PandemicPandemic FluFlu Lessons from 1918: Will It Happen Again? What Will We Do? [email protected] 1918 Pandemic FluSummary 1918 Pandemic FluSummary Sept-Dec 1918 = Deadly “Second Wave” 40 million died worldwide inone year 20 – world was infectedwiththeinfluenza One-quarter oftheU.S.and one-fifth ofthe felltoinfluenza virus “The Great War” Half ofU.S. soldiers,about43,000, whodiedin into itsdeadlyform, perhapsoriginatedin May haveexistedfor yearsbeforeitmutated (1) (1) [email protected] 1918 Pandemic: Pandemic: March fever, sore throat,andheadache hospital justbefore breakfastcomplainingof cook AlbertMitchell reportstothecamp Funston) Kansas: FortRiley, (Camp Morning, March11, 46 diedin this first wave By week's end 522 were sick hospital had107 sicksoldiers By noon,camp surgeonEdward R.Schreiner’s similar complaints Soon followed byCorporalLee W.Drakewith Army privateandcompany (3, 4) (3, 4) [email protected] 1918 Pandemic: March 1918 Pandemic: March (3, 4) (3, 4) Camp Funston Camp Funston [email protected] 1918 Pandemic: Spring - Summer Summer 1918 Pandemic: Spring- 1918 Pandemic: Spring - Summer Summer 1918 Pandemic: Spring- bulletin about“Spanish influenza” July: May: Spreadacross Africa& infected, spread toChinaand Mid-April and itspreadacross theAtlantic April: March 18: public health officials issuea 500 SanQuentinprisoners struckbyflu, French troops andcivilianswere In 7days,everyState hadcases (3, 4) (3, 4) [email protected] 1918 Pandemic: Summer1918 1918 Pandemic: Summer1918 when they first appear. This chart shows why we have to take outbreaks seriously (3, 4) (3, 4) [email protected] 1918 Pandemic: Pandemic: August symptoms of“thegrippe.” Pier begin reportingtosick-bay withtheusual board theReceiving ShipatCommonwealth August 30: August 27 mutates andbecomes highlytoxic. Somewhere inwestern France,thevirus beaten all over with aclub.” Flu sufferers said theyfelt likethey “had been cases transferred toChelsea Naval Hospital Commonwealth Pierwasoverwhelmed, 50 th More than 60sailorssick : Boston, sailorsstationed on (3, 4) (3, 4) [email protected] Second Wave: FiveWeeks Second Wave: FiveWeeks (5) (5) [email protected] Second Wave: FiveWeeks Second Wave: FiveWeeks (5) (5) [email protected] Second Wave: FiveWeeks Second Wave: FiveWeeks (5) (5) [email protected] Second Wave: FiveWeeks Second Wave: FiveWeeks (5) (5) [email protected] Second Wave: FiveWeeks Second Wave: FiveWeeks (5) (5) [email protected] 1918 Pandemic: Pandemic: September Americans die Almost 200,00 busy with warshipments Boston through theport arrivedin radio communications. influenza amongthe 5,000youngmenstudying in Cambridgereports thefirstcasesof The NavyRadioSchool atHarvardUniversity (3) (3) [email protected] 1918 Pandemic: September 1918 Pandemic: September population of the city.” spread tothecivilian disease inallprobability will precautions aretakenthe warned that “unless state health department Dr. JohnS. Hitchcockofthe epidemic isunderway. area newspapersthat an Department ofHealth alerts September 5: Massachusetts (3) (3) [email protected] 1918 Pandemic: September 1918 Pandemic: September Boston, MA Camp Devens September 15 (3, 4) (3, 4) [email protected] 1918 Pandemic: September 1918 Pandemic: September near Boston.Whathe seeschangeshislife: receives urgentorders toproceedCampDevens Dr. VictorVaughn,acting ArmySurgeonGeneral, ees63 menhad died of flu. Devens When Vaughnarrived atCamp cordwood.’” are stacked aboutthemorguelike sputum. Inthe morning,thedeadbodies cast; acough broughtuptheblood-stained full, yetothers crowdedin.Thefaces