Spanish influenza 1918-19: Lessons from history
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Transcript of Spanish influenza 1918-19: Lessons from history
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Spanish influenza 1918-19: Lessons from history
1. Historical context
2. Yakima’s experience
3. Lessons
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Why discuss Yakima’s Spanish Flu experience?
It happened
Teachable moment—before crisis
Advance preparation
– Essential to public health
– Reduces panic
– Limits damage
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Yakima County 1918
Yakima Avenue Speck Motors Sunnyside
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Impact: Seattle
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Rapid spread through the world
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Impact: Philadelphia
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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
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Impact: Yakima
Typical Yakima Daily Republic headline
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Advance conclusions…
Could be catastrophic
Preparation, rehearsal, and education
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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
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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
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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
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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
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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
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Response: police and transport
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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
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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
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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
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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”
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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
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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%
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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
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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.”
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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
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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
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Clear communication calms
Credibility and consistency essential
– Actionable communication
– Responsive leadership
Scalable: rehearse for range of scenario severity
Coordinate with media news directors
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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
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Social distancing concepts
School closures
Theater & restaurant closures
Business restrictions
Public meeting bans, including churches
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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
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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
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Questions and Discussion?