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BMJ. 2007 August 11; 335(7614): 279.
PMCID: PMC1941897
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Lessons in pandemic flu from 1918

Preparations for pandemic influenza tend to focus on vaccines and antiviral drugs. Neither were available in 1918 during the last pandemic, when city authorities had to rely on classical public health measures to limit the spread of disease. A careful trawl through over 1000 historical documents and an epidemiological analysis of the pandemic's trajectory in 43 US cities suggests these measures can work. Closing schools, preventing public gatherings, and setting up mandatory quarantine for sick people and their contacts were all associated with slower rise in deaths and a lower overall death rate. Cities, such as St Louis, that introduced multiple public health measures early in the pandemic and sustained them through the riskiest period, seemed to lose the fewest citizens overall, although it's impossible to say for certain whether these authorities' timely actions were responsible. The authors note that successful strategies in one city didn't necessarily translate to other cities in the study.

In 1918, timing was critical. In New York, the authorities introduced rigorous isolation and quarantine before any excess deaths had occurred. It had the lowest death rate on the eastern seaboard.seaboard.

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