Comparing The Flu Response

April 4, 2021
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Why were certain American cities hit brutally hard by the 1918 flu pandemic while others were spared?

“Schools, theaters, churches and dance halls in cities across the country were closed. Kansas City banned weddings and funerals if more than 20 people were to be in attendance. New York mandated staggered shifts at factories to reduce rush hour commuter traffic. Seattle’s mayor ordered his constituents to wear face masks.”

National Institute of Health describing the scene in America during the flu outbreak of 1918.


What They Researched: In 2007, the National Institute of Health funded two studies examining the government response to the flu pandemic of 1918.

What They Found: Government intervention (containment/restrictions) worked to help slow the spread of the flu, but the real life-saving factor: how quickly the measures were put in place.

One Example

Both St. Louis and Philadelphia put similar measures in place, such as banning large gatherings.

St. Louis put the ban in place 48 hours after first cases emerged.

Philadelphia put the ban in place two weeks after first cases emerged.

“Peak mortality” rates in St. Louis were 1/8 that of Philadelphia.


“… had San Francisco left its controls in place continuously from September 1918 through May 1919, the analysis suggests, the city might have reduced deaths by more than 90 percent.

Researchers concluded this about public measures: the earlier the better, and the longer imposed, the more effective. Many cities removed measures too early allowing re-transmission to occur.


“… in the event of a severe pandemic, cities will likely need to maintain (non-pharmaceutical interventions) for longer than the 2–8 weeks that was the norm in 1918.”

Both studies note the challenges of comparing the past and present. However, both came to the conclusion that during a pandemic with no vaccine, public measures may need to be in place longer than previously believed.

Something To Consider

Researchers said finding precise public measures, their timing and how effective (how many people REALLY followed the guidance) is challenging.

Some cities, like Philadelphia, handled a large influx of soldiers from WWI where others did not. This is one reason for the disease spread – but also a factor for concentrated mortality rates.

"…nonpharmaceutical interventions may buy valuable time at the beginning of a pandemic while a targeted vaccine is being produced.” Dr. Anthony Fauci reacting to this 2007 study. Dr. Fauci remains at the NIH’s National Institute of Allergy & Infectious Diseases, helping to lead the U.S. response to COVID-19.

Why Comparisons Between COVID-19 to the Flu Don’t Work: CLICK

by Jenna Lee,