🔒 How to flatten Covid-19 curve: What deep analysis of 1918 flu “lockdowns” tell SA

President Cyril Ramaphosa’s tough lockdown measures to stem the spread of Covid-19 are based on strategies that worked a century ago. And they may well prove to be the best defence against a pandemic that could easily kill hundreds of millions of people. Social, or physical, distancing isn’t a new idea — it saved thousands of American lives during the last great pandemic, reports National Geographic, which has examined how various cities handled the crisis and finds that this is probably the best way to limit deaths in the absence of a vaccine. It also draws attention to the fact that today’s crisis management measures, including the use of face masks, are the same as they were a century ago. The specialist publication’s historians conclude that cities that stayed in lockdown for longer saved more people, while those that eased restrictions too early saw a second spike in deaths. By the end of the pandemic, between 50 and 100 million people were dead worldwide, including more than 500,000 Americans, National Geographic reminds us. – Jackie Cameron

By Thulasizwe Sithole

After Philadelphia reported its first case of a deadly, fast-spreading strain of influenza on September 17, 1918, the next day, in an attempt to halt the virus’ spread, city officials launched a campaign against coughing, spitting, and sneezing in public, recounts National Geographic. Just two weeks after the first reported case, there were at least 20,000 more, it says.

Ten days after the first case emerged, the publication points out, the city hosted a parade that 200,000 people attended, with flu cases mounting until October 3, when churches, theatres, and public gathering spaces were shut down.

“The 1918 flu, also known as the Spanish Flu, lasted until 1920 and is considered the deadliest pandemic in modern history. Today, as the world grinds to a halt in response to the coronavirus, scientists and historians are studying the 1918 outbreak for clues to the most effective way to stop a global pandemic,” says National Geographic.

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Some of the points the publication’s historians highlight:

• Dramatic demographic shifts in the past century have made containing a pandemic increasingly hard, with the rise of globalisation, urbanisation, and larger, more densely populated cities facilitating a virus’ spread across a continent in a few hours — while the tools available to respond have remained nearly the same.
• Now as then, public health interventions are the first line of defence against an epidemic in the absence of a vaccine. These measures include closing schools, shops, and restaurants; placing restrictions on transportation; mandating social distancing, and banning public gatherings. (This is how small groups can save lives during a pandemic.)
• Getting citizens to comply with lockdown orders was a problem then as it is now. In 1918, a San Francisco health officer shot three people when one refused to wear a mandatory face mask. In Arizona, police handed out $10 fines for those caught without the protective gear.
• The most drastic and sweeping measures paid off. After implementing a multitude of strict closures and controls on public gatherings, St. Louis, San Francisco, Milwaukee, and Kansas City responded fastest and most effectively: Interventions there were credited with cutting transmission rates by 30-50%. New York City, which reacted earliest to the crisis with mandatory quarantines and staggered business hours, experienced the lowest death rate on the Eastern seaboard.

“In 2007, two studies published in the Proceedings of the National Academy of Sciences sought to understand how responses influenced the disease’s spread in different cities. By comparing fatality rates, timing, and public health interventions, they found death rates were around 50% lower in cities that implemented preventative measures early on, versus those that did so late or not at all. The most effective efforts had simultaneously closed schools, churches, and theatres, and banned public gatherings. This allowed time for vaccine development and lessened the strain on health care systems,” says National Geographic.

In a warning sign that lockdowns could extend for a longer period than many people expect, the studies found that relaxing intervention measures too early could cause an otherwise stabilised city to relapse. “St. Louis, for example, was so emboldened by its low death rate that the city lifted restrictions on public gatherings less than two months after the outbreak began. A rash of new cases soon followed. Of the cities that kept interventions in place, none experienced a second wave of high death rates,” say the writers.

In 1918, the studies found, the key to flattening the curve was social distancing – and that likely remains true a century later, in the current battle against coronavirus, emphasises National Geographic.