Flu Studies Point to Isolation for Prevention

Scientists examining the deadly flu pandemic of 1918 say it offers a lesson for dealing with a potential outbreak today: keep people away from each other. The government supports the approach, but skeptics say it's impractical.

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When the flu pandemic of 1918 killed millions worldwide, different American cities had very different death rates. When scientists looked at why, they said results offered lessons on how to prepare for the next pandemic.

But as NPR's Richard Knox reports, that's open to debate.

RICHARD KNOX: The debate is about how many flu deaths could be prevented by keeping people away from each other when the pandemic strikes. Would there be fewer deaths if officials cancelled public meetings, quarantined people at home when a family member gets sick, close the schools? The mainstream view is: these things would save a lot of lives. The U.S. government thinks so. Two new reports in the proceedings of the National Academy of Sciences strongly support it.

One study looked at how 17 cities coped in 1918. Where authorities took immediate measures to limit person-to-person contact, peak death rates where half as high as in cities that didn't. Dr. Marc Lipsitch of the Harvard School of Public Health says two of those cities tell the tale.

Dr. MARC LIPSITCH (Associate Professor, Harvard School of Public Health): In Philadelphia, the first cases of disease in civilians were reported on September 17th of 1918, but the major interventions to try to block transmission didn't happen until more than two weeks later on October 3rd.

KNOX: Philly had one of the highest death rates in the country. It was very different in St. Louis.

Dr. LIPSITCH: They responded within just a couple of days of the first cases among civilians. As a consequence, we think, the epidemic at its worst was not nearly so bad.

KNOX: One thing that stuck out about 1918 is what happened when cities let down their guard. Children went back to school, churches and dance halls reopened, and flu cases surged. Lipsitch says the lesson is draconian restrictions need to stay in place for the duration, maybe as long as six months. Businesses and workers would suffer, but that's the earliest a vaccine could be ready.

Dr. LIPSITCH: Everything else we do is a means of buying time until we have a vaccine and get it into people.

KNOX: But the price comes high: basically, the cost of disrupting everybody's life, the economy, the whole society. Researcher Neil Ferguson of Imperial College in London led the second study. He says there's another lesson from 1918.

Professor NEIL FERGUSON (Researcher, Imperial College London): One of the key lessons we learned from our analysis is how difficult it is to actually sustain these measures over a long period, and get population buying into them. The measures introduced in St. Louis and San Francisco ends up being very unpopular.

KNOX: The mayor of Seattle was run out of town. It's especially hard to keep the lid on when people see the number of flu cases going down. Ferguson says planners need to be prepared for that. But another leading public health authority doubts many of the classic measures cities used to blunt the 1918 pandemic would work in today's world.

Dr. D.A. Henderson of the University of Pittsburg led the historic effort to eradicate smallpox. His experience with the flu goes back to the relatively mild pandemic of 1957; about 80,000 Americans died then, roughly three times the toll in a regular flu season.

DR. D.A. HENDERSON (University of Pittsburgh Medical Center): I was in charge of surveillance at CDC for influenza in 1957. The speed with which that disease spread was just astounding.

KNOX: Henderson says that instead of planning to quarantine people and close schools, the government should be figuring out how flu victims will get care.

Dr. HENDERSON: Because if you cannot accommodate patients in hospitals, you're going to see a situation which could make the Katrina situation - where they couldn't provide medical care - look like nothing. We're not prepared for that.

KNOX: Henderson holds the minority view, but until the pandemic actually happens, no one can say for sure who's right.

Richard Knox, NPR News.

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