I have an unusual vantage on our current pandemic. In 2006, I worked in an unlikely role for the Swiss pharmaceutical manufacturer, Roche. I was responsible for strategy and planning for corporate pandemic preparedness. At that time, the world was deeply anxious about a different pandemic, the Avian Flu (or so-called, Bird Flu) pandemic. Roche was the producer of the most sought-after pharmacological countermeasure, Tamiflu, that governments, corporations and consumers alike were aggressively trying to stockpile. And during that time, I regularly heard the refrain, “It’s not a question of if, but when” from most of the experts about the next pandemic. What I frequently encountered were skeptics that questioned the possibility of a pandemic in our lifetime and ambivalence to prepare for the unknown. What was most troubling was a general belief that we can figure it out IF it gets bad enough. Perhaps no story better captures this sentiment than a set of stories frequently told by historians that studied the 1918 flu pandemic (the Spanish Flu). The side-by-side comparison of the cities of St. Louis and Philadelphia. If you haven’t read the story before, its a remarkable story worth reading and reflecting on what it means for our communities right now.
Few, if any of us, will personally know of the 1918 influenza pandemic caused by the H1N1 virus. By some accounts, it infected a third of the world’s population and killed 50 million people. St. Louis was one of the earliest cities affected by the virus given its proximity to a military barracks that is often cited as “ground zero” for the outbreak. At the time, St. Louis was one of the largest cities in the United States and right in the eye of this public health storm. They had already experienced several infections and the storm was brewing on the horizon. The City Health Commissioner, with the support of the mayor, undertook extraordinary and unprecedented draconian actions, including: school closures, the shuttering of theaters and “places of amusement” as well as churches. He took it to the next level very quickly and banned public gatherings of more than 20 people and closed the municipal court, playgrounds, library reading rooms, limited the use of public transportation and restricted hours for shopping. This was the start of what would later be described as social distancing. They also aggressively educated the public to minimize fear and rebellion. They produced pamphlets that informed the public on the threat and guidance on how to protect themselves, including the phrase “cover up each cough and sneeze, if you don’t you’ll spread disease.” As a result, St. Louis had one of the lowest influenza rates and according to public records of the time, of the 31,500 who got sick in St. Louis only 1,703 died.
Philadelphia, on the other hand, became a teachable lesson for public health experts. Around the same time period, returning soldiers who had been infected were turning up in numbers with the flu-like illness and physicians worried openly that this posed the risk of an epidemic. The city health commissioner and the medical board of Philadelphia dismissed the threat. They took few social distancing measures, unlike the city of Saint Louis. And perhaps most famously, the health commissioner approved a “Liberty Loan Parade”, despite protests from physicians and experts, to proceed as planned given its civic importance in terms of fundraising dollars for war bonds. Within a few days, all of Philadelphia’s hospitals were bursting with patients and by the end of the week nearly three thousand people had already perished. And although similar measures used in St, Louis were proposed, city officials met them with skepticism. From an editorial of the time, one journalist wrote: “What are they trying to do, scare everybody to death?” The fear of influenza is creating a panic, an unreasonable panic that will be promoted, we suspect, by the drastic commands of the authorities.” Only as the situation worsened to crisis levels, did officials order all schools, theaters and churches closed. By then, it was much too late. According to Penn Archives, Philadelphia experienced devastating levels of mortality with more than 12,000 deaths and 47,000 reported cases in just four weeks.
So, what’s the lesson to be learned? To borrow a quote from the historian John Barry, author of “The Great Influenza, when you mix politics and science, you get politics. There will be citizens and leaders alike who believe the current pandemic is hyped up, or worse yet, a hoax. But we cannot let unfounded conspiracy theory or political rhetoric get in the way of swift and coordinated action. Furthermore, we must also expect that life-as-usual, will be unusual, for a period of time. But with thoughtful, coordinated action and a heavy dose of good hygiene and social distancing, we can flatten out this curve and avoid becoming another public health footnote in the study of pandemics.