi official who was in attendance said. In the end, Exxon made the Kurdish deal.


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Hackers take aim at common medical devices

BUSINESS 476415023

Hackers take aim at common medical devices

Companies say patients not in danger while pledging vigilance.
The portable Medtronic CareLink 2090 Programmer.

The portable Medtronic CareLink 2090 Programmer.

Busy heart hospitals and clinics often have a procedure room where pacemaker and defibrillator patients go to get regular checkups on the small computers implanted inside their chests.

Lately, device companies have been reminding doctors to make sure to lock the doors and cabinets in those rooms, as reports surface that the machines used to conduct the device checkups could be vulnerable targets for hackers and thieves.

Since 2016, all three U.S. makers of pacemakers and defibrillators, all with major operations in Minnesota, have had cybersecurity warnings issued for the machines used by doctors to program and test implanted heart devices. Medtronic acknowledged a vulnerability in its programmer on Feb. 27, and Boston Scientific acknowledged a vulnerability in October. Both said the security issues presented little or no risk to patients when the Homeland Security Department publicized the issues.

St. Jude Medical, meanwhile, opted to sue the researchers and investors who claimed the med-tech company’s in-office programmers and at-home bedside monitors were surprisingly vulnerable to malicious computer hacking. Abbott Laboratories, which acquired St. Jude in 2017, quietly settled that litigation last month after issuing a series of software updates and vulnerability disclosures.

“Connected devices and remote monitoring have done so much to advance patient care in recent years,” said Kelly Morrison, a spokeswoman for Abbott Laboratories. “With any connected device, whether medical or nonmedical, there is always going to be some level of security risk. … We as an industry need to be vigilant about including the latest security protections in our products and updating them as technology evolves or as new vulnerabilities are identified.”

The U.S. health care market is home to many thousands of these cardiac-device programmers, which look like laptop computers and are designed to communicate wirelessly with implanted pacemakers and defibrillators. The programmers are intended to be used in an operating room when a device is implanted, and in a medical exam room during regular checkups.

They are not supposed to be sold online, where anyone could buy one and tear it apart. However, the Star Tribune found several available online as of Friday afternoon.

Heart-device programmers are designed to be compatible with many different versions of one company’s implanted devices. No programmer today can communicate with different companies’ devices. Manufacturers make them available to hospitals and clinics at no charge, and then lump the costs into the price tag for a pacemaker or defibrillator.

Device manufacturers say the in-office programmers that communicate with implanted heart devices would be of little use to a hacker who wanted to harm a patient. Dr. Jay Sengupta, co-director of the cardiac device clinic at Abbott Northwestern Hospital, agreed: “You have to go to a patient, put the wand over their pacemaker or defibrillator, and confirm the device model. Then the programmer essentially starts to communicate and download information,” he said.

Yet, independent computer hackers continue to buy used programmers from internet sites and exploit vulnerabilities to access patient data or network passwords.

“Things tend to fail at the interfaces. So if you’re looking for fruit as a researcher, you generally want to look where systems interact,” said longtime med-tech security researcher Ben Ransford, CEO of cybersecurity firm Virta Labs.

“The [Medtronic] programmer plays a crucial role in care, and also appears to be a Windows XP machine. … It looks like a pretty juicy target to an attacker. So I’m not at all surprised with the focus on this one.”

Medtronic said last week that a vulnerability in its CareLink 2090 programmer could not affect patient health.

The researcher who brought the issue to light, Billy Rios, disagrees. When Medtronic said it had disproved Rios’ allegation, Rios said his firm had already discovered a different “exploit chain” using the same vulnerabilities to allow a malicious hacker to change a patient’s therapy settings without their knowledge.

“We completed an assessment of [Rios’ vulnerability report] and outcomes are reflected in the associated [Homeland Security] advisory jointly approved by Medtronic and Mr. Rios,” Medtronic spokeswoman Kathleen Janasz said via e-mail Friday. “Researchers play an important role in the security field. While we don’t always agree, we believe their contributions overall can be valuable in identifying potential security vulnerabilities.”

There has never been a confirmed report of a hacker compromising a medical device with the intent to harm a patient, which some researchers say shows that the security system in place is working.

The Securities and Exchange Commission said last month that cybersecurity risks pose “grave threats” to investors and the nation. Yet one prominent med-tech stock analyst, who wasn’t authorized to talk on the record, said investors are not closely tuned in to the issue.

