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Research Article

Public health interventions and epidemic intensity during the 1918 influenza pandemic

Richard J. Hatchett, Carter E. Mecher, and Marc Lipsitch
  1. *Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892;
  2. ‡Department of Veterans Affairs, VA Southeast Network, 3700 Crestwood Parkway, Duluth, GA 30096;
  3. §Homeland Security Council, Executive Office of the President, EEOB, 1650 Pennsylvania Avenue NW, Washington, DC 20502; and
  4. ¶Department of Epidemiology and Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115

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PNAS May 1, 2007 104 (18) 7582-7587; first published April 6, 2007; https://doi.org/10.1073/pnas.0610941104
Richard J. Hatchett
*Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892;
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  • For correspondence: hatchettr@niaid.nih.gov
Carter E. Mecher
‡Department of Veterans Affairs, VA Southeast Network, 3700 Crestwood Parkway, Duluth, GA 30096;
§Homeland Security Council, Executive Office of the President, EEOB, 1650 Pennsylvania Avenue NW, Washington, DC 20502; and
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Marc Lipsitch
¶Department of Epidemiology and Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115
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  1. Edited by Burton H. Singer, Princeton University, Princeton, NJ, and approved February 14, 2007 (received for review December 9, 2006)

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  • Fig. 1.
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    Fig. 1.

    Excess P&I mortality over 1913–1917 baseline in Philadelphia and St. Louis, September 8–December 28, 1918. Data are derived from ref. 10.

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    Fig. 2.

    Relationship of (a) peak weekly excess P&I death rate and (b) total excess P&I death rate during the study period to the timing of various NPIs. Cities were divided evenly into those intervening early (black bars) vs. late or not at all (gray bars), and the median outcome for the early and late groups was plotted. The first two groups of bars assess overall timing of intervention, comparing those cities that announced four or more NPIs before experiencing 20/100,000 CEPID with those with three or fewer and those that announced five or more NPIs before experiencing 30/100,000 CEPID with those with four or fewer. The remaining groups compare those cities that announced particular measures before experiencing 30/100,000 CEPID with those that did not. Significance by Mann–Whitney U test: ∗, P < 0.05; ∗∗, P < 0.01.

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    Table 1.

    Summary of interventions and their timing across 17 cities

    InterventionNumber of 17 cities implementingMedian (interquartile range) epidemic stage (CEPID) at time of implementation*
    Making influenza a notifiable disease155.6 (3.1, 25.9)
    Emergency declarations4—
    Isolation policies1415.7 (7.6, 30.8)
    Quarantine of households where infection identified5—
    School closures1430.8 (15.1, 96.3)
    Church closures1529.9 (12.4, 130.6)
    Theater closures1529.9 (10.3, 66.9)
    Dance hall closures1144.7 (12.4, –)
    Other closures1384.7 (29.9, 322.0)
    Staggered business hours to reduce congestion in stores and on transit systems8—
    Mask ordinances2—
    Rules forbidding crowding on streetcars6—
    Private funerals1192.1 (30.8, –)
    Bans on door-to-door sales1—
    Interventions designed to reduce transmission in the workplace0—
    Protective sequestration of children3—
    Bans on public gatherings1530.8 (12.4, 118.1)
    No-crowding rules in locations other than transit systems3—
    Community-wide business closures1—
    • ↵*Shown only for interventions implemented in at least nine cities (>50%); 75th percentile not shown for interventions implemented in <13 cities.

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    Table 2.

    Correlation between influenza epidemic outcomes and timing of interventions in 17 U.S. cities in 1918

    Measure of interventionsOutcome: Excess weekly P&I deaths
    PeakNormalized peak1918 total
    Number of interventions before:
        10/100,000 CEPID −0.53, P = 0.03 −0.53, P = 0.03 −0.31, P = 0.22
        20/100,000 CEPID −0.68, P = 0.002 −0.64, P = 0.005 −0.52, P = 0.03
        30/100,000 CEPID −0.51, P = 0.04 −0.55, P = 0.02 −0.29, P = 0.27
        40/100,000 CEPID−0.32, P = 0.21−0.40, P = 0.11−0.07, P = 0.80
    CEPID at time of intervention:
        First0.08, P = 0.760.004, P = 0.87    0.07, P = 0.79
        Second 0.54, P = 0.02 0.47, P = 0.060.39, P = 0.12
        Third 0.54, P = 0.02 0.52, P = 0.03 0.31, P = 0.22
        Fourth 0.66, P = 0.004 0.70, P = 0.002 0.38, P = 0.13
        Fifth 0.55, P = 0.02 0.67, P = 0.003 0.27, P = 0.30
        Sixth0.26, P = 0.310.44, P = 0.080.05, P = 0.84
    CEPID at time of:
        Closing schools 0.54, P = 0.02 0.63, P = 0.007 0.25, P = 0.34
        Closing theaters 0.56, P = 0.02 0.72, P = 0.001 0.17, P = 0.52
        Closing churches 0.56, P = 0.02 0.70, P = 0.002 0.17, P = 0.53
        Closing dance halls0.03, P = 0.900.04, P = 0.870.15, P = 0.57
        Other closures0.33, P = 0.190.34, P = 0.180.24, P = 0.35
        Making influenza notifiable0.01, P = 0.97−0.07, P = 0.790.11, P = 0.67
        Bans on public gatherings0.46, P = 0.06 0.56, P = 0.02 0.27, P = 0.30
        Imposing case isolation0.16, P = 0.530.14, P = 0.590.13, P = 0.62
        Bans on public funerals−0.09, P = 0.750.09, P = 0.72−0.41, P = 0.10
    • Three measures of epidemic intensity. Peak weekly excess P&I death rate, normalized peak weekly excess P&I death rate (peak divided by median weekly rate during the study period), and 1918 study period total excess P&I death rate are related to number of interventions before reaching a specified CEPID, CEPID at time when specified numbers of interventions had been imposed, and CEPID at time when specific interventions had been imposed. Spearman rank correlations and associated P values are shown, with bold type for P < 0.05.

Data supplements

  • Hatchett et al. 10.1073/pnas.0610941104.

