Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic.

By H. Markel, Harvey B Lipman, J. A. Navarro, Alexandra Sloan, Joseph R Michalsen, A. Stern, Martin S. Cetron. Journal of the American Medical Association (JAMA), 2007

699 citations recorded by the source corpus.

CONTEXT A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure. OBJECTIVES To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, and to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density. DESIGN AND SETTING Historical archival research, and statistical and epidemiological analyses. Nonpharmaceutical interventions were grouped into 3 major categories: school closure; cancellation of public gatherings; and isolation and quarantine. MAIN OUTCOME MEASURES Weekly excess death rate (EDR); time from the activation of nonpharmaceutical interventions to the first peak EDR; the first peak weekly EDR; and cumulative EDR during the entire 24-week study period. RESULTS There were 115,340 excess pneumonia and influenza deaths (EDR, 500/100,000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major categories of nonpharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79%); this combination had a median duration of 4 weeks (range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality (Spearman r = -0.74, P < .001), lower peak mortality rates (Spearman r = 0.31, P = .02), and lower total mortality (Spearman r = 0.37, P = .008). There was a statistically significant association between increased duration of nonpharmaceutical interventions and a reduced total mortality burden (Spearman r = -0.39, P = .005). CONCLUSIONS These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. 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.

Subfields: Epidemiology, Infectious Diseases, Modeling and Simulation

View Paper: https://www.semanticscholar.org/paper/4fc04a7abc070a42f7d1e02b508df732f8e04e1f

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Citations in the corpus

Modeling human mobility responses to the large-scale spreading of infectious diseases (2011, background): “In the recent literature, a few attempts to model behavioral changes have been done [8, 9, 10, 11, 12, 13, 14] but any of these tackle the effect of social disruption inside a metapopulation framework.”
Coupled disease–behavior dynamics on complex networks: A review (2015, background): “Incorporating adaptive behavior into a model of disease spread can provide important insight into population health outcomes, as the activation of social distancing and other nonpharmaceutical interventions (NPIs) have been observed to have the ability to alter the course of an epidemic [50] [51] [5”
The Unprecedented Stock Market Reaction to COVID-19 (2020, background): “Markel et al. (2007) consider NPIs in 43 American cities (accounting for 22% of the U.S. population) from September 18, 1918, to February 22, 1919.”
Misinformation During a Pandemic (2020, positive): “Given the critical importance of early preventative measures (Bootsma and Ferguson, 2007; Markel et al., 2007) this difference in the timing of changes in cautious behaviors may have significant consequences for health outcomes.”
COVID-19 control in China during mass population movements at New Year (2020, positive): “[11] [12] [13] [14] [15] [16] [17] A single social distancing policy can cut epidemic spread, but usually multiple such policies-including more restrictive mea sures such as isolation and quarantine-are implemented in combination to boost effectiveness.”
Teacher Wellbeing During a Pandemic: Surviving or Thriving? (2020, background): “Although there is evidence from past and present pandemics linking decreased rates of viral transmission to the closure of schools (Markel et al., 2007), schools have opened, then closed, then opened, then closed in many parts of Australia, as the novel coronavirus forces schools into remote…”