Spanish influenza 1918-19: Lessons from history

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?