Pandemics: Different Eras, Different Reactions

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ASPartOfMe
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18 Apr 2020, 6:50 pm

How the news media played down the pandemics of yore, from Spanish flu to Swine flu

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When it comes to COVID-19, social media is a fire hose of facts, fears and fabrications. It’ll jazz you up and calm you down. It’ll make you scowl at toilet paper hoarders one minute, then bolt off to the store the next.

It was different in the age when people got their news from, well, newspapers. If you examine the archives to see how papers reported on the pandemics of yore — 1918, 1957, 1968, 2009 — you see how the culture is reflected in the tone. And you can’t help concluding that either they were made of sterner stuff than us, or they really didn’t know what they were up against. Or both.

Spanish flu, 1918.The papers noted the number of reported flu cases, the local deaths, the closings — but the stories were small. Wartime censorship kept a lid on bad news that might dent home-front morale. Plus, the appetite for death tolls and harrowing predictions was not abundant in a population exhausted by war news.

The occasional alarming anecdote would turn up. An item in the Minneapolis Morning Tribune on Oct. 30, 1918, has a raw, despairing quality absent in nearly every other story on the epidemic.

“A letter from a small town in the east says: ‘People are dying by the hundreds here. They cannot dig graves fast enough, and there is a shortage of caskets. I don’t know what we will do if this keeps up; it seems they will have to bury the dead without coffins.’ That’s how terrible the Spanish Influence is in some locations.”

That was not a news story, though. That was an ad for an anti-flu nostrum that was literally called Snake Oil — in case you wondered how bogus meds got that name.

Asian flu, 1957. On July 4, 1957, a headline in the Minneapolis Morning Tribune said, “Minnesota Keeps an Eye Out for Asian flu.”

The story:

“Minnesota health officials are on the alert for Asian flu. They are awaiting the result of a laboratory check on some 100 suspected cases that broke out in the past week at a Grinnell, Iowa, youth meeting. If the Iowa cases turn out to be Asian flu, it will be the disease’s first United States appearance outside apparent cases on both east and west coasts.”

That would seem to be important, no? Apparently not that important; the story ran on page 23.

According to the Des Moines Tribune on Aug. 16, it was Asian flu, and there were 200 suspected cases. But the story was headlined “Asian Flu Fails to Hit Iowa Hard,” and it ran on page 15, with the movie reviews and traffic accident reports.

The Morning Tribune ran a few stories about the Asian flu in July 1957. They included a news brief about an outbreak that sickened hundreds in Syria and an editorial calling for calm and praising the efforts of the World Health Organization and the U.S. public health services.

That was the official mood of the times: Our top people are on it. We have tools now. But there might have been something else at work, too, when you consider that people had endured the polio epidemic. Nature always had something nasty up its sleeve. Grit your teeth, wait and pray.

By August, the story was front-page material, but the stories discussed the new vaccine and its imminent arrival. The flu was always in the paper, but it was reported with as much emotion as the livestock prices. By the time the virus had run its course, the death toll in the United States was about 116,000. (Keep in mind that the population was only about half of what it is now, 172 million compared with an estimated 331 million.) The last grueling death rattle of World War I dominated the papers, not the flu. Which is not to say papers ignored it. They ran poems about it. Humorous poems, at that, mocking hypochondriacs and panic-mongers. And when they did take it seriously, it could backfire. The Winnipeg Tribune ran a front-page story about shop owners blaming the paper for hyping the flu and ruining business.

Hong Kong flu, 1968: The Asian flu permuted into a new variety, H3N2, also known as the Hong Kong flu. Stories about it started popping up in November and December, and again, the media had a business-as-usual tone. There were larger tales to tell — the journey to the moon, the trouble in Vietnam.

Said an Associated Press report on Dec. 27, 1968:

“Deaths attributed to the Hong Kong flu more than doubled across the nation in the third week of December. ... Official figures for the week showed roughly 500 more ‘pneumonia-influenced’ deaths recorded in 122 cities.”

The story ran on page 24. Hong Kong flu eventually would kill 100,000 people in the United States.

Swine flu, 2009: On April 25, the Star Tribune ran a front-page story of a flu epidemic in Mexico that had hit Texas and California. Two days later, on the top of the front page, was a report of more new cases, all over the planet. “It’s not a time to panic,” said the headline, quoting the White House.

This was H1N1, and the initial impact seemed mild. In the second week of June, the state was reporting 30 new cases a day, but there was a general shrug about it. At the time, according to a Star Tribune graphic, there were about 14,000 cases in the United States. And then it died out.

But it came back in the fall. There was a vaccine, but there wasn’t enough. “Vaccine rollout fuels anxiety,” read a headline, displaying a different tone than the headlines of earlier years. Anxiety about the authorities’ ability to cope was not the part you said out loud back then. President Barack Obama’s Oct. 25 announcement of a “national flu emergency” made the front page, but it wasn’t the top story.

The third paragraph noted that over 1,000 people had died from the flu.

There was a vaccine soon enough, but the rollout was plagued with glitches and ineffective batches. Nonetheless, the story did not dominate every page of the news or roil the markets. A few activities shut down — a summer camp here, a meeting there. A graduation ceremony had to make do with fist-bumps instead of handshakes. The news didn’t seem apocalyptic.

So why is COVID-19 getting such different treatment from the media?

Perhaps this is a unique intersection of a more virulent strain appearing at a point when social media and global interconnectivity amplifies everything. It’s hard to bear the bad news, and it makes you wish someone would write a humorous poem.


SPOTLIGHT: WHY DON'T WE EVER TALK ABOUT THE HONG KONG FLU
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The most cited historical comparison for COVID-19 dates back just over a century ago: the Spanish flu. The 1918 pandemic, which killed up to 50 million people worldwide, is mostly viewed today to as a testament to our improved ability to fight the spread of disease and limit loss of life. Yet there is a more recent, and strangely overlooked, example that may be much more worthy of our reflection, with points of comparison that say much about where we are today.

