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Lincoln High School on Fourth Avenue North in Billings

Lincoln High School on Fourth Avenue North, shown in this undated photo, served as an emergency Red Cross hospital during the influenza pandemic of 1918. Schools were closed for several weeks to prevent spread of illness. The old high school building is now part of Lincoln Education Center.

The Spanish influenza pandemic of 1918-1919 sickened an estimated 500 million people worldwide and killed up to 50 million, including 675,000 Americans. In Montana, the severe respiratory illness and related pneumonia killed nearly 4,200 people between September 1918 and June 1919, including 254 in Yellowstone County, 63 in Rosebud and 118 in Custer.

The pandemic overwhelmed Billings’ only hospital, St. Vincent. In October 1918, the Red Cross set up an emergency hospital in the Billings high school at North 30th Street and Fourth Avenue North to care for dozens of the worst cases.

“Medical science and public health were not prepared to grapple with the deluge of morbidity and death,” three Montana public health experts wrote in describing the pandemic’s toll on our state in the Summer 2018 issue of Montana The Magazine of Western History. Todd Harwell, Dr. Greg Holzman and Dr. Steven Helgerson noted that Montanans suffered many other infectious diseases in 1918, including 1,104 cases of smallpox, 179 cases of typhoid fever, 309 cases of diphtheria and 12,086 cases of measles. Influenza reporting wasn’t even required until after the pandemic hit.

Are we prepared to prevent pandemics now?

A recent exercise at the Johns Hopkins Center for Health Security showed that an epidemic of an influenza-like virus could kill 15 million Americans in a single year, according to an article in the Nov. 7 New England Journal of Medicine. Author Ron Klein also noted that “it would take less than 24 hours for a virus like the 1918 influenza to move from almost any point on the planet to Paris or Washington, Beijing or Riyadh.”

Threat of pandemic remains, but medical science has more weapons to use against it:

  • Surveillance.
  • Vaccines.
  • Anti-viral medication.
  • Antibiotics.
  • A strategic national stockpile of influenza vaccines and anti-viral medicine that has been rapidly distributed in bad flu seasons, such as the HINI epidemic of 2009.

“We have a lot of advantages now that they didn’t have back then. No World War I. They didn’t know what caused it. We’ve got vaccines and anti-viral medicines,” said Harwell, chief of the Montana Public Health and Safety Division in Helena. Harwell, Helgerson and Jim Murphy, head of the Montana Communicable Disease Bureau spoke about influenza prevention in a recent phone interview with The Gazette.

The virulent 1918 strain of influenza hit young, otherwise healthy adults. By the time authorities realized there was a problem, it was a pandemic — a huge worldwide contagion.

“One of the biggest things going for us now is the worldwide surveillance network,” Murphy said. “There’s worldwide cooperation to detect anything new as soon as possible.”

“Last year was a bad season,” Murphy said, with about 80,000 flu-related deaths nationwide and 79 in Montana. “So far, it looks like the right strains are in the vaccine.” As of last week, 31 cases had been confirmed in 11 counties from Missoula to Roosevelt.

“The biggest thing on the horizon is developing and introducing a universal flu vaccine with better coverage for more strains,” Harwell said.

Vaccines aren’t perfect. For one thing, they must be administered annually. The vaccine is grown in eggs, so production takes about six months. Every year, scientists use data to project which flu strains will be around in the October-March flu season. If the prediction proves wrong, the vaccine will be less effective and more people will get sick.

Access to the vaccine has improved in recent years, said Steven Helgerson, former Montana state medical officer. Many employers now offer flu shots at work. Pharmacies offer flu shots. “We want to make it as convenient as possible,” Helgerson said.

For all the research and knowledge gained over the past century, prevention is still a tough sell. Only about half of Montanans get annual flu shots, even though the vaccine is recommended for almost everybody over 6 months of age.

State and federal lawmakers must emphasize prevention. Too often, funding for disease research, development and prevention follows disasters and emergencies — even though lives and money could have been saved by investing sufficiently in public health and awareness.

A century ago, many Montana leaders (and their counterparts nationwide) minimized or ignored the influenza threat until people were dying. If history has taught us anything, we should know that protecting the population’s health is a basic responsibility of our government. Legislators, don’t sell public health short.

Dear Gazette readers, protect yourselves by getting a flu shot. Protect everyone around you by washing your hands often, sneezing and coughing into your sleeve and staying home if you are sick.

As Helgerson said: “The ability to work together is key to preventing modern influenza epidemics.”

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