Social distancing. School closures. How a pandemic flu changed Buffalo in 1918

BUFFALO, N.Y. — A century before coronavirus, the world grappled with another public health crisis of enormous consequence: the pandemic flu of 1918.

Direct comparisons between the two diseases are flawed, as they are caused by different viruses, and as medicine has advanced a lot in 100 years.

But one thing the two pandemics have in common are the disruptions to daily life that suddenly comprise our new reality: Social distancing, school and business closures, and intense efforts to increase hospital capacity in response to a serious public health emergency.

In Buffalo in 1918, “They put different regulations in place so people weren’t coming into close contact with each other. The mayor at that time issued a proclamation that restricted assembly of more than 10 individuals. This meant that public and private schools were closed. Churches were closed. Recreational facilities were closed as well, like theaters and bowling alleys and saloons,” says Shauna Zorich, MD, MPH, a University at Buffalo expert on infectious disease epidemiology.

“The restrictions were really rigorously enforced,” adds Zorich, a clinical assistant professor in the Department of Epidemiology and Environmental Health in the UB School of Public Health and Health Professions.

The rules may have felt draconian, but they appeared to be effective, helping to reduce deaths. In Buffalo, according to some estimates, less than 6 percent of the population was infected by the 1918 flu — notably lower than the average nationwide, Zorich says.

“When you think about 1918, the challenges that they faced during that time were just enormous. They had not yet identified the pathogen that caused influenza,” she says. “They didn’t even know they were dealing with a virus. And all of this was happening at the same time that medical personnel were deployed for World War I, so they also had a shortage of medical personnel.

“The list of the challenges they were facing in 1918 goes on and on, and yet Buffalo came out of it. The country came out of it — we survived. Yes, there was a tremendous loss of life, but everyone came together and persisted.”

In 1918, the influenza pandemic touched every corner of life in Western New York, including at UB.

Buffalo weathered the epidemic better than many cities because of the leadership provided by faculty and alumni of the university’s medical school, now the Jacobs School of Medicine and Biomedical Sciences, who advocated for strict public health measures in the city and were ably assisted by medical students.

With so many medical personnel toiling overseas as part of America’s war effort, “One thing they did in Buffalo was they called sophomore, junior and senior medical students to care for the sick,” Zorich says. “So that’s one specific way that UB was able to assist.”

The university’s Department of Epidemiology and Environmental Health — today part of the School of Public Health and Health Professions — was also established during this time. Launched in 1919 as the Department of Hygiene and Public Health, the unit’s first head was Walter S. Goodale, a doctor who had served on an advisory committee that had helped Buffalo navigate the pandemic flu. During the epidemic, Goodale also served as the first superintendent of the Buffalo City Hospital, which had opened in 1918 and later grew to become the Erie County Medical Center.

A century later, cities around the world are turning to many of the same low-tech public health measures that helped save lives in 1918. But public health and medicine have also evolved a lot since the early 20th century, and society is armed with new knowledge and tools that scientists and hospitals didn’t have back then.

“Some of the measures we see taken today were taken in 1918 as well,” Zorich says. “Because there is no vaccine yet, what we’re really focused on is non-pharmaceutical interventions. This means we’re taking actions at the individual and community level, like social distancing, to decrease the spread of communicable disease.”

However, “Today, we have more knowledge, we have more experience, we have more technology, and we have a better public health infrastructure,” she adds. “If we put these strengths to work, and if everyone does their part, we’re going to come out of this just like we came out of the 1918 pandemic, with hopefully many fewer lives lost.”