Four waves of pandemic influenza from 1918-1920 in New York City caused ~40,000 deaths, primarily of young-adults and children. The explosiveness of the autumn 1918 wave has led many to believe that in the event of a similar pandemic today early detection and intervention strategies may not be effective. Recent historical studies of the 1918 pandemic, however, provide evidence of controllable transmissibility, of a limited early wave4, and of social distancing measures significantly reducing pandemic impact in many US cities. Importantly, mitigation efforts initiated after the beginning of community-wide transmission (even up to the point of 3-6% of a population being infected) significantly reduced the total impact in 1918.
Objective
In response to an Institute of Medicine report recommending community-based pandemic influenza mitigation strategies be informed by surveillance and disease modeling, we aimed to assess the feasibility of using emergency department data to identify model derived threshold triggers for initiating intervention efforts in the event of a 1918-like pandemic.