The Hong Kong flu emerged on the Asian island nation in July 1968, and within two weeks had already infected some 500,000 people. Fueled by what was then a recent boom in air traffic, the virus spread swiftly throughout Southeast Asia, and on to the United States through soldiers returning from Vietnam. By the spring of 1970 it had extended worldwide, and killed one million people.

Unlike both the current coronavirus spread and the Spanish flu, the Hong Kong flu didn't seem to attract the attention it deserved. Just a few examples we dug up: In Sweden, this front page of daily newspaper Epressen read "Stockholmers Have To Learn To Walk," referring to infrequent tram traffic due to hospitalized conductors; in France, reporters from weekly Paris Match weren't sent to visit the city's overcrowded hospitals, but a movie set where actress Marina Vlady was found laying in bed — "she doesn't have the Hong Kong flu," quipped the magazine, " she's just shooting a movie;"

The global response to today's crisis couldn't stand in starker contrast, and the questions abound: How can we understand the nature of an elusive new virus? What must be done to mitigate its spread and lethality? What will it mean for the future? Indeed, the other great point of contrast with the Hong Kong flu, where no major quarantines were implemented, are the decisions being taken today in countries around the world to do everything possible to limit loss of life, including bringing the entire economy to a halt. That naturally leads to the very complicated question: How do we measure saving every human life against the longer term effects of a possible once-in-a-generation economic meltdown?

For now, it seems most of the world has agreed to prioritize the former at all cost. But as lockdowns are extended around the world and resources dwindle, we should expect that question to grow louder.


The closest reaction to todays COVID-19 reactions were Polio outbreaks.
1916 New York City polio epidemic - Wikipedia
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The 1916 New York City polio epidemic was an epidemic of polio ultimately infecting several thousand people, and killing over two thousand, in New York City, primarily in the borough of Brooklyn. The epidemic was officially announced in June 1916, and a special field force was assembled under the authority of Dr. Simon R. Blatteis of the New York City Health Department's Bureau of Preventable Diseases, with broad authority to quarantine those infected with polio and institute hygiene measures thought to slow the transmission of the disease. Polio was a poorly understood disease in this era, and official efforts to stem its spread consisted primarily of quarantines, the closure of public places, and the use of chemical disinfectants to cleanse areas where the disease had been present. Special polio clinics were established at various locations in the city for the treatment and quarantine of patients.

In addition, many informal remedies or preventative measures were tried by the frightened population, while public activities largely fell silent. Ultimately, the epidemic subsided in the winter months, with the cause remaining a mystery to investigators and the public.

Progress of the epidemic
On Saturday, June 17, 1916, an official announcement of the existence of an epidemic polio infection was made in Brooklyn, New York. Over the course of that year, there were over 27,000 cases and more than 6,000 deaths due to polio in the United States, with over 2,000 deaths in New York City alone.

According to the figures compiled by the New York City Department of Health, by June 1916 there were 114 verified cases of infantile paralysis in Brooklyn, practically all of them in the old South Brooklyn section. The outbreak appeared to be confined to infants and young children, less than 10% of the cases occurring in children over five years of age. The Department of Health stated that a careful investigation had failed to substantiate the view that the schools had a share in spreading the disease, pointing out that over 90% of the children were under the typical school age; that the cases were not limited or even more prevalent in any one school district, and that they were not at all limited to children in the same classroom.

The 1916 epidemic caused widespread panic and thousands fled the city to nearby mountain resorts; movie theaters were closed, meetings were canceled, public gatherings were almost nonexistent, and children were warned not to drink from water fountains, and told to avoid amusement parks, swimming pools, and beaches. The names and addresses of individuals with confirmed polio cases were published daily in the press, their houses were identified with placards, and their families were quarantined.Hiram M. Hiller, Jr. was one of the physicians in several cities who realized what they were dealing with, but the nature of the disease remained largely a mystery. In the absence of proven treatments, a number of odd and potentially dangerous polio treatments were suggested.

Because of the relation alleged to exist between polio and the stable fly, a survey was made to determine whether the cases were in the vicinity of stables, and the Sanitary Bureau took special pains to see that the manure in all of the stables in the affected districts was properly disposed of to prevent the breeding of flies.

In response to a call issued by Commissioner Emerson, a conference of experts was held at the Health Department on June 28, 1916, to discuss plans for the control of infantile paralysis in Brooklyn. At the conference it was decided to organize a special field force in Brooklyn under Simon R. Blatteis of the Department's Bureau of Preventable Diseases. A special staff of medical inspectors, sanitary inspectors, nurses, and sanitary police, would assist Blatteis, visiting all cases daily and see that strict quarantine was maintained, and that all the premises where a case of infantile paralysis exists were placarded. The Department of Health prepared a special pavilion at its Kingston Avenue Hospital for sufferers from infantile paralysis to be cared for by skilled specialists


When Polio Triggered Fear and Panic Among Parents in the 1950s
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In the 1950s, the polio virus terrified American families. Parents tried “social distancing”—ineffectively and out of fear. Polio was not part the life they had signed up for. In the otherwise comfortable World War II era, the spread of polio showed that middle-class families could not build worlds entirely in their control.

For the Texas town of San Angelo on the Concho River, halfway between Lubbock and San Antonio, the spring of 1949 brought disease, uncertainty and most of all, fear. A series of deaths and a surge of patients unable to breathe prompted the airlifting of medical equipment with C-47 military transporters.

Towns Practice Extreme Social Distancing

Fearful of the spread of the contagious virus, the city closed pools, swimming holes, movie theaters, schools and churches, forcing priests to reach out to their congregations on local radio. Some motorists who had to stop for gas in San Angelo would not fill up their deflated tires, afraid they’d bring home air containing the infectious virus. And one of the town’s best physicians diagnosed his patients based on his “clinical impression” rather than taking the chance of getting infected during the administration of the proper diagnostic test, writes Gareth Williams, Paralyzed with Fear: The Story of Polio. The scene repeated itself across the nation, especially on the Eastern seaboard and Midwest.

