As the coronavirus spreads in the U.S., it will ultimately fall to local health officials to determine appropriate responses. While the CDC and other federal agencies have a large role to play, state and municipal officials will be on the front lines. They will be the ones making some of the hardest decisions.

These officials might have to decide whether athletic events and other large gatherings are allowed to take place. They might find it tempting to take their cue from the president — who keeps downplaying the coronavirus — and disregard the risks. But before they do so, they might want to recall the story of one of their predecessors, a little over a century ago.

The year was 1918, the last year of World War I. Earlier that year, a new strain of influenza virus originated in China, spreading around the world from there.

The new strain arrived in the U.S. in the early fall, with two outbreaks in Boston at Army and Navy facilities. At this point, though, few people realized the dangers it posed.

In September, sailors from Boston arrived in Philadelphia’s naval district; four days later, 19 sailors reported symptoms of influenza.

At the time, Philadelphia offered fertile ground for viral transmission. Nearly 2 million people lived in close quarters, with many transient workers, soldiers and sailors coming and going. Yet many cities had these liabilities. Philadelphia, though, also suffered from a lethal combination of corruption and incompetence.

A single man ran the city as his personal fiefdom: state Sen. Edwin Vare, who operated an extensive and venal political machine. A former pig farmer, Vare hated the city’s elites, and he took pleasure in forcing them to stand by, helpless, as he ran the city through his corrupt cronies, including the mayor, Thomas Smith.

In this setting, the only person who could possibly get a handle on the growing outbreak was the city’s director of public health and charities, Dr. Wilmer Krusen.

In September 1918, Mayor Smith had been arrested and indicted in connection with the murder of a policeman. Yet Smith did not step down. The city was rudderless, leaving Krusen in the difficult position of formulating a response without the mayor.

By the middle of September, the Philadelphia Navy Yard was awash in cases. On Sept. 15, 600 sailors and Marines had to be hospitalized; two days later, five doctors and 14 nurses collapsed with the flu. A day after that, Krusen belatedly scheduled a meeting with the chief health officer at the Navy yard, Lt. Cmdr. R.W. Plummer.

Though larger, deadlier outbreaks had already erupted in Chicago and Boston, the two men dithered. The meeting broke up with Krusen agreeing to start a publicity campaign warning people to cover their mouths and noses when coughing and sneezing.

After two sailors died the following day, Plummer assured the city: “The disease has about reached its crest. We believe the situation is well in hand. From now on the disease will decrease.”

But 14 young, able-bodied sailors died the following day, and 20 more the day after that.

Philadelphia’s board of health issued a public sstatement that it was “convinced” by Krusen’s reassurances that “no epidemic of influenza prevails in the civil population.” By this time, though, the virulent strain of influenza was killing both civilians and soldiers throughout the country.

Krusen and Plummer did not restrict the movement of military personnel in the city, enabling sailors to spread the disease among the civilian populace.

On Sept. 28, Philadelphia was set to hold the largest parade in its history, a massive gathering designed to get people to subscribe to war bonds. All of Philadelphia’s ethnic neighborhoods planned to participate, as did sailors, soldiers, nurses, civic groups and many others.

Though Krusen had warned the city not to gather in crowds, he did not attempt to stop the parade. Several hundred thousand people clustered along the parade route, cheering on marchers, who moved through the city in a procession 2 miles long.

The following day, Krusen issued recommendations to the public that included the advice to avoid large crowds. Too late. A day later, the flu began raging uncontrolled: 635 new cases on Oct. 1 alone. The board of health closed all public schools and canceled some mass meetings. But it was too late. The parade had spread the disease throughout the city. Many now began to die.

As more died — 759 people on Oct. 10 alone — city morgues ran out of space. Bodies piled up; city employees dug mass graves. But they could not keep up.

By the time the epidemic burned itself out in November, approximately 150,000 people in the city had caught the disease; roughly 15,000, or 10%, died. This was a far higher death toll than almost every other city in the U.S., and, for that matter, most of the world.

This tragedy could have been prevented. But a toxic mix of corruption and complacency opened the door to disaster.

It’s a lesson that local officials should heed as they prepare their own responses to the unfolding pandemic. If you embrace optimism instead of realism or put politics ahead of medicine, you may find yourselves in a catastrophe of your own making.

Stephen Mihm, an associate professor of history at the University of Georgia, is a contributor to Bloomberg Opinion.


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