    Supporting Information

    Files in this Data Supplement:

    SI Appendix
    SI Table 3
    SI Table 4
    SI Table 5
    SI Table 6
    SI Table 7
    SI Table 8
    SI Table 9
    SI Table 10
    SI Table 11




    Table 3. Regression coefficients for timing of the epidemic (defined as the time in weeks when the excess death P&I rate first surpassed 10/100,000) and the number of interventions before CEPID = 20 in a linear regression including either variable or both

     

    Regression Coefficients

    Timing (95% CI)

    P

    Interventions (95% CI)

    P

    Model

    Timing

    -28.4

    (-61.5, 4.8)

    0.09

    --

    --

    Interventions before CEPID = 20

    --

    --

    -11.1

    (-20.1,-2.0)

    0.02

    Timing + interventions

    0.7

    (-49.7, 60.0)

    0.98

    -11.2

    (-26.4, 3.9)

    0.13





    Table 4. This table recapitulates Table 2, but dates the intervention from the last day on which an activity was permitted, rather than the day on which a ban was promulgated

      

    Outcome: Excess weekly P&I deaths

     

    Measure of interventions

    (a) Peak

    (b) Normalized peak

    (c) 1918 total

    (i)

    Number of interventions before 10/100,000 CEPID

    -0.48

    P = 0.051

    -0.46

    P = 0.06

    -0.27

    P = 0.29

     

    Number of interventions before 20/100,000 CEPID

    -0.67

    P = 0.003

    -0.65

    P = 0.005

    -0.49

    P = 0.045

     

    Number of interventions before 30/100,000 CEPID

    -0.47

    P = 0.055

    -0.51

    P = 0.04

    -0.26

    P = 0.31

     

    Number of interventions before 40/100,000 CEPID10

    -0.30

    P = 0.24

    -0.38

    P = 0.13

    -0.05

    P = 0.85

    (ii)

    CEPID at time of first intervention

    0.13

    P = 0.60

    0.12

    P = 0.63

    0.05

    P = 0.83

     

    CEPID at time of second intervention

    0.52

    P = 0.03

    0.44

    P = 0.08

    0.38

    P = 0.14

     

    CEPID at time of third intervention

    0.54

    P = .02

    0.52

    P = 0.03

    0.30

    P = 0.24

     

    CEPID at time of fourth intervention

    0.61

    P = 0.009

    0.63

    P = 0.007

    0.36

    P = 0.15

     

    CEPID at time of fifth intervention

    0.55

    P = 0.02

    0.67

    P = 0.003

    0.27

    P = 0.30

     

    CEPID at time of sixth intervention

    0.26

    P = 0.31

    0.44

    P = 0.08

    0.05

    P = 0.84

    (iii)

    CEPID at time of closing schools

    0.54

    P = 0.02

    0.63

    P = 0.007

    0.25

    P = 0.34

     

    CEPID at time of closing theaters

    0.56

    P = 0.02

    0.72

    P<0.001

    0.17

    P = 0.52

     

    CEPID at time of closing churches

    0.43

    P = 0.08

    0.54

    P = 0.03

    0.10

    P = 0.69

     

    CEPID at time of closing dance halls

    0.03

    P = 0.90

    0.04

    P = 0.87

    0.15

    P = 0.57

     

    CEPID at time of other closures

    0.33

    P = 0.19

    0.34

    P = 0.18

    0.24

    P = 0.34

     

    CEPID at time of making influenza notifiable

    0.01

    P = 0.97

    -0.07

    P = 0.79

    0.11

    P = 0.67

     

    CEPID at time of bans on public gatherings

    0.46

    P = 0.06

    0.56

    P = 0.02

    0.27

    P = 0.30

     

    CEPID at time of imposing case isolation

    0.16

    P = 0.53

    0.14

    P = 0.59

    0.13

    P = 0.63

     

    CEPID at time of bans on public funerals

    -0.09

    P = 0.75

    0.09

    P = 0.72

    -0.40

    P = 0.10





    Table 5. This table recapitulates Table 2, but dates the stage of the epidemic as the CEPID 7 days after the date of intervention (CEPID7)

      

    Outcome: Excess weekly P&I deaths

     

    Measure of interventions

    (a) Peak

    (b) Normalized peak

    (c) 1918 total

    (i)

    Number of interventions before 30/100,000 CEPID7

    -0.51

    P = 0.04

    -0.52

    P = 0.03

    -0.35

    P = 0.17

     

    Number of interventions before 50/100,000 CEPID7

    -0.74

    P = 0.0007

    -0.71

    P = 0.001

    -0.55

    P = 0.02

     

    Number of interventions before 100/100,000 CEPID7

    -0.73

    P = 0.0009

    -0.77

    P = 0.0003

    -0.43

    P = 0.08

     

    Number of interventions before 150/100,000 CEPID7

    -0.53

    P = 0.03

    -0.65

    P = 0.005

    -0.25

    P = 0.33

     

    Number of interventions before 200/100,000 CEPID7

    -0.43

    P = 0.09

    -0.49

    P = 0.046

    -0.26

    P = 0.31

    (ii)

    CEPID7 at time of first intervention

    0.25

    P = 0.33

    0.20

    P = 0.44

    0.20

    P = 0.43

     

    CEPID7 at time of second intervention

    0.67

    P = 0.004

    0.62

    P = 0.009

    0.47

    P = 0.06

     

    CEPID7 at time of third intervention

    0.71

    P = .002

    0.68

    P = 0.003

    0.48

    P = 0.052

     

    CEPID7 at time of fourth intervention

    0.76

    P = 0.0004

    0.81

    P = 0.0001

    0.45

    P = 0.07

     

    CEPID7 at time of fifth intervention

    0.69

    P = 0.002

    0.81

    P = 0.0001

    0.36

    P = 0.16

     

    CEPID7 at time of sixth intervention

    0.43

    P = 0.08

    0.60

    P = 0.01

    0.18

    P = 0.48

    (iii)

    CEPID7 at time of closing schools

    0.67

    P = 0.003

    0.74

    P = 0.0006

    0.37

    P = 0.14

     

    CEPID7 at time of closing theaters

    0.63

    P = 0.007

    0.78

    P = 0.0002

    0.24

    P = 0.35

     

    CEPID7 at time of closing churches

    0.62

    P = 0.007

    0.75

    P = 0.0005

    0.23

    P = 0.37

     

    CEPID7 at time of closing dance halls

    0.15

    P = 0.55

    0.15

    P = 0.56

    0.27

    P = 0.30

     

    CEPID7 at time of other closures

    0.42

    P = 0.09

    0.44

    P = 0.08

    0.27

    P = 0.29

     

    CEPID7 at time of making influenza notifiable

    0.21

    P = 0.41

    0.12

    P = 0.64

    0.24

    P = 0.35

     

    CEPID7 at time of bans on public gatherings

    0.54

    P = 0.03

    0.67

    P = 0.003

    0.28

    P = 0.28

     

    CEPID7 at time of imposing case isolation

    0.28

    P = 0.28

    0.26

    P = 0.31

    0.22

    P = 0.40

     

    CEPID7 at time of bans on public funerals

    -0.03

    P = 0.90

    0.15

    P = 0.56

    -0.37

    P = 0.14





    Table 6. This table recapitulates Table 2 but dates the stage of the epidemic as the CEPID 10 days after the date of intervention (CEPID10)

      

    Outcome: Excess weekly P&I deaths

     

    Measure of interventions

    (a) Peak

    (b) Normalized peak

    (c) 1918 total

    (i)

    Number of interventions before 50/100,000 CEPID10

    -0.51

    P = 0.04

    -0.52

    P = 0.03

    -0.35

    P = 0.17

     

    Number of interventions before 100/100,000 CEPID10

    -0.77

    P = 0.0003

    -0.77

    P = 0.0003

    -0.48

    P = 0.0499

     

    Number of interventions before 150/100,000 CEPID10

    -0.74

    P = 0.0007

    -0.78

    P = 0.0002

    -0.44

    P = 0.08

     

    Number of interventions before 200/100,000 CEPID10

    -0.77

    P = 0.0003

    -0.86

    P<0.0001

    -0.48

    P = 0.049

     

