1918 Influenza Escape Communities

In the summer of 2005, the Center for the History of Medicine was asked by the Defense Threat Reduction Agency (DTRA) to conduct research into and write a report on American communities that had experienced extremely low rates of influenza during the infamous 1918–1920 influenza pandemic (download a copy of the report). A team of historians from the Center for the History of Medicine visited these communities to locate, assess and collect available primary source material from libraries, archives and other private and public holdings. We then undertook a historical evaluation of the non-pharmaceutical interventions (NPI) as employed by successful communities during the second wave, September–December 1918, of the pandemic.

Ultimately, we selected seven communities that reported relatively few if any cases of influenza, and no more than one influenza-related death while NPI were enforced during the second wave of the 1918-1920 influenza pandemic:

Because of the apparently reduced morbidity and low mortality these communities experienced during the second wave of the pandemic, we have labeled them “provisional influenza escape communities.”  “Provisional” means that we cannot definitively determine on the basis of the historical evidence available to us if these communities sustained their low morbidity and mortality rates because of policy decisions made by their community leaders and public health officials, because the virus skipped some communities altogether and varied in its behavior in other communities (viral normalization patterns), or because of other factors such as population density, geography, and good fortune. Although ultimately it proved to have experienced significant numbers of influenza cases and deaths and was therefore not deemed a “provisional escape community,” we have included Camp Crane, Allentown, Pennsylvania on this website because of its unusual circumstances and the strong menu of NPI enacted.

Limited by the quantity and quality of data, we nevertheless ultimately concluded that protective sequestration (the shielding of a defined and still healthy group of people from the risk of infection from outsiders), if enacted early enough in the pandemic, crafted so as to encourage the compliance of the population involved without draconian enforcement measures, and continued for the lengthy period of time at which the area is at risk, stands the best chance of protection against infection. We also found that available data from the second wave of the 1918–1920 influenza pandemic fail to show that any other NPI (apart from protective sequestration) was, or was not, effective in helping to contain the spread of the virus. American communities engaged in virtually the same menu of measures. Despite these measures, most communities sustained significant illness and death; whether these NPI lessened what might have been even higher rates had these measures not been in place is impossible to say on the basis of available historical data.

However inconclusive are the data from 1918, the collective experiences of American communities from the pandemic are truly noteworthy, especially in light of the fact that faced with a pandemic today we would likely rely on many of these same NPI to attempt to contain the spread of the infection until pharmacological supplies of vaccine and antivirals were available.

A few words should be said about the newspaper collections in particular. During the height of the epidemic, many of the larger-circulation newspapers ran lengthy articles on influenza. In some cases, these articles ran many inches of column space. In order to keep the articles to one page apiece for ease of printing, and in order to keep the image size large enough for ease of viewing, some of the images have been digitally cut and spliced. In other cases, several smaller articles have been combined into one PDF file. For these reasons, the articles presented on this website do not necessarily appear exactly as they do in the original source material. While this is unfortunate, we ultimately decided that ease of printing and viewing were more important than retaining the “physical” integrity of the documents. The purpose of this site is not to preserve these documents, but rather to make the information contained within them more accessible to researchers and scholars. In addition, it should be noted that the digital images presented here were made from photocopies of either original documents (in the case of most of the archival material), or from microfilm copies (in the case of the newspapers and some of the archival material). As a result, the images—especially those from newspapers—are at times blurry, dark, cut-off, etc. We apologize for the poor image quality you may encounter, but we were forced to work with the limitations of the original source material.

Acknowledgments and Permissions:

Researchers at the University of Michigan Medical School’s Center for the History of Medicine would like to thank the following libraries, archives, and institutions for their assistance during our research and for granting us permission to digitize and present portions of their collections.

The information on this site and the digital documents contain herein are intended for education and research purposes only. Commericial use of the content of this website is prohibited. For commercial use of the digital documents, please contact the owning institution.