woreabluish coming into thewardsofhospital. Everybedwas “‘I sawhundredsofyoung stalwartmeninuniform (3, 4) (3, 4) [email protected] Waiting toBeInoculated: CampDeven Waiting toBeInoculated: CampDeven [email protected] 1918 Pandemic: September 1918 Pandemic: September take it.) poison Americans andwould not people thought itwasa plot to by Bayer in ,somany (But Aspirin hadjustbeeninvented quinine, and aspirinforthesick. Blue prescribed bedrest,good food,saltsof on howtorecognize theinfluenzasymptoms. Health Service,dispatches advicetothepress US SurgeonGeneral RupertBlue,U.S.Public (3) (3) [email protected] 1918 Pandemic: September 1918 Pandemic: September influenza strikingAmericans (bioterrorism). Corporation blames theGermansfor Sanitation Section, EmergencyFleet Lt. Col.PhilipDoane, headoftheHealthand particularly gentle withAmerica.” and there isno reason why theyshould be Germans have startedepidemics inEurope, numbers of personsareassembled. The a theateror someotherplace where large agents toturn looseSpanishinfluenza germsin “It wouldbe quiteeasyforone oftheseGerman (3) (3) [email protected] 1918 Pandemic: September 1918 Pandemic: September digging graves.” take your street laborers andset them to workers andset themto makingcoffins. Then urgent warning west.“Huntup yourwood- An agonized officialinthehard-hit eastsentan Francisco fallsillwithinfluenza. Wagner, a Chicagoannewly settledinSan reach thecity.September24: Board ofHealth,predicts Spanishfluwillnot Dr WilliamHassler, ChiefofSanFrancisco's Edward (3) (3) [email protected] 1918 Pandemic: September28 1918 Pandemic: September28 sang patriotsongs. Loan Drive,linkedarms, 200,000 gatherfor a fourthPhiladelphiaLiberty of “public amusement.” along withallother places theaters are orderedclosed, Churches, schools,and an epidemic exist. The cityis forcedtoadmit new cases ofinfluenza. Days aftertheparade, 635 (3) (3) [email protected] 1918 Pandemic: September 1918 Pandemic: September day. 869 in asingle Yorkers died, 30,000 New people to worry.” need forour epidemic. No announces, “Thecity isinnodangerofan York City,(whohad nomedicalexperience) Royal Copeland,Health CommissionerofNew (3) (3) [email protected] 1918 Pandemic: Pandemic: October influenza-related deaths inasingle day. several gruesome recordsfor themonth:289 October 6: market was putonhalf-days. sporting events. Churchesclosed andthestock Boston canceledLiberty Bondparadesand influenza. Perhaps learning fromPhiladelphia, October 2: Philadelphia poststhefirstof Boston registers202 deathsfrom (3) (3) [email protected] 1918 Pandemic: October 1918 Pandemic: October rehabilitation centers. for recruits inplaces likeold-age homes and injured soldiers abroadand athome, Bluelooks With many medicalprofessionals alreadytreating new funds. more than 1,000doctorsand700 nurseswiththe U.S. Surgeon GeneralRupert Blue setsouttohire and nursestodealwith thegrowingepidemic. the U.S.PublicHealth Servicerecruitphysicians October: Congressapproves $1 milliontohelp (3) (3) [email protected] 1918 Pandemic: October 1918 Pandemic: October lawbreakers. impact onpotential to influenza’s Attributed drops 43%: crime rate normal. times higherthan Philadelphia’s death rateforoneweekis700 A manisattackedfor spittingonthestreet. 