History provides great insights about the importance of honest gov't communication, trust in local, state, & federal officials, information distribution, & most of all proactive efforts to get ahead of a public health emergency. Let's consider the 1918 influenza epidemic. Thread.
I will begin with two main insights from the 1918-1919 period: 1. Where there were cancellations & postponements of large events, gatherings, other activities, as well as efforts to take more precautions, including what we'd now call "SoCals distancing" worked to slow spread.
2. Most Western nations were involved in the war. They attempted to control information, minimize risks, hide real data about infection + mortality, & continued to push hyper-patriotic activities as part of broader war effort. Media was part of this too. Thus, citizens were...
ill-informed and once the outbreak reached proportions that could not be minimized, fear & distrust significantly took over, rendering it much harder to find volunteers to care for others, e.g., than it otherwise would have been.
Also, a note: expectations about public health access and services, ability to treat, and government interventions to assist as well as inform wider publics have increased significantly, so not doing this sort of thing is all the worse in 2020 vis-a-vis 1918.
On to the history: the flu most likely began in Kansas in or around January 1918. Some scholars suggest it is possible origins were in France, China, or Vietnam earlier, but it is clear the outbreak began in the US and spread via soldiers.
At the time flu was not a "reportable" disease, but local Kansas doctors, then at Army bases where it took off flagged the disease as a concern. Federal officials did not respond in any substantive manner. In March the first soldier was documented ill. By late spring see below... 
Funston, Kansas. Appx 24 of the 36 largest US bases reported major outbreaks. Induction facilities, bases training troops for the war, transport vessels and hubs, then the front, were main vectors of global transmission. Consistently combatant nation gov'ts minimized risks
Ok, back to the story: In April and May the flu hit the front. This first wave of wasn't as deadly but it did put troops out of commission, which those in the military were loathe to admit. British Grand Fleet, admitted over 10k sailors to sick bay in May & June (only 4 died).
On some French posts more than half of their soldiers were unable to fight, and yet the flu seemed to be more of a nuisance, and it was often referred to as the "three day fever" (a seemingly soothing term that then circulated among civilian populations, see NY, Oct. 1918 below)
But it was when King Alonso VIII of Spain, a noncombatant nation, caught the "flu" as it spread rapidly, that the Spanish press (unlike US, British, French, German...) covered the epidemic & possible treatments in great detail, giving rise to the impression it was a "Spanish Flu"
May 22, 1918, headlines in Spain rang alarm bells across Europe; still the general pattern was to minimize risks, not take action to prevent gatherings or transmission, and not to share information. By June influenza spanned the globe, from the US to Algeria to New Zealand...
Meanwhile, in the UK, newspapers were legally forbidden from discussing the outbreak under the Defence of the Realm Act (1914). Gov't officials, as in the US, argued prosecution of the war took precedence over informing the public or policy changes to policy to prevent outbreak.
In a few places the writing was on the wall: this would get worse. As John Barry notes, in early summer 1918 "At one French Army post of 1,018 soldiers, 688 were hospitalized and 49 died—5 percent of that population of young men, dead."
Still, as the summer months of 1918 pushed forward US, British, French, and other observers saw cause for optimism, justifying their secrecy, minimizing of risks, and prioritization of the war. US troops + material seemed to be pushing the catastrophic war toward a conclusion
But then, as we now know, the influenza cropped up, far worse, in Switzerland in July and August. The second wave was coming it and it would make the first one pale in comparison...
This prompted a US Naval intelligence officer, in a report stamped “Secret and Confidential,” warned “that the disease now epidemic throughout Switzerland is what is commonly known as the black plague, although it is designated as Spanish sickness & grip.” encyclopedia.1914-1918-online.net/article/influe…
From late summer through fall Western gov'ts, local, regional, state, and federal generally and catastrophically stuck to their guns; they continued to minimize, not be proactive about containment or quarantine, not share information widely, and even to endorse gatherings.
