It's a rare event when public officials have to reach back over 100 years to make comparisons, but that's exactly what's happening now with the new coronavirus.
The Spanish flu ripped around the globe in 1918 and 1919. Global counts of how many people died vary wildly, but in the United States, it's estimated that 675,000 were killed.
In Ohio, many of the steps and interventions in place now for the new coronavirus were also taken. Patients were isolated, schools were closed, people were told not to gather.
The stories from that time show closures and restrictions were in place up to six weeks. Cities that were slow to react paid the consequences in sickness and death.
Ohio Gov. Mike DeWine, the Imperial College in London and others have invoked the century-old pandemic to demonstrate the importance of social and physical distancing measures to stop the spread of deadly viruses.
"Examples of the measures adopted during this time included closing schools, churches, bars and other social venues," a report from the Imperial College said. "Cities in which these interventions were implemented early in the epidemic were successful at reducing case numbers."
Last Sunday, as St. Patrick's Day celebrations loomed, DeWine shut down bars and restaurants in the state.
He, too, used the example of the Spanish flu, saying Philadelphia didn’t move as quickly as St. Louis to enact social distancing – which led to Philadelphia experiencing a far worse outbreak.
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The University of Michigan Center for the History of Medicine compiled a city-by-city look at the Spanish flu pandemic that details response, death rates and often how the virus was introduced and spread in each municipality.
What is clear from their research is that cities were largely in charge of their own response, whereas in 2020, governments at the state level are taking a more active role.
Here's a comparison of estimated deaths per 100,000 residents:
- Philadelphia - 705.
- Cleveland - 474.
- Cincinnati - 451.
- Louisville - 406.
- St. Louis - 358.
- Columbus - 312.
- Dayton - 295.
- Toledo - 295.
The Spanish flu came in three waves. In most places, the first wave in the summer of 1918 was considered a typical seasonal outbreak, not that widespread with mainly the elderly succumbing to it.
It was the second wave in the fall of 1918 that was far worse with mostly young adults dying.
The comparison DeWine made between St. Louis and Philadelphia showcases the variety of responses across a country that was also suffering through World War I.
The result in St. Louis is widely credited to a forward-thinking health commissioner, Dr. Max Starkloff, who was actively monitoring the disease as it spread.
He took swift action on Oct. 8, issuing closure orders. Despite strong protests from city government and the business community, he closed schools, churches and social centers such as theaters. The closures lasted on and off until December.
The disease struck earlier in Philadelphia. The city had already seen 525 cases and 70 deaths, but still held its Liberty Loan parade, which St. Louis canceled. The public health leader in that city told the public he believed the virus was contained in the military camps in the city.
The rest is history. On per capita basis, nearly twice the number of people died in Philadelphia than in St. Louis. Philly's hospitals were also overwhelmed.
Queen City death toll: 1,700
In Cincinnati, the city took quick action, but despite that there was a relatively high death rate.
When the Spanish flu first hit the city in early October, city health officer William Peters severely limited hospital visitations and recommended people stay away from theaters, public meetings and military camps.
But only days later, he came to believe thousands were already infected and he met with other city leaders.
On Oct. 5, all public and private schools, theaters, churches and Sunday schools were ordered to close. Public and private meetings were canceled. This effectively closed restaurants.
This was nearly a week earlier than other major Ohio cities.
On Oct. 7, saloons were told they could only sell liquor to be consumed off-premises.
Less than two weeks later, Peters came down with the Spanish flu himself, though he would recover quickly.
Throughout the crisis, Peters would report that cases were declining only to change to his mind and report the opposite, sometimes within the span of only two days.
Police were ordered to enforce the bans on gatherings. Peters and the Board of Health stood its ground against churches, performance venues and businesses.
On Oct. 30, during a general meeting, they tightened restrictions, ordering retail shops to close by 5:30 p.m. and shortening the hours of operation for other businesses.
All the restrictions were lifted on Nov. 11 and cases quickly spiked again. But now, Peters limited his restrictions to children: closing elementary schools and any other schools that had a significant number of sick children.
He also barred anyone under 16 from theaters, stores and public gatherings.
By early Dec., the board was considering a citywide shut down of all businesses, except those necessary for sustaining basic essentials. Instead, the board just limited business hours again on Dec. 12. This restriction was lifted two days later.
About a week later, with new cases of the virus declining, all restrictions on schools and children's activities were lifted as well.
About 1,700 people died from influenza during the outbreak that year, with the vast majority of deaths being children and working-age adults.
Other Ohio cities reacted
Cleveland was slow to the respond to the Spanish flu and suffered the worst death rate in Ohio. Its per capita death rate was worse than New York City and Chicago as well.
Cleveland's health commissioner was warned of the flu on Sept. 22, but it wasn't until Oct. 4 that he began issuing recommendations to the public. Closures didn't come until Oct. 14.
Dayton was quick to institute quarantine orders and closed schools, churches and theaters a week earlier than Cleveland. Columbus followed suit, but researchers think other factors outside of the government response spared the city from a higher death rate.
Toledo also maintained a low death rate during the epidemic. However, cases began to appear there about a week later than most Ohio cities. Leaders there still capitalized on the situation and were better prepared. They also aggressively quarantined homes, more than 8,000, where people suffering from the flu lived.
In all the cities in Ohio, most of the restrictions were lifted by the second week of November.
The infection rates in all cities were quite high. Cincinnati officials estimated that nearly a quarter of citizens in the city caught the flu, though the accuracy of that is up for debate.
While the restrictions in some places were as short as one month, the economic impact was steep. Researchers estimated that Cleveland businesses lost about $1.25 million, about $20 million adjusted for inflation.