    Number of interventions before 250/100,000 CEPID10

    -0.52

    P = 0.03

    -0.56

    P = 0.02

    -0.31

    P = 0.23

     

    Number of interventions before 300/100,000 CEPID10

    -0.52

    P = 0.03

    -0.57

    P = 0.02

    -0.32

    P = 0.20

    (ii)

    CEPID10 at time of first intervention

    0.29

    P = 0.26

    0.24

    P = 0.36

    0.25

    P = 0.33

     

    CEPID10 at time of second intervention

    0.70

    P = 0.002

    0.64

    P = 0.005

    0.52

    P = 0.03

     

    CEPID10 at time of third intervention

    0.74

    P = 0.0008

    0.70

    P = 0.002

    0.52

    P = 0.03

     

    CEPID10 at time of fourth intervention

    0.82 P = 0.0001

    0.85

    P<0.0001

    0.53

    P = 0.03

     

    CEPID10 at time of fifth intervention

    0.73

    P = 0.0009

    0.84

    P <0.0001

    0.43

    P = 0.08

     

    CEPID10 at time of sixth intervention

    0.62

    P = 0.009

    0.73

    P = 0.001

    0.40

    P = 0.11

     

    CEPID10 at time of seventh intervention

    0.66

    P = 0.004

    0.69

    P = 0.002

    0.49

    P = 0.045

    (iii)

    CEPID10 at time of closing schools

    0.67

    P = 0.003

    0.75

    P = 0.0005

    0.39

    P = 0.13

     

    CEPID10 at time of closing theaters

    0.72

    P = 0.001

    0.85

    P<0.0001

    0.38

    P = 0.14

     

    CEPID10 at time of closing churches

    0.66

    P = 0.004

    0.77

    P = 0.0003

    0.30

    P = 0.25

     

    CEPID10 at time of closing dance halls

    0.17

    P = 0.50

    0.17

    P = 0.50

    0.30

    P = 0.23

     

    CEPID10 at time of other closures

    0.48

    P = 0.053

    0.48

    P = 0.049

    0.35

    P = 0.17

     

    CEPID10 at time of making influenza notifiable

    0.26

    P = 0.30

    0.18

    P = 0.48

    0.27

    P = 0.30

     

    CEPID10 at time of bans on public gatherings

    0.60

    P = 0.01

    0.72

    P = 0.001

    0.36

    P = 0.15

     

    CEPID10 at time of imposing case isolation

    0.29

    P = 0.27

    0.27

    P = 0.30

    0.23

    P = 0.36

     

    CEPID10 at time of bans on public funerals

    -0.01

    P = 0.98

    0.16

    P = 0.53

    -0.34

    P = 0.18





    SI Appendix

    Bibliography for individual interventions, by city

    Summary of interventions and their timing across 17 cities.

    Intervention

    Comments

    No. of 17 cities implementing

    Median (interquartile range) epidemic stage (CEPID) at time of implementation*

    Making influenza a notifiable disease

    Based on first definitive reference in available source(s)

    15

    5.6 (3.1, 25.9)

    Emergency declarations

    Official declaration of public health (or other) emergency by authorities

    4

    --

    Isolation policies

    Based on first definitive evidence of community-wide policy, beyond public exhortation alone (e.g., opening of isolation ward, designation of influenza hospital, implementation of policy of home isolation, etc.)

    14

    15.7 (7.6, 30.8)

    Quarantine of households/

    placarding of houses where infection identified

    Based on first definitive reference in available source(s)

    5

    --

    School closure

    Based on date policy announced

    14

    30.8 (15.1, 96.3)

    Church closure

    Based on date policy announced

    15

    29.9 (12.4, 130.6)

    Theater closure

    Based on date policy announced

    15

    29.9 (10.3, 66.9)

    Dance hall closure

    Based on date policy announced

    11

    44.7 (12.4, --)

    Other closure

    Based on date policy announced (includes places of amusement such as billiard halls, saloons, soda fountains, etc.)

    13

    84.7 (29.9, 322.0)

    Introduction of staggered business hours to reduce congestion in stores and on transit systems

    Based on date policy announced; typically applied to retail outlets, not offices

    8

    --

    Implementation of mask ordinances

    Based on date of introduction of community-wide policy (some cities implemented mask orders for specific occupations but these were not scored as community-wide policies)

    2

    --

    Implementation of rules forbidding crowding on streetcars

    Based on implementation of community-wide policy, beyond public exhortation alone (i.e., evidence of enforcement)

    6

    --

    Private funerals

    Based on date policy announced; sometimes coupled with restrictions on weddings

    11

    92.1 (30.8,--)

    Ban on door-to-door sales

    Based on date policy announced

    1

    --

    Interventions designed to reduce transmission in the workplace

    Defined as implementation of community-wide policy to promote social distancing in workplace, beyond public exhortation alone

    0

    --

    Protective sequestration of children

    Defined as implementation of community-wide rules banning the public congregation of children or forbidding children to enter certain establishments (e.g., theaters, retail stores, etc.)

    3

    --

    Ban on public gatherings

    Based on date policy announced

    15

    30.8 (12.4, 118.1)

    Implementation of no-crowding rules in locations other than transit systems

    Based on implementation of community-wide policy, beyond public exhortation alone (i.e., evidence of enforcement)

    3

    --

    Implementation of community-wide business closures

    Scored for declaration of general business closure, not closure of specific kinds of establishment (e.g., ice cream parlors, taverns). Similar to current concept of "snow days". Based on dates of implementation.

    1

    --

    *Shown only for those interventions implemented in at least nine cities (>50%); 75th percentile not shown for interventions implemented in <13 cities.

    Baltimore

    Events

     

    First reported case

    "177 new 'flu' cases - Health office to take drastic action against disease - 10 more deaths at Meade", Baltimore Sun, October 2, 1918, p. 16.

    First reported death

    "'Flu' spreading in city - Over 30 cases reported by physicians in last few days - Only one death last week - Alleged control of disease termed camouflage in respect to civilians by Health Board', Baltimore Sun, September 29, 1918, p. 9.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    Video clip and description of event available from United States Library of Congress, accessed online at http://memory.loc.gov/cgi-bin/query/r?ammem/papr:@filreq(@field(NUMBER+@band(trmp+4147))+@field(COLLID+roosevelt)) on November 20, 2006.

     

     

    Dates of Interventions

     

    Reportable Disease

    "37 die from flu - Edgewood Arsenal reports 23 and Meade 13 - 396 new cases at Meade", Baltimore Sun, September 30, 1918, p. 14.

    Isolation

    "177 new 'flu' cases - Health office to take drastic action against disease - 10 more deaths at Meade", Baltimore Sun, October 2, 1918, p. 16.

    Schools

    "'Flu' toll big; 78 die at Meade - Seventy victims reported by the Health Department - Schools to close; 30,000 are absent - New cases, including Sunday's, 1,650 - 667 in counties", Baltimore Sun, October 8, 1918, p. 16.

