Pandemics: learning from the past

Despite all the contributions of modern medicine, most authorities seem to agree that much of the progress towards longer, healthier lives over the past hundred-odd years has come from preventative measures: in particular, raising living standards and improvements in sanitation. And as this article notes, even in the absence of a cure, epidemics can be successfully blunted -- if there is enough vision and will:

When the Spanish flu reached the United States in the summer of 1918, it seemed to confine itself to military camps. But when it arrived in Philadelphia in September, it struck with a vengeance.

By the time officials there grasped the threat of the virus, it was too late. The disease was rampaging through the population, partly because the city had allowed large public gatherings, including a citywide parade in support of a World War I loan drive, to go on as planned. In four months, more than 12,000 Philadelphians died, an excess death rate of 719 people for every 100,000 inhabitants.

The story was quite different in St. Louis. Two weeks before Philadelphia officials began to react, doctors in St. Louis persuaded the city to require that influenza cases be registered with the health department. And two days after the first civilian cases, police officers helped the department enforce a shutdown of schools, churches and other gathering places. Infected people were quarantined in their homes.

Excess deaths in St. Louis were 347 per 100,000 people, less than half the rate in Philadelphia. Early action appeared to have saved thousands of lives. . .

This month, researchers published two new studies in The Proceedings of the National Academy of Sciences comparing public-health responses in cities like St. Louis and Philadelphia.

Using mathematical models, they reported that such large differences in death rates could be explained by the ways the cities carried out prevention measures, especially in their timing. Cities that instituted quarantine, school closings, bans on public gatherings and other such procedures early in the epidemic had peak death rates 30 percent to 50 percent lower than those that did not. . .

What these results mean for a future epidemic is not clear. “If avian flu became a pandemic tomorrow,” Dr. Ferguson said, “we would start a crash program to make a vaccine.”

But he added that rigid preventive measures like quarantines, mandated mask wearing and widespread business closings would still need to be put in place.

“What our study shows,” he continued, “is that interventions even without a vaccine can be effective in blocking transmission. What’s much less certain is whether society is prepared to bear the costs of implementing such intrusive and costly measures for the months that would be required to manufacture a vaccine.”

It's not as if there's any choice, though. To dither under such circumstances is to die.

Posted by David on April 23, 2007 12:19 PM