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  • Hello, everybody.

  • Welcome to the Minnesota State Office Building Room 300 South for today's presentation on the 1918 influenza pandemic.

  • My name is Brian McDaniel and I will be your moderator today.

  • This is a topic that interests me.

  • Ah, lot in my capacity as lobbyist for many health organizations, but probably most closely associate ID.

  • But this would be the local Public Health Association of Minnesota before I introduce our panel.

  • Just wanted to give you a little bit of a few seconds of background on what will be talking about today.

  • The 1918 pandemic flu pandemic, which went from January 1918 to December of 1920 was an unusually deadly influenza pandemic involving the H one n one influence of iris, which we're all aware of.

  • It infected 500 million people around the world and resulted in the deaths of 50 to 100 million or 3 to 5% of the world's population, making it one of the deadliest natural disasters in human history.

  • This month marks the 1/100 anniversary of the first case of the in the United States, and we're pleased to have this panel of history and public health experts with us to discuss the 1918 pandemic and what lessons we can draw from it today.

  • Thank you all for being here, and we welcome you here.

  • Next week when we're gonna be presenting Pandemic the Musical, you will see me as worried.

  • Boy number four, Our panel today, Dr Michael Foster.

  • Home to my right is our region's Professor McKnight, Presidential Endowed Chair in Public Health, The director of the Center for Infectious Disease Research and Policy, a distinguished teaching professor in the division of Environmental Health Sciences School of Public Health, a professor in the Technological Leadership Institute College of Science and Engineering and the agent professor in the medical school, all at the University of Minnesota.

  • He is the author of the 2017 book Deadliest Enemy.

  • Our War Against Killer Germs, in which he not only details the most pressing infectious disease Threats of our day believes out a nine point strategy and how best to address them with preventing a global flu pandemic.

  • At the top of the list to my left is Chris Harrison on epidemiologist and director of the infectious disease de Mi Ology Prevention and Control Division at the Minnesota Department of Health.

  • In this role, she is responsible for HIV, STD, TB, refugee health and immunization programs, as well as the emerging infection, home, home, food borne, vector born and zoonotic disease activities.

  • Come on, people.

  • Um, it's really yeah.

  • Miss Erismann received her bachelor of science and nursing from ST Olaf College and her master of public health and epidemiology from the University of Minnesota to my far right is Lois Henrickson, and she is the curator of the wagon Steen Historical Library of Biology and Medicine at the University of Minnesota.

  • She has an MLS from the University of Denver and a love of history, which led her to a career in archives and special collections.

  • She worked in the University of Minnesota's archives for a number of years and later made the move too rare.

  • Books and manuscripts in the Wing and Steam Historical Library, which has a specialization in medicine and natural history before 1930.

  • Now that I've given everyone's credentials, we're out of time.

  • Thank you so much.

  • Uh, no, Miss Hendrickson.

  • You wanted to give a little bit of ah, background.

  • Yeah, off the 1918 pandemics, So I thought I'd um as ah, historian and library in a curator of rare materials.

  • Talk a little bit about the pandemic here in Minnesota, and you notice that in front of me, I also have some materials from our collection.

  • So while we are rare book collection, we also have some artifacts.

  • So in front of me, I have a Grey's Anatomy that belonged to the second director of the Minnesota Department of Health, Henny Bracket, and to the right, I have some artifacts from our collection.

  • In front, you'll see a map that was a Saint Paul map of influenza by the Citizens Committee.

  • And so if we have time at the end of this session, you're welcome to come up and and look at some of the artifacts.

  • There's cold remedies, things you might recognize, like Vicks vapor rub things for, um, gargling porters that are antiseptic.

  • The germ theory is fairly new at this time, and of course, there would also have been things like aspirin and things that we still use today.

  • So in Minnesota, um, as Brand said, um, a small group of people compared to 100 million that died, there were about 100 40,000 influenza cases in about 12,000 Minnesotans out of the roughly 2,000,007 the 5705 listed in 1910 cents.

  • It's tied This influence up Pandemic was concurrent with both the World War.

  • It was near the end of World War One and here in Minnesota with the Cloak, a Duluth Moose Lake.

  • Natural History, natural disaster of fire that burned 1500 square miles and left 450 people debt.

  • So they held.

  • Service is here in Minnesota were stressed when the influenza pandemic came along.

  • Um, Minnesota's mortality rate ranked 26 out of 27 states.