The virus was poliomyelitis, a highly contagious disease with symptoms including common flu-like symptoms such as sore throat, fever, tiredness, headache, a stiff neck and stomach ache. For a few though, polio affected the brain and spinal cord, which could lead meningitis and, for one out of 200, paralysis. For two to 10 of those suffering paralysis, the end result was death.

Transmitted primarily via feces but also through airborne droplets from person to person, polio took six to 20 days to incubate and remained contagious for up to two weeks after. The disease had first emerged in the United Sates in 1894, but the first large epidemic happened in 1916 when public health experts recorded 27,000 cases and 6,000 deaths—roughly a third in New York City alone.

After rabies and smallpox, polio was only the third viral disease scientists had discovered at the time, writes David Oshinksi in Polio: An American Story. But a lot remained unknown. Some blamed Italian immigrants, others pointed to car exhausts, a few believed cats were to blame. But its long incubation period, among other things, made it difficult even for experts to determine how the virus transferred.

Polio Hysteria Finally Subsides With Vaccine

The Journal of Pediatrics, parenting guru Benjamin Spock, every expert and most editorial boards warned against irrational “polio hysteria.” And yet, Oshinski tells us, headlines and images of polio victims were familiar features on the front pages in the summer months. American parents were petrified. A 1952 survey found that Americans feared only nuclear annihilation more than polio.

The random pattern the disease struck made parents feel helpless, as was the lack of a cure. As middle-class parents saw it, something like this was not supposed to happen. Infectious disease had been the leading cause of death in 1900, it was no longer in 1950. They had survived the Great Depression, fought and won World War II, and returned safely from a dangerous world. Oshinski shares this recollection of a journalist from that time: “Into this buoyant postwar era came a fearsome disease to haunt their lives and to help spoil for those young parents the idealized notion of what family life would be. Polio was a crack in the fantasy.”


The reaction to Polio cannot compare to COVID-19. In areas where outbreaks occured the fear and reactions were comparable and familiar but there was not anything remotly like the worldwide shutdowns of coronavirus and even in the areas where there was an outbreak the economy was not completly shutdown.

Perhaps the then recent Polio panics caused people to be more stoic about the '57 and '68 flu pandemics.


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19 Apr 2020, 3:46 am

Very interesting. Thank you for posting. I’m not sure I’d ever heard of the Hong Kong flu before.

Both the Hong Kong and Asian flus infected a large percentage of the population. They killed less than 0.5% of the people they infected, about 1 million people. Although as we have seen with this disease, those numbers are estimates.

It’s not clear what the death rate is for Covid-19 but it seems to be substantially higher, probably around 1-1.5% but possibly as high as 3.5%. If that ended up infecting everyone in a short space of time then we would have tens of millions of deaths.

It’s certainly frustrating that the news is seemingly only covering one thing, but it truly is impacting on all areas of life, and that’s pretty unavoidable.



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19 Apr 2020, 4:34 am

My aunt remembers "that big flu outbreak in 1970" when she was a young GP. My mother who was still at school back then, remembers there were like 5 people in class (of normally 30 or more), including her - she didn't catch it.
Must have been the Hong Kong flu.
The media of People's Republic of Poland were all silent about it.


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19 Apr 2020, 6:41 am

I used to hear about the Hong Kong flu when I was a kid.

The scary thing about COVID19 is its unusual symptoms—like loss of taste and smell. There is also a relatively high incidence, it seems, of cardiac and neurological manifestations.

The Asian and Hong Kong flus didn’t seem to have these cardiac and neurological manifestations, though the Spanish flu had a high lethality and a high incidence of dramatic complications.

I believe part of the reason why there have been a great amount of restrictions is because of the nature of our reactions to untoward events.

I also believe part of the reason is the mysterious nature of this virus (or viruses?). It seemed like the Asian and Hong Kong strains had more predictable
symptoms and trajectories than COVID19. Also, its nature as a “novel” virus.

In general, there is a stronger, more vigilant reaction to untoward events in recent times, versus that of previous generations.

This is shown in the articles posted by APOM.



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19 Apr 2020, 10:33 am

magz wrote:
My aunt remembers "that big flu outbreak in 1970" when she was a young GP. My mother who was still at school back then, remembers there were like 5 people in class (of normally 30 or more), including her - she didn't catch it.
Must have been the Hong Kong flu.
The media of People's Republic of Poland were all silent about it.

That is similar to what I remember from the “Hong Kong Flu” in 6th grade. One day I was one of only five people out of 25 in my class. It came in two big waves. The strongest wave in America was brought to the country from returning Vietnam War soldiers and hit in December 1968. The second wave in the winter of 1969-1970 was strongest in most of the rest of the world.

Here is an excerpt from an article from an American newsweekly demonstrating a less panicked almost joking attitude toward the pandemic.

Infectious Diseases: A2-Hong Kong-68, or Whatever - Time Magazine December 13, 1968 edition
Quote:
A plague was moving across the U.S. last week. Hundreds of thousands of Americans were sniffling, hacking, running low fevers and complaining that their bones ached. The vast majority of adults said they had "the flu," and many tried to show their medical sophistication by identifying it as "Hong Kong flu."

In most cases, the precise identity of the affliction and the microbe causing it was unknown. Cautious doctors described their patients' illnesses simply as "URD" or "URI" (for upper respiratory disease, or upper respiratory infection) and let it go at that. Whatever its nature, the illness was emptying schools and offices, stripping military installations of active-duty personnel, and decimating Broadway casts. Jane Morgan in the title role and eight other players in Mame had to yield their places to understudies. The cast of George Ml had five out. Playing the barber in Man of La Mancha, Leo Blum became so ill that he fell off the stage, and since his understudy was ill, the stage manager had to pinch-hit. At the Metropolitan Opera, John Alexander had to give up after two acts of La Sonnambula. And in Philharmonic Hall, Pianist Jose Echaniz could not even make it past intermission.