    Churches

    "Vaccine sent to check 'flu' - Supply received here from U.S. Medical School in Washington - Churches included in closing order - 214 deaths reported in city and 2,853 new cases are heard from", Baltimore Sun, October 11, 1918, p. 14; "No church tomorrow - First time in city's history sacred edifices ordered closed - Many previous epidemics - But modern science recognizes the necessity of preventing all unnecessary gatherings", Baltimore Sun, October 12, 1918, p. 5.

    Theaters

    "'Flu' toll up; theatres shut - All private schools and colleges ordered to close - Regulation applies to entire state - 117 deaths in city in last 33 hours - 91 soldiers die", Baltimore Sun, October 9, 1918, p. 16.

    Dance halls

    "177 new 'flu' cases - Health office to take drastic action against disease - 10 more deaths at Meade", Baltimore Sun, October 2, 1918, p. 16.

    Other closures

    "Vaccine sent to check 'flu' - Supply received here from U.S. Medical School in Washington - Churches included in closing order - 214 deaths reported in city and 2,853 new cases are heard from", Baltimore Sun, October 11, 1918, p. 14.

    Staggered business hours

    "'Flu' cuts store hours - Dr. Blake orders them to open after 9:30 and close at 4:30 - 81 die in city; 1525 new cases - 75 die at Meade, with 455 new cases - 15 expire at McHenry", Baltimore Sun, October 10, 1918, p. 16.

    Private funerals

    10/11/1918 is date of church closure; first reference to ban on funerals "Ban still on funerals - Churches opened today for all other regular services - Dr. Blake gives his reasons - Impossible because of poor ventilation and inadequate embalming - 110 deaths reported" Baltimore Sun, October 27, 1918, p. 14.

    Ban on public gatherings

    "Vaccine sent to check 'flu' - Supply received here from U.S. Medical School in Washington - Churches included in closing order - 214 deaths reported in city and 2,853 new cases are heard from", Baltimore Sun, October 11, 1918, p. 14; "Saloons restricted; Laurel Track closed - 'Flu' epidemic leads to order shortening business hours for bars - Dentists required to mask - Fewer new cases are reported in city and state - Fifty deaths occur at Meade and five at Fort McHenry", Baltimore Sun, October 12, 1918, p. 14; "'Flu' epidemic believed on wane - Death rate increases but fewer new cases are reported - Baseball games are banned - thirty-two soldiers die at Meade and 120 new cases of pneumonia are reported - Six succumb at Fort McHenry", Baltimore Sun, October 13, 1918, p. 14.

    Boston

    Events

     

    First reported case

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 40, citing Forty-seventh Annual Report of the Health Department of the City of Boston for the Year 1918, p. 44. Also, Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York; Viking, 2004, p. 184. No citation.

    First reported death

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 40, citing Boston Evening Transcript, September 10, 1918 (no page number); and Monthly Bulletin of the Health Department of the City of Boston, vol. 7 (September 1918), p. 184.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 40, citing Boston Daily Globe, September 3, 1918.

    Other

    Baseball Almanac, accessed online at http://www.baseball-almanac.com/ws/yr1918ws.shtml on November 20, 1918.

     

     

    Dates of Interventions

     

    Isolation

    "Vigorous action to stamp out grippe - 18 deaths from disease in Boston yesterday - City hospital closed to visitors for indefinite period", Boston Daily Globe, September 18, 1918, p. 3.

    Schools

    "Influenza adds 1009 to death list in day - Boston schools close - Urgent appeal made for nurses - Governor calls attention to seriousness of situation in proclamation", Boston Daily Globe, September 25, 1918, p. 1.

    Churches

    "Saloons, billiard rooms, soda fountains closed - Order effective at 12:01 AM Sunday - Churches asked to suspend services - Gasoline ban remains - Day's deaths 183", Boston Daily Globe, October 5, 1918, p. 1; "'How dry I am' to be tune in Boston - King grippe hangs 'K.O' on drinking places - Churches and bowling alleys also closed by epidemic - Want something to do? Nothing doing", Boston Daily Globe, October 6, 1918, p. 4.

    Theaters

    "Public gatherings barred till Oct. 7 - Sunday church services declared optional - Better car service asked - Grippe deaths in 24 hours 156", Boston Daily Globe, September 27, 1918, p. 1.

    Dance halls

    "Public gatherings barred till Oct. 7 - Sunday church services declared optional - Better car service asked - Grippe deaths in 24 hours 156", Boston Daily Globe, September 27, 1918, p. 1.

    Other closures

    "Saloons, billiard rooms, soda fountains closed - Order effective at 12:01 AM Sunday - Churches asked to suspend services - Gasoline ban remains - Day's deaths 183", Boston Daily Globe, October 5, 1918, p. 1; "'How dry I am' to be tune in Boston - King grippe hangs 'K.O' on drinking places - Churches and bowling alleys also closed by epidemic - Want something to do? Nothing doing", Boston Daily Globe, October 6, 1918, p. 4.

    Staggered business hours

    "Big drop shown in influenza deaths - Day's total in Boston 149 - Reports encouraging - State-wide closing of all public meeting places urged - Day's developments in grippe situation", Boston Daily Globe, October 6, 1918, p. 1.

    Private funerals

    "Influenza deaths in Boston fewer - Red Cross rushing nurses and doctors here - Public funerals prohibited - Many churches to close", Boston Daily Globe, September 28, 1918, p. 1.

    Ban on public gatherings

    "Public gatherings barred till Oct. 7 - Sunday church services declared optional - Better car service asked - Grippe deaths in 24 hours 156", Boston Daily Globe, September 27, 1918, p. 1.

    Cambridge

    Events

     

    First reported case

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, Table D, p. 20.

    First reported death

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, Table D, p. 20.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    Cambridge Chronicle, October 19, 1918, p. 1.

     

     

    Dates of Interventions

     

    Reportable Disease

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, p. 30.

    Emergency Declaration

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, p. 32.

    Isolation

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, p. 30.

    Churches

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, p. 32.

    Other closures

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, p. 32.

    Private funerals

    City of Cambridge, Massachusetts. Annual report of the Board of Health for the year ending December 31, 1918, p. 32.

    Chicago

    Events

     

    First reported case

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 40.

    First reported death

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 40.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 106.

     

     

    Dates of Interventions

     

    Reportable Disease

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 82.

    Isolation

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 104.

    Quarantine

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, Chart XX, p. 81.

    Theaters

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 106.

    Dance halls

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 106.

    Other closures

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 106.

    Private funerals

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 112.

    Protective Sequestration

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, Appendix E ("Letter to John Alcock, General Superintendent of Police, City of Chicago"), p. 147.

    Ban on public gatherings

    Robertson JD. Report and handbook of the Department of Health of the City of Chicago for the years 1911 to 1918 inclusive. Chicago, 1919, p. 106.

