Preparing for a Pandemic - Then and Now

by Dr. Joseph Iser  Chief Health Officer, SNHD  Member Since 2013

by Dr. Joseph Iser

Chief Health Officer, SNHD

Member Since 2013

One hundred years ago another wave of the deadly 1918 flu pandemic was peaking in the United States. This second highly fatal wave struck between September and November and was responsible for most of the deaths attributed to the pandemic. It was also during this time that the New York City Board of Health added flu to its list of reportable diseases and required all cases of influenza be isolated at home or in a city hospital.

By the end of September 1918, Camp Devens, a United States Army training camp outside of Boston, had reported 14,000 flu cases (about one-quarter of the total camp population) and 757 deaths. By October, the flu pandemic was estimated to have killed 195,000 Americans during just that month. During this time, the United States was experiencing a severe shortage of professional nurses. In the city of Philadelphia more than 500 corpses were awaiting burial. Chicago, along with other cities, closed its movie theaters, night schools, and prohibited public gatherings.

November brought the end of World War I and a resurgence of the virus as people gathered to celebrate Armistice Day. In December, public health officials began educating the public about the dangers of coughing, sneezing, and the improper disposal of “nasal discharges.” Stores and factories were encouraged to stagger their opening and closing hours, and people asked to walk when possible instead of using public transportation.

The 1918 influenza pandemic was the most severe pandemic in recent history. It killed more than 50 million people worldwide and is estimated to have killed 675,000 people in the United States. Today, the Centers for Disease Control and Prevention (CDC) works with state, local, public, and private health care partners to conduct surveillance, improve preparedness, and provide education on seasonal and pandemic influenza viruses. These efforts have improved our ability to respond to the threat another global pandemic would pose to our communities. Despite this progress, there are gaps that still need to be addressed to ensure we can respond effectively to a future outbreak.

More recent influenza activity emphasizes the need for enhancements to response capabilities on a local, state, national, and global scale. The avian influenza A (H5N1) viruses first spread from poultry to infect humans in Hong Kong in 1997. The H1N1 pandemic was first detected in the United States in April 2009. This virus was a unique combination of influenza genes that had never been identified in either animals or people. To coordinate and improve efforts to prevent, control, and respond to pandemic influenza viruses, the U.S. Department of Health and Human Services (HHS) developed a Pandemic Influenza Plan in 2005. At the local level, the Southern Nevada Health District has response plans that are exercised regularly. Seasonal flu clinics provide real-world experience, and both public and private partners are engaged in testing elements of preparedness plans on both a small and large scale throughout each year.

In addition to the ongoing surveillance and preparedness activities that are continually occurring, each flu season can provide unique challenges. This past flu season, the effectiveness of one of the virus strains contained in the flu vaccine received a great deal of attention. While this was a legitimate issue, and improving vaccine development must be addressed, public health professionals, health care providers, and health care agencies can best serve their patients by staying united in delivering the overriding message that the flu vaccine is still the best protection from the flu.

The Health District will continue to provide flu vaccinations, educational messaging, and surveillance this flu season. Surveillance is a collaborative effort with local health care partners to determine when flu activity begins in the community, what types of influenza viruses are circulating, the impact the disease is having on the community in terms of morbidity and mortality, and to detect any changes that may be occurring in the viruses. This past season, the Health District implemented enhancements to its surveillance that allows it to capture more cases. Surveillance is conducted in keeping with CDC guidelines. When flu cases are reported, the outcome of the case may be delayed. Health District staff review patient medical records, death certificates, and laboratory records, as well as verify case definitions to reconcile influenza surveillance activities to ensure reporting is as accurate as possible.

While there has been a great deal of progress made since the 1918 pandemic, the threat of an influenza pandemic continues to be very real and could be devastating to our communities. Resources are needed for vaccine development, expanded surveillance, and increased reserves of anti-viral medications. For this season, we can encourage patients to get their annual flu vaccine.

The Health District will post updated flu surveillance information on its website at