Part II, in the US..."it is the same as the grip" "new name for an old familiar disease" Even as Boston was getting hit very hard in September, starting with a military base at Camp Devens, governors, mayors, & the media kept saying the influenza so bad, go about your business...
The US's Sedition Act, like the UK's Defense of the Realm Act, pushed politicians and the media to obfuscate and lie. The propaganda machine of the Committee on Public Information propelled the flu epidemic. c-span.org/video/?c466982…
Woodrow Wilson & top officials contemplated but rejected stopping transports to Europe to prevent spread, near the end of the war. Wilson was briefed on more information sharing, as well as policies related to events including distancing would help prevent US spread. No action.
The end of September the influenza had spread across the country, largely at and via military training camps -- so much so that on September 26th the Army canceled its nationwide draft call. And yet no blanket federal policies (possible under wartime conditions) were announced.
H/T to John Barry for quote. The US Surgeon General Rupert Blue argued, still, that “There is no cause for alarm if precautions are observed.”
New York City’s public health director declared “other bronchial diseases and not the so-called Spanish influenza...[caused] the illness of the majority of persons who were reported ill with influenza.”
LA's public health chief said, “If ordinary precautions are observed there is no cause for alarm.” Health officials were not prepared. But by Oct 10, LA city council passed Ordinance 38522 imposing a quarantine of schools, theaters, & public gatherings. scpr.org/programs/offra…
The best and most well known point-counterpoint for lessons learned is St. Lous vs. Philadelphia in September 1918. Philly officials blithely went forward with a Liberty Loan Parade on Sept. 28 1918 smithsonianmag.com/history/philad…
Within 72 hours of the parade, virtually every bed in Philadelphia’s 31 hospitals was filled. By October 5, app. 2,600 people had died from the flu/complications. 7 days later it was up to 4,500. daily.jstor.org/the-1918-parad…
In contrast, in St. Louis (US's 4th biggest city), tracking nearby outbreaks City Health Commissioner Dr. Max Starkloff working with Mayor Henry Kiel, on Oct. 7 closed city schools, theatres, movie houses, + banned public gatherings of more than 20 people. Oct. 8 closed churches.
St. Louis, courts, playgrounds, libraries, all closed, public transport was limited, even stores operated with heavy restrictions. Thus, St. Louis had one of the lowest infection + death rates of any comparable city. See St. Louis vs. Kansas City ncbi.nlm.nih.gov/pmc/articles/P…
Officials sticking to their response strategies & not adapting is another major lesson. Philadelphia's public health director, Wilmer Krusen, though he could confine the outbreak, pushed for parade. Even after he kept saying not to be “panic stricken over exaggerated reports.”
The Philly and national media did not help. If they even acknowledged it, they kept suggesting what was happening with the military could be kept away from the civilian population.
Worse yet, media + pols held up modern science as a miracle path forward. No need to worry or be particularly proactive (sound familiar?), they asserted. "Scientific Nursing Halting Epidemic," said the Philadelphia Inquirer
October 15, 1918. So Americans were confused & fearful.
October 15, 1918. So Americans were confused & fearful.
Again the Philadelphia case's lies + naive optimism is tragically insightful. As John Barry writes: "At its worst, the epidemic in Philadelphia would kill 759 people...in one day. Priests drove horse-drawn carts down city streets, calling upon residents to bring out their dead"
"...many were buried in mass graves. More than 12,000 Philadelphians died—nearly all of them in six weeks." smithsonianmag.com/history/journa…
Deep into October, now staggering numbers of people infected + dying (over 50% of San Antonio was infected, Kansas City was ravaged), draft disbanded, fear was taking deep hold. Volunteers became harder to find to care for the sick, many medical professional still in army.
Many employers found 50% of the work force out at any given time. There are amazing social histories of this moment (final book and article recs to come at the end of the thread)...
But here's a telling quote, via John Barry again: In the nation's capital, Washington, D.C., William Sardo said, “It kept people apart...You had no school life, you had no church life, you had nothing...It completely destroyed all family and community life...
