As I’ve written before, this is no 1918, but the pandemic a century ago left us with several lessons in public-health management and mismanagement, and it provides important information about whether or not banning public gatherings is an effective intervention.
During the terrible pandemic of 1918, all public-health responses were hobbled by the fact that the cause of the outbreak was unclear. Although it would take another 15 years to identify a virus as the culprit, influenza was generally understood to be spread through close contact. Despite this, there was, at least for a while, no ban on large public gatherings. In September, in the midst of both the war effort and the pandemic, the city of Philadelphia held the Liberty Loan Parade. Local newspapers reported that more than 100,000 people thronged the streets. Deaths from the flu quickly spiked. Soon 100 people a day were dying. The Liberty-bonds march had actually liberated the virus.
In contrast, St. Louis canceled its parade and very quickly introduced a number of efforts to promote social distancing. As a result, the excess mortality rate in the city was less than a third the rate in Philadelphia.
Keeping a safe distance from one another takes a lot more work than simply skipping a Broadway show. In 1918, measures included closing schools and churches, staggering business hours to reduce congestion on the transit system, and quarantining households where a member had been diagnosed with influenza. Other restrictions were appropriate for the time that today seem rather quaint. Dance halls were closed, door-to-door sales were banned, and you could be arrested for spitting in public. Researchers looking at how these measures affected mortality in 17 cities across the U.S. discovered that cities that aggressively implemented multiple interventions early on had peak death rates that were half those of cities that failed to do so. That’s a remarkable decrease, and surely supports the cancellation of many public gatherings today, from political rallies to basketball games.
Yascha Mounk: Cancel everything
The lessons from school closings are more mixed. Across New York State, decisions varied; the city kept its school system open, though Albany and Rochester closed for weeks. Elsewhere, Chicago kept its school system open, but Pittsburgh, Baltimore, and Portland closed theirs. Cleveland adopted a smart approach of ongoing reassessment. If more than 20 percent of the children were absent at a local school, it would be closed. If more than 10 percent were absent from a school district as a whole, it, too, closed. This rapid-feedback system gave teachers more autonomy, and increased cooperation between health departments and school districts.
Do school closings help limit the spread of influenza? It’s a tough question to answer definitively, but at best they appear to have a moderate effect in reducing transmission, if—and this is important—the rate of illness from influenza in children is high compared with adults. One unusual feature of COVID-19 is that children seem to be largely spared from illness. This means that school closings would do less to reduce its spread than the precedents of 1918 might suggest.