Influenza: Effective control measures in the 1918 flu pandemic

Which control measures worked, and which didn't, in the great influenza pandemic of 1918?

The great influenza pandemic of 1918 is estimated to have killed between 50 and 100 million people. This historical episonde has much to teach us about what works and what doesn't, when dealing with the pandemics of today. Wilfred Kellogg, the head of the California State Board of Health wrote this book in 1919, a few short months after the peak of the pandemic. In it, he evaluates the effectiveness of the different measures that were used (such as face masks, quarantines, etc.). Kellogg compares the death rates in the largest cities in the United States based on which controls were implemented. The sometimes counterintuitive outcomes are discussed.

Quotes:

"A period of sufficient time has elapsed since the beginning of the epidemic in this country that we can now cease mere speculation and use to advantage the actual experiences of different communities and various large cities, which have gathered accurate data on the epidemic. Some cities closed no gathering places, some closed nearly all, and others adopted an intermediate course."

"There is only one explanation for the discrepancy between the case rates and the death rates in that part of the curve for November 23 to November 30, which shows that for two weeks there were about as many deaths occurring as there were cases reported. This would indicate that physicians, in their optimism following the subsidence of the main portion of the epidemic, unconsciously stretched a point in favor of the diagnosis against influenza."

"Having Boston's experience before it, in which city closing was not instituted until the peak of the epidemic was reached, Washington closed everything before a dozen cases were known to exist in the city. The obvious conclusion from an inspection of these curves is that closing, at least in large cities, avails little or nothing."

"Quarantine of whole communities, either intentional or unintentional, kept the disease out absolutely so long as quarantine was maintained. This is but another proof that the disease is of contact infection. Influenza has, in this way, been kept out of a number of institutions; and from an entire camp, namely, Goat Island Naval Training Station in San Francisco Bay."

"New York City, before referred to, as one of those cities that did not prohibit public gatherings, did not use masks either, and its record of deaths is lower than that of any of the other larger cities."

"Many instances were observed among hospital attendants where apparently the mask was no protection to the wearers. This was the experience of the San Francisco Hospital, which, during the epidemic, was converted into an influenza hospital. In this institution 78 per cent of the nurses contracted influenza notwithstanding the fact that this is probably the best conducted hospital and under the best discipline of any similar institution in the state."

"Another most important reason for the failure of the mask, when universally worn, lies in the fact that the majority of masks worn under compulsory ordinances were not properly made and could not reasonably be expected to have any value whatever. Many instances were observed where the mask consisted of only one or two layers of a very coarse-mesh gauze, and the majority of the masks furnished by the Red Cross, which probably made up the bulk of those used, were undeniably too light and coarse in texture to do more than afford a comfortable feeling of safety on the part of the wearer."