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Rapid Response was Crucial to Containing the 1918 Flu Pandemic

eattles mayor ordered his constituents to wear face masks. The first study found a clear correlation between the number of interventions applied and the resulting peak death rate seen. Perhaps more importantly, both studies showed that while interventions effectively mitigated the transmission of influenza virus in 1918, a critical factor in how much death rates were reduced was how soon the measures were put in place.

Officials in St. Louis introduced a broad series of public health measures to contain the flu within two days of the first reported cases. Philadelphia, New Orleans and Boston all used similar interventions, but they took longer to implement them, and as a result, peak mortality rates were higher. In the most extreme disparity, the peak mortality rate in St. Louis was only one-eighth that of Philadelphia, the worst-hit city in the survey. In contrast to St. Louis, Philadelphia imposed bans on public gatherings more than two weeks after the first infections were reported. City officials even allowed a city-wide parade to take place prior to imposing their bans.

If St. Louis had waited another week or two, they might have fared the same as Philadelphia, says the lead author on the first study, Richard Hatchett, M.D., an associate director for emergency preparedness at NIAID. Despite the fact that these cities had dramatically different outcomes early on, all the cities in the survey ultimately experienced significant epidemics because, in the absence of an effective vaccine, the virus continued to spread or recurred as cities relaxed their restrictions.

The second study also shows that the timing of when control measures were lifted played a major part. Cities that relaxed their restrictions after the peak of the pandemic passed often saw the re-emergence of infection and had to reintroduce restrictions, says Neil Ferguson, D.Phil., of Imperial College, London, the senior author on the second study. In their paper, Dr. Ferguson and
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