With the start of the COVID-19 pandemic in 2020, it is hard to overlook the shocking irony of a pandemic that began so close to the 100-year anniversary of the 1918 flu pandemic. When studying and comparing these two pandemics, many similarities can be seen, but stark differences can also be observed due to incredible medical advances made in the past century.
During the 1918 flu pandemic, one of the primary methods to keep the number of flu cases low was through non-pharmaceutical interventions (). NPIs are actions, other than vaccines and medicine, that people can take to help slow the spread of disease, such as the .
Personal NPIs are actions an individual can take, such as staying home if you are sick, washing hands often, and wearing face masks. Environmental NPIs include routine surface cleaning to kill flu viruses that may be present on commonly touched surfaces. Community NPIs are actions, policies, or strategies performed by a larger group. This can include social distancing and temporary closures of public spaces and .
In the 1918 flu pandemic, NPIs could be seen through mandatory quarantines for sick individuals, school closures, bans on public gatherings, and campaigns against spitting. In Philadelphia, the first case of the flu appeared in early September 1918. By this point, cases of the flu were present throughout the country, so many were aware of the threat this illness posed. Nevertheless, the city of Philadelphia still held the infamous Liberty Loan parade, failing to comply with recommended community NPIs. Due to this parade, with 200,000 attendees, 20,000 influenza cases were reported within two .
NPIs are certainly still used today, but they are no longer our primary method of disease control. However, historically examining the use of NPIs during the 1918 flu pandemic can demonstrate and prove how effective these interventions can be. A study examining historical evidence for the impact of NPIs during the 1918 flu pandemic used data on the timing of 19 classes of NPIs in 17 U.S. cities. Using this data, the researchers were able to determine that early implementation of multiple interventions was associated with reduced disease transmission. The researchers found that “cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates approximately 50% lower than those that did not, and had less-steep epidemic curves.” Early implementation of school, church, and theater closures was associated with lower peak death rates, but no single intervention showed improved outcomes. This demonstrates that the best outcomes were achieved through the implementation of multiple NPIs in combination, .
One of the biggest changes in our daily lives since the beginning of the pandemic has been frequent mask wearing, but this was used as a NPI even in the 1918 flu pandemic. They were widely worn throughout the country, and they were mandatory in the city of San Francisco. However, many of these masks were either too thick to allow comfortable breathing, or too thin to be Now, masks have become a normal part of our lives, with many people continuing to wear them, even as the number of COVID-19 cases decreases. There are many types of masks, allowing individuals to find ones that feel the most comfortable for them, while also proving effective.
Ideally, NPIs are used as a method of disease prevention before a vaccine can be developed, controlling the spread of disease as much as possible before vaccines can be used as a more effective disease control method. The distribution of COVID-19 vaccines began in December of 2020, approximately nine months after the beginning of the pandemic. Since then, millions of people have received the .
In the 1918 flu pandemic, many vaccines were developed and used, but not nearly as many vaccines were distributed for the 1918 flu pandemic as the COVID-19 pandemic. Much of the existing medical literature had contradictory claims on the success of the vaccine, and there was no consensus on how to judge the results of vaccine trials at the . Overall, while there were certain vaccines that existed at the time, there were not enough measures to prove their efficacy, and many people were skeptical of their use. It was not until 1938 that Jonas Salk and Thomas Francis developed a vaccine that successfully inactivated the .
During the 1918 flu pandemic, there were certainly some effective measures, such as the implementation of multiple, continuous NPIs, that we can still learn from today. Measures such as social distancing and public space closures were effective in preventing the spread of disease in 1918, as they are now. Due to modern medicine, we can combine these effective preventative measures with the additional, highly effective method of disease prevention: the vaccine.
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