Source: Shane Oliver  @ShaneOliverAMP

This is about as close as we will get to a pure lab experiment measuring the efficacy nonpharmaceutical interventions (NPIs) intended to reduce infectious contacts, folks.

The 1918 influenza pandemic resulted an estimated 500,000–675,000 deaths in the U.S. and 50–100 million deaths worldwide.

The intensity of the 1918 pandemic, whether assessed as total excess deaths, the rate of increase in the epidemic curve, or peak death rates, varied widely among U.S. cities. Cities also varied widely in their choice and timing of implementation of NPIs designed to reduce disease spread. Many cities closed schools, churches, theaters, dance halls, or other public accommodations; made influenza a notifiable disease; banned funerals or other public gatherings; or introduced isolation of sick persons. In some cases, these NPIs were put in place in the first days of epidemic spread in a city, whereas in other cases, they were introduced late or not at all.  — PNAS

Note how St. Louis flattened the death curve (not the infection curve) with aggressive action in banning public gatherings within a few days of the first cases being reported.  Philly was complacent, however, downplaying the threat and lagging in its policy response by just a few weeks more than St. Louis.  Two weeks!

The contrast of mortality outcomes between Philadelphia and St. Louis is particularly striking. The first cases of disease among civilians in Philadelphia were reported on September 17, 1918, but authorities downplayed their significance and allowed large public gatherings, notably a city-wide parade on September 28, 1918, to continue. School closures, bans on public gatherings, and other social distancing interventions were not implemented until October 3, when disease spread had already begun to overwhelm local medical and public health resources. In contrast, the first cases of disease among civilians in St. Louis were reported on October 5, and authorities moved rapidly to introduce a broad series of measures designed to promote social distancing, implementing these on October 7. The difference in response times between the two cities (≈14 days, when measured from the first reported cases) represents approximately three to five doubling times for an influenza epidemic. The costs of this delay appear to have been significant; by the time Philadelphia responded, it faced an epidemic considerably larger than the epidemic St. Louis faced. Philadelphia ultimately experienced a peak weekly excess pneumonia and influenza (P&I) death rate of 257/100,000 and a cumulative excess P&I death rate (CEPID) during the period September 8–December 28, 1918 (the study period) of 719/100,000. St. Louis, on the other hand, experienced a peak P&I death rate, while NPIs were in place, of 31/100,000 and had a CEPID during the study period of 347/100,000. Consistent with the predictions of modeling, the effect of the NPIs in St. Louis appear to have had a less-pronounced effect on CEPID than on peak death rates, and death rates were observed to climb after the NPIs were lifted in mid-November (7–9).  — PNAS

Policy Failure

Here’s to hoping we are St. Louis and not  Philadelphia but our late start, dithering, and horrendous leadership, including misinformation and mixed messaging disseminated by the Administration almost surely condemns the nation as a whole to the fate of  The City of Brotherly Love  during the fall of 1918.

…Alex Azar [Secretary of Health and Human Services], he did go to the president in January. He did push past resistance from the president’s political aides to warn the president the new coronavirus could be a major problem. There were aides around Trump – Kellyanne Conway had some skepticism at times that this was something that needed to be a presidential priority.

But at the same time, Secretary Azar has not always given the president the worst-case scenario of what could happen. My understanding is he did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear – the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall. — NPR

Upshot

Trust the scientists.  Though I  believe in miracles, and we are going to need a big one, but never bank one.

As the death toll rises and the economic carnage increases, there is going to be holy hell to pay come the November election.  

President Wilson And The 1918 Flu

Very eerie parallels of how President Woodrow Wilson handled the 1918 Flu.  See here.