Lessons to be learned from the Spanish flu pandemic of 1919 -Part 2 -Pearls and Irritations (original) (raw)
Spanish influenza of 1918-19: The extent and spread in South Australia
Australasian epidemiologist, 2015
The 1918-19 Spanish influenza was the first pandemic for which official records were compiled in South Australia. This followed the recognition of the disease as notifiable under the Public Health Act and the establishment of a surveillance system by the then South Australia Central Health Board (a precursor to the current South Australian Health Department). This is the first paper to describe the Spanish influenza epidemic for South Australia from an epidemiological and geographical perspective. Notification numbers were retrieved from the South Australian Central Health Board meeting records. Data were entered into an Excel spreadsheet and Epi info 7 software to enable a geographical analysis. There were 8,839 influenza notifications: of these, 4,854 (55.0%) originated from metropolitan areas (Attack Rate 9.9 per 1,000 population) and 3,985 notifications (45.0%) originated from regional areas (Attack Rate 8.0 per 1,000 population). There was a lack of comprehensive epidemiologica...
The 1918 Spanish influenza pandemic: plus ça change, plus c’est la même chose
Microbiology Australia, 2020
Towards the end of world war one, the world faced a pandemic, caused not by smallpox or bubonic plague, but by an influenza A virus. The 1918–19 influenza pandemic was possibly the worst single natural disaster of all time, infecting an estimated 500 million people, or one third of the world population and killing between 20 and 100 million people in just over one year. The impact of the virus may have influenced the outcome of the first world war and killed more people than the war itself. The pandemic resulted in global economic disruption. It was a stimulus to establishment of local vaccine production in Australia. Those cities that removed public health restrictions too early experienced a second wave of infections. Unfortunately, it seems that the lessons of infection control and epidemic preparedness must be relearnt in every generation and for each new epidemic.
THE SPANISH FLU PANDEMIC – A LESSON NOT LEARNED
The Covid-19 pandemic that began last year inevitably prompted scientists to look back at the last major Spanish flu pandemic that occurred a century ago, sweeping across the globe and contributing to massive human losses from which some nations had to recover. Much like today, the threat of the Spanish flu was initially underestimated, most likely due to the hostilities happening as a result of WWI. The War ended, but the virus evolved from an epidemic to a major, unprecedented pandemic. Authorities reacted slowly to the spread of the flu, and the health system was completely unprepared to deal with the new and unknown danger. At first, even doctors, virologists, and epidemiologists could not come to terms with the type of virus they were dealing with. However, as the pandemic spread, the world adapted to the new conditions. States and local authorities introduced a series of restrictive measures to prevent the spread of the virus, hygiene measures were tightened, and there were orders for the mandatory wearing of masks, as well as the closure of shops, and cultural and educational institutions. There are many points that are similar from the time of the Spanish flu pandemic to today's conditions related to Covid-19. Just as it had unexpectedly appeared in 1918, the Spanish flu disappeared in 1920. It took scientists more than a decade after the end of the pandemic to discover the cause of the outbreak, but even today there are still many unknowns related to the Spanish flu.