    Cincinnati

    Events

     

    First reported case

    Sanitary Bulletin of the City of Cincinnati, October 1, 1918

    First reported death

     

     

     

    Amplifying Events

     

    Liberty Loan Parades

     

     

     

    Dates of Interventions

     

    Reportable Disease

    The Ohio Public Health Journal, Volume IX, Number 11, November 1918, p. 452

    Isolation

    Sanitary Bulletin of the City of Cincinnati, September 19, 1918

    Quarantine

    Sanitary Bulletin of the City of Cincinnati, September 19, 1918

    Schools

    Sanitary Bulletin of the City of Cincinnati, October 10, 1918

    Churches

    Sanitary Bulletin of the City of Cincinnati, October 10, 1918

    Theaters

    Sanitary Bulletin of the City of Cincinnati, October 10, 1918

    Dance halls

    Sanitary Bulletin of the City of Cincinnati, October 10, 1918

    Other closures

    Sanitary Bulletin of the City of Cincinnati, October 10, 1918

    Private funerals

    Sanitary Bulletin of the City of Cincinnati, October 10, 1918

    Ban on public gatherings

    Sanitary Bulletin of the City of Cincinnati, October 10, 1918

    Cleveland

    Events

     

    First reported case

     

    First reported death

     

     

     

    Amplifying Events

     

    Liberty Loan Parades

     

     

     

    Dates of Interventions

     

    Reportable Disease

    The Ohio Public Health Journal, Volume IX, Number 11, November 1918, p. 452

    Isolation

    "1200 new cases of flu - Thirty-four more deaths are reported - Epidemic crisis near - Hospital facilities extended to meet situation", Cleveland Press, October 19, 1918.

    Schools

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Churches

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Theaters

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Dance halls

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Other closures

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Transit use discouraged

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Private funerals

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Ban on public gatherings

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    No crowding rule

    The City Record of the Cleveland City Council, October 21, 1918, File No. 47932, citing promulgation of health regulations by Acting Commissioner of Health H.L. Rockwood.

    Indianapolis

    Events

     

    First reported case

     

    First reported death

     

     

     

    Amplifying Events

     

    Liberty Loan Parades

     

     

     

    Dates of Interventions

     

    Reportable Disease

    Richards S. 1918 Influenza pandemic: a glimpse of Indiana. Indiana State Department of Health. Accessed online at http://www.in.gov/isdh/dataandstats/epidem/2006/Feb/1918_influenza_pandemic.htm on November 12, 2006.

    Emergency Declaration

    "Flu pandemic state calamity - Governor calls on every county to form health commissions - Disease runs wild", Indianapolis Star, November 24, 1918.

    Schools

    "Influenza has reached epidemic stage in state - Tight lid is placed on all public meetings throughout Indiana - Board of Health acts", Fort Wayne News and Sentinel, October 10, 1918, p. 12. Also Richards S. 1918 Influenza pandemic: a glimpse of Indiana. Indiana State Department of Health. Accessed online at http://www.in.gov/isdh/dataandstats/epidem/2006/Feb/1918_influenza_pandemic.htm on November 12, 2006.

    Churches

    "Influenza has reached epidemic stage in state - Tight lid is placed on all public meetings throughout Indiana - Board of Health acts", Fort Wayne News and Sentinel, October 10, 1918, p. 12. Also Richards S. 1918 Influenza pandemic: a glimpse of Indiana. Indiana State Department of Health. Accessed online at http://www.in.gov/isdh/dataandstats/epidem/2006/Feb/1918_influenza_pandemic.htm on November 12, 2006.

    Theaters

    "Influenza has reached epidemic stage in state - Tight lid is placed on all public meetings throughout Indiana - Board of Health acts", Fort Wayne News and Sentinel, October 10, 1918, p. 12. Also Richards S. 1918 Influenza pandemic: a glimpse of Indiana. Indiana State Department of Health. Accessed online at http://www.in.gov/isdh/dataandstats/epidem/2006/Feb/1918_influenza_pandemic.htm on November 12, 2006.

    Masks

    "Board prepares to enforce flu mask wearing - Observance of order, effective today, to decide whether suspension of business is necessary - Cases drop slightly - School commissioners appeal for permission to reopen high schools, offering co-operation", Indianapolis Star, November 20, 1918, p. 1.

    Ban on public gatherings

    "Influenza has reached epidemic stage in state - Tight lid is placed on all public meetings throughout Indiana - Board of Health acts", Fort Wayne News and Sentinel, October 10, 1918, p. 12. Also Richards S. 1918 Influenza pandemic: a glimpse of Indiana. Indiana State Department of Health. Accessed online at http://www.in.gov/isdh/dataandstats/epidem/2006/Feb/1918_influenza_pandemic.htm on November 12, 2006.

    Kansas City

    Events

     

    First reported case

    "Stop gatherings - Schools, theaters, film shows and churches closed until influenza is checked - Health board orders it - The Board of Education will shut up the schools this afternoon - Cowgill authorized the issuance of the order to protect public health - Until further notice - the Liberty Bond Luncheons the only meetings that are excepted", Kansas City Star, October 7, 1918.

    First reported death

    "Ask Met. Aid in Influenza - Crowded cars a menace, health officials say - The company is asked not to let more than fifteen persons stand in a car - Many deaths and new cases", Kansas City Star, October 5, 1918.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    McGuinn N. Kansas City, Kansas Public School System, 1819-1961. Kansas City, Kansas; United School District 500, 1966. Accessed online at http://www.kckps.org/DISTHISTORY/dist-history/mcguinn/mcguinn_1918.htm on November 20, 2006.

     

     

    Dates of Interventions

     

    Reportable Disease

    "To quarantine influenza - Missouri Health Board's orders in effect here", Kansas City Star, September 30, 1918.

    Emergency Declaration

    "Stop gatherings - Schools, theaters, film shows and churches closed until influenza is checked - Health board orders it - The Board of Education will shut up the schools this afternoon - Cowgill authorized the issuance of the order to protect public health - Until further notice - the Liberty Bond Luncheons the only meetings that are excepted", Kansas City Star, October 7, 1918.

    Isolation

    "To quarantine influenza - Missouri Health Board's orders in effect here", Kansas City Star, September 30, 1918.

    Quarantine

    "To quarantine influenza - Missouri Health Board's orders in effect here", Kansas City Star, September 30, 1918.

    Schools

    "Stop gatherings - Schools, theaters, film shows and churches closed until influenza is checked - Health board orders it - The Board of Education will shut up the schools this afternoon - Cowgill authorized the issuance of the order to protect public health - Until further notice - the Liberty Bond Luncheons the only meetings that are excepted", Kansas City Star, October 7, 1918.

    Churches

    "Stop gatherings - Schools, theaters, film shows and churches closed until influenza is checked - Health board orders it - The Board of Education will shut up the schools this afternoon - Cowgill authorized the issuance of the order to protect public health - Until further notice - the Liberty Bond Luncheons the only meetings that are excepted", Kansas City Star, October 7, 1918.

    Theaters

    "Stop gatherings - Schools, theaters, film shows and churches closed until influenza is checked - Health board orders it - The Board of Education will shut up the schools this afternoon - Cowgill authorized the issuance of the order to protect public health - Until further notice - the Liberty Bond Luncheons the only meetings that are excepted", Kansas City Star, October 7, 1918.

    Other closures

    "2nd hand and cleaning shops closed by city - Health officials believe influenza spread is due to old clothing", Kansas City Post, October 9, 1918.

