Monday, March 23, 2020

A Social Distancing History Lesson -- Philadelphia vs. St. Louis in 1918


1918 Liberty Loan Parade

When the influenza epidemic of 1918 infected a quarter of the U.S. population, killing hundreds of thousands nationally and millions across the globe, seemingly small choices made the difference between life and death.

As the disease was spreading, Wilmer Krusen, Philadelphia’s health commissioner, allowed a huge parade to take place on September 28; some 200,000 people marched. In the following days and weeks, the bodies piled up in the city’s morgues. (Within 72 hours, every bed in Philadelphia's 31 hospitals was filled. And, by the end of the next week, more than 4,500 were dead.) By the end of the season, 12,000 residents had died.

In St. Louis, a public-health commissioner named Max Starkloff decided to shut the city down. Ignoring the objections of influential businessmen, he closed the city’s schools, bars, cinemas, and sporting events. Thanks to his bold and unpopular actions, the per capita fatality rate in St. Louis was half that of Philadelphia. (In total, roughly 1,700 people died from influenza in St Louis.)”

(Yascha Mounk. “Cancel Everything.” The Atlantic. March 10, 2020.)

Though the H1N1 virus infected 80% of the population in Spain, it seemed far away from Philadelphia – it mainly spread through Europe and Asia, according to information from the University of Pennsylvania Archives & Records Center.

The virus didn't reach the US until the spring of 1918, among military personnel, the CDC says. As US troops came home from World War I, cases popped up in cities like Boston.

Leah Asmelash of CNN relates what happened in Philadelphia ...

The virus spread to Philadelphia on September 19, 1918, through the Philadelphia Navy Yard, U.Penn states. In a matter of days, 600 sailors had the virus. Yet, Philadelphia didn't cancel its Liberty Loan Parade (to promote government bonds issued to apy for Worl War I), scheduled for just a little more than a week later. Meant to be a patriotic wartime effort, the parade went on as scheduled on September 28, bringing 200,000 Philadelphians together.”

Make no mistake, the parade wasn't all to blame. Other factors contributed to the flu's spread, including high population and poor working and living conditions. Still, it's an example of what not to do during a pandemic, according to CDC's Division of Global Migration and Quarantine.

A different story played out in St. Louis, just 900 miles away. Within two days of detecting its first cases among civilians, the city closed schools, playgrounds, libraries, courtrooms, and even churches. Work shifts were staggered and streetcar ridership was strictly limited. Public gatherings of more than 20 people were banned.

The key to social distancing appears to be the speed to which its initiated. Philadelphia delayed and the consequences were severe.

This is an important historical report of the effectiveness of social distancing and other measures taken during the 1918 Pandemic (H1N1 virus). It is imperative to apply this American history lesson to the 2020 COVID-19 Coronavirus disease. Drastic measures are in place to stop the spread of the disease and to save potentially millions of lives. The people of the United States must adhere to critical instructions and restrictions that protect all citizens. No one can imagine what might happen if large groups of people ignore the regulations.


Understanding Parallels to the Past

The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919. In the United States, it was first identified in military personnel in spring 1918. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.

Like the 1918 influenza, COVID-19 has the potential to maim and kill untold numbers of people. In 1918, with no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that could be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.

Social control measures such as closing schools and banning public gatherings played a significant role in slowing the advance of the 1918 influenza pandemic in a number of U.S. cities, but their success depended on how soon the measures were deployed and how slowly they were lifted.

Research

Research supports social distancing. In 2007, Proceedings of the National Academy of Sciences (PNAS) were the first to give statistical support to the past usefulness of nonpharmaceutical interventions (NPIs), the term for an array of social-distancing measures such as school closures and business "snow days" that planners believe may mitigate the impact of future flu pandemics.

Neil Ferguson, D.Phil., director of the MRC Centre for Outbreak Analysis and Modeling at Imperial College London and lead author of one of the 2007 papers said …

"We have had (as of 2007) very little data to suggest that NPIs could have a major effect on transmission during a pandemic; these things have not been looked at in a robust way. This is the first indication that maybe they would work if you are prepared to bite the bullet and accept the inherent costs."

Nancy Tomes, PhD. relates her research and the importance of the lessons learned from the 1918-1919 pandemic. History can teach us all valuable lessons. Please be aware of this one and also be willing to apply the knowledge to defeat the coronavirus of 2020.

The influenza pandemic came to the United States, wrote physician George Price in December 1918, in the guise of both “destroyer and teacher.” Like the Black Death had centuries before, he observed, influenza had many lessons to teach, if only people were wise enough to comprehend them …

The Spanish influenza arrived in the United States at a time when new forms of mass transportation, mass media, mass consumption, and mass warfare had vastly expanded the public places in which communicable diseases could spread. Faced with a deadly 'crowd' disease, public health authorities tried to implement social-distancing measures at an unprecedented level of intensity.

Recent historical work suggests that the early and sustained imposition of gathering bans, school closures, and other social-distancing measures significantly reduced mortality rates during the 1918–1919 epidemics. This finding makes it all the more important to understand the sources of resistance to such measures, especially since social-distancing measures remain a vital tool in managing the current H1N1 influenza pandemic. To that end, this historical analysis revisits the public health lessons learned during the 1918–1919 pandemic and reflects on their relevance for the present.”

(Nancy Tomes. “Destroyer and Teacher”: Managing the Masses During the 1918–1919 Influenza Pandemic.” Public Health Rep. 2010; 125. Suppl 3: 48–62. 2010)




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