Doctors, nurses still use lessons learned from 1918

Lessons learned 100 years ago during the 1918 flu pandemic are still being applied today.

Physicians and public-health nurses continue to advise people to cover their mouths when they cough or sneeze, wash their hands frequently, and avoid crowds during flu season. These practices became popular during the outbreak.

"There have been many advances in infection control since then but a lot still comes down to those basics," said Nancy Weissbach, M.D., an infectious diseases specialist at Saint Vincent Hospital.

When the 1918 flu outbreak occurred, there were no flu vaccines or antiviral drugs available. Medical researchers hadn't yet discovered the flu virus and there were no laboratory tests to detect the virus, according to the U.S. Centers for Disease Control and Prevention.

Treatment for seriously ill flu patients was limited, said Ferdinando Mirarchi, D.O., director of emergency medicine at UPMC Hamot.

"They didn't have ventilators, they didn't have antiviral medicines and they didn't have antibiotics to treat post-influenza bacterial infections like pneumonia," Mirarchi said.

New tools to combat the spread of flu at the time included quarantining infected patients, using disinfectants, promoting good hygiene and limiting large gatherings. Some people started wearing face masks in public.

About 500 million people worldwide were infected by the 1918 H1N1 flu virus and at least 50 million of them died, including 675,000 Americans, the CDC reported. The pandemic caused the average life expectancy in the U.S. to decline by about 12 years for men and women.

A new worldwide outbreak like the 1918 flu pandemic could happen again, Weissbach said. Less lethal worldwide outbreaks occurred in 1957, 1968 and 2009.

"Another outbreak is not a matter of 'if' as much as a matter of 'when,'" she said. "Flu viruses change constantly and an outbreak can occur when a new strain emerges that people don't have immunity against."

The difference is that hospitals have more tools to help the sickest of patients, and people themselves are stronger and healthier than they were a century ago, Mirarchi said.

There is also flu vaccine, which isn't always a perfect match against the most common flu strains but usually offers some protection against the disease.

"If it happens today, I don't think an outbreak would be as bad as it was in 1918 and 1919," Mirarchi said. "I don't see it having such a high mortality rate, though it would make a lot of people sick."

David Bruce can be reached at 870-1736 or by email. Follow him on Twitter at www.twitter.com/ETNbruce.