The experience of other large cities was spotty. In Los Angeles, 15 members of the Rams' 40-man football squad gave up practice because of the flu. In Denver, the Hong Kong virus was blamed for a significant increase in the number of deaths due to influenza and pneumonia. Chicago and Detroit were holding their breaths.

The thing to note is that both my school and Broadway, did not close despite an obvious extreamly contagious disease going on. One person testing positive for COVID was enough to shut down professional sports in America. 15 players one one team in 1968 did no such thing.

Unintentionally “social distancing” a term not yet invented did work. School closed. for a week or so for the regularly scheduled Christmas-New Years vacation. When we came back it was like nothing happened, everything was normal.


COVID has gotten my mother to open up about past outbreaks. She mentions beach closings and quarantines from polio and having the flu when she was pregnant with me. That was in 1957 during the “Asian flu” pandemic. Maybe that is why I am autistic. :D

kraftiekortie wrote:
I believe part of the reason why there have been a great amount of restrictions is because of the nature of our reactions to untoward events.

I think the Columbine mass school shooting and 9/11 was the triggers for cultural change. Add social media’s instant and constant bombardment and people are more easily panicked.


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20 Apr 2020, 3:16 am

I was in school for the swine flu outbreak. As far as I remember I was the only person who took time off for it. I’m sure that’s not correct but we didn’t have classrooms with only a few people in them.



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20 Apr 2020, 3:44 am

ASPartOfMe wrote:
Unintentionally “social distancing” a term not yet invented did work. School closed. for a week or so for the regularly scheduled Christmas-New Years vacation. When we came back it was like nothing happened, everything was normal.

I'm curious about something:
Here, the Christmas-New Year break is typically the time of massive travel - often with public transport - to spend Christmas with extended family and New Year Eve with friends. The result is, every minor seasonal outbreak of flu, rotaviruses and whatever is on the board that year, gets efficiently distributed through all the country. Absence at schools and offices is typically worse after the break.
That's why this year I cancelled my Easter plans even before we had the lockdowns.
Yet you say, you remember the break actually helped.

Was it different where you lived back then? Did a lot of people travel and meet relatives during the break or did they rather stay at home?


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20 Apr 2020, 4:03 am

depends on what you mean by "back then" - in my childhood, travel via airplane was still expensive and mainly for wealthy "jet setters," everybody else took the train or bus or drove as gas was cheaper [25 cents or so] back then. there was still travel but a lot more basic and rare [closer to home] than nowadays. what too many people don't seem to get about this "novel virus" is that its R0 [rate of infection] is roughly twice that of the more common flu. the geometric progression of that results in higher numbers in a shorter time/multiplication of infections. it is also more severe in its whole-body impact, esp. on the lungs, than milder flu bugs of the past.



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20 Apr 2020, 4:27 am

By "back then" I mean the 1968-1970 Hong Kong flu outbreak.
We don't fly much, Poland is small enough for trains and buses.


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20 Apr 2020, 10:05 am

magz wrote:
ASPartOfMe wrote:
Unintentionally “social distancing” a term not yet invented did work. School closed. for a week or so for the regularly scheduled Christmas-New Years vacation. When we came back it was like nothing happened, everything was normal.

I'm curious about something:
Here, the Christmas-New Year break is typically the time of massive travel - often with public transport - to spend Christmas with extended family and New Year Eve with friends. The result is, every minor seasonal outbreak of flu, rotaviruses and whatever is on the board that year, gets efficiently distributed through all the country. Absence at schools and offices is typically worse after the break.
That's why this year I cancelled my Easter plans even before we had the lockdowns.
Yet you say, you remember the break actually helped.

Was it different where you lived back then? Did a lot of people travel and meet relatives during the break or did they rather stay at home?

They went to relatives for Christmas and adults socialized on New Years Eve and maybe went to the store to bring back returns but otherwise most stayed home the rest of the time.. The big thing was that we were not crammed together in schools all day long during the vacation. And we were crammed together, we were named the baby boom generation for a reason. All the people that were soldiers in World War Two had delayed getting jobs, getting married and having families Thus in the next decade and a half or so there was a spike in births. The peak of the baby boom in the US was 1957 the year I was born.


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20 Apr 2020, 11:23 am

Baby Boom was even more pronounced here, after millions of citizens died during the war. My parents went to classes of 40 students in primary school.
By the way, you were born the same year my mother was.


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20 Apr 2020, 12:07 pm

magz wrote:
By the way, you were born the same year my mother was.

And Fnord


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20 Apr 2020, 12:50 pm

I was born 4 years later.

In our family, we stayed home for both Christmas and New Years. We might drive to see my grandmother in the Bronx, and my other set of grandparents in New Jersey.

We hardly even ate out much. McDonald’s was sort of a luxury. Once a year, we went to a semi-fancy restaurant.



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20 Apr 2020, 6:37 pm

kraftiekortie wrote:
I was born 4 years later.

In our family, we stayed home for both Christmas and New Years. We might drive to see my grandmother in the Bronx, and my other set of grandparents in New Jersey.

We hardly even ate out much. McDonald’s was sort of a luxury. Once a year, we went to a semi-fancy restaurant.


Going out to dinner was considered a treat. We went out once a month to the Italian place for a hero and a couple of slices of pizza.


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21 Apr 2020, 1:50 am

That's even my childhood.
Eating out is still considered either a treat or a workplace necessity, cooking at home is the norm here.
But typical Christmas of my childhood and adolescence consisted 20-30 people crammed in my grandmother's apartament and about 12 people in my other grandmother's apartament the next day.
After my grandmothers died, the generation of my parents carry on and we drive from a big gathering at my parents' to another big gathering at mu husband's parents' (some 150 km / 95 miles between them).
That's why I couldn't imagine Christmas break helping ease an epidemics.


