“How (and How Not) to Battle Flu: A Tale of 23 Cities: Scientists Are Still Studying the 1918 Spanish Flu Pandemic, the Deadliest of the 20th Century, Looking for Lessons for Future Outbreaks”, 2007-04-17 (; similar):
When the Spanish flu reached the United States in the summer of 1918, it seemed to confine itself to military camps. But when it arrived in Philadelphia in September, it struck with a vengeance. By the time officials there grasped the threat of the virus, it was too late. The disease was rampaging through the population, partly because the city had allowed large public gatherings, including a citywide parade in support of a World War I loan drive, to go on as planned. In four months, more than 12,000 Philadelphians died, an excess death rate of 719 people for every 100,000 inhabitants.
The story was quite different in St. Louis. Two weeks before Philadelphia officials began to react, doctors in St. Louis persuaded the city to require that influenza cases be registered with the health department. And two days after the first civilian cases, police officers helped the department enforce a shutdown of schools, churches and other gathering places. Infected people were quarantined in their homes.
Excess deaths in St. Louis were 347 per 100,000 people, less than half the rate in Philadelphia. Early action appeared to have saved thousands of lives.
…Dr. Hatchett, who is a researcher at the National Institutes of Health, said the findings might hold lessons for the 21st century. “When multiple interventions were introduced early, they were very effective in 1918”, he said, “and that certainly offers hope that they would be similarly useful in an epidemic today if we didn’t have an effective vaccine.”
…What these results mean for a future epidemic is not clear. “If avian flu became a pandemic tomorrow”, Dr. Ferguson said, “we would start a crash program to make a vaccine.” But he added that rigid preventive measures like quarantines, mandated mask wearing and widespread business closings would still need to be put in place. “What our study shows”, he continued, “is that interventions even without a vaccine can be effective in blocking transmission. What’s much less certain is whether society is prepared to bear the costs of implementing such intrusive and costly measures for the months that would be required to manufacture a vaccine.”