  • Pennsylvania, Maryland and New Jersey had the highest mortality rates.

  • Michigan, Minnesota and Wisconsin had the lowest, and in both Minneapolis and ST Paul.

  • The first Peak Accord accord on October 19th through October 22nd Um, and a second peek a little bit later.

  • So what were some of the issues people faced communications regarding influenza coordination between different levels and branches of government containment measures, Infection control, medical resource is and future, uh, epidemic preparedness planning.

  • So I just want to talk about a few of them with regard to Minnesota communication.

  • Of course, newspapers were that one of the primary means of communication in 1918.

  • But in World War, people were encouraged to print positive news.

  • So it took a while for Spanish flu to really make it onto the front page of the paper.

  • Finally, here in Minneapolis, Sense of September 14th in the Minneapolis paper, the first article appeared abouts influenza, also known as Spanish flu.

  • Six days later, the city health commissioner of Minneapolis, H.

  • M.

  • Guilford, said Spanish flu does not exist in Minneapolis and never has, but it will probably reach here during the fall.

  • Eight days later, the first case appeared in Wells, Minnesota, and on September 29th.

  • A few days later, they officially declared that influenza had made its way to Minneapolis on October 1st.

  • So about two weeks after the newspaper first announced Spanish flu, Guilford says that Spanish influenza is becoming increasingly of interest to civilians.

  • But it's not reportable by law, and Health Department has kept informed on Lee by the courtesy of physicians so gathering information, the State Board of Health is up against some serious difficulties.

  • Other documents, official documents spread the news.

  • Dr Bracken Who's Grey's Anatomy?

  • We have up here sent a telegram at night to the U.

  • S Public Health Service on October 2nd saying, Please send 100 copies of your supplement epidemic influenza.

  • The next day, October 3rd, he sent another night telegram.

  • Please send 10,000 copies.

  • The flu is moving very rapidly.

  • Other means of communication were enlisted.

  • Postal workers, Boy Scouts, teachers, mail carriers, teachers who were out of work from the closing of the school were asked to volunteer and actually to canvass from home to home to see how families were doing.

  • So.

  • Coordination between levels of government, where that wanted to close the schools were another issue, and the two cities had really different philosophies on whether they should close their schools or not.

  • ST.

  • Paul Sport of help, headed by Dr Simon, said that school nurses were the best defense against the spread of disease, and closing the schools would allow school Children's cases to go undetected.

  • Minneapolis Doctor Gil for disagreed, saying that the 30 school nurses they had would not be able to adequately care for the 50,000 pupils in this system.

  • That was the last time that Minneapolis and ST Paul ever disagreed.

  • So, really, at the heart of this matter was whether or not the Board of Health had the legal authority to close schools.

  • And Guilford in Minneapolis kind of threw down the Gotland.

  • And, he said, the direct snapping of the fingers of the Board of Education in the face of the health Department As a matter that requires the attention of the courts.

  • And if the justice system were not enough, he added, he intended to use police force Children who were either in closed schools or not.

  • We're encouraged to practice their own preventive mesh INS measures.

  • There was a poem that appeared in the Minneapolis Tribune.

  • It said, Protect your schoolmates from disease.

  • Use your handkerchief when you sneeze.

  • Municipalities and governments also responded with additional containment measures, which sometimes today are called non pharmaceutical interventions.

  • Community mitigation guidelines.

  • Your social distancing measures.

  • Dr.

  • Guilford in Minneapolis tended to be rather proactive.

  • Dr.

  • Simon and ST Paul asserted that the isolation of influenza cases would be more effective in preventing the spread of disease, and so these two approaches play out in public spaces in really different ways.

  • The local, the Minnesota State Board of Health Underhanded bracket Random recommended that theaters movie houses be allowed to open so long as proper ventilation was used and dangerous coffers were excluded.

  • Dance halls and pool room's, on the other hand, should be closed.

  • Dr.

  • Guilford ordered all Minneapolis schools, churches, theaters, dance halls, a 1,000,000,000 pyre, Alors, to be closed, saying, I do not want to be alarmist but diseases not controllable by ordinary measures.

  • The same poll council did not follow suit but did issue an emergency or in regulating the business hours of stories and theaters to keep streetcar congestion to a minimum, and eventually they closed their public places.

  • On November 6, Sample also had a citizen's committee, 15 physicians, church leaders and community members who were recommending policy changes.