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26 Apr 2020, 3:54 pm

How New York handled 1918 - Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library

Quote:
When the Norwegian vessel Bergensfjord steamed into New York City’s harbor on August 11, 1918, an unusual welcoming committee awaited on shore. The ship held 11 crew and ten passengers infected with a new and particularly aggressive form of influenza. On the pier were ambulances and health officer for the Port of New York, who immediately whisked the ill sailors to a city hospital. Sailors who had become ill during the voyage but were now recovering as well as those in contact with the sick while on board where put under close surveillance by New York City Department of Health nurses.New York – no stranger to epidemics – had a long-standing tradition of disease surveillance, isolation, and quarantine, and it was this mechanism that went into immediate effect.

Over the course of the next several weeks, more ships bearing ill sailors arrived at New York harbor. On August 16, the Nieuw Amsterdam arrived in New York from Rotterdam, with 22 passengers aboard sick with influenza. On September 4, a French liner Rochambeau arrived with 22 new cases of influenza on board; two victims had already died at sea. The city’s health department placed all the ill men in isolation at the Willard Parker Hospital on East 16th Street and at the French Hospital on W. 34th Street. In an attempt to lessen the likelihood of influenza spreading to New York’s population, health commissioner Dr. Royal S. Copeland placed the entire Port of New York under quarantine on September 12. The difficulty, Copeland admitted, was that other East Coast ports may not be as rigid in their methods of disease control, therefore allowing influenza to enter New York from another city. A few days later, 23 new cases were discovered among sailors from the United States Navy. Then, on September , thirteen seamen were discovered ill with influenza and transferred from their naval training ship to the Kingston Avenue Hospital in Brooklyn. Copeland told the public that there was no need for alarm.

Still, Copeland tightened the city’s disease control measures. On September 17, the city’s Board of Health added influenza to the list of reportable diseases, thus, according to the sanitary code, requiring all cases to be isolated. Copeland announced that homes with cases would be quarantined while the patient recovered, while cases in tenements would be isolated in a city hospital. The move came none too soon: three civilian and two military cases were discovered the next day and placed under isolation. Copeland worried that the disease would spread to New York’s schoolchildren, and he cautioned schools to send home children who were sneezing or coughing in class. To the general public, he had signs printed and distributed warning of the dangers of influenza, how to prevent it, and how to treat it. He also met with representatives from theaters, movie houses, and public transportation to enlist the aid of managers in preventing the spread of influenza.Meanwhile, Dr. William H. Park, head of the city’s Bureau of Laboratories, busied himself and his staff with trying to identify the causative microbe in the hopes of developing a vaccine.

By September 24, New York had well over 100 new cases of influenza with which to deal. Copeland worried about the growing number of cases and his ability to isolate them all. Given that the case rate was likely to rise quickly, hospitals would soon no longer be able to place cases in isolation wards; general wards would have to be opened to influenza patients. He sent instructions to hospitals on how to handle epidemic caseloads. Four days later, city physicians reported an additional 324 cases, with Brooklyn being the worst hit borough. Copeland remained calm, telling reporters and residents that there was no cause for alarm. New York had experienced a total of approximately 1,000 influenza cases thus far, he said, only a tiny percentage of the city’s 5.6 million population. He did ask the city government for $5,000 with which to fight the growing epidemic, however. The Board of Estimate, so impressed with Copeland’s appeal and the seriousness of the situation, appropriated five times that amount, and gave the health commissioner $25,000 in emergency funds.

Unlike the health commissioners of other American cities, Copeland’s strategy for combating the epidemic was not to issue closure orders, but rather to quickly identify and isolate those who fell ill. He reiterated to the public the need to put sick family members in their own room while they recovered and to limit contact with that person for the duration of their illness. Health officials isolated as many cases as they could in city hospital wards. Examination rooms were established at Pennsylvania and Grand Central stations, where a nurse and physician team at each could examine all passengers who arrived feeling ill. Those found to be suffering from influenza were removed to a hospital or put in the care of friends and not allowed to continue on public transportation. New York’s schools, which had a long-standing program of child health monitoring and care, were kept open. Under the direction of Dr. S. Josephine Baker, director of the Department of Health’s Bureau of Child Hygiene, school physicians inspected children each morning and sick students were sent home. In school, classes were kept separate from each other, and all students were instructed to go straight from school to their homes at the end of the day and not to mingle or form crowds. “We have no intention at this time of closing the schools,” Copeland stated, “as I believe that the children are better protected in the schools than they would be in the streets.” New York’s schools remained open for the duration of the epidemic.

By the first days of October, New York’s epidemic started getting under way in earnest. On October 4, physicians reported 999 new influenza cases for the previous 24-hour period, bringing the total number of cases since the start of the epidemic to approximately 4,000. Nearly 700 of those cases were among the city’s schoolchildren. The Brownsville section of Brooklyn was particularly hard hit, and all of the borough’s hospitals were overcrowded. Still, Copeland was sanguine about the situation. Putting these figures in perspective, he told the public that Massachusetts – a state with half the population of New York City – had 100,000 cases of influenza. There was still no need to issue a closure order, he added.

Yet, Copeland did not stand idly by and watch the epidemic unfold. On October 4, he and the board of health resolved that the epidemic of influenza, “while not alarming at the present moment, necessitates care on the part of the citizens of the City of New York.” In conjunction with business owners, the board therefore enacted a staggered schedule for all stores except those selling food and drugs in the hopes of reducing congestion on public transportation. Businesses that normally opened before 8:00 am or closed after 6:00 pm were not affected. All other stores and offices, however, were required to hold to a new schedule that staggered opening and closing times in fifteen-minute increments. Each of the city’s 46 theaters and movie houses was assigned a specific opening schedule between 7:00 pm and 9:00 pm to spread out the evening entertainment crowds. That evening, the first of a series of explosions rocked the T. A. Gillespie Shell Loading Plant in the Morgan section of South Amboy, New Jersey, across the Raritan Bay from the southern tip of Staten Island. The explosion triggered a fire and more explosions that lasted three days, forcing the evacuation of South Amboy as well as nearby Perth Amboy and Sayreville. In the chaos of the mass exodus, thousands fled their homes, with many traveling to New York for refuge. The next afternoon, city officials closed the bridges and halted subway traffic, leaving thousands to cram aboard the ferries as they fought their way to and from home. On the very day that Copeland intended to begin a program to lessen congestion on public transportation, the Gillespie explosion caused the exact opposite. With little it could do to control the situation, the board of health delayed implementation of the staggered business hours until Monday, October 7.

