
Nonpharmaceutical Interventions by US Cities During 1918-1919 Influenza Pandemic - skmurphy
https://jamanetwork.com/journals/jama/fullarticle/208354
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skmurphy
Key grafs: objectives and conclusions.

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.

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.

These findings contrast with the conventional wisdom that the 1918 pandemic
rapidly spread through each community killing everyone in its path. Although
these urban communities had neither effective vaccines nor antivirals, cities
that were able to organize and execute a suite of classic public health
interventions before the pandemic swept fully through the city appeared to
have an associated mitigated epidemic experience. Our study suggests that
nonpharmaceutical interventions can play a critical role in mitigating the
consequences of future severe influenza pandemics (category 4 and 5) and
should be considered for inclusion in contemporary planning efforts as
companion measures to developing effective vaccines and medications for
prophylaxis and treatment. The history of US epidemics also cautions that the
public's acceptance of these health measures is enhanced when guided by
ethical and humane principles