851 NewYorkersdie ofinfluenzainoneday: (3) (3) [email protected] 1918 Pandemic: October 1918 Pandemic: October history, 195,000 Americans die from influenza. October, 1918: 12,191 dead. with anestimated 47,094reported casesand October 27: Health. Whether ithelpedwas adebate. were delivered tothePhiladelphia Boardof prevent influenza.Over 10,000inoculations announces thathe has developedavaccineto October 19: hldlpi’ epidemic subsides Philadeliphia’s Philadelphia Dr.C.Y. White Deadliest month inU.S. (3) (3) [email protected] 1918 Pandemic: Pandemic: November remove their protectiveface masks. Franciscans thatitissafe--and legal--to November 21:Sirenswail signalingtoSan San Franciscanstake tothestreets. Celebrating theend ofTheGreatWar,30,000 2,122 SanFranciscans had diedfrom influenza But everybody woreafacemask! Much dancingandsinging (3) (3) [email protected] 1918 Pandemic: December 1918 Pandemic: December of influenzaarereported inSanFrancisco But optimismwasmisplaced: 5,000newcases (3) (3) [email protected] The Toll The Toll in the nation pattern inevery State Representative of mortality in Kansas Influenza epidemic December, 1918. September- above baseline) Peaked at230+/day, 12-15x ---Infl ---- All deaths(upper line) uenza deaths [email protected] The Toll The Toll 25 million to37 million Worldwide death toll: 675,000 to850,000 people United Statesdeath toll: Ten times as many as in The Great War supports) lacked energy tofeedthemselves andno infected, many survivorsstarved todeath(they 80-90% of theSamoanpopulation was killed inNome,Alaska Sixty percentoftheEskimo populationwas (3,4) (3,4) [email protected] The Toll:Cities The Toll:Cities (3,4) (3,4) [email protected] The Toll:Three Waves The Toll:Three Waves U.S. totalinfluenza epidemicmortalityrates (5) (5) [email protected] Pandemic FluContainment Strategies Pandemic FluContainment Strategies Diagnoses must be quick to be effective Last Resort: Diagnosis andTreatment: 12/21/1918) vaccine had no"scientificbasis," (JAMA, not know the flu’stypeorsource, aneffective Prophylaxis into sleeve Prevention: laws againstspitting inpublic,socialdistancing Laws, Regulation and Rules: e.g., masks,handwashing, cough (vaccinations): In1918they did e.g., quarantine, (2) (2) [email protected] 1918 Laws,Regulation andRules 1918 Laws,Regulation andRules (bubonic plague) of theMiddle Ages Conditions in1918 similarto theBlack Death coffins, morticians andgravediggers Shortage of healthcareworkers, medicalsupplies, Bodies piled up fines enforced byextrapoliceofficers Those who ignoredfluordinances hadtopaysteep railroads wouldnottake passengerswithoutthem Some townsrequired asignedcertificatetoenter, Funerals werelimited to15minutes Stores couldnothold sales (2) (2) [email protected] Prevention Prevention Social distancing Education andtraining: Washyourhands! Public healthdepartments distributedgauzemasks (2) (2)

A From Septic Paws Protect yourjaws And wearthe gauze “Obey thelaws Flu Slogan: ” [email protected] Diagnosis and Treatment Last Resort: Diagnosis and Treatment Last Resort: (2) (2) resources 1918 Patients in Influenza Hospital for overwhelmed will be and medical Hospitals Emergency [email protected] Impact of1918 PandemicFlu Impact of1918 PandemicFlu and died rapid deaths People were struckwithillness onthestreet higher in1918 thaninprevious years Death rate for15to34-year-olds was20times epidemics, whichwerelessthan 0.1%. previous Mortality rate2.5% per100,000,vs 10 years Average lifespanin theUSwasdepressedby (1) (1) [email protected] Impact ofPandemic Flu Impact ofPandemic Flu the window All standard assumptions andplans wentout overwhelmed Shortage of physicians,health resourceswere concerts) Olympics, WorldCupSoccer, airports, public healthstandpoint (considerthe and largeparties,a completedisasterfroma People celebrated Armistice Daywithparades (1) (1) [email