Meanwhile, new cases tallies continued to mount: 2,000 on October 9, then 3,100 on October 11, and some 4,300 on October 12. Copeland believed that dirty and crowded theaters were a major culprit in the spread of the epidemic, and on October 11 he announced that individual theaters would be allowed to remain open only if they were well ventilated, clean, and did not allow patrons to cough, sneeze, or smoke. A next day, the health department closed several theaters due to failure to meet the new sanitary codes. Several others closed because of low attendance.

The surging cases taxed the city’s resources, and Copeland realized that he and the health department needed help in combating the epidemic. On October 12, he created a special Emergency Advisory Committee to assist him. Included were representatives of private and public city hospitals, institutional and home nursing, the Red Cross, merchants, social services, the United States Public Health Service, and the city’s Department of Education. One of the first orders of business was to divide the city into 45 districts (eventually increased to 150) to help distribute resources. As in nearly every community across the nation, the severe shortage of nurses and the care they provided was the most pressing problem. Community organizations across the city pitched-in, organizing volunteer nurses, collected food and supplies for needy families, and offering their automobiles for ambulance services and doctors’ calls. Lillian Wald, pioneer of the visiting nurse profession and champion for health care services for the poor, volunteered her formidable nursing organization, the Henry Street Settlement in the lower East Side of Manhattan, to manage home nursing across the city. The head of Mayor John Hylan’s Committee of Women on National Defense, Millicent Hearst (wife of newspaper tycoon William Randolph Hearst), was appointed chair of a special committee to help coordinate food relief and transportation for visiting nurses. The Red Cross, the Henry Street Settlement, the Brooklyn Visiting Nurses Association and several other volunteer organizations organized an Emergency Nurses’ Council to help recruit nurses and allocate medical care, and to organize volunteers for door-to-door canvassing of homes with influenza cases. New York University and Bellevue Hospital put their third-year medical students to work as volunteers in the cause.Across the city, people and organizations volunteered their services to help bring an end to the epidemic and to alleviate the suffering of the ill.

The epidemic continued to grow worse. On October 19, physicians reported 4,875 new cases of influenza. Some began to grow impatient, and took their frustrations out on Copeland and Mayor Hylan. In Staten Island, several shipbuilding companies reported a 40 per cent drop in productivity due to sick employees unable to show for work. Acting on behalf of the shipyards, Richmond Borough President Calvin Van Name implored Hylan to order Copeland to close Staten Island theaters, saloons, and other places of amusement in the hopes of bringing a swift end to the epidemic. Business owners prepared to counter any such move. A few days later, the deputy police commissioner asked Copeland to close movie houses and dance halls on Staten Island. One city doctor, a representative of the Medical Society of New York County, complained that the health department neglected to quarantine every passenger on the Bergensfjord when it arrived in August, and instead only isolated the sick crew. Former health commissioner and now Superintendant of Mount Sinai Hospital, S. S. Goldwater, protested Copeland’s decision to keep the city’s schools open during the epidemic. He believed that the “paper program,” as he called it, of monitoring students for illness was sound, but that there was “almost criminal laxity” in carrying out the program. As a result, he argued, sick children were not being excluded from school.

Copeland would not budge. First, he believed that the epidemic would soon crest and then decline. He also believed that the school program was working, and cited evidence indicating that at least half of the absences in school were not due to illness but to overly concerned parents who decided to keep their children home. Mayor Hylan stood by his health commissioner. Responding to told Van Name and Goldwater, Hylan stated that he would not meddle with Copeland’s authority. “Dr. Copeland has been placed in charge of the Health Department,” he wrote to Van Name, “and I will not interfere with him at the behest of a former incumbent of the office who is attempting to take advantage of a very grave and serious condition that is a menace to the public health to advertise himself and to encumber the work that Dr. Copeland is seeking to accomplish.” Copeland responded to Van Name in a less acerbic tone. Citing death rates from Boston, Baltimore, Washington, DC, and Philadelphia – all cities that had enacted closure orders – Copeland wrote Van Name that New York City had weathered the epidemic thus far with much better results. He added that his department had closely monitored Staten Island’s epidemic and had worked to procure hospital beds, nursing care, and other resources for the community. “It is my judgment that when the history of the influenza epidemic in America is written,” he wrote, “as an official of the City of New York you will not be ashamed of the chapter devoted to the care of this metropolis.” Copeland did close several movie houses and dance halls in Staten Island for failing to maintain proper ventilation and sanitary conditions. As a nod to local power, he and the board of health amended the New York Sanitary Code to give each borough’s assistant sanitary superintendent the authority to close public places where food and drink were handled or stored if those places were found to be in an unsanitary condition. The board also made coughing and sneezing without covering your nose or mouth a misdemeanor.

Volunteers, city workers, and health officials continued their work. The volunteers at the Winifred Wheeler Day Nursery at the East Side House Settlement (then located in Manhattan’s Upper East Side) created a day nursery to care for 100 children who could not go home because family members were too ill to care for them. Dr. H. G. MacAdam, chief of Department of Health’s Institutional Inspection division, personally took charge of finding lodging for influenza orphans. “I look on myself as the official ‘daddy’ of all these little ‘shavers,’ and will work day and night to see that they do not contract the influenza,” he declared.36 The women of the Emergency Committee and its affiliated organizations worked day and night to organize nurses and relief work. By late-October, these women were feeding and caring for over 3,000 New Yorkers each day.

