Day 38: Closing Schools Like It's 1918

ABC reports from the governor's mouth that New York State has jumped to 142 cases, 19 in the eponymous city. Kansas has reported its first case today. Connecticut reported its first case yesterday, apparently ex California. Washington State has stealthily reported 3 more deaths in their ever-increasing case counts, bringing the US to 22 deaths among 551 cases.

A JAMA paper from 2007 has been making the Internet rounds lately, Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic. The interventions were school closings, isolation/quarantine (isolation for the actually ill, and quarantining of their contacts), and banning of public gatherings:

Public gathering bans typically meant the closure of saloons, public entertainment venues, sporting events, and indoor gatherings were banned or moved outdoors; outdoor gatherings were not always canceled during this period (eg, Liberty bond parades); there were no recorded bans on shopping in grocery and drug stores.

While people were still susceptible to flu after (or during) these interventions, they did have some benefits, namely,

[...]delaying the temporal effect of a pandemic; reducing the overall and peak attack rate; and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for production and distribution of pandemic-strain vaccine and antiviral medication. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure.

It's a good read, but the tl;dr conclusion is:

These findings contrast with the conventional wisdom that the 1918 pandemic rapidly spread through each community killing everyone in its path. Although these urban communities had neither effective vaccines nor antivirals, cities that were able to organize and execute a suite of classic public health interventions before the pandemic swept fully through the city appeared to have an associated mitigated epidemic experience.

It would be nice if we learned from the past, but we seem to forget instead. New York City was a model of public health promptness a hundred years ago, while Boston took a long time to react and suffered for it (see Table 1). Nevertheless, a few Massachusetts schools have closed for the moment: The Stratton School in Arlington was closed by the city due to a Biogen parent's symptomatic kid.

Individual schools in Boston, Malden, Plainville, Plymouth, Wellesley, and Worcester have closed for Friday or Monday, often for far less reason (e.g., in Worcester it's a contact of a relative of a staffer) in conjunction with a wiping-down-the-school effort and a planned reopening after the scrub. This is hardly a unified public health intervention. At least Boston University is planning for remote learning, though in an abundance-of-caution way rather than a do-it-yesterday way.

Education Week has a map of coronavirus-related school closures, though several recent Massachusetts cases seem to be misreported at ongoing closures rather than cleaning days. (Wellesley has already reopened.) New York and New Jersey have several district closures. In Seattle, whose response time wasn't too bad in 1918, many schools have already reopened.

Cancellations: Never mind those scrub-by-night school cancellations; NEFFA has been cancelled.

P.S. The New York Post reports the head of the Port Authority was among today’s cases. Though he’s been in contact with the governor, he’s not getting tested.

P.P.S. Five more deaths, four in Washington and one through community spread in Santa Clara County, California, have brought the US death count to 27. Santa Clara County has cancelled "mass" gatherings (of a thousand people) for three weeks. Italy has banned gatherings and restricted movement across the country.

P.P.P.S. Following in Ireland's footsteps, Boston has cancelled our St. Patrick's Day parade. Chicago has not.