1918 Spanish Flu: Cities enforcing early restrictions lowered death rates

"The stricter the isolation policies, the lower the mortality rate"

Virus Outbreak Hungary Doctors take on protective suits before they enter the isolation room at the care unit of the new COVID-19 infected patients inside the Koranyi National Institute of Pulmonology in Budapest, Hungary | AP

Researchers analysing the preventative measures adopted during the 1918 'Spanish flu'—the deadliest pandemic of the 20th century—have found that cities which enforced early, broad isolation and prevention measures had lower mortality rates.

The influenza pandemic, caused by an H1N1 virus with genes of avian origin, killed more than 50 million worldwide. Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic that affected one-fifth to one-third of the world's population.

With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can 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.

The scientists, including Stefan E. Pambuccian from Loyola University in the US, reviewed published research from three papers, said measures like closing of schools, banning of mass gatherings, and mandated mask wearing, case isolation and disinfection/hygiene measures were effective in curtailing the disease in several cities.

According to the review research, published in the Journal of the American Society of Cytopathology, the US cities San Francisco, St. Louis, Milwaukee and Kansas City collectively had 30 to 50 per cent lower disease and mortality rates than cities that enacted fewer and later restrictions.

One study the scientists reviewed showed that these cities also had greater delays in reaching peak mortality, with the duration of the controlling measures correlating with a reduced total mortality burden.

"The stricter the isolation policies, the lower the mortality rate," Pambuccian said.

The Loyola University scientists said just like in the current COVID-19 pandemic, many people in 1918 and 1919 thought the strict measures were not appropriate or effective at the time.

The Spanish flu killed an estimated 675,000 in the US, "and there was skepticism that these policies were actually working," Pambuccian said, adding that the measures adopted did indeed make a difference.

"In 1918, the world was still at war "with overcrowded barracks," with much of the US living with "poverty, poor nutrition, poor hygiene, household/community-level crowding, and a lack of preparation of the population and decision makers due to cognitive inertia and poor medical and insufficient nursing care," Pambuccian said.

"Although the world is a much different place than it was 100 years ago, the efficacy of the measures instituted during the 1918-19 pandemic gives us hope that the current measures will also limit the impact of the COVID-19 pandemic," he added.

(With input from PTI)

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