Although St. Jude’s stock did drop after the cyber-vulnerabilities in its devices were revealed in August 2016, Abbott’s offer to acquire the company didn’t change, and the roughly $25 billion deal went through as expected in January 2017.

The St. Jude vulnerabilities appeared to be the most serious of the three major U.S. pacemaker companies. Abbott says it has taken several steps to mitigate the risks, including those from vulnerabilities in its Merlin PCS programmers.

Before the fixes were applied, researchers with the firm MedSec Holdings said a malicious hacker could have used weaknesses in the system to “reverse engineer” programs on the device and then cause it to issue unintended commands to an implanted pacemaker.

That account was verified by a team of independent researchers with the firm Bishop Fox, whose report is public as part of the now-settled lawsuit.

In October 2017, Boston Scientific confirmed that its Zoom Latitude programmers contained vulnerabilities that would allow someone to obtain a patient’s personal health information if the device fell into the hands of a hacker. The company advised doctors to keep the programmer in a secure or locked location and erase the health data before removing it from the facility.

On Feb. 27, Medtronic confirmed that its CareLink 2090 programmer harbored vulnerabilities that would let a hacker obtain credentials for its software-update network, allowing an attacker to read material on the network, but not “write” to the network. Security researcher Rios has said other vulnerabilities do allow write access, but they are in the process of being confirmed and mitigated.

Security experts say there will always be tension between the cyber protections in heart devices and the health benefits of wireless access to them. Mark Lanterman, chief technology officer with Computer Forensic Services in Minnetonka, said gains in convenience often mean small losses of security, which is why vigilance is needed.

“They all could do a better job with respect to security,” Lanterman said. “But I think that by continuing to call them out and pointing out the shortcomings, they are going to come around. Because they don’t want a patient to be hurt, either.”


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The military keeps encountering UFOs. Why doesn’t the Pentagon care?

The military keeps encountering UFOs. Why doesn’t the Pentagon care?

We have no idea what’s behind these weird incidents because we’re not investigating.

March 9

Christopher Mellon served as deputy assistant secretary of defense for intelligence in the Clinton and George W. Bush administrations. He is a private equity investor and an adviser to the To the Stars Academy for Arts and Science.

In December, the Defense Department declassified two videos documenting encounters between U.S. Navy F-18 fighters and unidentified aircraft. The first video captures multiple pilots observing and discussing a strange, hovering, egg-shaped craft, apparently one of a “fleet” of such objects, according to cockpit audio. The second shows a similar incident involving an F-18 attached to the USS Nimitz carrier battle group in 2004.

The videos, along with observations by pilots and radar operators, appear to provide evidence of the existence of aircraft far superior to anything possessed by the United States or its allies. Defense Department officials who analyze the relevant intelligence confirm more than a dozen such incidents off the East Coast alone since 2015. In another recent case, the Air Force launched F-15 fighters last October in a failed attempt to intercept an unidentified high-speed aircraft looping over the Pacific Northwest .

A third declassified video, released by To the Stars Academy of Arts and Science , a privately owned media and scientific research company to which I’m an adviser, reveals a previously undisclosed Navy encounter that occurred off the East Coast in 2015.

It’s like the movie “Mean Girls,” except it’s in the White House. This week: Some guy named Sam, plus “Ted,” “Beto” and “Dave.”

Is it possible that America has been technologically leap-frogged by Russia or China? Or, as many people wondered after the videos were first published by the New York Times in December, might they be evidence of some alien civilization?

Unfortunately, we have no idea, because we aren’t even seeking answers.

I served as deputy assistant secretary of defense for intelligence for the Clinton and George W. Bush administrations and as staff director for the Senate Intelligence Committee, and I know from numerous discussions with Pentagon officials over the past two years that military departments and agencies treat such incidents as isolated events rather than as part of a pattern requiring serious attention and investigation. A colleague of mine at To the Stars Academy, Luis Elizondo, used to run a Pentagon intelligence program that examined evidence of “anomalous” aircraft, but he resigned last fall to protest government inattention to the growing body of empirical data.

