The 1918–1920 Influenza Pandemic Escape Community Digital Document Archive (review)

"Escape communities" were those rare towns, institutions, and military posts that experienced few (if any) cases or deaths during the autumn 1918 wave of Spanish flu—historical oddities of concern to public health and national security policymakers now devising mitigation plans for future influenza pandemics. In 2005, at the request of the federal Defense Threat Reduction Agency (DTRA), the Center for the History of Medicine (CHM) at the University of Michigan organized a research team to verify the extremely low morbidity and mortality rates for select U.S. settlements and institutions, and to assess the local record for evidence concerning the effectiveness of disease control measures such as isolating the sick, quarantining the exposed, closing schools, postponing mass gatherings, wearing masks, and issuing public health alerts. This Web site represents the team's findings: digitized copies of the far-flung primary source materials, accumulated and analyzed; detailed case-study reports for seven communities; and the final write-up on community-level success (or not) at avoiding or minimizing the numbers of cases.

It was hoped that this historical inquiry might be informative to today's health authorities in deciding policies for influenza control. Nonpharmaceutical interventions (NPI), as coined by the World Health Organization, may be the principal tool to manage the consequences of a pandemic given meager medical options, but there are few data available regarding the efficacy of NPI. Theoretically, limiting people's exposure to infection through NPI should slow the pandemic and thus modulate demands upon health-care institutions, and buy time for society until sufficient and effective vaccines and antiviral therapies become available. NPI may have parallel benefits in the case of an emergent disease outbreak that involves a fast-moving lethal pathogen such as SARS, or an epidemic that results from a biological weapons attack, especially with an engineered organism that has no medical countermeasures. This latter scenario helps explain the commissioning of the CHM by DTRA, a Department of Defense agency tasked with safeguarding the United States and its allies from weapons of mass destruction.

The only NPI for which these medical historians could locate some sign of effectiveness in the 1918 context was "protective sequestration." The secluded mountain community of Gunnison, Colorado, and the San Francisco Naval Training Station on Yerba Buena Island, California, were two settlements whose healthy, not-yet-exposed residents effectively cut themselves off from outside contact for months, thus evading the autumn epidemic. On this evidence—and that from other places, like the Trudeau Tuberculosis Sanatorium in remote Saranac Lake, New York—the researchers suggest that protective sequestration might be an answer, albeit an impractical one. However, they admit an inability to rule out other contributing factors such as the virus's biology, the population density, geography, or dumb luck. This caveat, and the report's refrain that one "cannot easily translate these examples into contemporary public health policymaking" (p. 41), suggest the historians' acute self-awareness about the potential ramifications of their findings, both practically and politically.

The complex circumstances prompting the digital archive's creation and the historians' tentative conclusions brought to mind Ruth Milkman's 1986 essay in Feminist Studies where she contemplated the consequence of two prominent feminist historians testifying as expert witnesses, on opposite sides, in the Sears, Roebuck sex-discrimination case: she noted that it was "difficult to imagine a forum less tolerant of the nuanced, careful arguments in which historians delight than a courtroom," a setting that demands "yes or no answers to complex questions."¹ Similarly, traces left in the historic record by an organic event like Spanish flu are sure to vex health...