Wednesday, March 25, 2020

Need for Second Closure Order in 1918 Should Remind us not to Stop Distancing too Soon

You might have seen this chart circulating from a 2007 study of public health measures during the 1918 flu pandemic.

The two rises for St. Louis roughly correspond
to dates of our closure orders
"Public health interventions and epidemic intensity
during the 1918 influenza pandemic", 2007
The Smithsonian wrote about half of it in "Philadelphia Threw a WWI Parade That Gave Thousands of Onlookers the Flu." That big spike is directly related to the parade.

Though the scale for Philadelphia's peak reduces the apparent variation on the line for St. Louis, St. Louis had two smaller humps, one towards the end of October, the other in mid-December.

In mid-November, schools had opened and public gatherings were permitted again. But then the rate of new flu cases started increasing again, requiring a second round of closures.

First closure order, October 12th, 1918
(Image at top, October 13th, 1918)
We see the same pattern here in Salem, one closure in mid-October, reopening and relaxation of distancing in mid-November, and then as flu increases again a second closure order the end of December.

Reopening, November 11th, 1918

In the society column, November 13th, 1918
In fact, Salem's opening coincided with the Armistice and its celebrations. But transmission and cases soon increased again.

Second closure order, December 30th, 1918
People complained and argued the isolation of sick people was the only thing that mattered and the problem was the quarantine wasn't rigid enough.

Afternoon paper complaint, December 30th, 1918
But this missed transmission by people who showed no symptoms or who did not seem very sick. Hard quarantine only stopped transmission by the sickest, and did not act on the full spectrum of contagiousness.

Mayor Keyes defended closure in morning paper,
January 2nd, 1919
The two papers used a disagreement to squawk at each other, but Mayor Keyes seemed to be on firmer ground. Medical science and epidemiology is more advanced now, and it still argues for more distancing and more closures. We would not today argue for "lifting" the ban in favor of a "quarantine system" this early, or even primarily relying on a quarantine system.

The afternoon response, January 6th, 1919
We know now that "good results" did follow
"closing public places."
As we hear calls for an "Easter" relaxation and return to business, we should remember the near certainty of calamity this would bring. The need for a second closure order here wasn't so much because a new wave of disease was arriving from outside of Salem; it was because the relaxation of distancing allowed disease already here to circulate more widely.

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