Meanwhile, reports from different services and agencies remain largely ignored and unevaluated inside their respective bureaucratic stovepipes. There is no Pentagon process for synthesizing all the observations the military is making. The current approach is equivalent to having the Army conduct a submarine search without the Navy. It is also reminiscent of the counterterrorism efforts of the CIA and the FBI before Sept. 11, 2001, when each had information on the hijackers that they kept to themselves. In this instance, the truth may ultimately prove benign, but why leave it to chance?

(A Pentagon spokesman did not respond to requests from The Washington Post for comment, but in December, the military confirmed the existence of a program to investigate UFOs and said it had stopped funding the research in 2012.)

The military personnel who are encountering these phenomena tell remarkable stories. In one example, over the course of two weeks in November 2004, the USS Princeton, a guided-missile cruiser operating advanced naval radar, repeatedly detected unidentified aircraft operating in and around the Nimitz carrier battle group, which it was guarding off the coast of San Diego. In some cases, according to incident reports and interviews with military personnel, these vehicles descended from altitudes higher than 60,000 feet at supersonic speeds, only to suddenly stop and hover as low as 50 feet above the ocean. The United States possesses nothing capable of such feats.

On at least two occasions, F-18 fighters were guided to intercept these vehicles and were able to verify their location, appearance and performance. Notably, these encounters occurred in broad daylight and were independently monitored by radars aboard multiple ships and aircraft. According to naval aviators I have spoken with at length, the vehicles were roughly 45 feet long and white. Yet these mysterious aircraft easily sped away from and outmaneuvered America’s front-line fighters without a discernible means of propulsion.

From my work with To the Stars Academy, which seeks to raise private funds to investigate incidents like the 2004 Nimitz encounter, I know they continue to occur, because we are being approached by military personnel who are concerned about national security and frustrated by how the Defense Department is handling such reports. I am also familiar with the evidence as a former Pentagon intelligence official and a consultant who began researching the issue after the Nimitz incident was brought to my attention. On several occasions, I have met with senior Pentagon officials, and at least one followed up and obtained briefings confirming incidents such as the Nimitz case. But nobody wants to be “the alien guy” in the national security bureaucracy; nobody wants to be ridiculed or sidelined for drawing attention to the issue. This is true up and down the chain of command, and it is a serious and recurring impediment to progress. 

If the origin of these aircraft is a mystery, so is the paralysis of the U.S. government in the face of such evidence. Sixty years ago, when the Soviet Union put the first manmade satellite in orbit, Americans recoiled at the idea of being technologically surpassed by a dangerous rival, and the furor over Sputnik ultimately produced the space race. Americans responded vigorously, and a little more than a decade later, Neil Armstrong set foot on the moon. If these craft mean that Russia, China or some other nation is concealing an astonishing technological breakthrough to quietly extend its lead, surely we should respond as we did then. Perhaps Russian President Vladi­mir Putin’s recent chest-thumping claims about propulsion breakthroughs are not pure braggadocio. Or, if these craft really aren’t from Earth, then the need to figure out what they are is even more urgent.

Lately, media coverage of the issue of unidentified aerial vehicles has focused on an expired $22 million congressional earmark for Bigelow Aerospace, a contractor with ties to former Senate Democratic leader Harry Reid (Nev.). The money mostly funded research and analysis by that contractor, without participation from the Air Force, NORAD or other key military organizations. The real issue, though, is not a long-gone earmark, helpful though it may have been, but numerous recent incidents involving the military and violations of U.S. airspace. It is time to set aside taboos regarding “UFOs” and instead listen to our pilots and radar operators.

Within a roughly $50 billion annual intelligence budget, money is not the issue. Existing funds would easily cover what’s needed to look into the incidents. What we lack above all is recognition that this issue warrants a serious collection and analysis effort. To make headway, the task needs to be assigned to an official with the clout to compel collaboration among disparate and often quarrelsome national security bureaucracies. A truly serious effort would involve, among other things, analysts able to review infrared satellite data, NORAD radar databases, and signals and human intelligence reporting. Congress should require an all-source study by the secretary of defense while promoting research into new forms of propulsion that might explain how these vehicles achieve such extraordinary power and maneuverability.

As with Sputnik, the national security implications of these incidents are concerning — but the scientific opportunities are thrilling. Who knows what perils we may avoid or opportunities we might identify if we follow the data? We cannot afford to avert our eyes, given the risk of strategic surprise. The future belongs to not only the physically brave but also the intellectually agile.