Bulletin of The World Health Organization, 2009
Objective To examine the level of stated compliance with public health pandemic influenza control measures and explore factors influencing cooperation for pandemic influenza control in Australia. Methods A computer-assisted telephone interview survey was conducted by professional interviewers to collect information on the Australian public's knowledge of pandemic influenza and willingness to comply with public health control measures. The sample was randomly selected using an electronic database and printed telephone directories to ensure sample representativeness from all Australian states and territories. After we described pandemic influenza to the respondents to ensure they understood the significance of the issue, the questions on compliance were repeated and changes in responses were analysed with McNemar's test for paired data. Findings Only 23% of the 1166 respondents demonstrated a clear understanding of the term "pandemic influenza". Of those interviewed, 94.1% reported being willing to comply with home quarantine; 94.2%, to avoid public events; and 90.7%, to postpone social gatherings. After we explained the meaning of "pandemic" to interviewees, stated compliance increased significantly (to 97.5%, 98.3% and 97.2% respectively). Those who reported being unfamiliar with the term "pandemic influenza," male respondents and employed people not able to work from home were less willing to comply. Conclusion In Australia, should the threat arise, compliance with containment measures against pandemic influenza is likely to be high, yet it could be further enhanced through a public education programme conveying just a few key messages. A basic understanding of pandemic influenza is associated with stated willingness to comply with containment measures. Investing now in promoting measures to prepare for a pandemic or other health emergency will have considerable value. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. املقالة. لهذه الكامل النص نهاية يف الخالصة لهذه العربية الرتجمة
A Case Study on the Spanish Flu 1918 - How it burrowed Into the City of New Orleans
International Journal of Science and Research (IJSR)
The influenza outbreak killed more people in New Orleans than had died even in the very worst yellow fever epidemics. How did the outbreak turn into this destructive form initially, health workers misjudged the virus' threat. Citizens have not heeded advice to stop public demonstrations, and have opted to attend parades and protests. Victims died instantly, often within hours following an illness. The advent of the ship represented New Orleans' first exposure of a disease that eventually killed at least 40 million people around the worldand forced health care providers here and beyond to enforce the same kind of social distancing steps that officials have requested in the face of the current coronavirus threat: quarantine of the infected, quarantining those exposed to them, the prohibition of mass gatherings and public interactions. They acquire time to study, physicians, and hospitals to treat the current patients without comorbidities collapsing in the health care system, researchers to develop vaccines for others, and drug companies to generate and administer the vaccination. But New Orleans took longer than many other large U.S. cities in 1918 to begin implementing social distancing measuresseven days after the local death rate rose on Oct. 1. And New Orleans had their sanctions lifted fairly early: after 78 days. Social distancing may be the best solution if viewed purely from the viewpoint of public health, they say, but these are the decision-making government officials, and they have to calibrate public health, timing, economics, and common opinion. The epidemic that lasted until 1918-1919, is considered the deadliest pandemic in human history. Today, as the world is grinding to a halt in reaction to the coronavirus, the 1918 epidemic is being examined by scientists and historians as clues to the most successful way to avoid a global pandemic. The then-implemented attempts to curb the spread of flu, may gilessons for combating the curb the illness.
The impact of pandemic influenza, with special reference to 1918
International Congress Series, 2001
Pandemic influenza, by definition, affects the overwhelming majority of countries and population subgroups in the world in a very short period of time. The impact of pandemics is not merely a matter of the biology of the particular virus in individuals. Pandemics are a social phenomenon affected by prevailing social circumstances, e.g., war, economic conditions, crowding, and food supply. In turn, pandemics affect social organization and events, e.g., governance and famine. Much of the study of pandemic influenza has been in industrialized countries in temperate zones; the occurrence of excess morbidity and mortality, and the strain on health care and other services in these countries are well known. A conference in 1998 brought together an increasingly large body of historical research about the pandemic of ''Spanish influenza'' in 1918-1919. It included interesting contributions about the impact of the pandemic in areas such as sub-Saharan Africa, India (where mortality is estimated at 17 million, or about half the world total), and the Pacific Islands. There are important lessons for contemporary society from the impact of the pandemic of 1918-1919 and other pandemics. One can make a compelling case for pandemic preparedness, including developing and executing strategies both to prevent and to ameliorate pandemic spread.
“Destroyer and Teacher”: Managing the Masses during the 1918–1919 Influenza Pandemic
Public Health Reports, 2010
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.
