Good old fashioned measures may still save lives in a pandemic

Researchers in the United States have discovered that public health measures such as quarantines, school closings and bans on public gatherings greatly reduce the death toll in flu pandemics.

A pandemic occurs when a flu strain such as the avian flu, mutates so that it acquires the ability to pass between people easily.

Experts believe that current vaccines and people's immune systems will not offer protection against such a new infectious virus, like the Spanish flu in 1918-19 which killed 40 million people, 550,000 of them in the United States.

The risk of a flu pandemic has been in the news since 2003 with the re-emergence of the deadly H5N1 strain of bird flu.

Dr. Howard Markel, director of the University of Michigan Center for the History of Medicine says even today it will still take six months once a pandemic starts to have enough vaccine manufactured and distributed.

Dr. Markel and specialists at the University of Michigan worked with experts at the U.S. Centers for Disease Control and Prevention on non-medical protective measures taken in 43 cities from Sept. 8, 1918, through Feb. 22, 1919.

Although these urban communities had no effective vaccines or antiviral drugs, they were able to organize and execute a suite of classic public health measures - called non-pharmaceutical interventions or NPIs – before the pandemic gained full force.

They examined public health records, newspaper reports and other chronicles of activity and found that those cities that responded earliest and sustained their response did best.

The researchers give the example of St. Louis which closed schools and canceled public gatherings early in the pandemic and maintained those measures for 10 weeks and as a result had a markedly lower number of flu deaths than other cities.

Markel says in the event of a pandemic the old-fashioned methods will hopefully buy time until a vaccine can be developed; he says public health is everyone’s responsibility.

Critics say however that what worked in the United States of 1918-19 might not work today, as the world is a different place and interventions that were effective against the flu in 1918 may not be relevant to the preparations needed today.

Markel says the study provides evidence that basic public health measures can slow the passage of germs, and guidelines on such measures should be recommended by the federal government and carried out by the states.

The findings are published in the current issue of the Journal of the American Medical Association.