1918 flu showed it's vital to act early

One of the enduring riddles of the 1918 pandemic — the worst flu season in the history of humankind — was why some cities were spared the high death toll that ravaged other municipalities.

Researchers reporting in the Proceedings of the National Academy of Sciences in two analyses have found that in cities where health officials imposed stringent containment measures, the population fared better than in cities where plans were helter-skelter or were cobbled together too late to make a difference.

An estimated 600,000 people in the United States and as many as 50 million worldwide died in the pandemic. The fierce wave of illnesses struck at the close of World War I just when people thought they could breathe a sigh of relief. More U.S. troops died of influenza — sometimes called the Spanish flu — than in the war.

In an era when even the best medical minds had no idea that the globe-circling pandemic was caused by a virus, some cities were able to limit infections through common-sense methods, scientists now say. They also theorize that lessons from the past can have relevance today should another pandemic strike.

Schools, theaters, churches and dance halls in cities across the country were closed. Kansas City, Mo., instituted a ban on weddings and funerals if more than 20 people were to gather. The mayor of Seattle ordered people to wear face masks.

In cities with stringent enforcement of such plans, fewer people died.

"A primary lesson of the 1918 influenza pandemic is that it is critical to intervene early," said Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases, which funded one of the studies.

"Nonpharmaceutical interventions may buy valuable time at the beginning of a pandemic while a targeted vaccine is being produced," he said.

Municipalities throughout the United States are creating pandemic flu plans in the event a deadly flu strain, such as H5N1, develops the genetic capacity to spread easily through human populations. H5N1 now is a pandemic among birds.