As we learn more about the evolving situation with regard the H1N1 strain of influenza circulating around the world, it is useful to look to our past experiences with pandemic influenza to learn and apply any lessons that can help mitigate sickness and death.
Let's call this a tale of two cities...in the 1918 Spanish Influenza epidemic, a minimum of 50 million people around the world died from the flu or from secondary infection. But not all localities experienced the same death rate, largely due to the public health guidance that was followed in that specific area. In the US, St. Louis and Philadelphia had vastly different outcomes, despite the fact that the same strain of influenza infected their communities.
In 1918, there were no influenza vaccines or antivirals and limited international travel. The public health responses were limited to isolating the ill, quarantining houses, closing schools, canceling worship services, restricting the size of funerals and weddings, closing saloons and theaters, restricting door-to-door sales, discouraging the use of public transportation, staggering the hours of business and factory operations, imposing curfews and, in some places, recommending the use of face masks in public.
