Bench-to-Community: Making Pandemics History
Doctors have imposed quarantine orders since at least 1374, when the Port of Venice officially isolated foreigners and shippers for 40 days to keep out infectious scourges. Through the ages, some people sensed that public health measures like quarantining the sick and isolating people after exposure to the sick would save lives during an influenza pandemic, but it’s never been proven—until now. Howard Markel, M.D., Ph.D., and his team at the U-M Center for the History of Medicine questioned the conventional wisdom that as the Spanish Flu ravaged the United States and elsewhere, little could be done to stop its deadly toll.
The historical record of the deadly 1918 to 1919 influenza pandemic in the U.S. is extensive. It makes up one of the largest documented experiences with the use of social restrictions to control the spread of an infectious disease. Markel and his team, in collaboration with a group at the federal Centers for Disease Control and Prevention, wondered whether city-to-city variations in death rates could be associated with public health measures. Did making people stay home save lives?
Proof of concept
The researchers selected 43 U.S. cities representing a combined population of approximately 23 million. Traveling to the Library of Congress, New York Public Library and other historical research centers, the team combed—one frame of microfilm at a time—1,144 primary and secondary sources, such as U.S. census data, municipal records, newspapers and handbills. Covering a 24-week period—Sept. 8, 1918 through Feb. 22, 1919—the researchers documented when officials in each city “turned on” public restrictions such as quarantine, isolation, school closures and bans on public gatherings. They also documented when these measures were “turned off” and compared each city’s start and end dates for restrictions to its death rate for the same time frame. For nearly all cities, the death rate went down when social restrictions were in place. Access data specific to each of the 43 cities.
Government revises its recommended public health tactics
The extensive U-M/CDC research helped reshape what the federal government now advises states, counties, towns and businesses to do in the event of a flu pandemic. On Feb. 6, 2007, the CDC and the U.S. Department of Health and Human Services issued new interim planning guidance on the use of social restrictions—called non-pharmaceutical interventions—to reduce the pandemic’s harm. These measures would also provide a cushion of time for the development and distribution of vaccines and antiviral drugs, while reducing the crush on essential infrastructure.
Pandemic planning at UMHS
Planning what to do in a pandemic is complicated for any institution or business, but UMHS must also assess how to meet the needs of our patients. A Pandemic Planning Committee has been meeting since May 2006. The issues are so complex that 20 teams are involved, looking at such things as clinical capacity, staffing, supplies, education and more. The committee estimates HHC would admit 20,000 patients in 12 weeks! That’s half our annual admissions within three months. Preliminary Committee recommendations to Health System leaders were made in December 2006, and work continues in a number of teams to refine and advance the plan.