Sardo, cont'd: "The terrifying aspect was when each day dawned you didn’t know whether you would be there when the sun set that day.” theatlantic.com/photo/2018/04/…
Among the things that stand out across the nations and peoples responding to the global influenza epidemic in 1918-1919 is how much government and media complicity in minimizing the risks, botching the responses, led to fear, atomism, & a lack of unity when it was needed most.
In the U.S., it was mayors, city/local health chiefs, local doctors, & governors who were the advance guard; those that were most proactive and cautious, most willing to flaunt the federal gov't seemed to do best in hindsight. history.com/news/spanish-f…
Holding church services, court proceedings, barber shops, classes outside, trying masks, and limiting gatherings as well as public transit were solid first measures that at least conveyed the gravity of the situation.
Baltimore took action October 12, along similar lines to St. Louis, and it was hard for officials, who often faced push back from clergy, business leaders, and others ... by Nov. 8 things were a bit better... baltimoresun.com/maryland/carro…
I'd be remiss not to talk about the global stakes & the waves of influenza epidemic. The early 1918 first wave wasn't as bad; it reinforced insular, minimizing reactions by wartime governments & media, leaving most nations ill-prepared or worse for the far more deadly second wave
Around the world, the less developed nations & health systems fared far worse. Estimates suggest Mexico had 2.3-4% of population death rates. Russia and Iran seemingly were near 7% population mortality. In small villages in Africa + Alaska everyone died.
On Fiji Islands in 1918, in just over two weeks 14% of the population died; other islands/communities had similar numbers. Why? In part because without preparation + policy, when nearly everyone is sick, there is no one to care for them-thus the concern with flattening the curve
These are my thoughts but they are derived from some exceptional work by fellow historians, scholars, writers
With links, I highly recommend
If you are thinking about what to advocate for now in terms of how to understand particularly the US's history with the influenza epidemic consider urban history + social distancing: This chart of the 1918 Spanish flu shows why social distancing works qz.com/1816060/
Early Release - Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures - Volume 26, Number 5—May 2020 - Emerging Infectious Diseases journal - CDC wwwnc.cdc.gov/eid/article/26… via @CDCgov
Social distancing could buy U.S. valuable time against coronavirus @washingtonpost washingtonpost.com/health/2020/03…
1918-1919 US & #WWI combatant nations minimized outbreak knowledge, prevented reporting, did not distribute honest information, & did not take proactive steps to limit transmission nationally or international. This facilitated wider spread & generated fear + distrust.
As NY responded, they pushed lines like "every bit helps" re: covering sneezes (Oct. 7, 1918)
In Fall 1918 as it became clear states needed to push prevention, they developed handy information like the following from Virginia
In September 1918, at last, the military really began to kick up their own recommendations Directive from Washington, D.C., regarding treatment and procedures, Sept. 26, 1918,
Naval Districts and Shore Establishments.
Naval Districts and Shore Establishments.
Again, so much of the overall approach (for better & worse), in absence of Fed leadership came from local levels -- consider this telegram from county food administrator to headquarters, Oklahoma City, re: cancellation of public meetings, Oct 3, 1918. U.S. Food Administration.
Deadly siege: 1918 flu slammed Pacific County chinookobserver.com/news/local/dea…
For some excellent teaching materials and primary sources on the Influenza Epidemic of 1918, including those used in this thread, see @USNatArchives archives.gov/exhibits/influ…
I will begin with two main insights from the 1918-1919 period: 1. Where there were cancellations & postponements of large events, gatherings, other activities, as well as efforts to take more precautions, including what we'd now call "social distancing" worked to slow spread.
I will begin with two main insights from the 1918-1919 period: 1. Where there were cancellations & postponements of large events, gatherings, other activities, as well as efforts to take more precautions, including what we'd now call "social distancing" worked to slow spread.
Sorry that this thread is so long and a bit messy, still, I hope it is illuminating.