PLoS ONE, 2009
Background: Influenza causes annual epidemics and often results in extensive outbreaks in closed communities. To minimize transmission, a range of interventions have been suggested. For these to be effective, an accurate and timely diagnosis of influenza is required. This is confirmed by a positive laboratory test result in an individual whose symptoms are consistent with a predefined clinical case definition. However, the utility of these clinical case definitions and laboratory testing in mass gathering outbreaks remains unknown. Methods and Results: An influenza outbreak was identified during World Youth Day 2008 in Sydney. From the data collected on pilgrims presenting to a single clinic, a Markov model was developed and validated against the actual epidemic curve. Simulations were performed to examine the utility of different clinical case definitions and laboratory testing strategies for containment of influenza outbreaks. Clinical case definitions were found to have the greatest impact on averting further cases with no added benefit when combined with any laboratory test. Although nucleic acid testing (NAT) demonstrated higher utility than indirect immunofluorescence antigen or on-site point-of-care testing, this effect was lost when laboratory NAT turnaround times was included. The main benefit of laboratory confirmation was limited to identification of true influenza cases amenable to interventions such as antiviral therapy. Conclusions: Continuous re-evaluation of case definitions and laboratory testing strategies are essential for effective management of influenza outbreaks during mass gatherings.
Canadian Medical Association Journal, 2007
I n spring 2003 the largest outbreak of severe acute respira- tory syndrome (SARS) outside Asia occurred in Toronto, Ont., including 257 probable cases and 43 deaths. 1 Transmission of SARS was largely confined to hospitals through contact with infected patients. To limit the spread of SARS, a provincial health emergency was declared, with widespread restrictions on the nonurgent use of hospital-based services at all 32 hospitals in the Greater Toronto Area. Ambulatory and inpatient medical and surgical activity was restricted to urgent cases, and respiratory isolation rooms were expanded. In addition, visitor access was severely restricted, and the use of personal protective equipment by staff in high-risk areas was mandated. Three community hospitals were closed for a few weeks to several months. A centralized system was created to screen all requests for inter-hospital patient transfers. 2 These restrictions lacked measures to mitigate the impact on potentially vulnerable patients, such as those with chronic diseases, elderly patients and low-income patients. Our objectives were to determine the extent to which these restrictions reduced the use of elective hospital-based services. We also sought to determine whether these restrictions disrupted urgent services or affected vulnerable patient groups and whether there were spillover effects into other sectors of the health care system or areas of the province that were not targeted by the restrictions. The results of our study may assist health care planners in designing large health care systems with better adaptability during epidemics, when restrictions may be needed to limit nosocomial spread or to increase hospital capacity. The study population comprised all Ontario residents with a valid health insurance number who resided in the Greater Toronto Area (hereafter referred to as Toronto), London or Ottawa from March 2000 to April 2004. All of the hospitals that were subject to SARS restrictions were located in Toronto. Ottawa and London were chosen as regions for comparison because they are large urban centres with multiple hospital sites and tertiary care hospitals that form organizationally complex, self-contained health care systems and because they are sufficiently distant from Toronto to make
2020
Since the introduction of COVID-19-related public health measures, notifications for most nationally notifiable diseases have declined when compared to previous years. Physical distancing, travel restrictions, and emphasis on hygiene are likely to have affected the number of expected notifications, with the greatest reductions observed among disease spread via person-to-person contact such as influenza, and among overseas-acquired infections such as dengue virus and measles. However, quantifying the magnitude of the effect of COVID-19 public health measures on communicable diseases in Australia will be difficult, due to confounding factors such as: changes in testing priorities in laboratories; diversion of resources to the COVID-19 response; changes in health-seeking behaviours; greater utilisation of telehealth practices; and financial impacts such as income loss and ability to afford healthcare. It is considered likely that these other factors will have also impacted notification...
The "Spanish Flu" of 1918: Exploring the Rampant Spread and America's Response
The 1918 flu pandemic, also known as the "Spanish flu," is one of the deadliest pandemics ever. This essay explores how the pandemic started and spread in America, providing insight into its initial appearance and subsequent spread. By examining primary sources and scholarly accounts, this essay examines the introduction of the 1918 flu to American shores, tracing its pathways and patterns of transmission. Moreover, this essay sheds lights on the precautionary measures taken by American authorities to mitigate the impact of the pandemic. Through an evaluation of public health campaigns, quarantine protocols, and community responses, this essay highlights the strategies implemented to safeguard public health. By describing the historical context and giving a clear overview of how the 1918 flu started and spread in America, this essay helps us understand it better and learn from it for future pandemics. The findings show the importance of taking proactive measures to control diseases, which can teach us valuable lessons for future public health crises.
