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Volume 12, Number 12—December 2006

Dispatch

Nonpharmaceutical Influenza Mitigation Strategies, US Communities, 1918–1920 Pandemic1

Howard Markel*Comments to Author , Alexandra M. Stern*, J. Alexander Navarro*, Joseph R. Michalsen*, Arnold S. Monto†, and Cleto DiGiovanni‡
Author affiliations: *The University of Michigan Medical School, Ann Arbor, Michigan, USA,; †The University of Michigan School of Public Health, Ann Arbor, Michigan, USA; ‡US Department of Defense, Fort Belvoir, Virginia, USA

Main Article

Table

Six communities that along with Bryn Mawr College escaped influenza pandemic, 1918–1920

Characteristics Yerba Buena, CA Gunnison, CO Princeton University, NJ WPIB, PA* Trudeau Sanatorium, NY Fletcher, VT Bryn Mawr College, PA
Population ≈6,000 1,329 in town, 5,590 in county 1,142 179 students; faculty and staff also lived on-site 356 patients admitted in 1918; 259 discharged; average daily patient census of 150 737 465
Geographic isolation Small island off coast of San Francisco Small mountain community in western Colorado; commercial, educational, and transportation hub Student body in a small college town; campus somewhat separated from the town Located in a busy residential Pittsburgh neighborhood but somewhat isolated by standards of the day A small institute on the outskirts of a very small mountain community in upstate New York Very small rural community in upstate Vermont Student body in a small college town; only 10 miles from Philadelphia
Ordinary or special population Primarily a military population; ≈1,000 civilian family members and workers were present Ordinary population composed of native-born and immigrant residents All-male student body; 92% of students were members of a military training corps Student body was blind and thus isolated by standards of the day Patients and staff were tubercular and were thus isolated by standards of the day Ordinary rural population All-female student body
Period of protective sequestration Sep 23 – Nov 21,1918 Oct 31, 1918 – Jan 20, 1919 (countywide); public closures and imposed social distancing as of Oct 8, 1918 Never under a full protective sequestration, as recruits and cadets continually arrived and left; restrictions on off-campus travel (with perimeter control) imposed Oct 8–Dec 21, 1918 Early Oct – late Nov 1918 A de facto protective sequestration existed due to its geographic and institutional isolation Not applicable ≈Oct 1–Nov 7, 1918
Cases and deaths 0 cases, 0 deaths during protective sequestration 0 cases, 0 deaths in town (2 cases, 1 death in county) 68 cases, 0 deaths in student population† 12 cases, 0 deaths 0 cases, 0 deaths 2 cases, 0 deaths 110 cases, 0 deaths

*WPIB, Western Pennsylvania Institution for the Blind.
†One professor died.

*WPIB, Western Pennsylvania Institution for the Blind.
†One professor died.

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1Presented, in part, at the 5th CDC National Conference on Public Health Law, held in Atlanta, Georgia, USA, June 2006.

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