Copeland himself worked tirelessly on combating the epidemic, finding hospital beds for patients, ensuring theaters and movie houses were properly ventilated, allocating resources and manpower, and on trying to win over his detractors. With more than 2,000 bodies of influenza victims awaiting burial in Queens, Copeland arranged for 50 city street sweepers to work as gravediggers at Cavalry Cemetery, and had Brooklyn Borough President Edward Riegelmann dispatch an additional 25 men from his borough to assist.38 Eventually, the stress of working round-the-clock for five weeks straight took its toll on the beleaguered health commissioner; he was unable to work on Sunday, October 27 and spent the entire day resting in bed with exhaustion. Copeland was back at work the next morning. His son, however, did not fare quite as well. Although he recovered, the 8-year-old fell ill with influenza in late-October. His school, the private Ethical Culture School at 33 Central Park West, had been closed since October 20 because of parents’ and teachers’ fear of influenza. Copeland said this was further proof that children were safer in schools than playing in the streets.

By November, New York’s epidemic situation had improved sufficiently for Copeland to announce the disbanding of the Emergency Committee and a return to normal operating hours for businesses. On November 1, Copeland met with his Advisory Committee and representatives from the various nursing and relief agencies to receive their final reports and to thank the members for their hard work during the city’s epidemic.41 The next day, he announced that the staggered business hour plan would be removed, and on November 4 the board of health met and resolved to rescind the October amendments to the Sanitary Code. Beginning the evening of Tuesday, November 5, businesses could return to their normal hours.42 Smoking in theaters could resume, but establishments would still be required to maintain proper ventilation and to prevent crowding. Just over 700 cases were reported for the day, a drastic decline from the daily tallies of the previous weeks.43 New York’s epidemic was over.

November was a time for hope and renewal. With the end of the epidemic – although influenza continued to circulate for the next several months – New Yorkers could begin to piece their lives back together. On November 11, city residents celebrated the end of the Great War with wild abandon. In a victory parade, Mayor Hylan led a throng of city employees in a triumphant and jubilant march up Fifth Avenue as celebrants showered them in confetti. Among the marchers were more than 200 men and women from the Department of Health who were applauded by crowd for their role in ending the epidemic. “Look at the bunch that put the ‘flu’ out of business!” was the cheer.

In an interview with the New York Times printed on November 17, Copeland recounted the story of New York’s recent epidemic and offered his argument for why the city had fared so well while other East Coast cities had been so hard-hit. First, he said, the health department worked to isolate the early cases coming from ships landing at the port. Once cases began to appear amongst the resident population and the disease gained a foothold in the city, the health department turned its full attention to combating the epidemic, organizing several advisory panels and committees and working in cooperation with volunteer organizations to allocate resources, recruit and direct nurses, and relieve the suffering of the ill and their families. Unlike other cities, he said, New York did not issue school closure orders. “They may have been just the right things to do in those places; I don’t know their conditions,” he wrote. “But I do know the conditions of New York, and I know that in our city one of the most important methods of disease control is the public school system.” Three-quarters of New York’s one million schoolchildren live in tenements, he said, where their homes were frequently crowded and unsanitary and where their parents were primarily occupied in putting food on the table and keeping a roof over their heads. Those parents simply could not afford the time or money to provide proper medical attention. It was much better, therefore, to keep the schools open so that children could be monitored for illness by school physicians and nurses.

As for theaters and movie houses, Copeland said that the big, modern establishments were not places that spread influenza. The smaller, hole-in-the-wall theaters that had improper ventilation were problematic, and his department worked hard to close those establishments until the issues could be rectified. Those theaters that remained open were made “centres of public health education” through instructions on proper cough and sneeze etiquette, information on how influenza spreads, and instructions on how to properly treat and recover from the disease. By keeping theaters and places of amusement open, Copeland said, he helped maintain morale and kept the city from “going mad on the subject of influenza.”

Copeland’s greatest anxiety was public transportation, especially subways, which he believed were the most dangerous of all public places because of the tremendous crowding they caused. People who are sick, he argued, do not go to theaters or churches. They do, however, still go to work. Thus, he worked to make sure subways were well ventilated and he asked the board of health to pass the temporary staggered business hour amendment to the city’s sanitary code.

Ending the interview, Copeland compared New York to other East Coast cities. His city had done better than Boston, Washington, Baltimore, or Philadelphia, all places that had issued closure orders. Why? Copeland attributed it to New York’s long history of fine and efficient public health work and to a health department that had worked diligently for the previous two decades to alleviate unhealthy conditions in the streets, tenements, shops, and restaurants. “The fact that the death rate was kept down so low, and that the epidemic did not assume more alarming proportions,” he said, “is a wonderful tribute to the city’s health control in years past.” Through the tireless actions of Copeland and his staff at the health department, and through the amazing volunteer work of the city’s relief organizations, New York was able to weather its epidemic with a significantly lower morbidity and mortality rate than other nearby cities. Overall, from September 15 through November 16 – the period of New York’s epidemic – the city experienced nearly 147,000 cases influenza and pneumonia, which resulted in 20,608 deaths. These figures gave New York an excess death rate of 452 per 100,000 individuals, the lowest on the Eastern seaboard. Copeland could be proud of his city of the work he did.

NOTES
1 “Early Manifestations of Influenza from Transatlantic Vessels Arriving at New York,” Box 146, Folder 1622, Record Group 90 – Records of the United States Public Health Service, National Archives and Records Administration, College Park, MD; “Epidemiology and Administrative Control of Influenza. Address by Louis I. Harris, Director of the Bureau of Preventable Disease, New York City Department of Health, delivered at a meeting of the Eastern Medical Society, Oct. 11, 1918, and published in the New York Medical Journal,108:7 (26 October 26, 1918).

