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History Lesson: How St. Louis Reduced the Death Toll With Swift and Broad Closures in the 1918 Flu Pandemic

(Click to enlarge) Comparing 1918 influenza mortality St. Louis and Philadelphia. Source: Hatchett R, Mecher C, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proceedings of the National Academy of Sciences May 2007, 104 (18)

In the 1918 influenza pandemic that killed millions worldwide, St. Louis was a leader in implementing social distancing measures to prevent the spread of the flu. Among the 10 largest U.S. cities at the time (St. Louis was sixth-largest), St. Louis achieved the lowest death rate. Credit is given to city Health Commissioner Dr. Max Starkloff and Mayor Henry Kiel for implementing closures of schools, churches, theaters and other public meeting places over the objections of local businesses. By comparison, the peak death rate in Philadelphia was eight times that of St. Louis; the overall death rate in St. Louis was half that of Philadelphia.

“A primary lesson of the 1918 influenza pandemic is that it is critical to intervene early,” said Anthony S. Fauci, MD, director of the NIH National Institute of Allergy and Infectious Diseases, in 2007. He made that statement in conjunction with publication of a systematic analysis of interventions in the 1918 pandemic. This analysis reviewed 19 public health measures taken in 17 U.S. cities, and cited social distancing as practiced in St. Louis as the most effective measure. (Read the PNAS analysis)

Dr. Max Starkloff, St. Louis Health Commissioner in 1918

The St. Louis Medical Society was a strong supporter of Dr. Starkloff and his efforts.

Here are two articles from Missouri Medicine describing St. Louis efforts in 1918 to control the spread of the flu:

The 1918 Influenza in Missouri: Centennial Remembrance of the Crisis
By David S. McKinsey, MD, Joel P. McKinsey, MD & Maithe Enriquez, PhD
Missouri Medicine July-August 2018

A Century of Influenza Prevention in St. Louis
By Robert B. Belshe, MD
Missouri Medicine March-April 2012



Recent St. Louis-area media coverage of the 1918 St. Louis response:

St. Louis Post-Dispatch

St. Louis Post-Dispatch – Tony Messenger column




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