Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: Nonpharmaceutical interventions implemented in the United States during the 1918-1919 influenza pandemic are worth revisiting, as was done by Dr Markel and colleagues.1 Lessons from the past may mitigate future influenza pandemics. However, this pandemic occurred in a very particular moment of history.
World War I was ending, and migration patterns (particularly of military personnel) need to be taken into account when analyzing this event. It would have been interesting to know city-to-city variations according to the number of military personnel returning home and whether this had any association with the bimodal pattern shown in certain cities. In parts of the world where the war had little impact, like South America, influenza mortality was much lower than in the Northern hemisphere.2
Dib J. Nonpharmaceutical Interventions Implemented During the 1918-1919 Influenza Pandemic. JAMA. 2007;298(19):2260-2261. doi:10.1001/jama.298.19.2260-a