Editor's note: This article is a part of a series reviewing Utah and U.S. history for KSL.com's Historic section.
PROVO — A new dataset published by BYU researchers this week and a coinciding soon-to-be-published research paper give a better understanding of the impact public health interventions had during the 1918 influenza pandemic, including that death rates nearly doubled in cities where there were poor mitigation efforts.
While it's a review of something that happened over a century ago, it could offer insights into measures regarding the handling of the COVID-19 pandemic today — considering the many parallels between the 1918-19 pandemic and the coronavirus outbreak.
Researchers from BYU worked with the nonprofit genealogical organization FamilySearch on "Families of the 1918 Pandemic." The website currently allows users to view the list of people who died from the 1918 pandemic from nearly a dozen states, including Utah. It lists 2,408 flu-related deaths across the Beehive State just from 1918 alone.
The database also provides the names and genealogical history of those who died from the pandemic over a century ago.
Exact numbers aren't known, but the 1918-19 influenza pandemic is believed to have led to the deaths of over 50 million people worldwide. Many epidemiologists and infectious disease specialists look back at it for answers on how to handle a pandemic without a viable treatment or vaccine, which was the case for most of 2020. It's still the case until herd immunity is reached, which is believed to be several more months away, at best.
"That's what we loved about the website we set up. It links you right to the FamilySearch profile for each person because we want you to see these as real people, and we want you to see if you have a personal connection to them," said Dr. Joseph Price, an economics professor at the university and co-author of the dataset and a research paper on the matter.
But one issue that has plagued the understanding of the pandemic is that data wasn't readily kept back then. Today, the Utah Department of Health provides all sorts of daily information that shows where new COVID-19 cases are and different virus trends; whereas, a large chunk of the documented data from a century ago comes from fragments found in newspapers or correspondents from the time.
Price and Stanley Fujimoto, a computer science graduate student at BYU, began working on a similar project before the COVID-19 pandemic began. They, along with the University of Michigan researchers, received a grant from the National Institutes of Health on a project that originally started with Ohio.
When the largest global pandemic since that 1918 influenza outbreak hit the U.S. last year, the BYU researchers' work took on a different meaning and they used what they knew to focus more on another angle.
"I think what motivated us was to better understand which interventions help during a pandemic," Price said. "There are lots of discussions with should we close schools? Should we close churches? Should we close other public facilities? Cities had to make those same decisions back in 1918."
With the help of another student on the project, the group began sifting through cause-of-death data from 1918 death certificates available on FamilySearch. By breaking down the data by detailed locations, they were able to cross-reference records with exact location and dates of death with dates of when mitigation efforts were put in place based on newspaper records from the time.
Price, BYU student Carver Coleman, and a researcher at the University of Notre Dame also used death certificate data in a handful of cities across Ohio and Massachusetts, as well as known timings of public health intervention efforts to compare the death rates within the cities studied. Their early research concluded that death rates during the outbreak in fall 1918 — the worst wave of the pandemic — were nearly twice as high in cities that didn't implement any interventions compared to ones that did.
The paper is expected to be published soon, after it was delayed by issues with how some death certificates were filled out in Massachusetts, Price said.
Prior to the study, there were some mostly anecdotal examples from 1918 that showed what could happen from poor pandemic response. The most notable flub from that time was the Philadelphia Liberty Loan parade. City officials ignored calls from health officials to cancel the parade, and the event was quickly linked to thousands of infections. Smithsonian Magazine noted that the parade attracted about 200,000 attendees; the city ended up with overrun hospitals within days, and about 4,500 influenza deaths were reported in the city in a period about two weeks after the parade.
There were also tales of success documented. Parades and other public gatherings were banned in Milwaukee, and the total number of deaths from the pandemic was less than 500, according to the Milwaukee Journal Sentinel.
The BYU dataset goes beyond just these known stories. For example, the 2,408 Utah flu deaths are from data collected from all 29 counties in the state. Every county had at least three influenza deaths in 1918, with Salt Lake County — home to some 160,000 people at the time — with the most deaths: 928. The disease claimed close to 0.6% of the county's population that year.
Salt Lake County had a mix of loose and strong restrictions during 1918. The county's largest restrictions in 1918 came during the holiday season after an uptick of flu cases and deaths were reported following celebrations to the end of World War I. To offer some sort of comparison between Salt Lake County's story and Milwaukee's, census records indicate that Milwaukee's population at the time was somewhere in the range of 2.5 times larger than Salt Lake County's, but data from BYU and the Milwaukee Journal Sentinel indicate Salt Lake County had nearly twice as many flu deaths.
The BYU project isn't over. The group of about a dozen researchers now say their goal is to create the first-ever dataset that includes every single individual who died in the pandemic across the globe, which will include going through millions of records. Thanks to an automated system they created, they're able to transcribe over 100,000 death records in less than two hours.
Once complete, it may just provide the most comprehensive review of how public health measures impacted deaths during the 1918 pandemic. That would help better us understand the connection between the two, not just as the fight against COVID-19 continues — and where exact links between deaths and mitigation efforts can be finalized until it's over — but possibly for future pandemics.
"I think what's going to happen is when the (COVID-19) pandemic ends, we're going to want to know what were the long-term consequences? And that's where the historical data can be really useful," Price said. "We're not going to know the consequences of the COVID-19 pandemic for a long time, so the ability to look to the past to know better what we can learn — and I think there's a lot of discussions if you can compare pandemics.
"But I think there's still a lot we can learn from the 1918 pandemic."