  • Other measures of containment we're suspending church service is asking people whose names were air L to go to the nine o'clock service and dizzy to go to the 10 o'clock service and in saloons.

  • Each man was supposed to have three feet around him at the by rail, and an inspector was sent out to measure that it wasn't quite enough work for them to do right.

  • I'll state these containment ushered.

  • Measures also were reflected.

  • Northfield closed its public meeting spaces, and some of the schools that you saw in Northfield Carlton ST Olaf had cases 29 at Carlton 41 at ST Olis.

  • Also, there were guidelines implemented for infection control for the public.

  • The Minneapolis Tribune noted that because of the widespread nature of epidemic, quarantine will be impossible save as individuals and physicians are able to establish voluntary court quarantine, both cities attempted to combat.

  • Influenced by limiting crowding your places.

  • Both cities enacted streetcar regulations aimed to keep the air fresh by mandating open windows.

  • This cost several complaints in Minneapolis because people were getting sick, or they said they were getting six due to winter cold.

  • So a compromise was reached, allowing streetcars with heating and ventilation systems to close their windows once the temperature dropped to 30 teary 32 degrees Fahrenheit.

  • ST.

  • Paul targeted elevators is a place where influenza could easily be transmitted.

  • Buildings with fewer than six stories were not permitted to use their elevators and inch aska where, uh, Anthony Simon's died.

  • Mourners were so concerned about for his contagiousness that they said their rosaries across the street and did not enter the parent's home.

  • So citizens also practice infection control measures.

  • Um, in a little black box on the front page of the September 25th Minneapolis Tribune.

  • They had some advice.

  • Do this and foil the germ of influenza.

  • Avoid crowds.

  • Keep away from persons who cough or sneeze.

  • Have all fresh air possible.

  • Sleep with your windows open where warm clothing.

  • Keep your feet dry and do not use individual and use individual drinking cups.

  • People especially vulnerable to influenza letter carriers.

  • Mass transit workers.

  • Others who came in contact with the public.

  • People used over the counter remedies.

  • Some of what you see up here.

  • Antiseptic powders.

  • Quiet.

  • I used to keep fever, stone and malaria name brands like Dover's powder appropriation of epic epic opium and potassium sulphate used to induce sweating an aspirin, which was fairly recent, maybe about 20 years available to people but not fully understood because it was suggested that a person take 1000 milligrams every three hours, the equivalent of almost 25 standard 325 milligram aspirin tablets.

  • This is about twice the daily dosage generally considered safe today and of course, medical resource is were at the epicenter.

  • Hospitals were placed off limits to all visitors.

  • Private hospitals volunteered to relieve the city hospital of non influenza patients and reported in on October 8th in Minneapolis, so many cases were taken to the city hospital yesterday that the attendants had not finished counting them last night.

  • All of the city hospital ambulance have been turned over to influence a calls.

  • Emergency calls are being answered by the police ambulance.

  • The Saint Paul mayor told residents.

  • With more than half our doctors and nurses in war service, we dare not take any chances of a possible epidemic here and placed patients in isolation wards in the city hospital.

  • Your son was a critical part of medical response, but nursing staff was can't contracting influenza as well, and hospitals were desperate for staff.

  • So they reached out for volunteers, citizens committees, the Red Cross and, um, mothers to go and help people who couldn't manage their homes and take care of their Children, including getting terrible organizations like the wild day nursery involved.

  • Because so many Children are left either temporarily parentless or orphans because of the influenza economically, um, most of the evidence shows that the pandemic was economic influence with short term.

  • But interestingly, it shows that it caused a reduction in human capital for individuals who were in utero during the pandemic and that had economic implications for decades after the pandemic.

  • There's lots of lessons to be learned from the pandemic, recognizing that there's a lot of differences between now and 1918.

  • Just, for example, there's a different understanding of privacy, civil and constitutional rights as they relate to public health.

  • There's changes in transportation with aviation, personal computers and understanding of diseases.

  • And so how did the change in Minnesota?

  • So because physicians were obligated to report cases to the authorities, they failed to see the pandemic coming.

  • So the cornerstone of public health epidemiology, the study of patterns, causes and effects of disease now find the received full recognition as a science.

  • Epidemiology requires data, so gathering data became more important.

  • By 1925 all U.

  • S.

  • States had a national disease reporting.

  • Sorry, you ever just coughed?