The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response
Public Health Reports, 2010
New York City approached the 1918 influenza epidemic by making use of its existing robust public health infrastructure. Health officials worked to prevent the spread of contagion by distancing healthy New Yorkers from those infected, increasing disease surveillance capacities, and mounting a large-scale health education campaign while regulating public spaces such as schools and theaters. Control measures, such as those used for spitting, were implemented through a spectrum of mandatory and voluntary measures. Most of New York City's public health responses to influenza were adapted from its previous campaigns against tuberculosis, suggesting that a city's existing public health infrastructure plays an important role in shaping its practices and policies during an epidemic.
Boats, trains, and immunity: the spread of the Spanish flu on the island of Newfoundland
2007
When the Spanish Flu began sweeping the globe in the waning months of World War I few could have imagined that nearly one-third of the world's population would become infected and that it would kill many more people than the War itself (Burnet and Clark 1942; Barry 2004; Taubenberger and Morens 2006). The pandemic was a truly global phenomenon that touched nearly every country of the world (see Phillips and Killingray [2003] for examples of experiences with the epidemic in a variety of places). Estimates of the overall mortality from the flu vary widely, but a recent comprehensive review of the data places the level at 50 million or more (Johnson and Mueller 2002). It is unlikely that the actual number of deaths will ever be certain because many regions known to have experienced the epidemic did not keep adequate records of births, deaths, illness, and other vital statistics. This problem is also complicated by the fact that at the time of the epidemic, doctors were not obligated to report influenza to the health authorities in either the United States (Crosby 1989) or most other parts of the world. Furthermore, the epidemic was so severe in many places that it was probably difficult for medical staff to keep up with the recordkeeping needed to ensure accuracy. Taking into account data uncertainties as much as possible, Johnson and Mueller (2002) estimate that the worldwide mortality rate averaged 2.5-5 deaths per thousand population (0.25-0.5%), although this average obscures substantial heterogeneity across regions and even communities. For example, estimates of death rates in the Americas range from 1.2 per thousand in Argentina to 39.2 per thousand in Guatemala, Australia experienced an estimated death rate of only 2.7 per thousand, while the death rate in Fiji has been estimated at 54.9 per thousand. Significant heterogeneity was also apparent at the community level. Analysis of the data to be described below suggests that the overall death rate in Newfoundland and Labrador was only about 5 per thousand, a level similar to the worldwide average, but two communities in Northern Labrador, Hebron and Okak, experienced 68 percent and 78 percent (680 and 780 per thousand) mortality, respectively (Markham 474 Palmer, Sattenspiel, and Cassidy 1986). The situation in Okak was so severe that the community was completely abandoned following the epidemic. Where the flu originated and how it spanned the globe remain matters of debate, although numerous studies have documented that its worldwide spread was clearly associated with the movement of military troops during the last few months of World War I (see, for example, Pettigrew 1983; Crosby 1989; Zylberman 2003; Smallman-Raynor and Cliff 2004). Most scholars who have studied the epidemic believe that it arose in the United States in the early spring of 1918, with the most common scenario being that it began in Kansas (Vaughan 1921; Burnet and Clark 1942; Crosby 1989). Scholars also generally agree that there were three separate waves of Spanish Flu in most places and in some areas there appeared to be an "echo" wave in 1920. It is important to note, however, that although the pandemic is usually characterized by three waves, there was much geographic heterogeneity in its local expression, with some regions experiencing three distinct waves and others experiencing only two or even just one wave (Vaughan 1921; Jordan 1927; Pyle 1986; Crosby 1989; Potter 2001). In addition, there is some evidence for multiple peaks within individual waves in some places (Vaughan 1921). The first wave of the epidemic is usually considered to cover the time from its apparent arrival in March or April of 1918 until the end of July 1918. From its likely origin in the midwestern United States, the epidemic spread to military bases in several midwestern and southeastern US states. American soldiers probably carried the flu to France in early April from which it spread to other parts of Europe. There is some uncertainty about the US origin, however, because China, Japan, and France all reported some cases of flu in