1918 Flu Epidemic Teaching Valuable Lessons - Actions Taken Apparently Were Effective

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1918 Flu Epidemic Teaching Valuable Lessons Actions Taken Apparently Were

Effective

http://www.washingtonpost.com/wp-dyn/content/article/2006/12/12/AR2006121201628.\

html

By Brown

Washington Post Staff Writer

Wednesday, December 13, 2006; Page A04

New analysis of how American cities responded to the killer Spanish flu of

1918 suggests that closing schools, banning large gatherings, staggering work

hours and quarantining households of the ill may have saved tens of thousands of

lives.

Which of the many non-pharmaceutical interventions was especially effective in

reducing mortality is unknown, but all would theoretically be available should

pandemic influenza again sweep the country.

The new findings run counter to previous research that concluded that the

public health measures instituted in 1918 may have delayed or dampened the

epidemic in many cities but probably had little effect on the ultimate death

toll.

The new data were presented this week to Centers for Disease Control and

Prevention experts, who are helping to draw up guidelines for what local health

departments might do during the early stage of an influenza pandemic, when a

vaccine would be unavailable and there would be too few antiviral drugs to go

around.

" There is reason for optimism. Even almost 100 years ago, with some very

simple tools, there may have been an effect of these measures, " said

Cetron, a physician who directs global migration and quarantine at the CDC.

Many epidemiologists think the time is ripe for an influenza pandemic: the

outbreak of a novel, contagious strain of the virus capable of infecting

virtually everyone on Earth.

The H5N1 strain of avian influenza, which since 2003 has killed millions of

birds and 154 people, mostly in Asia, is considered by many experts to have

pandemic potential. The latest victim was a 35-year-old Indonesian woman who

died Nov. 28 -- the 57th fatal case out of 74 in that country.

In 1918, the public health responses included isolating the ill, quarantining

houses, closing schools, canceling worship services, restricting the size of

funerals and weddings, closing saloons and theaters, restricting door-to-door

sales, discouraging the use of public transportation, staggering the hours of

business and factory operations, imposing curfews and, in some places,

recommending the use of face masks in public.

Markel, a physician and historian at the University of Michigan Medical

School, is leading a project to analyze the experience of 45 American cities,

looking for relationships among flu cases, mortality and public health measures.

The researchers used a model to determine what the epidemic would have looked

like had no measures been taken and compared that result with a city's actual

experience.

St. Louis closed its schools at a time when flu was causing 21 more deaths per

100,000 people per week than what had been seen in previous years. That step --

the earliest taken by any of 33 cities analyzed so far -- appears to have

reduced St. Louis's flu mortality by 70 percent.

Cincinnati responded less quickly, invoking public health measures when excess

deaths from flu were 46 per 100,000. It reduced its potential flu mortality by

45 percent. Philadelphia was extremely late, not acting until its excess death

rate was 250 per 100,000. That reduced mortality by 28 percent, Markel and his

colleagues found.

How U.S. communities would react to a sudden closure of schools is uncertain,

although the experience this past fall of one rural Appalachian county suggests

that there may be little opposition over the short term.

Yancey County, in rural and mountainous western North Carolina, closed its

2,559-student school system from Nov. 2 to 13 because of an outbreak of

influenza B. A random survey of households found that 91 percent supported the

school board's decision.

In half of those households, all the adults worked outside the home. During

that period, one-quarter of them had to take time off from work, mainly because

they were ill themselves or had to care for a sick family member, and not simply

to stay with children not in school, said April J. of the CDC's Epidemic

Intelligence Service, who investigated the outbreak.

In only two of 220 households did adults have to pay for extra child care when

schools were closed. In most cases, relatives and friends stepped in to help,

found.

Randi J. Airola, © 517-819-5926

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