  • They're reporting in public health policies changed and the lesson health it took health authorities took away that from the catastrophe was there was no reason to blame individuals and government saw the benefit of starting to change their concept of medicine.

  • The United States.

  • We went with employer based insurance systems, other places.

  • Other countries went with socialized medicine.

  • And finally, in 1919 we saw the beginning of today's International Bureau for Fighting Epidemics of Forerunner of today's World Health Organization.

  • I had no idea at the video it's sense of, you know, I tried to the 1918 one.

  • Well, I think Andi think you misunderstood.

  • I think first thing after asking, maybe you everyone feel for you to China.

  • But Alaska, Dr Earl Strom was this particular strain of H one n one in 1918 especially lethal, or were there other circumstances that intensified?

  • It's a fact.

  • Well, first of all, one has to take a step back, understand what pandemic influenza really is.

  • Influenza viruses are naturally occurring events in while aquatic birds and have been for several 100 million years.

  • And what has happened a revolutionary time is those viruses that, attached to the cells of the intestine to the duck or other aquatic bird can infect humans.

  • But over time, if they were able to escape the aquatic bird and get into one of several other animal species they didn't acquire.

  • The ability to basically with a lock and key get into the human lung cell in the pig is one of the most notorious of all of the middle.

  • You might say game players, because they have receptor cells on their lungs for both bird viruses and human viruses.

  • And so we get these viruses mixed up in the pig's lung salad niks come out.

  • That's where the term swine flu comes from.

  • Now we do know that in some cases, while bird viruses can get in domestic poultry and then changed there, too, as we've seen recently in China and so forth.

  • But to say that this would happen in 1918 is our history is really to say, That's all our review.

  • American C Back.

  • For those of you who have studied this carefully, we know that there were at least 16 influenza pandemics dating back to the 16 hundreds.

  • Hippocrates wrote about a very classic influence.

  • A pandemic that may have been every bit of it is dangerous and disruptive.

  • It was the 19 pandemic, so we have to be careful not to say that this was an unusual event, and that's one of the reasons why we're so concerned about what could be the next time.

  • We have a 1918 event because history surely shows that that could happen now in terms of Was this a more lethal virus norm during normal seasonal flu years, where we have different strains of seasonal flu virus?

  • Which, by the way, is the residual strains of a previous pandemic that hung around in people.

  • You'll see very different patterns of illness in terms, whether they're very young or very old.

  • For example, in 1918 the average age of deaths actually was about 28 years of age in 1968 and 19 1957 1968 when two additional pandemics came along.

  • H two into a three into the average age of death was in the high sixties, which was much more.

  • What you would expect to see with life expectancy 19 8 are in in 2009 actually came along.

  • Another H one n one, which didn't have the number of cases but surely had a very significant impact on those that got it.

  • And the average age of deaths in the United States was 38.

  • If you adjust for life expectancy, that number of the age of deaths and 90 and 2000 and nine was younger than it was in 1918.

  • And so flu viruses interact differently with different people we know about the 1918 virus, and we saw again in 2000 and nine is the fact that these viruses actually caused the immune system of the host to react.

  • Many of the deaths of seasonal flu occur when somebody developed a secondary bacterial pneumonia as a result of damage to lungs.

  • In this case, this cause we call a signing kind storm cited kind storms are where you set off almost like a septic shock picture.

  • But you don't have bacteria in your blood, and it causes severe damage to all your internal organs.

  • Today, we can't handle these kinds of illnesses with this sign, a kind storm any better than we did in 19 8 It's not about antibiotics.

  • And so what we worry about is that coming back again, because in that case, modern medical science was gonna do a whole lot for us.

  • We have a machine called ECMO machine, which can basically breathe and sense.

  • Pump your blood for you.

  • That can help, but they're very limited number.

  • So we're just a vulnerable today toe.

  • A 1918 pandemic is Warren 1918.

  • In terms of that, if, in fact it is this virus human immune system response damage that occurs you had mentioned of the progression from poultry pigs.

  • Your working theory is that that is how the 1918 pandemic started.

  • Is that still something that people have believer ascribed?

  • Well, you know, we don't know for certain where 1918 started, there is, I think the most reasonable date actually says it may have been in Kansas, and it may have been associated with the military base there that actually training for World War soldiers.

  • I might add that very few people realize this, But for historical standpoint, eight times as many soldiers died in Europe from swine flu has died from all the war combined.

  • So it was clearly something that was on the mind set of.