Politics, Pushback, and Pandemics: Challenges to Public Health Orders in the 1918 Influenza Pandemic.

During the first wave of the COVID-19 pandemic in the United States, many state governors faced an increasing number of acts of defiance as well as political and legal challenges to their public health emergency orders. Less well studied are the similar acts of protest that occurred during the 1918-1919 influenza pandemic, when residents, business owners, clergy, and even local politicians grew increasingly restless by the ongoing public health measures, defied public health edicts, and agitated to have them rescinded. We explore several of the themes that emerged during the late fall of 1918 and conclude that, although the nation seems to be following the same path as it did in 1918, the motivations for pushback to the 2020 pandemic are decidedly more political than they were a century ago.

A Tale of Many Cities: A Contemporary Historical Study of the Implementation of School Closures during the 2009 pA(H1N1) Influenza Pandemic.

Applying qualitative historical methods, we examined the consideration and implementation of school closures as a nonpharmaceutical intervention (NPI) in thirty US cities during the spring 2009 wave of the pA(H1N1) influenza pandemic. We gathered and performed close textual readings of official federal, state, and municipal government documents; media coverage; and academic publications. Lastly, we conducted oral history interviews with public health and education officials in our selected cities. We found that several local health departments pursued school closure plans independent of CDC guidance, that uncertainty of action and the rapidly evolving understanding of pA(H1N1) contributed to tension and pushback from the public, that the media and public perception played a significant role in the response to school closure decisions, and that there were some notable instances of interdepartmental communication breakdown. We conclude that health departments should continue to develop and fine-tune their action plans while also working to develop better communication methods with the public, and work more closely with education officials to better understand the complexities involved in closing schools. Lastly, state and local governments should work to resolve lingering issues of legal authority for school closures in times of public health crises.

The effect of reactive school closure on community influenza-like illness counts in the state of Michigan during the 2009 H1N1 pandemic.

BACKGROUND: In sum, 559 Michigan schools were closed as a nonpharmaceutical intervention during the influenza A 2009 (H1N1) pandemic. METHODS: By linking the proportion of schools closed within a district to state influenza-like illness (ILI) surveillance data, we measured its effect on community levels of ILI. This analysis was centered by the peak week of ILI for each school district, and a negative binomial model compared three levels of school closure: 0%, 1%-50%, and 51%-100% of schools closed from three weeks leading up to ILI peak to four weeks following ILI peak rate. RESULTS: We observed that school closures were reactive, and there was no statistically significant difference between ILI rates over the study period. There was an elevated rate ratio for ILI at 51%-100% closure, and a reduction in the rate ratio at the 1%-50% compared to the 0% closure level. CONCLUSIONS: These findings suggest that district level reactive school closures were ineffective.

Assessing Argentina's response to H1N1 in austral winter 2009: from presidential lethargy to local ingenuity.

Argentina experienced a heavy burden of novel H1N1 influenza in austral winter 2009. In early July 2009, Argentina reported more than 1,500 cases and was confronting the highest per capita H1N1 mortality rate in the world. By September 2009, more than 500 people had died of H1N1 in Argentina. Unlike sister countries Chile and Mexico, Argentina's national authorities did not respond by implementing mitigation measures such as public gathering bans and school closures or by issuing broad-based messages about personal hygiene and disease prevention. Around the globe, many observers expressed dismay at this inaction. For example, The Economist scolded the country's leadership for its halting response and seeming apathy to an escalating health crisis. Why did Argentina, a middle-income country with a developed and, in many respects, sophisticated system of health and education, fall short in enacting a national pandemic plan during the 2009 H1N1 outbreak? What can we learn from Argentina's experiences about obstacles and opportunities during a pandemic crisis? This article, based on extensive qualitative research, including document capture, media analysis, and oral history interviews, assesses Argentina's mixed response to H1N1 during austral winter 2009, and adds to a growing body of studies focused on how governments and health systems in the Americas performed during the 2009-2010 H1N1 pandemic. When the first cases of novel H1N1 influenza were identified by the U.S. Centers for Disease Control and Prevention (CDC) in mid-April 2009, Argentina's national health ministry appeared to be prepared. Starting in 2002, primarily in response to the prospect of avian influenza, the health ministry had formulated a preparedness plan and, beginning in 2005, had conducted at least five pandemic simulation exercises. In April 2009, Argentina's health ministry activated its pandemic response plan, triggering the establishment of an executive-level situation room equipped with rapid communications and computer surveillance to track events as they unfolded. In addition, several expert committees were assembled to assess the situation and solicit input from health practitioners, academics, hospital staff, and allied professionals.

"Better off in school": School medical inspection as a public health strategy during the 1918-1919 influenza pandemic in the United States.

During the 1918-1919 influenza pandemic in the United States, most cities responded by implementing community mitigation strategies, such as school closure. However, three cities--New York City, Chicago, and New Haven, Connecticut--diverged from the dominant pattern by keeping their public schools open while the pandemic raged. This article situates the experiences of these three cities in the broader context of the Progressive era, when officials and experts put great faith in expanding public programs in health and education. It adds an important dimension to the historical understanding of the 1918-1919 influenza pandemic and offers lessons for public health practitioners and policymakers today who might face difficult decisions about how to respond to the 2009 H1N1 influenza pandemic.

Truth and transparency in a time of crisis.

Lessons from history underline the importance of having direct lines of communication to and from public health officials, who must remain free from policital bias in times of crisis.