Lessons from the Spanish flu: Early restrictions lowered disease, mortality rates
Cities that adopted early, broad isolation and prevention measures had lower disease and mortality rates during the Spanish flu era.
Large events are cancelled, restaurants and non-essential businesses are closed, and in many states, residents have been asked to shelter in place, all to limit the spread and impact of the COVID-19 coronavirus. But are strict and early isolation and other preventative mandates really effective in minimizing the spread and impact of a disease outbreak?
Dr. Stefan Pambuccian, a Loyola Medicine cytologist, surgical pathologist and professor and vice chair of the Department of Pathology and Laboratory Medicine at Loyola University Chicago Stritch School of Medicine, has reviewed published data and research from three papers dating back to the 1918-19 Spanish flu pandemic, which infected one-fifth to one-third of the world's population and killed 50 million people.
WHAT'S THE IMPACT
Pambuccian studied the Spanish flu, including prevention measures and outcomes, to help develop standards for staffing and safety in the cytology lab, where infectious diseases like the COVID-19 coronavirus are diagnosed and studied at the cellular level.
According to the data and analysis, cities that adopted early, broad isolation and prevention measures -- closing of schools and churches, banning of mass gatherings, mandated mask wearing, case isolation and disinfection/hygiene measures -- had lower disease and mortality rates.
These cities included San Francisco, St. Louis, Milwaukee and Kansas City, which collectively had 30% to 50% lower disease and mortality rates than cities that enacted fewer and later restrictions. One analysis showed that these cities also had greater delays in reaching peak mortality, and the duration of these measures correlated with a reduced total mortality burden.
Like today, not everyone in 1918 and 1919 thought the strict measures were appropriate or effective at the time.
An estimated 675,000 people died in the U.S. from the Spanish flu, and while there was public doubt as to whether these measures were working, they truly did make a difference, despite rampant poverty and poor nutrition and hygiene.
THE LARGER TREND
In anticipation of political resistance, a working group of public health leaders -- with input from more than 50 other experts in public health, healthcare, medicine, and law -- issued its own set of detailed policy recommendations to lawmakers earlier this month.
Among the framework's chief recommendations are large-scale measures around boosting the country's healthcare, testing, and containment capacities; requiring coverage of preventive and diagnostic services related to COVID-19 with no cost-sharing; protecting especially vulnerable populations; providing financial and logistical support to impacted workers and employers; expanding resources and assistance for frontline healthcare providers; facilitating the rapid development of a COVID-19 vaccine and treatment while restricting price-gouging; and investing in key public health infrastructure.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
