Some Encouraging News from 1918

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In a 2007 National Academy of Sciences study of the Spanish Flu, researchers used  data on the timing  of 19 classes of NPIs in 17 U.S. cities during the 1918 pandemic to test whether early implementation of multiple NPI interventions was associated with reduced disease transmission. Indeed, the researchers found that “cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates 50% lower than those that did not and had less-steep epidemic curves.” In other words, the timely introduction of NPI measures reduced peak mortality in the surveyed cities.

The finding of reduced peak mortality seems to confirm that the timely introduction of multiple interventions does indeed buy time to prepare for the peak of the pandemic and in this sense plays a positive role. The finding does not rule out that NPIs simply transfer illness and death to later dates and hence does not lower cumulative mortality.

On this point, researchers find that “cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (20%) and less statistically significant than that for peak mortality.”

The lower cumulative mortality rate is the most encouraging finding from the 1918 flu experience, although this finding is less robust than the effect on peak mortality.