The Single Most Important Lesson From the 1918 Influenza – The New York Times

But an Army study found no difference in morbidity and mortality between camps that did and did not follow orders, because over time most became sloppy. Further investigation found that only a tiny number of camps rigidly enforced measures.

For interventions to work, people have to comply and they have to sustain that compliance; most of that depends on voluntary efforts and individual behavior. Army camps in wartime failed to sustain compliance, so it will be an enormous challenge for civilian communities in peacetime to do so. At the height of the H1N1 outbreak, Mexico City urged mask usage on public transit and distributed free masks. Usage peaked at 65 percent; 10 days later it was at 10 percent.

Today we are still trying to stop the disease from becoming deeply entrenched. If that fails, we will need tougher measures. Scott Gottlieb, a former commissioner of the Food and Drug Administration, has talked of states shutting down their economies. Thats whats going to need to happen, he said. Close businesses, close large gatherings, close theaters, cancel events. All of that happened in 1918 in most cities. On Monday, after initially calling for limiting gatherings to 250 people a recommendation based on a desire not to disrupt rather than on modeling the federal government finally recommended that no more than 10 people gather.

But many cities and states have yet to take stringent action. They should, and now.

In 1918 many cities imposed restrictions, lifted them too soon, then reimposed them. Covid-19s average incubation period is more than double influenzas, so compliance may have to be sustained for months, and openings and closings may also have to be repeated. Again, if the public is going to comply over time, they will have to be led, inspired or compelled.

That brings us back to the most important lesson of 1918, one that all the working groups on pandemic planning agreed upon: Tell the truth. That instruction is built into the federal pandemic preparedness plans and the plan for every state and territory.

In 1918, pressured to maintain wartime morale, neither national nor local government officials told the truth. The disease was called Spanish flu, and one national public-health leader said, This is ordinary influenza by another name. Most local health commissioners followed that lead. Newspapers echoed them. After Philadelphia began digging mass graves; closed schools, saloons and theaters; and banned public gatherings, one newspaper even wrote: This is not a public health measure. There is no cause for alarm.

Trust in authority disintegrated, and at its core, society is based on trust. Not knowing whom or what to believe, people also lost trust in one another. They became alienated, isolated. Intimacy was destroyed. You had no school life, you had no church life, you had nothing, a survivor recalled. People were afraid to kiss one another, people were afraid to eat with one another. Some people actually starved to death because no one would deliver food to them.

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The Single Most Important Lesson From the 1918 Influenza - The New York Times