Lessons from 1918
By Colleen Carroll
The frightening comparison between Covid-19 and the 1918 pandemic has left many weary of what’s still to come of the still burgeoning epidemic. However it seems possible that guidance from the pandemic that killed 50 million people could save lives in the present. It is the lessons from a 100-year-old virus that has led much of the country in it’s response to such an ancient yet unfamiliar enemy.
A local look at the 1918 Pandemic
“In Kent, they actually knew who patient zero was,” said former reporter and local historian Roger DiPaolo. “He was a 22-year-old man from New York who had come to work at the raincoat factory.”
DiPaolo, who now serves as historian in residence for the Kent Historical Society has published works on the history of Kent, including the 1918 pandemic.
“By the middle of 1918 Kent and Ravenna went into a quarantine,” DiPaolo said. “They shut down schools, the churches, poolrooms, dance halls, any gathering place.”
DiPaolo says that Kent and Ravenna were the most at risk because they were the most populated areas in portage county at the time.
“The board of health in both Kent and Ravenna called the shots in terms of ordering places closed,” DiPaolo said.
DiPaolo explains that by late October the virus spread past Kent and Ravenna to Deerfield and eventually the rest of Portage county. The virus first arrived in the United States in the summer of 1918.
“The Red Cross was reporting 400 cases in portage county in mid-October and it climbed to 700 two weeks later,” DiPaolo said. “In Kent you had 680 cases by the end, that was 10% of the population that was sick.”
DiPaolo explained the one county hospital located near Ravenna was quickly overwhelmed.
“There was only one county hospital and just a handful of doctors that had to respond to this,” DiPaolo said. “If you got sick you were probably treated to a limited extent at home and if you died it was probably at home.”
DiPaolo also explained that the decision to close churches was met with conflict from citizens, who were unable to hold memorials for dead family member.
“They talked about churchless Sundays and nobody went to church, but this was obviously before internet,” DiPaolo said. “If you had the misfortune of dying you just got buried and that was it, no funeral.”
DiPaolo says that the immigrant population was at most risk of the virus due to language barriers.
“There was a large immigrant population in both Kent and Ravenna,” DiPaolo said. “They stuck to themselves and a lot of the Italian and Polish people never learned to speak English so a lot of them didn’t have access to the doctors.”
DiPaolo also noted that the recent ending of World War I also had a heavy impact on Portage County communities.
“It’s really interesting that in October, November and December you had War fatalities vying for space on the front page over flu fatalities.” Said DiPaolo. “The war is ending and then you have the flu virus, in Ravenna there was a lift on public gathering ban for the celebration of the war ending on November 11th, Kent however had no celebration.”
DiPaolo said the celebration caused an uptick in Ravenna cases.
Lessons taught from 1918
in Kent States History department
The disappearances between Kent and Ravenna’s responses to the 1918 pandemic were not uncommon within the state and the country. In Ohio governor James Cox left the decisions up to local governments and officials, according to Ohio history connection.
“It depended by location on who was calling the shots,” said Jennifer Hivick, a Kent student pursuing her Masters in the History department. “In some places like St. Louis it was public health officials calling the shots, in other places it was government.”
Hivick studies the history of medicine and public health and specializes in the US response to the 1918 pandemic. Hivick brings up the often-referenced pandemic response comparison between Philadelphia and St. Louis.
“It shows how the rules that were put into place prevented St. Louis from having such a huge outbreak compared to Philadelphia,” Hivick said. “In Philadelphia the governor pretty much said ‘were going to keep it normal and not change anything’, they even had a celebration parade for the war. It didn’t go well.”
In St. Louis, however, public officials were mandating school shut downs, social distancing and quarantine.
According to a study from the National Academy of Sciences Philadelphia saw more than 4,500 deaths during a two-week peak, St. Louis reported only 345. Hivick explains that because of the delegation of response control to local town and state authorities the flu hit certain areas much worse than others. Hivick expressed concerns of the similar lack of unified response by the Unites States to the current Covid-19 pandemic.
“It’s not how it should ideally be,” Hivick said. “During the Ebola crisis there was federal response and it was more centralized, unfortunately now there is a huge separation of state and government with these public health decisions.”
Hivick explains that in 1918 health officials made safety recommendations that are strikingly concurrent to today’s advice.
“People were told to keep distance from each other, they educated people early on explaining the symptoms and how its contracted,” Hivick said. “They canceled public events, declared a public health emergency and had strict fines for doctors who did not report numbers on the Pandemic.”
Hivick said measures were taken in New York City to prevent large numbers of people on the subway.
“In New York City they staggered the people on the subway who were traveling to work,” said Hivick. “White collar businesses would open at 8:30, shops would open at 9:15, so everyone who had to go into work wasn’t rushing in at the exact same time.”
Hivick explains that 1918 helped to shape the modern health system through nursing practices as well a mass data recording.
“During 1918 one of the things that really impacted public health was developing a central reporting system which didn’t exist beforehand,” Hivick said. “It serves as an early warning system, there are specific reportable diseases that a physician has to report to health officials at the national level.”
The reporting system allows officials to predict where hotspots might be before an outbreak, Hivick says Ohio governor Mike DeWine was able to make shutdown decisions based on the reporting system.
Lessons not always learned
Dr. Tara Smith, an epidemiologist at Kent State, believes this reporting is being hindered because of a lack of testing.
“In Ohio we are only testing for the most part health care workers and those with serious infections,” Smith said. “We don’t really know how many cases we have in Ohio or really anywhere else, so we don’t know the extent of this epidemic and trying to get back to some semblance of normal and opening back up relies on having those tests available in order to stop transmissions changes.”
While some reports have speculated a seasonality to arise from this pandemic Smith says it is unlikely to occur anytime soon.
Smith explains that seasonality occurs in some strains of coronavirus that cause common cold, but the pandemic has not shown signs of seasonality.
“we have not seen coronavirus infections decrease in areas that are already warm,” said Smith. “Singapore has an ongoing outbreak and they are quite warm; Australia has an outbreak and they are warm. Seasonality may be something that will happen over time, once the population has more immunity to the virus, but so far we don’t think warm weather will stop the virus this summer.”
Smith says that the 1918 pandemic data heavily influenced the quarantine and social distancing response for this pandemic
“We’re using data from 1918 and looking at how different cities responded to that pandemic and trying to implement that right now,” said Smith. “That is why the focus is on social distancing and trying to keep from overwhelming hospital to keep out death rates lower.”
Smith says lessons were also learned from the 2009 Swine Flu pandemic.
“In 2009 we had a similar situation where personal protective equipment for our healthcare workers were low and we were running out of them,” Smith said.
Smith explains that past administrations had measures in place to prepare for epidemics including a stockpile of personal protective equipment and a detailed pandemic plan that was lost between administrations.
“Some of the lessons we’ve learned from past epidemics were lost or at least not followed,” Smith said.
Smith also notes the importance of having a unified response to health crises, citing the response to the Ebola virus.
“President Obama appointed an Ebola Tzar to manage everything, keeping the press briefed, keeping everything going, it’s something many people have called for in this response,” Smith said. “President Trump put Vice President Pence in charge, we were hoping to have someone else who has management experience dealing with these sorts of things.”
Smith hopes the lessons learned from this experience will stick this time.
“I think we learned some things from prior outbreaks but it’s one thing to know them and another to implement them,” Smith said.
