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The Pan Flu Answer?

August 17, 2007

177005101_41ad719c64 A recent study from the AMA has been making the rounds on the blogosphere, and I’d be remiss if I didn’t pass it along and put in my two cents.

According to researchers out of the CDC and University of Michigan, upon review and comparison of the measures taken by 43 cities during the 1918-1919 Spanish Flu and their respective death rates, it’s been postulated that early and consistent non-pharmaceutical measures (NPM) provided some form of relief from the higher death rates that other cities endured.

While there are caveats that must be noted, this seems to jibe with what I’ve felt will be a significant factor in dealing with an influenza pandemic.  Social distancing, isolation and quarantine, schools closing and other social tools will save lives.  Contrary to some critic’s (see Kathleen Neuzil’s comment in the linked CIDRAP article) beliefs, pandemic preparedness is not a zero-sum game.  Working towards developing a vaccine will not take away from planning to institute these non-pharmaceutical measures – and likewise the other way ’round.  I agree that while NPM are not “the answer,” I feel that vaccines are also not “the answer.”  Due to delays in development and distribution of a vaccine for a pandemic strain, many people will already have succumbed by the time it is usable and possibly contributed to continuing mutations in the disease.  Furthermore, the idea of a limited release of what will be known as “The Cure,” is something that I want absolutely nothing to do with.  You want something fraught with racial, political and economic consequences in a world full of people who are already convinced they have a pretty good chance of dying?  See Revere’s post from earlier today.   The point is that all solutions are far from perfect, which is why the idea of pandemic flu is so damn scary.

In order to demonstrate how scary, I’m working on retrieving a slide I saw once at a pandemic flu presentation that compared the death rates over time in Philadelphia and St. Louis during the 1918-1919 Spanish Flu.  In the meantime, here is a Washington Post report from December 2006 that references these stats.  Philadelphia’s death rate was higher, and had a much higher slope than was found in St. Louis.  The difference?  St. Louis closed their schools earlier (the change in slope was correlated to the time of the decision to close schools).  Once the pandemic was underway, closing the schools in Philadelphia did little to stem the tide.  St. Louis, however, opened their schools earlier than Philadelphia and experienced a rise in flu deaths while Philadelphia’s deaths continued to taper off.  Additionally, I’ll also post an article written by a University of Pennsylvania medical student who was put in charge of running an emergency hospital during the Spanish flu.  I’ve seen references to his description of what became of Philadelphia and his patients while gripped by the disease, such as this (under the Social Impact header).  See what I mean?  Scary.

Ultimately, I have to agree with the Revere’s conclusion while discussing this report:

What these data do seem to establish is that the better prepared and organized a community is, the better off it will be. And the more a community ignores and denies a problem, the worse off it will be. This is the real message, not that “quarantines work.”

Photo credit: dj_jonny_flash


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