The story starts in 1665. While plague ravaged London, the, King, court and Parliament fled to Oxford. In contrast, the Lord Mayor and aldermen announced that they, and civic authorities such as sheriffs would remain in the city to combat the plague. The burden of combatting the epidemic landed squarely on the shoulders of the local authority.
During the influenza pandemic of 1918-19 local responses had a direct bearing on the impact of the pandemic. Crossing the pond, briefly, the contrasting experiences of New York City and Philadelphia are instructive. The war had put both cities in a bind. NYC was the major embarkation point for troops headed to Europe and that wasn’t going to stop. Philadelphia was a major naval base with ships and sailors constantly coming and going. New York City mobilised a massive, multilingual public health effort and ‘flattened the curve’. Philadelphia flouted public health advice and paid a deadly price, a fatality rate 50% higher than NYC.
NYC’s Health Commissioner Royal S Copeland acted swiftly when he realised the extent of the epidemic. Employers were ordered to introduce staggered work times to reduce rush hour crowding on public transit. Department literature was translated into Italian and Yiddish. Between vaudeville acts department employees took to the stage to deliver public health lectures in all three languages.
In contrast to Copeland, Dr. Wilmer Krusen, director of public health and charities for Philadelphia, insisted mounting fatalities were just a severe seasonal flu. On September 28, the city went forward with a Liberty Loan parade attended by tens of thousands of patriotic citizens. Ten days later over 1,000 Philadelphians were dead. When the flu finally abated in the spring of 1919, over 15,000 citizens of Philadelphia had lost their lives. Local decisions matter and they need to be driven by epidemiology not politics and economics.
One of the most significant aftereffects of the pandemic was a newfound focus on public health. This was particularly true in New York, specifically its poorest and newest inhabitants, Italian immigrants. Dr. Antonio Scalla, himself an Italian immigrant, was a respiratory specialist involved in the pandemic fight. To trace the disease he had students surveying the city’s slums reporting the infected and, incidentally recording conditions - persons per room, availability of water, a flush toilet, and so on. This program had two long term effects. Post pandemic this data revealed the horrible conditions and led the city to initiate a public housing program. Ideally, this pandemic will inspire a similar understanding of the importance of public health and corresponding funding.
On the downside there is a significant difference between then and now that requires attention. During the influenza pandemic there was very limited pushback on municipal restrictions such as masking and restricting public gatherings. This is not the case today as large-scale protests in London and Manchester in early November made clear.
Going forward the key takeaways from 1918 can be summarized as preparation, communication and coordination. Preparation refers to adequate supplies of PPE and ICU beds but also preparation for testing and contact tracing. Accurate, timely, granular local data is essential confronting an infectious disease.
Communication must be clear, unitary and appropriate for the audience. In 1918, in a revolutionary move the Local Government Board employed ‘new’ media, the motion picture. It distributed a twenty-minute film, ‘Dr Wise on influenza’. The only problem with it was not enough copies to meet the demand from local authorities. Today new media is Tiktok, Twitter and Facebook. They need to be integral to any communication strategy. This is particularly true in light of the misinformation that floods social media today.
Cooperation between all levels of government and with community groups is essential. The latter can provide everything from information on groups and neighbourhoods at elevated risk to volunteers. Intergovernmental cooperation ensures adequate funding, unitary messaging and reduces duplication of services.
The single most important lesson, to be drawn from the influenza pandemic and the current one is simple, this will happen again. Zoonotic diseases (passing from animals to humans as COVID-19 did) are frighteningly common. MERS, SARS, Ebola and Zika are all examples of recent zoonotic infectious diseases and each had the potential to develop into a pandemic. They were bullets dodged. With COVID-19 the bullet hit the mark and it is inevitable that another one will also in the future.
Bob Gordon is a Canadian historian and journalist. He is the author of Life after COVID-19: Lessons from Past Pandemics was published by Morton’s in November 2020. It is available at www.mortonsbooks.co.uk , on Amazon and at independent booksellers.