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

Yakima County 1918

Yakima Avenue Speck Motors Sunnyside

Impact: Seattle

Rapid spread through the world

Impact: Philadelphia

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

Military camps

Impact: Yakima

Typical Yakima Daily Republic headline

Advance conclusions…

Could be catastrophic

Preparation, rehearsal, and education

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

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

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

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

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

Response: police and transport

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

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

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

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”

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

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%

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

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.”

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

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

Clear communication calms

Credibility and consistency essential

– Actionable communication

– Responsive leadership

Scalable: rehearse for range of scenario severity

Coordinate with media news directors

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

Social distancing concepts

School closures

Theater & restaurant closures

Business restrictions

Public meeting bans, including churches

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

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

Questions and Discussion?