Public health interventions and epidemic intensity during the 1918 flu pandemic
pnas.org
pnas.org
> Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic.
In other words, a similar amount of people died regardless of these interventions, but the cases were spread out over a longer time period. They also note that the virus spreads as soon as interventions are relaxed, suggesting many cities just delayed the infection.
Edit: thanks for the comments below - my comment was just to point out that these interventions didn't cut the death rate in half, as a quick reading of the submitted headline might suggest.
PS (edit): oh, and it also wouldn't really keep businesses from preparing for a pandemic, because of pandemics strike one once in several decades this will be long enough for market forces to have preparing companies displaced by those who don't. The market favors the optimist who bets on no pandemic happening in their lifetimes.
Economic declines cause very real harm to real people -- mostly the working poor.
People lose their jobs, their houses, and their healthcare in recessions.
You may feel immune if you're a tech worker -- and you may be for a time -- but you're not immune to layoffs either.
So if we can blunt the peak infection rate, more people will survive, even if the total number of cases is the same.
> Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (≈20%) and less statistically significant than that for peak death rates.
The full area you’re quoting seems to say that implementating multiple interventions had an impact, but no single one had an effect if done on its own.
Relevant section:
> Cities with more early NPIs also had fewer total excess deaths during the study period (Fig. 2 b, Table 2, 1918 total), but this association was weaker: cities with three or fewer NPIs before CEPID = 20/100,000 experienced a median total excess death rate of 551/100,000, compared with a median rate of 405/100,000 in cities with four or more NPIs (P = 0.03).
They also noted second waves of infection only occurred once restrictions had been lifted. If we delayed a peak till a vaccine was developed or an existing treatment discovered, we could lower deaths further.
It seems appropriate to bring up on International Women's Day that women's labor at the time was largely that of 'homemaker' - a highly self-sufficiency oriented role. To put it in tech terms, there were a lot more people WFH, and a lot less dependencies on external services. Women were only 20% of the labor force at the time vs 47% today [1].
I say this NOT to advocate for a return to this state, just pointing out a large factor to consider, one often overlooked.
The site guidelines say: "Please use the original title, unless it is misleading or linkbait; don't editorialize."
My recollection:
There is a book called The Hot Zone that examines the successful containment of Ebola by "uneducated savages" in the jungles of Africa.
The village elders decided to barricade roads and stop letting in outsiders. They told their people "Don't go to the white man's hospital" because you would go with something fixable, like a broken leg, and die of Ebola, which was killing like 90 percent of people.
They quarantined you by insisting you stay home if you got sick. They would leave food on your doorstep for you. If the food sat there untouched for three days, they burned your hut down without going in to check if you were alive.
Obviously, I'm not advocating for burning people's houses down. But it's an interesting case study of successful containment using non-pharmaceutical interventions.
If you are willing to throw things out, disinfect like crazy, limit social contact, etc, there's a lot you can do without drugs to stop the spread. But it's damnably inconvenient and most modern people's seem to want to take a pill and carry on as usual. We seem extraordinarily averse to being inconvenienced.
1918 hit 20 year olds the worst while this virus targets the elderly. The biggest issue now is the need for ICU care to survive. We know mortality rates but that implies care, otherwise it turns into Wuhan. Only 90,000 ICU beds in the whole U.S. and this is the situation happening in Italy right now.
So since the virus is more or less endemic, spreading infections over time is the best way to save lives. Washing hands and canceling all big group events at least until summer are the teo obvious moves.
[Edit] US cities screenshot: https://imgur.com/a/Vzm9wN5
I'm working on a thing and would love to be able to include things like this.
??? Thanks but no thanks.