A lifesaving lesson from 1918

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In recent weeks multiple published articles have compared the very different ways in which St. Louis and Philadelphia responded to the outbreak of the Spanish flu in 1918. That pandemic infected approximately 500 million people across the world, killing 20 million to 50 million. In the United States, about 675,000 died, yet death tolls differed considerably among cities nationwide.

In the case of St. Louis, the strong-willed city health commissioner, Max Starkloff, began preparing and issuing public warnings about avoiding crowds even before the city had its first flu case. And when the flu did appear, Starkloff quickly shut down schools and non-essential businesses over the loud objections of powerful business leaders. 

In Philadelphia, on the other hand, the health commissioner actively downplayed the obvious surge in local flu cases and refused to cancel a parade that would draw 200,000 people. Within a week of the parade, the hospitals were overflowing, and more than 2,600 Philadelphians died.

The ultimate result of these different approaches led to St. Louis experiencing 358 deaths per 100,000 in population while Philadelphia suffered over twice those many casualties (748 per 100,000). 

Notably, Rochester also had among the lowest mortality rates from the 1918 flu, especially compared with similar cities across the state. As chronicled by the University of Michigan Center for the History of Medicine in its Influenza Encyclopedia, Rochester’s leaders in 1918 also took aggressive steps to fight the spread of the Spanish flu. In fact, the number of deaths in Rochester, at 360 per 100,000, was nearly identical to the results achieved in St. Louis.

Rochester’s death rate per 100,000 was 32 percent lower than that of Buffalo, 33 percent lower than that of Syracuse, and 35 percent lower than Albany’s rate. Further, as shown in the figure below, Rochester experienced a much lower number of peak deaths during the outbreak, with a peak death rate that was approximately half of what was seen in Buffalo, Syracuse and Albany. 

In fact, it’s quite striking to see how similar—both in terms of death numbers and shape—the graphs of Buffalo, Syracuse and Albany look compared to one another. By contrast, the graph for Rochester is much flatter and somewhat broader, with even a smaller resurgence of deaths occurring in late December and early January of 1919 (which are outside the bounds of these graphs).

So, what did Rochester do in 1918 that seemed to contribute to these results? Shortly after being warned by the state that a possible influenza epidemic was coming, Rochester began preparing, even though it had only two unconfirmed cases at the time. A separate ward to take care of potential patients was set up at Rochester General Hospital. By Oct. 9, Rochester’s commissioner of public safety announced the closure of all schools, as well as theaters and skating rinks. 

Next, the city and the Chamber of Commerce asked manufacturing and retail business to stagger hours to prevent overcrowding on trolley cars. Soon after the city closed churches, bars and “ice cream parlors.” In the meantime, five makeshift hospitals were set up around Rochester to augment the capacity of local hospitals, which would otherwise have been overwhelmed by the 10,000 influenza cases that occurred in October 1918.

Toward the end of October, as the number of cases started falling, residents and workers pushed the health commissioner to quickly lift the restrictions, especially to help those whose livelihoods were being affected. Despite being sympathetic to their request, the health commissioner acted carefully again, waiting another week before finally lifting the restrictions.

In other words, local officials in 1918 were doing many of the same things we see being done in Rochester today. And while each epidemic has its unique dynamics, the one thing 1918 clearly teaches us is that different approaches by local officials can yield very different results. For the sake of today’s Greater Rochester, let’s hope our officials and our neighbors have the resolve and wisdom to do the difficult things necessary to minimize the tragic consequences we now face.

Alex Zapesochny is Rochester Beacon publisher. All Rochester Beacon coronavirus articles are collected here.

3 thoughts on “A lifesaving lesson from 1918

  1. Thank you for this very informative article. I have been impressed with our local leaders’ response and hope their good judgment continues.

  2. Thank you Alex Zapesochny. What are the chances you can move to the DC and further educate some of its occupants?

  3. This was both very informative and assuring. It seems we’ve been through this in the past and we CAN do it again. Thank you. I’ve shared it on Facebook.

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