Spanish influenza 1918-19: Lessons from history

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Spanish influenza 1918-19 Lessons from history

• 1. Historical context
• 2. Yakimas experience
• 3. Lessons

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Why discuss Yakimas Spanish Flu experience?

• It happened
• Teachable momentbefore crisis
• Advance preparation
• Essential to public health
• Reduces panic
• Limits damage

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Yakima County 1918
Yakima Avenue
Speck Motors Sunnyside

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Impact Seattle
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Rapid spread through the world
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Impact Philadelphia
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The 1918 Pandemic

• 1/5 of worlds population affected
• Result
• Total 675,000 dead in the U.S.
• More than 20,000,000 dead worldwide

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Military camps
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Impact Yakima

• Typical Yakima Daily Republic headline

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Advance conclusions

• Could be catastrophic
• Preparation, rehearsal, and education

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Week 1 Yakima hears of new illness

• Day 0 43 deaths in Boston 5000 soldiers at
  Camp Devens under treatment
• Day 1 Epidemics at 6 military bases

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Week 2 Pandemic catches fire

• Draft cancelled Death rate of army at home
  beyond control
• Day 6 Flu in 26 states
• Day 15 Misplaced optimism in Yakima in October 4
  headline

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Week 3 Pandemic hits Yakima

• Day 17 Flu hits Seattle
• Days 19-26 44 cases Yakima
• Seattle 300 new cases / day
• All county schools, churches, theaters, and
  public gatherings closed
• Day 23 Passengers panic on train to Yakima

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Week 3 Health care strained

• Nurses scarce
• Misinformation Cases seem to be decreasing
• Day 28 6200 deaths in 30 cities
• Yakima officials seek site for influenza hospital
  
• 58 cases in city and county, whole families ill

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Week 4 Influenza hospital

• Army camps death rate of 206 per thousand cases
• Camp Lewis quarantined with more than 200 cases
  in 24 hours.
• Influenza hospital established in Yakima

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Response police and transport
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Week 5 Healthcare system overwhelmed

• 20 to 40 new cases / day
• Nurse shortage, physicians cant keep up
• Gauze masks mandated
• Keep off the streets
• Courts close. Nobody allowed into/out of jail

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Week 5 gt100 new cases per day

• All stores except groceries and butchers closed
  for 6 days
• Nearly 500 teachers sent home

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Week 6 Confusing message to public

• Day 44 Public told Yakima flu at standstill
• Day 44 7 die in Yakima
• Day 46 Public told flu on the decline in city
• Day 46 Record number of patients in flu hospital
• Day 46 Stores reopened

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Week 7 WWI Ends, US celebrates

• 50-100 new cases per day
• 32 people arrested for not wearing masks
• Masks removed one dayto celebrate defeat of
  Germany

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Week 8 Conflict of interestconfusing message

• More people from Yakima died by flu than by war
• Ban on public gatherings lifted, theaters opened
• Public told Yakima death rate low
• Public told Spreading in county and Homes
  placarded

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Week 9 2nd wave begins in Yakima

• Day 69 Influenza on increase, start of 2nd wave
• 15 of Yakima teachers out sick
• Day 71 New record number of patients in flu
  hospital

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Week 10 Officials feel conflicting interests

• Health head says Many persons have urged him to
  put the ban on while Others are strongly
  opposed
• People know that influenza is prevalent here and
  yet they have gone ahead and held their dances,
  church meetings and large gatherings of all
  kinds.
• Excess mortality rate of 25

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Week 11 Impact on public services

• 36 students absent
• 25 teachers out sick
• Second wave in full swing
• Influenza strikes post office
• Street car workers hard hit
• Superior court closed
• Nurses unobtainable

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Week 12 Deaths level, then decrease

• Day 84 40 students absent
• 18 deaths in 4 days
• 15 houses placarded
• 713 cases under a physicians care
• Day 90 27 students absent
• Day 92 Public told For the first time in 6
  weeks 24 hours have passed without a death from
  influenza.

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Weeks 14-17 Flu subsides

• Day 104 20 students out
• 45 of 80 deaths in December 1918 due to influenza
• Day 115 Public health head says little
  influenza in county now
• Day 125 Flus last gaspSt. Elizabeths crowded
  with flu patients

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Summary

• 14 weeks of major impact on Yakima county in 2
  waves
• 2 fatality rate
• Public policy conflicts surfaced during weeks 4
  and 5
• Commercial interests
• Public fatigue and boredom
• Relaxation of social distancing measures spurred
  second wave

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Clear communication calms

• Credibility and consistency essential
• Actionable communication
• Responsive leadership
• Scalable rehearse for range of scenario severity
• Coordinate with media news directors

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Mental health matters

• Sensible preparations reduce chaos
• Knowledge decreases anxiety, helplessness,
  depression
• Scale of disaster is critical
• Breakdown of social institutions causes massive
  trauma lasting years
• Imagine a nationwide Katrina
• No outside backup

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Social distancing concepts

• School closures
• Theater restaurant closures
• Business restrictions
• Public meeting bans, including churches

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Public Education points

• Cover your cough
• Be prepared
• Wash hands regularly
• Dont go to work sick in pandemic
• Avoid touching eyes, nose, and mouth
• Teach kids to do same

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Basic preparation for everyone

• Home preparation
• Food for 2 weeks
• Water
• Medicine
• Basic supplies
• Business preparations
• Encourage telecommuting
• Create minimum staff plans
• Change business culture for pandemic

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Questions and Discussion?