During the flu pandemic in 1918, although the world was a very different place, the discussion was just as intense.
That pandemic killed an estimated 5 million people worldwide, including 675,000 Americans, before it was all over.
While the vast majority of cities closed their schools, three chose to keep them open – New York, Chicago and New Haven, according to historians.
The decisions of health officials in those cities were largely based on the hypothesis of public health officials that students were safer and better at school. Namely, it was the height of the Progressive Era, with its emphasis on hygiene in schools and more nurses for every student than can be imagined now.
“For students from tenement districts, the school has provided a clean, well-ventilated environment where teachers, nurses and physicians already practice – and document – in-depth, routine medical inspections,” according to the Public Health Reports article.
The city was one of the hardest and earliest affected by the flu, said Dr. Howard Markel, a medical historian and director of the Center for the History of Medicine at the University of Michigan. He co-authored the 2010 article Public Public Reports.
Students were not allowed to gather outside of school and had to report them immediately, according to Copeland. Teachers checked students for signs of the flu, and students who had symptoms were isolated.
If students had a fever, one of the health departments would take them home, and the health official would judge whether the conditions were suitable for “isolation and care,” according to Public Health Reports. If not, they were taken to a hospital.
“The health department required families of children who return home to have a family doctor or use the services of a public health doctor at no cost,” the Public Health Report article said.
The argument in Chicago to leave schools open to its 500,000 students was the same: keeping schools would keep children off the streets and away from infected adults, the reasoning went.
If social distance were then useful, it would have been easier due to the fact that absenteeism in schools collapsed during the pandemic, perhaps because of what one Chicago public health official among parents called “fluphobia.”
“The absenteeism rate was so high, it really did not matter” that schools were open, Markel said.
The paper concluded that an analysis of data revealed that “the decision to keep the schools of this city open during the recent flu epidemic was justified.”
And in New York then, Health Commissioner Copeland told the New York Times: “How much better it has been to have children under the constant observation of qualified people than to close schools.”
New York “did not do the worst, but it also did not do the best,” Markel said, adding Chicago was a little better.
Research showed that cities that carried out quarantine and isolation, school closure and bans on public meetings performed best, he said.
“The cities that did more than one” of these measures “did better. School dormitories were part of that contribution,” Markel said.
Public health experts, including Markel, are quick to point out that Covid-19 is not a flu, which is a well-known disease in 1918. There is still a lot to learn about the new coronavirus and the disease that causes it, Covid -19.
The right decision today, Markel said, is school closure.
“It’s better,” he said, “to be safe than sorry.”
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