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Over 500 Canadian doctors protest raises, say they’re being paid too much (yes, too much)

Over 500 Canadian doctors protest raises, say they’re being paid too much (yes, too much)

Photo by Caiaimage/Robert Daly

In Canada, more than 500 doctors and residents, as well as over 150 medical students, have signed a public letter protesting their own pay raises.

“We, Quebec doctors who believe in a strong public system, oppose the recent salary increases negotiated by our medical federations,” the letter says.

The group say they are offended that they would receive raises when nurses and patients are struggling.

“These increases are all the more shocking because our nurses, clerks and other professionals face very difficult working conditions, while our patients live with the lack of access to required services because of the drastic cuts in recent years and the centralization of power in the Ministry of Health,” reads the letter, which was published February 25.

“The only thing that seems to be immune to the cuts is our remuneration,” the letter says.

Canada has a public health system which provides “universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay,” the government’s website says.

The 213 general practitioners, 184 specialists, 149 resident medical doctors and 162 medical students want the money used for their raises to be returned to the system instead.

“We believe that there is a way to redistribute the resources of the Quebec health system to promote the health of the population and meet the needs of patients without pushing workers to the end,” the letter says.

“We, Quebec doctors, are asking that the salary increases granted to physicians be canceled and that the resources of the system be better distributed for the good of the health care workers and to provide health services worthy to the people of Quebec.”

A physician in Canada is paid $260,924 ($339,000 Canadian) for clinical services by the government’s Ministry of Health per year on average, according to a report from the Canadian Institute for Health Information published in September 2017. On average, a family physician is paid $211,717 ($275,000 Canadian) for clinical services and a surgical specialist is paid $354,915 ($461,000 Canadian), according to the same report.

This is total gross pay, however, and does not take into account overhead each doctor pays to operate, as the Canadian Institute for Health Information is careful to point out to CNBC Make It.

In May 2016, one physician publicly broke down the cost of running his family practice, and though he brought in $231,033 ($300,000 Canadian), he was left with $136,906 ($177,876 Canadian) after subtracting his business expenses — but before taxes and employment benefits are taken out.

The cost of medical school in Canada is subsidized by provincial governments, according to The Association of Faculties of Medicine of Canada. The cost varies depending on whether a student is a Canadian citizen, permanent resident or foreign student and the particular school. For Canadian citizens or permanent residents, tuition for the first year of medical school ranges from $2567 ($3,334 Canadian) to $20,064 ($26,056 Canadian), according to The Association of Faculties of Medicine of Canada’s website.

The same group, the Médecins Québécois pour le Régime Public (MQRP), that published the aforementioned public letter, also published a letter on February 17 opposing $500 million worth of pay increases for specialist doctors. The group called the pay increase “indecent.”

And on February 1, the MQRP published a letter denouncing working conditions of nurses. “The nurses are exhausted by a heavy workload. They argue that the chronic lack of staff and the fatigue caused by repeated overtime, sometimes mandatory, for lack of replacement of the team, have an impact on the safety of patient care,” the letter says.



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Elon Musk agrees with Trump on China’s car tariffs

President Trump and Tesla CEO Elon Musk are on the same page regarding China’s car tariffs.

Musk asked Trump on Twitter if there should be “equal & fair rules” between the U.S. and China concerning cars, noting that China places a 25 percent import duty on American vehicles but the U.S. only places a 2.5 percent import duty on cars from China.

“Do you think the US & China should have equal & fair rules for cars? Meaning, same import duties, ownership constraints & other factors,” Musk said on Twitter Thursday.

“I am against import duties in general, but the current rules make things very difficult. It’s like competing in an Olympic race wearing lead shoes,” he added.

Trump signed a proclamation Thursday to exert a 25 percent tariff on most steel imports and a 10 percent tariff on most aluminum imports.

Trump read Musk’s tweets out loud at a press conference about the steel and aluminum tariffs.

“We are going to be doing a reciprocal tax program at some point, so that if China is going to charge us 25 percent or if India is going to charge us 75 percent and we charge them nothing … We’re going to be at those same numbers. It’s called reciprocal, a mirror tax,” Trump added.

The Trump administration has requested an arrangement with China that would trim the U.S. annual trade deficit with China by $100 billion, the Wall Street Journal reports.



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