Two United States Cities Who Proved Social Distancing is Key to Crushing Pandemics
The 1918-1919 Spanish Flu pandemic is something of an academic oddity to both historians and viral researchers. An instructor pointed this out when I was a graduate history student, noting that despite the numerous lives lost, the epidemic was strangely understudied. Finding understudied subjects in history isn’t unusual, but when our best estimates suggest at least one-third of the world’s population contracted the virus, killing roughly forty to fifty million people, this is one calamity you’d expect academics to tear into.Understudied subjects are like blood in the water to historians, and from 2002 to 2012, a flood of academic works were published, analyzing every facet of the disaster. Many of these books and journal articles are a potent source for the CDC’s Covid-19 counterstrategies, particularly since the Spanish Flu of 1919 was relatively recent as well as devastating.The United States had endured epidemics prior to 1919; cholera, for example, was among the nastiest throughout the mid-nineteenth century, but what makes the recent research so useful is this: record keeping. Our medical establishment documented everything like never before, and the newspapers of the time give us a snapshot of what was actually happening. Contemporary news publications are one of the key sources we have that show us what worked to slow, or prevent, infection and what strategies failed.Through newspapers, we know what happened in cities who scoffed at the danger, those who didn’t, and what happened in all of them when the third and final wave slammed into the United States long after everyone believed the threat was over. Thus, we’ll look at two cities, one who ignored the danger, one who didn’t.
The Case Studies
In late summer 1918, the second Spanish flu wave slammed into the United States, primarily carried by soldiers returning from Europe. The incredibly infectious virus established a foothold in Boston, then spread to New York and Philadelphia, before streaming westward into St. Louis and San Francisco.There was no vaccine, no quick exchange of medical information between organizations, or, perhaps worst of all, no centralized institution to guide America’s response. The responsibility fell on the shoulders of mayors and city health officials, who suddenly found themselves beset with questions they could not answer. Should they order every citizen to wear a gauze face mask? Close schools, workplaces, financial centers, and ban all public gatherings? The United States was in the middle of a war, how could they justify shutting everything down?Ultimately, nobody knew for certain.
PhiladelphiaThe Philadelphia public health director, Wilmer Krusen, made the worst decision of just about anyone. When the first civilian cases were reported on September 21, 1918, he and his medical board told Philadelphians could lower their risk of catching the flu by staying warm, keeping their feet dry and their “bowels open,” according to John M. Barry in The Great Influenza: The Story of the Deadliest Pandemic in History.
The number infected rose by the day, but Krusen refused to ban gatherings. Nor would he entertain any stronger measures whatsoever. Why did he do this, you ask? Because there was an important parade scheduled for the 28th, a Liberty Loan event expected to raise millions in war bonds. Infectious disease experts pleaded with Krusen to cancel, but he refused to hear it and the parade went on. Worse, he publicly downplayed the danger, imploring the public to rally at the event.
The parade included dignitaries, marching bands, local officials, Boy Scouts, and soldiers, forming a two-mile-long procession as they marched down streets thronging with spectators.
Unaware their public health director had ignored the danger, several hundred thousand people attended. Seventy-two hours later, all thirty-one of Philadelphia’s hospitals were full. By the end of the week, 4,500 were dead, and the infection blazed through the population.
St. LouisA different story played out in St. Louis, just 900 miles away. When the second wave of flu hit the U.S., and reports filtered out from Boston, New York, and Philadelphia, St. Louis didn’t dither. The moment the nearby Jefferson Barracks reported a case and went under quarantine, the city acted.In early October, city health commissioner, Dr. Max C. Starkloff, ordered the closure of schools, movie theaters, saloons, sporting events and other public gathering spots. Churches were told to suspend Sunday services. At the time, with nearly 800,000 residents, St. Louis was among the top 10 largest American cities.It was a bold move, and one that was exceptionally unpopular. Theater owners, some of the largest taxpayers at the time, protested the closures. Musicians and entertainers claimed the quarantine threatened their careers. Starkloff pressed on.Within two days of the quarantine, eight soldiers at Jefferson Barracks were dead, another eight residents died at St. Louis City Hospital and the number of area flu cases topped 1,150.When the flu continued its rampage throughout November, Starkloff imposed stricter quarantines, closing down all businesses, excluding only banks, newspapers, embalmers and coffin makers. Inside factories that couldn’t shut down during wartime production, doctors roamed the floors, watching workers for any signs of flu-like fever and cough.The quarantine was temporarily lifted on November 18 following a sharp decline in illnesses. Believing the danger past, Starkloff began returning the city to normalcy. It wasn’t a crazy decision. From all available data, the worst was over. Sadly, the flu roared back in the first weeks of December, taking everyone by surprise. On the 10th, at least sixty people in St. Louis in one day.Today, we call Starkloff’s measures social distancing, but the important point is this: it worked. Had Starkloff possessed contemporary technology, he’d have known to wait just a few more weeks, but even so, according to a 2007 analysis of Spanish flu death records, the peak mortality rate in St. Louis was only one-eighth of Philadelphia’s death rate at its worst.