    Staggered business hours

    "A drastic ban is on - Stores employing more than 25 are restricted, also, in the new influenza edict - Open at 9, close at 4 - Not more than 20 persons may stand in a street car, the Health Board orders - Public conveyances must keep the windows open - Stops music at hotels and cafes - Effective now indefinitely - All gatherings of 20 or more persons, including parties, weddings, and funerals prohibited", Kansas City Star, October 17, 1918.

    Transit use discouraged

    "Stop gatherings - Schools, theaters, film shows and churches closed until influenza is checked - Health board orders it - The Board of Education will shut up the schools this afternoon - Cowgill authorized the issuance of the order to protect public health - Until further notice - the Liberty Bond Luncheons the only meetings that are excepted", Kansas City Star, October 7, 1918.

    Private funerals

    "To quarantine influenza - Missouri Health Board's orders in effect here", Kansas City Star, September 30, 1918.

    Protective Sequestration

    "Flu bans in both cities removed at noon today - Conditions so much improved as to make restrictions unnecessary - Only 2 new cases - Monday's usually big death list was reduced to only 13", Kansas City Post, December 23, 1918.

    Ban on public gatherings

    "Stop gatherings - Schools, theaters, film shows and churches closed until influenza is checked - Health board orders it - The Board of Education will shut up the schools this afternoon - Cowgill authorized the issuance of the order to protect public health - Until further notice - the Liberty Bond Luncheons the only meetings that are excepted", Kansas City Star, October 7, 1918.

    No crowding rule

    "A drastic ban is on - Stores employing more than 25 are restricted, also, in the new influenza edict - Open at 9, close at 4 - Not more than 20 persons may stand in a street car, the Health Board orders - Public conveyances must keep the windows open - Stops music at hotels and cafes - Effective now indefinitely - All gatherings of 20 or more persons, including parties, weddings, and funerals prohibited", Kansas City Star, October 17, 1918.

    Newark

    Events

     

    First reported case

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258. No citation.

    First reported death

     

     

     

    Amplifying Events

     

    Liberty Loan Parades

     

     

     

    Dates of Interventions

     

    Isolation

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258, citing Newark Evening News, September 27, 1918.

    Schools

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258, citing Newark Evening News, October 10, 1918.

    Churches

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258, citing Newark Evening News, October 10, 1918.

    Theaters

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258, citing Newark Evening News, October 10, 1918.

    Dance halls

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258, citing Newark Evening News, October 10, 1918.

    Other closures

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258, citing Newark Evening News, October 10, 1918.

    Ban on public gatherings

    Galishoff S. Newark and the great influenza pandemic of 1918. Bulletin of the History of Medicine 1969;43(3):246-258, citing Newark Evening News, October 10, 1918.

    New Orleans

    Events

     

    First reported case

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 63, citing Annual Report of Surgeon General of Public Health Service 1919, p. 123, and Public Health Reports, vol. 33 (September 27, 1918), p. 1625.

    First reported death

     

     

     

    Amplifying Events

     

    Liberty Loan Parades

     

     

     

    Dates of Interventions

     

    Reportable Disease

    "Closing schools sought to stop dread epidemic - Surgeon General of Public Health Service wants meetings to stop" New Orleans Times-Picayune, October 8, 1918, p. 5.

    Isolation

    "Closing schools sought to stop dread epidemic - Surgeon General of Public Health Service wants meetings to stop" New Orleans Times-Picayune, October 8, 1918, p. 5. Also, "Red Cross nurses of Gulf Division are mobilizing - Spread of influenza calls for experienced workers to volunteer", New Orleans Times-Picayune, October 8, 1918, p. 14.

    Schools

    "Schools closed; churches also will suspend - Drastic steps taken to prevent further spread of influenza", New Orleans Times-Picayune, October 9, 1918, p. 1. Also, Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    Churches

    Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    Theaters

    Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    Dance halls

    "Schools closed; churches also will suspend - Drastic steps taken to prevent further spread of influenza", New Orleans Times-Picayune, October 9, 1918, p. 1. Also, Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    Other closures

    "Schools closed; churches also will suspend - Drastic steps taken to prevent further spread of influenza", New Orleans Times-Picayune, October 9, 1918, p. 1. Also, Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    Staggered business hours

    "All shows, churches are ordered closed to fight epidemic", New Orleans Times-Picayune, October 10, 1918, p. 1.

    Transit use discouraged

    "All shows, churches are ordered closed to fight epidemic", New Orleans Times-Picayune, October 10, 1918, p. 1. Also, Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    Ban on public gatherings

    Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    No crowding rule

    Parish of Orleans and City of New Orleans. Report of the Board of Health, 1919, p. 131.

    New York City

    Events

     

    First reported case

    "To fight Spanish grip. - Health officials discuss an educational campaign on the disease", New York Times, September 16, 1918, p. 10.

    First reported death

    Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York; Viking, 2004, p. 270. No citation. See also, "Find 114 new cases of influenza here - Health Commissioner says heeding of warnings will prevent spread of illness - No need for isolation - Hospitals to observe a "modified quarantine" - 10,000 placards forbid coughing and sneezing", New York Times, September 24, 1918, p. 9.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    "Acclaim Wilson as he marches in big Loan parade - President walks the entire route, smiling and bowing to city's tribute - Enthusiast tries to reach him to shake his hand and is beaten by crowd - Roars for war veterans - Allied fighters get rousing reception in their march down Fifth Avenue", New York Times, October 13, 1918, p. 1.

     

     

    Dates of Interventions

     

    Reportable Disease

    "Must report all Spanish influenza - Pneumonia, its sequel, is now listed by Health Board to check spread here - 30 new cases at Upton - Three also stricken in family of Jersey City soldier home on leave from Camp Dix", New York Times, September 18, 1918, p. 24.

    Isolation

    "Find 114 new cases of influenza here - Health Commissioner says heeding of warnings will prevent spread of illness - No need for isolation - Hospitals to observe a "modified quarantine" - 10,000 placards forbid coughing and sneezing", New York Times, September 24, 1918, p. 9.

    Staggered business hours

    "Drastic steps taken to fight influenza here - Health Board issues 4 P.M. closing orders for all stores except food and drug stores - Hours for factories are fixed - Plan, in effect today, to reduce crowding on transportation lines in rush periods. - Time table for theatres - Radical regulations necessary to prevent shutting city up tight, says Dr. Copeland", New York Times, October 5, 1918, p. 1.

    Transit use discouraged

    "New cases reach higher total here; 352 of influenza in yesterday's report, Brooklyn leading - 22 deaths, including pneumonia", New York Times, September 29, 1918, p. 15.

    Omaha

    Events

     

    First reported case

     

    First reported death

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 38, citing Omaha World-Herald, October 3, 1918 (no page number).

     

     

    Amplifying Events

     

    Liberty Loan Parades

     

    Other

    Gernhart G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 41, citing Omaha Daily Bee, October 5, 1918 (no page number).

     

     

    Dates of Interventions

     

    Reportable Disease

    Gernhart G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 40, citing Omaha Daily News, October 10, 1918 (no page number).

    Quarantine

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 66, citing Omaha World-Herald, December 20, 1918 (no page number).

    Schools

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 38, citing Omaha World-Herald, October 4, 1918 (no page number).

    Churches

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 38, citing Omaha World-Herald, October 4, 1918 (no page number).

