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Public Health Agencies Forgot Lessons from 1957-58 Pandemic

Picture this: a virulent disease originates in China, then spreads to the far corners of the world, leaving millions dead and infecting far more.

What may sound like a description of today’s public-health crisis brought on by COVID-19 is actually a description of a virus from over six decades ago, known as H2N2 or Asian influenza. Yet the similarities and differences between the two pandemics, and how medical professionals and governments then and now confronted their respective contagions, provide perspective, as today’s novel coronavirus continues to defy efforts to contain its spread.

Insight into the epidemiologic behavior of Asian influenza is contained in a study led by the late D. A. Henderson, M.D.  that appeared in August 2009 in Biosecurity and Bioterrorism.  The study, “Public Health and Medical Responses to the 1957-58 Influenza Pandemic,” was undertaken to help plan for a severe outbreak of the H1N1 virus projected for fall 2009.

“Using historical surveillance reports, published literature, and media coverage, this article provides an overview of the epidemiology of and response to the 1957-58 influenza pandemic in the U.S., during which an estimated 25 percent of the population became infected with the new pandemic strain,” the authors write.

The Spread of a Virus

The Asian flu emerged in China in February 1957 and quickly spread to Hong Kong before migrating to eastern Asia and the Middle East over the next few months.

By summer, the United States had experienced its first cases.  In anticipation of a full-scale epidemic in the fall, the Association of State and Territorial Health Officials (ASTHO) met in Washington in late August to map out a nationwide response.

Keep Kids in School, Protect the Vulnerable

Immunization through available vaccine was viewed as the most promising way to stem the spread of H2N2, even though ASTHO recognized that drug manufacturers would not be able to produce sufficient doses of the vaccine for two or three months. The Eisenhower administration’s Surgeon General recommended giving vaccine priority to:

  • “Individuals whose services were necessary to maintain the health of the community;
  • Individuals who were necessary to maintain other basic community services; and
  • People with tuberculosis and others who, in the opinion of a physician, constituted a special medical risk.”

The authors note how the importance of home care was stressed.  ASTHO also stated that “there is no practical advantage in the closing of schools or the curtailment of public gatherings as it relates to the spread of the disease(emphasis added by the authors).”  Henderson and his colleagues added that this was in recognition by health officials at the time who “saw no practical means to limit the spread of the infection.”

In accordance with ASTHO guidelines, schools opened in September and large public gatherings, including fall football games, took place. The nation’s six vaccine manufacturers increased the number of doses delivered from 4 million in August to 17 million by November, enough to cover about 17 percent of the population.  Commercial activity was not interrupted.

Disease Disappears in 8 Months

The disease peaked in late October, with new outbreaks declining sharply in November and all but terminating by the end of that month.

“Given the limited amount of vaccine available and the fact that it was not more than 60 percent effective, it is apparent that vaccine had no appreciable effect on the trend of the pandemic,” the authors point out.

After it appeared that the flu had run its course, a second, three-month-long wave of excess influenza and pneumonia deaths began in January 1958 and peaked in late February. Once it was past its peak, the disease quickly disappeared. Deaths from the unexpected second wave appear to have resulted from small, sporadic outbreaks.

All told, some 45 million Americans (25 percent of the population) were infected by the Asian flu, and just between 70,000 and 116,000 died from H2N2 in the United States (see related article, page 14).

During the 6-month pandemic of October 1957 to March 1958, the National Office of Vital Statistics expected to receive 830,000 death certificates [from all causes] – a figure based on long-term trends in mortality,” the authors write. “In fact, there were 62,000 more deaths than this, of which 19,000 represented excess deaths from pneumonia and influenza.

Henderson and his colleagues pointed out that the 1957-58 pandemic was different from 13 previous Type A epidemics between 1934 and 1963 “in that the genetic character of the virus ‘shifted’ significantly so that few in the population had residual immunity. The type A viruses (H1N1) were supplanted by the H2N2 strain.”

Summarizing their findings, the authors wrote:

“The 1957-58 pandemic was such a rapidly spreading disease that it became quickly apparent to U.S. health officials that efforts to stop or slow its spread were futile.  Thus, no efforts were made to quarantine individuals or groups, and a deliberate decision was made not to postpone or cancel large meetings such as conferences, church gatherings, or athletic events for the number of reducing transmission.  No attempt was made to limit travel or screen travelers. Emphasis was placed on providing medical care to those who were afflicted and on sustaining the continued functioning of community and health services. The febrile, respiratory illness brought large numbers of patients to clinics, doctors’ offices, and emergency rooms, but a relatively small number of those infected required hospitalization.”

The authors further found that school absenteeism due to influenza was high, but schools were not closed unless the number of students or teachers fell to sufficiently low numbers to warrant closure.  A significant number of health care workers were said to have been afflicted, but hospitals were able to adjust appropriately to handle patient loads. The study cited data on industrial absenteeism showing no interruption of essential services. The nationwide economic impact of the pandemic appears to have been negligible.  (see related article, page #)

 

Bonner R. Cohen, Ph.D., (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.

 

Internet info:

D.A Henderson, Brooke Courtney, Thomas Inglesby, Eric Toner, Jennifer Nuzzo, “Public Health and Medical Responses to the 1957-58 Influenza Pandemic,” Biosecurity and Bioterrorism, 2009:  http://www.upmc-biosecurity.org/website/resources/publications/2009/2009-08-05-public_health_medical_responses_1957.html

 

Bonner R Cohen
Bonner R. Cohen is a senior fellow with the National Center for Public Policy Research, a position he has held since 2002.

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