Pandemic disease policies

Key Vocabulary: Pandemic

Question Focus Document: Topeka Health Service, "Get the Anti 'Flu' Habit", 1918

Compelling Policy Question: What outcomes should policy makers consider when making pandemic disease policies, the consequences of restricting, or of not restricting citizen's daily lives?

Pandemic Disease Policy Case Study: Topeka City Health Officer, Dr. Clark's "Official Notice"

(Source of the Official Notice)

Historic Context:

With the start of World War One in 1914, the mobilization of soldiers all around the world began, including the United States in 1917. The mobilization of the soldiers and the movement of large numbers of troops made it easy for a viral disease to spread rapidly. Historians and Virologists disagree on the origin of the "Spanish Influenza", with some arguing it began in China, and others arguing it began in Kansas at Fort Riley.

Despite the debate over where the virus began, the deadly virus began to rapidly spread around the world. In the Spring of 1918 there was a "first wave" of the Spanish Influenza which did not prove too be to deadly, but during a second wave in the fall of 1918 people were dying within hours of showing symptoms. As the Pandemic swept across America many States and cities began passing measures to stop the spread of the disease.

Section #1 Guiding Question: Why do some people believe the Government should create restrictions for a citizen's daily life in response to pandemic diseases?

The Secretary of the Kansas Board of Health, Dr. S.J. Crumbine, said in a 1918 statement on the Spanish Influenza closing order...

Dr. Crumbine's Biography (Quote source)

The epidemic is here. We cannot get away from it, so the thing to do is to take the most effective methods of slowing it down. The history of the disease shows that its virulence depends to a considerable extent upon the rapidity of transmission.

If we can keep folks away from crowds, have them take precautions against the disease, we can extend the period of transmission so that the disease loses its virulence and becomes only a light cold and many are not infected who might take the disease.

A general closing order is the most effective method of slowing down the disease.

In 1918, the U.S. Public Health Service created a poster titled, "Coughs and Sneezes Spread Diseases - As Dangerous as Poison Gas Shells".

In 1918, the U.S. Public Health Service distributed a poster titled, "Use the Handkerchief and Do Your Bit to Protect Me!".

In 1918, Chicago's Commissioner of Health, John Dill Robertson, released a poster for theaters to display titled "Influenza Frequently Complicated with Pneumonia is Prevalent at this Time Throughout America.

1918, the Virginia State Board of Health furnished a poster titled, "Save Yourself from Influenza...Follow Two Simple Rules".

In October of 1919 the North Carolina State Board of Health published two cartoons titled "The Way the Germans Did It At Chateau-Thierry," and "The Way North Carolinians Do It At Home," in their The Health Bulletin

The first cartoon states: "During the recent war approximately 1000 men from North Carolina were killed in battle."

The second cartoon stated, "During the epidemic last fall and winter 13,644 North Carolinians laid down their lives to a "spit-borne" disease--influenza!"

Section#2 Guiding Question: Why do some people believe the Government should not restrict a citizen's daily life in response to Pandemic Diseases?

During a meeting of the American Public Health Association in 1918, New York's Health Commissioner Dr. Royal S. Copeland said...

(Excerpts/link to original source)

The most important part of disease control is the public school system. We have a million schoolchildren in New York, and 700.000 of them come from tenement homes, the poorest homes on earth.

It will be better for these children to... go to school where the schoolhouses are sanitary and are under the strict regulation... than to permit them to linger in the school yards or in the basements, etc.

It was better for these children to be attending school than to be at home under unpleasant and unhygienic surroundings.

If any child showed symptoms or signs which indicated the possibility of influenza, that child was put in a room by himself until examined by a nurse or by a doctor to discover whether he or she had influenza, and... a board of health doctor or nurse would find out whether the family had a family physician, and if so, whether there was a possibility of isolating and protecting other members of the family. If not, the child was to be placed in a hospital where it could be given care.

It is a great deal better to care for children in this way than to turn them loose on the streets to play where they will.

On October 5th, 1918, the Philadelphia Inquirer ran a cartoon made by Jim Nasium titled "An Unwelcome Visitor".

On October 12, 1918, The Los Angeles Times published a cartoon titled, "And Then (A Little Sneaky Music, Professor!) Enters The Villain, Senor Spanish Influenza.

(For this section focus on the the ideas of the image in the lower right hand corner of the cartoon)

What was the result of the debate, and what were the consequences?

The State of Kansas, and many other States around the United States required schools, restaurants, theaters, etc. to close in order to slow the spread of the "Spanish Influenza". These decisions were all made by State and Local officials. The Federal Government did not require the quarantining of people, even though they legally had the power to do so. The Federal Government did pass H.J. Res. 33, which authorized the spending of $1,000,000 to help fight the spread of the disease.

A study done by a group of medical researchers on 43 different U.S. cities' policies during the Spanish Influenza pandemic titled "Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic" found that "The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality, lower peak mortality rates, and lower total mortality. The conclusion of the research was that nonpharmaceutical interventions such as social distancing, school closures, and shutting down of public places saved lives. The researchers generated this suggestion: "In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.

Some researchers believe as many as fifty million people across the world were killed by the "Spanish Flu" pandemic, including an estimated 675,000 Americans.

A chart of deaths in major cities, showing a peak in October and November 1918

Graph courtesy of the National Museum of Health and Medicine) - Pandemic Influenza: The Inside Story. Nicholls H, PLoS Biology Vol. 4/2/2006.