# 1045
More of a confirmation of what we already knew.
In the absence of an effective vaccine, and with a major shortage of anti-viral drugs, stringent community control measures can have a major effect on the mortality and morbidity of a pandemic.
That's the findings published today in JAMA (Journal of the American Medical Association) by medical historian Howard Markel.
Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic
Howard Markel, MD, PhD; Harvey B. Lipman, PhD; J. Alexander Navarro, PhD; Alexandra Sloan, AB; Joseph R. Michalsen, BS; Alexandra Minna Stern, PhD; Martin S. Cetron, MD
Of course, earlier this year, the CDC adopted most of these strategies in their Interim Community Strategy For Pandemic Influenza Mitigation (Warning: LARGE PDF).
Early school closures, social distancing, cancellation of public events, and even some forms of isolation and quarantine can, when combined, slow and reduce the spread of influenza through a community.
This report from the VOA.
Historians Point to Non-Drug Measures to Reduce Deaths During Flu Pandemic
By Jessica Berman
Washington
07 August 2007An estimated 40 million people around the world died in the flu pandemic of 1918, including a half million in the United States. Experts studying the outbreak have found that a great number of lives were saved in the United States by limiting situations where people might spread the flu to one another. VOA's Jessica Berman reports that modern-day researchers are examining the past to find ways to handle future flu outbreaks.
Medical historian Howard Markel looks to the past for clues on what to do if a deadly avian flu hits and before scientists have found a vaccine or treatments.
Markel directs the Center for the History of Medicine at the University of Michigan. He says before scientists would be able to develop effective therapies against the avian flu there could be a crucial interval of about six months.
"And we thought what if this could be used, not as a cure, but to buy time; to lower the number of cases, to lower the number of deaths, and to lower the rush of people seeking medical care or running to the hospital, so you could buy time, in effect, to make these wonderful vaccines that would in turn prevent people from ever getting influenza," he said.
Markel and colleagues at the U.S. Centers for Disease Control looked at the public health impact of what he calls "good old-fashioned" measures in the United States in response to the 1918 pandemic.
These include steps such as school closures, cancellation of public gatherings, isolation and the much stricter quarantine of infected individuals.
The researchers selected 43 American cities that had complete records of how many people got sick, how many died, and what public health measures the cities took in response to the flu pandemic.
Markel says investigators studied the numbers of flu deaths in each city as well as the types and length of non-drug measures used to fight the disease. He says they found the fewest deaths in cities that adopted the most precautions.
"So that if you did quarantine and isolation, that was good," he said. "But if you did quarantine, isolation and school closure, that was even better. It's sort of like putting three levels of Swiss cheese on top one another, but the wholes don't all match up. So, you get better protection if you use more layers of cheese."
Markel says investigators also found that the longer public health measures were in place the more effective they were.
The results of the study are published in the Journal of the American Medical Association.
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