Imagining a Better Future by Re-imagining the Past

Saturday, March 28, 2020

Special Post - America In Crisis

Normally, I post every other week. However, as America responds to the Covid-19 pandemic I thought I would write an extra blog post to help understand the current crisis from a historical perspective.

The Spanish flu of 1918 - 1920 was one of the deadliest pandemics America has ever seen. An estimated 675,000 Americans are thought to have died. The Spanish flu was different than most in that the young were heavily impacted. Mortality was high in people younger than 5 years old and those who were 20-40 years old.

When the Spanish flu first appeared mid-September of 1918 it was thought to be simply the spread of the common flu. However, by late September it had begun to spread throughout the civilian population with devastating consequences.

The spread of the disease was helped by the fact that several governments failed to follow the advice given by the young science of pathogenic microorganisms. For example, according to John M. Barry, author of The Great Influenza: The Story of the Deadliest Pandemic in History, the public health director for the city of Philadelphia, PA, Wilmer Krusen, thought people could lower their risk of catching Spanish Flu by staying warm, keeping their feet dry and their “bowels open.”

Even in 1918, it was understood that what today we call “social distancing” would help slow the spread of disease. However, as the rate of civilian cases grew, Krusen still refused to heed the warnings of infectious disease experts and ignored calls by the medical community to limit gatherings. Rather than cancel the upcoming Liberty Loan Parade that was to take place on September 28 Krusen decided that it should still take place.

The parade had horrifying consequences. The number of Spanish flu cases in Philadelphia exploded overnight. In less than three days after the parade, all of the hospitals in Philadelphia were full. And by the end of the week, 2,600 people were dead.

Another failure was San Francisco, CA. The city health officials claimed that gauze masks were “99 percent proof against influenza.” They weren’t alone in this belief. The governor of California declared that it was the “patriotic duty of every American citizen” to wear a mask. San Francisco took this to the next level and made it a law. Someone caught in San Francisco in public without a mask would be arrested on a charge of “disturbing the peace” and fined $5.

Sure, in the early days of the pandemic San Francisco had a low rate of infection. Later studies have shown that the reason wasn’t the masks but was likely due to the closing of the naval installations before the pandemic appeared, a city ban on social gatherings as well as the closing of all places of “public amusement.”

In November the city officials thought that the pandemic was over. As a result, they rescinded the order to wear masks and the various bans on social gatherings and entertainment. They couldn’t have been more wrong.

In January of 1919, a third wave of the Spanish flu struck San Francisco. When the city officials tried to reinstate the ban on social gatherings and public entertainment, the business community protested and the city caved. The result was San Francisco saw some of the highest death rates from the Spanish flu of any American city. An analysis in 2007 found that 90% of the deaths in San Francisco could have been prevented had the bans been maintained.

Not every American city handled the Spanish flu crisis as poorly as Philadelphia and San Francisco. There were some cities that got it right. One such city was St. Louis, MO.

Even before the first case in the city was reported St. Louis the city health commissioner, Dr. Max Starkloff, placed local physicians on high alert. He also wrote an editorial in a local newspaper (St. Louis Post-Dispatch) about the importance of avoiding crowds.

When the Spanish flu cases started to spread from nearby military barracks to the civilian population Starkloff took additional steps. He immediately closed schools, movie theaters, and pool halls. He also placed a ban on all public gatherings. Unlike San Francisco, when businesses balked he stood his ground. As the number of infections grew, Starkloff took the pressure off the hospitals by having the infected treated at home by volunteer nurses. The result was that the St Louis hospital system was never overwhelmed.

The same 2007 analysis of Spanish flu death records mentioned earlier shows how the response by the city of St. Louis' saved lives. At its peak, the mortality rate in St. Louis was only one-eighth of Philadelphia’s. While many lives were still lost, the city of St. Louis, to use modern terminology, “flattened the curve.”

George Santayana is credited with the aphorism that "Those who cannot remember the past are condemned to repeat it." Hopefully, we can learn from our ancestors and take the needed steps to save lives.

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