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Spanish influenza 1918-19: Lessons from history

Spanish influenza 1918-19: Lessons from history. 1. Historical context 2. Yakima’s experience 3. Lessons. Why discuss Yakima’s Spanish Flu experience?. It happened Teachable moment—before crisis Advance preparation Essential to public health Reduces panic Limits damage.

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Spanish influenza 1918-19: Lessons from history

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  1. Spanish influenza 1918-19: Lessons from history 1. Historical context 2. Yakima’s experience 3. Lessons

  2. Why discuss Yakima’s Spanish Flu experience? • It happened • Teachable moment—before crisis • Advance preparation • Essential to public health • Reduces panic • Limits damage

  3. Yakima County 1918 Yakima Avenue Speck Motors Sunnyside

  4. Impact: Seattle

  5. Rapid spread through the world

  6. Impact: Philadelphia

  7. The 1918 Pandemic • 1/5 of world’s population affected Result: Total: 675,000 dead in the U.S. More than 20,000,000 dead worldwide

  8. Military camps

  9. Impact: Yakima • Typical Yakima Daily Republic headline

  10. Advance conclusions… • Could be catastrophic • Preparation, rehearsal, and education

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Response: police and transport

  17. Week 5: Healthcare system overwhelmed • 20 to 40 new cases / day • Nurse shortage, physicians can’t keep up • Gauze masks mandated • “Keep off the streets” • Courts close. Nobody allowed into/out of jail

  18. 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

  19. Week 7: WWI Ends, US celebrates • 50-100 new cases per day • 32 people arrested for not wearing masks • Masks removed one day—to celebrate defeat of Germany

  20. Week 8: Conflict of interest=confusing 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”

  21. 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

  22. 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%

  23. 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

  24. Week 12: Deaths level, then decrease • Day 84: 40% students absent • 18 deaths in 4 days • 15 houses placarded • 713 cases under a physician’s 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.”

  25. 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: Flu’s last gasp—St. Elizabeth’s crowded with flu patients

  26. 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

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

  28. 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

  29. Social distancing concepts • School closures • Theater & restaurant closures • Business restrictions • Public meeting bans, including churches

  30. Public Education points • Cover your cough • Be prepared • Wash hands regularly • Don’t go to work sick in pandemic • Avoid touching eyes, nose, and mouth • Teach kids to do same

  31. 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

  32. Questions and Discussion?

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