    Theaters

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 38, citing Omaha World-Herald, October 4, 1918 (no page number).

    Other closures

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 49, citing Omaha World-Herald, October 22, 1918 (no page number).

    Staggered business hours

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 49, citing Omaha World-Herald, October 22, 1918 (no page number).

    Transit use discouraged

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 61, citing Omaha World-Herald, December 12, 1918 (no page number).

    Private funerals

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 47, citing Omaha Daily Bee, October 12, 1918 (no page number).

    Ban on public gatherings

    Gernhart, G. A forgotten enemy: Omaha encounters the 1918 influenza pandemic. MA Thesis, Department of History, University of Nebraska, December 1998, p. 49, citing Omaha World-Herald, October 22, 1918 (no page number).

    Philadelphia

    Events

     

    First reported case

    Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York; Viking, 2004, p. 201. No citation. Also Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 71, citing Philadelphia Inquirer, September 19, 1918 (no page number).

    First reported death

    Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York; Viking, 2004, p. 201. No citation.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 72, citing Philadelphia Inquirer, September 29, 1918 (no page number).

     

     

    Dates of Interventions

     

    Reportable Disease

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 71, citing Johnston JI, "History and Epidemiology of Epidemic Influenza," Studies on Epidemic Influenza. Publications from the University of Pittsburgh School of Medicine (1919) (n.p., n.d.), p. 20.

    Isolation

    Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York; Viking, 2004, p. 221. No citation.

    Schools

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 74, citing Philadelphia Inquirer, October 4, 1918 (no page number). Also, "Pennsylvania closes all meeting places - Philadelphia appeals for physicians to check rapid spread of influenza there", New York Times, October 4, 1918, p. 24; "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006.

    Churches

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 74, citing Philadelphia Inquirer, October 4, 1918 (no page number). Also, "Pennsylvania closes all meeting places - Philadelphia appeals for physicians to check rapid spread of influenza there", New York Times, October 4, 1918, p. 24; "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006.

    Theaters

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 74, citing Philadelphia Inquirer, October 4, 1918 (no page number). Also, "Pennsylvania closes all meeting places - Philadelphia appeals for physicians to check rapid spread of influenza there", New York Times, October 4, 1918, p. 24; "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006.

    Dance halls

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 74, citing Philadelphia Inquirer, October 4, 1918 (no page number). Also, "Pennsylvania closes all meeting places - Philadelphia appeals for physicians to check rapid spread of influenza there", New York Times, October 4, 1918, p. 24; "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006.

    Other closures

    Crosby AW. America's Forgotten Pandemic: The Influenza of 1918 (2nd Edition). New York; Cambridge University Press, 2003, p. 74, citing Philadelphia Inquirer, October 4, 1918 (no page number). Also, "Pennsylvania closes all meeting places - Philadelphia appeals for physicians to check rapid spread of influenza there", New York Times, October 4, 1918, p. 24; "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http//www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006.

    Private funerals

    "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Ban on public gatherings

    "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Pittsburgh

    Events

     

    First reported case

    "Physicians order to report cases", Pittsburgh Sun, October 4, 1918, accessed online (ps03) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 12, 2006

    First reported death

     

     

     

    Amplifying Events

     

    Liberty Loan Parades

    "Liberty Day program", Pittsburgh Sun, October 11, 1918, accessed online (ps20) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 20, 2006.

     

     

    Dates of Interventions

     

    Reportable Disease

    "Influenza sweeping nation; Pittsburgh under quarantine - Measures taken in many directions by health authorities to check disease - Saloons are closed - Also all places of amusement - Church and school attendance to be limited - Protect hospitals", Pittsburgh Gazette Times, October 5, 1918, accessed online (pgt07) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Isolation

    "Influenza sweeping nation; Pittsburgh under quarantine - Measures taken in many directions by health authorities to check disease - Saloons are closed - Also all places of amusement - Church and school attendance to be limited - Protect hospitals", Pittsburgh Gazette Times, October 5, 1918, accessed online (pgt07) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Schools

    "Schools close as deaths from epidemic grow - Decrease in number of new cases, however, is reported this morning - Nurses are mobilized", Pittsburgh Sun, October 24, 1918, accessed online (ps35) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Churches

    "Churches are closed under health order - Sale of liquor in clubs as well as on hotel tables stopped to thwart influenza - Health inspector dies", Pittsburgh Sun, October 7, 1918, accessed online (ps13) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Theaters

    "Closing order will be obeyed in Pittsburgh - Managers of theaters act promptly - No performances today - Nurses called for", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Private funerals

    "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Ban on public gatherings

    "Growth of epidemic prompts drastic order by Dr. Royer - Health officials throughout Pennsylvania told to enforce edict to letter - All amusements hit - Closing of schools and churches left to discretion of local boards - Other cities act", Pittsburgh Gazette Times, October 4, 1918, accessed online (pgt06) at http://www.med.umich.edu/medschool/chm/influenza/wpib.htm on November 10, 2006

    Seattle

    Events

     

    First reported case

    "Pneumonia increases", Seattle Post-Intelligencer, September 26, 1918, p. 5.

    First reported death

    Communication from the Mayor to the Seattle City Council, October 7, 1918. Seattle City Clerk's Office, Comptroller File 71547.

     

     

    Amplifying Events

     

    Liberty Loan Parades

     

     

     

    Dates of Interventions

     

    Reportable Disease

    "Epidemic takes 23 as new serum is offered here", Seattle Daily Times, October 6, 1918, p. 1.

    Emergency Declaration

    Ordinance No. 38799 of the Seattle City Council, signed by Mayor Hanson October 9, 1918.

    Isolation

    Ordinance No. 38799 of the Seattle City Council, signed by Mayor Hanson October 9, 1918. Also, "504 more cases of influenza - Number of sufferers from malady reported since Saturday now reaches 806. - Thousands are being inoculated with new serum with good results, say officers", Seattle Daily Times, October 9, 1918, p. 1.

    Quarantine

    Ordinance No. 38971 of the Seattle City Council, signed by Mayor Hanson December 5, 1918.

    Schools

    "Churches, schools, shows close - Epidemic puts ban on all public assembly", Seattle Daily Times, October 5, 1918, p. 1.

    Churches

    "Churches, schools, shows close - Epidemic puts ban on all public assembly", Seattle Daily Times, October 5, 1918, p. 1.

    Theaters

    "Churches, schools, shows close - Epidemic puts ban on all public assembly", Seattle Daily Times, October 5, 1918, p. 1.

    Dance halls

    "Churches, schools, shows close - Epidemic puts ban on all public assembly", Seattle Daily Times, October 5, 1918, p. 1.

    Other closures

    "Churches, schools, shows close - Epidemic puts ban on all public assembly", Seattle Daily Times, October 5, 1918, p. 1.

    Masks

    "Seattle ordered to wear masks to prevent malady", Seattle Daily Times, October 28, 1918, p. 1. Also, "Wear influenza masks or walk, mayor orders - No excuses for not obeying rule will be accepted tomorrow, declares Hanson", Seattle Daily Times, October 28, 1918, p. 1.

    Ban on public gatherings

    "Churches, schools, shows close - Epidemic puts ban on all public assembly", Seattle Daily Times, October 5, 1918, p. 1.

