After an intense, year-long examination of the public health response of 43 American cities during the 1918-1919 epidemic, researchers at the Center for the History of Medicine and the CDC concluded that those cities that used social distancing measures and other non-pharmaceutical interventions in 1918 fared better than those that did not. More specifically, we found a strong association between early, sustained, and layered use of NPI and mitigating the consequences of the epidemic. Our results were published in Journal of the American Medical Association in August 2007 (freely available at http://jama.jamanetwork.com/article.aspx?articleid=208354), and subsequently became the basis for the Department of Health and Human Services’ community mitigation guidelines for pandemic influenza.
Even with a growing literature on the historical, epidemiological, and public health aspects of the 1918 influenza epidemic in the United States, significant gaps remained in our social and cultural understanding of this cataclysmic event. Although influenza infected and affected nearly every community across the nation, each experienced the epidemic in markedly different ways. Contrary to the popular imagination, the history of the 1918 influenza epidemic is hardly a monolithic one and can be best characterized as many tales of multiple places and people. Consequently, narratives that capture the human dimension of epidemic response often can best be told from the local and personal perspective. At the same time, over-generalizations can discredit or distort the stories of the participants, the varying nature of community responses, and diminish the lessons that we can glean from studying the past.
For this reason, we continued our study of the 1918-1919 influenza epidemic. We expanded our list of American cities to fifty. We visited hundreds of libraries and archival repositories across the nation, gathering thousands of pages of newspapers, public health reports and bulletins, and other documents. Using these materials, we crafted a detailed narrative essay for each city, exploring the story of influenza’s arrival in each community and the havoc it caused, but also documenting the civic response, the political and economic ramifications, and, in every community, the heroism and courageousness of doctors, nurses, and countless volunteers who gave their all to fighting the epidemic. Realizing that even this work would not allow us to tell the complete story, in 2009 we invited renowned historians of public health and experts on influenza virology to write original articles on various thematic aspects of the epidemic, including the science of influenza, public health in the early-20th century, and the institutional and community responses to the disease. Those essays became the basis for a special supplemental issue of Public Health Reports, sponsored by the U.S. Centers for Disease Control and Prevention and the University of Michigan Center for the History of Medicine, and published in April 2010 (freely accessible at http://www.publichealthreports.org/archives/issuecontents.cfm?Volume=125&Issue=9).