2 “Early Manifestations of Influenza from Transatlantic Vessels Arriving at New York,” Box 146, Folder 1622, Record Group 90 – Records of the United States Public Health Service, National Archives and Records Administration, College Park, MD.

3 “Quarantine Put in Force to Check Influenza Here,” New York American, 12 Sept. 1918, 1.

4 “To Fight Spanish Grip,” New York Times, 16 Sept. 1918, 16.

5 “Influenza Attacks 13 on Naval Training Ship,” New York American, 17 Sept. 1918, 11.

6 Minutes of Department of Health of the City of New York, 17 September 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY; Sanitary Code of the Board of Health of the Department of Health of the City of New York (New York, 1920), 37-40. The sanitary code was reprinted in 1920 with the revisions and amendments made during the previous several years.

7 “New York Prepared for Influenza,” New York Times, 19 Sept. 1918, 11.

8 “66 Dead of Influenza in Naval Ranks,” New York American, 19 Sept. 1918, 3; “47 New Cases of Influenza are Reported,” New York American, 20 Sept. 1918, 11.

9 “F. D. Roosevelt Spanish Flu Victim,” New York Times, 20 Sept. 1918, 14.

10 “Influenza on Wane in City,” New York American, 21 Sept. 1918, 5.

11 “Find 114 New Cases of Influenza Here,” New York Times, 24 Sept. 1918, 9.

12 “New Influenza Cases in the City Doubled,” New York Times, 28 Sept. 1918, 10.

13 “85,000 in Bay State Ill with Influenza,” New York Times, 30 Sept. 1918, 9.

14 Baker, S. Josephine. Fighting for Life. (New York: The MacMillan Company, 1939), 155-56.

15 “$25,000 Voted to Fight Grip Epidemic Here,” New York American, 28 Sept. 1918, 11.

16 “Spanish Grip Seizes 999 in One Day Here,” New York American, 4 Oct. 1918, 11.

17 Minutes of Department of Health of the City of New York, 4 October 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY.

18 “Revise Timetable in Influenza Fight,” New York Times, 6 Oct. 1918, 1.

19 “Spanish Grip Here Jumps 60 per cent,” New York American, 9 Oct. 1918, 11; “157 in 3,077 New Cases of Grip Succumb,” New York American, 11 Oct. 1918, 13’ “Health Board Orders Masks as Grip Grows, New York American, 12 Oct. 1918, 13.

20 Minutes of Department of Health of the City of New York, 11 October 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY; “Fight Stiffens Here Against Influenza,” New York Times, 12 Oct. 1918, 13. Initially, Copeland required that theaters not admit children 12 years of age or younger, but quickly rescinded restriction when it became apparent that most theater managers were following the new sanitary codes. See “Asks Experts’ Aid to Check Epidemic,” New York Times, 13 Oct. 1918, 18.

21 “Asks Expert’s Aid to Check Epidemic,” New York Times, 13 Oct. 1918, 18; Copeland to Lillian Wald, 12 October 1918, Reel 9, Box 11, Folder 5, Lillian D. Wald Papers, New York Public Library, New York, NY.

22 “Will District City in Influenza Fight,” New York Times, 15 Oct. 1918, 10.

23 “Emergent Aid Corps Named to Fight Grip,” New York American, 15 Oct. 1918, 11.

24 “Fight Stiffens Here against Influenza,” New York Times, 12 Oct. 1918, 13.

25 “Copeland Asks Aid in Influenza Fight,” New York Times, 16 Oct. 1918, 24.

26 “Copeland Refuses to Close Schools,” New York Times, 19 Oct. 1918, 24.

27 “Influenza on Wane in Manhattan,” New York American, 23 Oct. 1918, 11.

28 “Influenza Cases Drop 305 in City, New York Times, 21 Oct. 1918, 12.

29 “Asks Expert’s Aid to Check Epidemic,” New York Times, 13 Oct. 1918, 18.

30 “Copeland Refuses to Close Schools,” New York Times, 19 Oct. 1918, 24.

31 “City Reports Drop in Influenza Cases,” New York Times, 20 Oct. 9.

32 Copeland to Van Name, 4 Nov. 1918, Mayor John Hylan Papers, Correspondence Received, Department of Health, Box 72, folder 796, New York City Municipal Archives, New York, NY.

33 “Grip Wanes, But Copeland Urges Care,” New York American, 25 Oct. 1918, 9.

34 Minutes of Department of Health of the City of New York, 19 October 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY.

35 “Nursery Taken over By Women,” New York American, 25 Oct. 1918, 9.

36 “Dr. MacAdam Now ‘Daddy’ to Well Babies,” New York American, 28 Oct. 1918, 5.

37 “Sunday Grip Aid Given by Women,” New York American, 28 Oct. 1918, 5.

38 Copeland to Hylan, 29 October 1918, Box 72, folder 795, Mayor John F. Hylan Papers, Correspondence Received, Department of Health, Box 72, folder 796, New York City Municipal Archives, New York, NY.

39 “Dr. MacAdam Now ‘Daddy’ to Well Babies,” New York American, 28 Oct. 1918, 5.

40 “Copeland Satisfied by Influenza Tour,” New York Times, 30 Oct. 1918, 10.

41 “City Epidemic Bans Soon to be Removed,” New York American, 2 Nov. 1918, 11.

42 Minutes of Department of Health of the City of New York, 4 Nov. 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY.

43 “Business

44 New York Department of Health, “Our Part in the Victory Parade,” Staff News. 6:12 (1 December 1918), 8.

45 “Epidemic Lessons Against Next Time,” New York Times, 17 Nov. 1918, 42.

46 “Epidemic Lessons Against Next Time,” New York Times, 17 Nov. 1918, 42; Annual Report of the Department of Health of the City of New York for the Calendar Year 1918 (New York City: 1919), 210-11.


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