protected] We TendtoForget . Pandemics Death TollSince1900: We TendtoForget . Pandemics Death TollSince1900: 1968-1969 1957-1958 1918-1919 Worldwide...700,000+ U.S....34,000+ Worldwide...1-2,000,000 U.S....70,000+ Worldwide...40,000,000+ U.S....600,000+ [email protected] Why BeConcerned? Why BeConcerned? SARS.” more afraidofaflu pandemicthanIamof matter ofif,butwhen thiswillhappen.Iamfar “We’re due[foranother pandemic].Itsnota Journal, May 29,2003 Albert Osterhaus, WHOScientist, WallStreet [email protected] Modern Predictions Modern Predictions California States United Location Deaths 541,433 60,875 Hospital- izations 2,358,089 273,090 # ofCases 66,914,573 8,067,075 [email protected] Goal: AvoidJaws andChickenLittle! Goal: AvoidJaws andChickenLittle! [email protected] What Should We Do? What Should We Do? Happens Nothing And . Breaks Out A Pandemic If We. Do Nothing Do Something Do [email protected] What Should We Do? What Should We Do? Happens Nothing And . Breaks Out A Pandemic If We. down doomsayers! money! Wecanput We Skated!saved Do Nothing Do Something Do [email protected] What Should We Do? What Should We Do? Happens Nothing And . Breaks Out A Pandemic If We. down doomsayers! money! Wecanput We Skated!saved Do Nothing lose elections! stupid. Politicians paranoid, dumb, We werewasteful, “Chicken LittleEffect” Do Something Do [email protected] What Should We Do? What Should We Do? Happens Nothing And . Breaks Out A Pandemic If We. down doomsayers! money! Wecanput We Skated!saved j elections! We lose our die. Politicians lose We blew it!People “Jaws Effect” obs. Do Nothing lose elections! stupid. Politicians paranoid, dumb, We werewasteful, “Chicken LittleEffect” Do Something Do [email protected] What Should We Do? What Should We Do? Happens Nothing And . Breaks Out A Pandemic If We. down doomsayers! money! Wecanput We Skated!saved j elections! We lose our die. Politicians lose We blew it!People “Jaws Effect” obs. Do Nothing are very smart. down deniers! We society. Wecan put saved lives.Saved We are heroes!We lose elections! stupid. Politicians paranoid, dumb, We werewasteful, “Chicken LittleEffect” Do Something Do [email protected] What Should We Do? What Should We Do? We shouldplan,notbe wasteful,but. Prepared! Be [email protected] What Should We Do? What Should We Do? . dropped restrictions tooearly, shouldhave held on until that kept restrictions inplace savedlives, buteven they wave ofcases anddeaths.Cities likeSanFrancisco settled down. Citiesthatdidnot do thissawasecond Keep measures inplaceafterthings seemtohave and liveswere lost,itwasoneof theworsthitcities. cases in1918andsaved lives.Philadelphiadidnot, St. Louisrespondedstrongly withintwodaysofthefirst what ishappening. Be preparedtointervene early,evenifitisnotclear 7 7 [email protected] [email protected] References References 5. 4. 3. 2. 1. Daniel Jordan, PhD: For moreinformation on thispresentation contact: 7. Rapid Responsewas Crucialto BiologyVol. The InsideStory.,PLoS 6. NichollsH. PandemicInfluenza: http://history1900s.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=his http://history1900s.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=his http://virus.stanford.edu/uda/ http://virus.stanford.edu/uda/fluresponse.html#mask http://www.pbs.org/wgbh/amex/influenza/ http://avianflu.futurehs.com/?cat=75 bubonic_plague%2Findex.html tory1900s&zu=http%3A%2F%2Fhome.nycap.rr.com%2Fuseless%2F 2Finfluenza%2Ftimeline%2Findex.html tory1900s&zu=http%3A%2F%2Fwww.pbs.org%2Fwgbh%2Famex% 422006 [email protected] Containing the1918 FluPandemic. 805-981-5258