This is a 2005 study conducted by the University of Michigan Medical School on 7 towns that had experienced extremely low influenza rates. The report is lengthy and I've written a summary here: http://www.setbb.com/fluwiki2/viewto...forum=fluwiki2. We can bring any part of it over here for discussion if there is an interest.
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General Conclusions from the Historical Record with Policy Recommendations
Pandemic Preparedness
• Swift, agile, decisive, and coordinated action based on accurate information and advanced preparedness planning, before the appearance of influenza in the local area, is critical.
• Standardized case definitions for suspected, probable, and confirmed diagnoses promote clarity and consistency in disease tracking and play a positive role in disease containment.
Benefits and Liabilities of Protective Sequestration
• Successful protective sequestration was the exception to the rule in the 1918-1920 pandemic. The escape of a community from the brunt of the pandemic was likely the result of multiple factors in the cases we studied, not least of which included good fortune, viral normalization patterns, and geographical separation. We should not be seduced into thinking we can easily translate these historical examples into contemporary situations.
• 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 during which the area is at risk, stands the best chance of protection against infection. When implemented
successfully, protective sequestration also involves quarantine of any outsider who seeks entry, self-sufficiency in the supplies necessary for daily living, enforcement of regulations when necessary (including fining and jailing), and the ability of those sequestered to entertain themselves and maintain some semblance of a normal life. It also involves a brand of bold leadership which may not be common.
• It is likely that once an outbreak of a highly virulent virus easily transmitted from person to person via aerosol or respiratory droplets occurs, larger communities will not be able to escape pandemic influenza completely. For this reason, plans for the protective sequestration of sub-communities within these areas should be considered. For example, personnel and facilities critical to the maintenance of national security and universities should consider formulating plans for the rapid protective sequestration of their populations at the first onset of cases in the wider region and before cases develop locally.
• It is important to recall that the most successful protective sequestrations were maintained for a period of months to ensure that the pandemic was well on the wane. Measures to ensure the integrity of the protective sequestration (as well as concomitant NPI) while preventing alienation, depression, loneliness, stigmatization, resentment, and hostility among the confined population should be developed as a central part of a pandemic preparedness plan.
• Protective sequestration employed during the second wave may have prevented influenza cases during this period and may have been a factor in these communities experiencing milder morbidity and mortality rates in successive waves once the measures were lifted. Conversely, these measures have the potential to create susceptible populations affected by subsequent waves of influenza. At the very least, in current pandemic planning, protective sequestration could shield selected populations from infection until vaccines and antiviral agents become available.
Nonpharmaceutical Interventions (NPI) During a Pandemic
• Available data from the second wave of the 1918 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, including: 1) the isolation of ill persons; 2) the quarantine of those suspected of having direct contact with the ill; 3) social distancing measures, such as the cancellation of schools and mass gatherings; 4) reducing an individual’s risk for infection, (e.g., face masks, hand washing, respiratory etiquette); and 5) public health information campaigns and risk communications to the public. 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.
• If other NPI stand a chance of working, the lines of political and legal authority must be transparent. The harmonious cooperation of trusted and competent local, state and federal health officials, backed by the letter of the law, is critical. Internecine rivalries or disagreements between local, state, and federal agencies have a strong potential to detract from pandemic influenza prevention and containment. More broadly, this is one of the strongest themes in the history of epidemics and disasters in the United States over the past two centuries.
• At present there is great debate among public health experts on the efficacy of face masks. Learning a lesson from the past, we should not let masks engender a false sense of protection. Indeed, we could not locate any consistent, reliable data that would support the conclusion that face masks, as available and as worn during the 1918-1920 influenza pandemic, conferred any protection to the populations that wore them. Furthermore, recommendations and laws regarding face masks during this period often incited political and legislative controversies as well as outright resistance. In addition, when public health authorities relaxed these measures because they believed the pandemic had passed, only to confront new cases of influenza in their communities, they frequently found that the reinstitution of a face mask ordinance was met with a much lower degree of support and compliance when compared to its initial implementation. We also found numerous examples of people wearing face masks incorrectly during the 1918-1920 pandemic. Instructing people on the proper use of face masks (if they are to be worn at all in an upcoming pandemic), as well as their limitations, is important to public health education efforts.
• Our study uncovered repeated examples of social concerns and anxieties associated with the mandated delay of funeral arrangements and/or the reduction of attendance at funerals in order to cut down on human contact during the crisis. An influenza pandemic has the potential to cause large numbers of deaths. The emotional strain of not being able to dispose of the dead promptly, and in accordance with cultural and religious customs, has the power to create social distress and unrest and needs to be considered in contemporary pandemic preparedness planning.
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