Preparing for Emergencies, Then and Now

State Representative Harriet L. Stanley, Chair of the Joint Committee on Health Care Financing, offers her thoughts on the the controversial public health emergency preparedness bill known as the "Pan Flu Bill." The West Newbury Democrat says her post is adapted from a lecture developed by Professor William Stanhope of the Institute for Biosecurity at Saint Louis University and from a summary by Representative Steven M. Walsh (D-Lynn):

Everyone knows that the Commonwealth is facing unprecedented revenue shortfalls and massive budget cuts are on the way. Yet, somehow that financial anxiety has broadened into a general sense of mistrust that has found its way to the gold dome on Beacon Hill.

On October 8, the Massachusetts House adopted public health emergency preparedness legislation previously known as the “Pan Flu Bill.” The bill had been considered in the last three Legislative sessions. Yet, even with last spring’s swine flu scare and predictions of an early onset in 2009, it did not pass easily. It came with so much controversy and misinformation that it took weeks of internal persuasion and heavy editing in order to pass.

What’s going on here? We know the reality is that a worldwide epidemic is overdue or that the next terrorist attack could contain pathogens. Yet, any real attempt to prepare for a new pandemic or bioterrorist attack is met with resistance. Sometimes completely irrational resistance. We should really learn from history and our past mistakes.

In 1918, an influenza pandemic swept through the United States, known as the “Spanish flu.” It was one of the deadliest pandemic outbreaks of the 20th century, with some 50 to 100 million deaths worldwide.

At the height of the epidemic, two cities took two very different paths and forever changed history.

In late September 1918, Philadelphia planned a major rally for the Liberty Bonds to fund World War I. Even as flu cases in local hospitals continually increased, the mayor and Director of Public Health decided not to cancel the parade.

Over 200,000 people packed into four city blocks, and the parade was reported to be the largest in Philadelphia’s history. The very next day there was an outbreak of Spanish flu in Philadelphia and within days hundreds of thousands of people fell ill. There were 759 fatalities in a single day.

According to counts at the time, Philadelphia had the highest premature death rate per thousand in comparison to other U.S. cities while St. Louis possessed one of the lowest premature death rates during the influenza epidemic in 1918.

A few weeks after Philadelphia’s Liberty Bond parade, another one was scheduled to take place in St. Louis. The number of Spanish flu cases in St. Louis was on the rise; so, the mayor and the Commissioner of Public Health decided to cancel the Liberty Bond rally and strictly enforce restrictions on public gatherings. They also closed schools, churches, and theaters; imposed steep fines for not reporting a case of influenza; and enforced other mundane public health laws, like no spitting in public. In addition, business hours were restricted. When it was all over, St. Louis had one of the lowest rates of Spanish flu for urban cities in the country.

If this is what happens when we try to plan for public health emergencies, imagine trying to reform the state’s entire health care system.