    St. Louis

    Events

     

    First reported case

    "Family of seven here ill with influenza", St. Louis Post-Dispatch, October 5, 1918.

    First reported death

    Alfred A. Jost, d. 10/3/1918, as reported in St. Louis Obituary Index, at http://www.slpl.lib.mo.us/libsrc/obit18b.htm, accessed on November 12, 2006.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    "Thousands view big military parade in downtown streets - Cost of war brought home to public in huge spectacle in which all branches of the service were represented." St. Louis Globe-Democrat, September 28, 1918, Part II, p. 1.

     

     

    Dates of Interventions

     

    Reportable Disease

    "Fifty show symptoms of influenza in city", St. Louis Post-Dispatch, October 6, 1918, p. 7B.

    Isolation

    "Influenza closing order extended to all churches - Dancing in hotels and cafes banned", St. Louis Post-Dispatch, October 8, 1918, p. 1.

    Schools

    "To close schools and theaters to check influenza", St. Louis Post-Dispatch, October 7, 1918, p. 1.

    Churches

    "Influenza closing order extended to all churches - Dancing in hotels and cafes banned", St. Louis Post-Dispatch, October 8, 1918, p. 1.

    Theaters

    "To close schools and theaters to check influenza", St. Louis Post-Dispatch, October 7, 1918, p. 1.

    Dance halls

    "Influenza closing order extended to all churches - Dancing in hotels and cafes banned", St. Louis Post-Dispatch, October 8, 1918, p. 1.

    Other closures

    "Influenza closing order extended to all churches - Dancing in hotels and cafes banned", St. Louis Post-Dispatch, October 8, 1918, p. 1.

    Staggered business hours

    "Big stores to close at 4 p.m. next week", St. Louis Post-Dispatch, October 19, 1918. Also, "New saloon hours for downtown zone", St. Louis Post-Dispatch, October 22, 1918, p. 6.

    Transit use discouraged

    "City takes action to check influenza - Street cars, by this order, will not carry any straphangers", St. Louis Post-Dispatch, November 8, 1918, p. 8.

    Door-to-door sales

    "559 new influenza cases and 32 deaths - Mortality for 24 hours largest yet, but the percentage is small", St. Louis Post-Dispatch, October 18, 1918, p. 3.

    Protective Sequestration

    "Schools closed, children banned from theaters - 707 more cases up to noon today", St. Louis Post-Dispatch, November 28, 1918, p. 1.

    Ban on public gatherings

    "Governor forbids all public gatherings in state", St. Louis Post-Dispatch, October 9, 1918, p. 2.

    Snow Days

    "City takes action to check influenza - Street cars, by this order, will not carry any straphangers", St. Louis Post-Dispatch, November 8, 1918, p. 8. Also "Closing order in force, and is generally obeyed", St. Louis Post-Dispatch, November 9, 1918, p. 1.

    Washington

    Events

     

    First reported case

    "Influenza kills here - One death and two new cases reported in District - Thousands ill at camps - Eighteen fatal cases in day at Camp Devens and fourteen at Camp Dix - Army nurse dead at Bridgeport, Conn. - Fewer cases at New York and Boston", Washington Post, September 22, 1918, p. 3.

    First reported death

    "Influenza kills here - One death and two new cases reported in District - Thousands ill at camps - Eighteen fatal cases in day at Camp Devens and fourteen at Camp Dix - Army nurse dead at Bridgeport, Conn. - Fewer cases at New York and Boston", Washington Post, September 22, 1918, p. 3.

     

     

    Amplifying Events

     

    Liberty Loan Parades

    "Sousa to help Loan - Band of 300 pieces here today for parade and concerts - At Liberty Hut tonight - Saturday's subscriptions in District estimated at $3,000,000. - Banks will remain open tonight and tomorrow night until 9 o'clock to encourage early pledges - Part payments of $5 and $10 monthly on $50 and $100 bonds will be taken by banks", Washington Post, September 30, 1918, p. 1.

     

     

    Dates of Interventions

     

    Reportable Disease

    "Seven die of epidemic - Day's report on Spanish influenza lists 57 new cases - 30 victims in District jail - Conference of Potomac Division of American Red Cross planned for today at Roanoke abandoned. Teachers sending home children suspected of having disease", Washington Post, October 1, 1918, p. 1.

    Schools

    "City fights grippe with severe steps - All schools are closed; theaters may follow - Store opening at 10 A.M. - Cigar stands and news dealers exempt from order - 11 deaths in city yesterday", Washington Post, October 3, 1918, p. 1.

    Churches

    "47 more die of 'flu' - Number greatest since malady swept city; 1,466 new cases - Stop all public meetings - Brownlow and Fowler also fix status of church services - Health officer denounces landlords who fail to heat apartments. Marked increase in new cases and deaths at Army camps. Total Army cases 198,799. Pneumonia also is spreading", Washington Post, October 10, 1918, p. 1.

    Theaters

    "Theaters closed to stay influenza - Movies and public dance halls also in order - Churches next likely - Crest of epidemic has not yet reached city; 11 deaths - Doctors too busy to report - Commissioners active directing measures - Private schools asked to close - Hospital established for girl war workers - Staggered hours in effect - Washington is made sanitary zone with Dr. Mustard in command", Washington Post, October 4, 1918, p. 1.

    Dance halls

    "Theaters closed to stay influenza - Movies and public dance halls also in order - Churches next likely - Crest of epidemic has not yet reached city; 11 deaths - Doctors too busy to report - Commissioners active directing measures - Private schools asked to close - Hospital established for girl war workers - Staggered hours in effect - Washington is made sanitary zone with Dr. Mustard in command", Washington Post, October 4, 1918, p. 1.

    Staggered business hours

    "City fights grippe with severe steps - All schools are closed; theaters may follow - Store opening at 10 A.M. - Cigar stands and news dealers exempt from order - 11 deaths in city yesterday", Washington Post, October 3, 1918, p. 1.

    Private funerals

    "'Flu' kills 24 more - 279 new cases in District, making total about 10,000 - Ban on public funerals - Dr. Fowler also warns people not to come to Washington - Hospitals so crowded no facilities are left patients from out of town - Declares relatives of stricken should remain away. Health officer warns of danger in attending meetings", Washington Post, October 7, 1918, p. 1.

    Ban on public gatherings

    "City fights grippe with severe steps - All schools are closed; theaters may follow - Store opening at 10 A.M. - Cigar stands and news dealers exempt from order - 11 deaths in city yesterday", Washington Post, October 3, 1918, p. 1.

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Public health interventions and epidemic intensity during the 1918 influenza pandemic
Richard J. Hatchett, Carter E. Mecher, Marc Lipsitch
Proceedings of the National Academy of Sciences May 2007, 104 (18) 7582-7587; DOI: 10.1073/pnas.0610941104

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Public health interventions and epidemic intensity during the 1918 influenza pandemic
Richard J. Hatchett, Carter E. Mecher, Marc Lipsitch
Proceedings of the National Academy of Sciences May 2007, 104 (18) 7582-7587; DOI: 10.1073/pnas.0610941104
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