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- - - - “Worst hit among the public utilities were the Hongkong Telephone Co, and China Light and Power. Two hundred of 300 workers of each company were affected,” the newspaper reported.
      - And it wasn’t only human life that was impacted.
      - On May 1, 1969, the Post published a story by international news agency UPI with the attention-grabbing headline “EVEN WHALES CATCH HK FLU”. The report said three whales – Shamu, Kilroy and Ramu – at Sea World in the Californian city of San Diego had come down with Hong Kong flu and had to be dosed with antibiotic pills concealed in mackerel. (Ramu was the hardest hit, and was getting 375 pills every six hours, according to his veterinary surgeon, Dr David Kenney.)
      - he virus is still in circulation today, surfacing from year to year in mutated forms of seasonal influenza, rendering vaccines less effective.
        And while advances in medicine and technology means fewer deaths, seasonal flus can still be fatal. Just last week a nine-year old girl died in Hong Kong after catching the flu, the third such death reported in 2018. (She had other chronic illnesses.)
- - - - It’s unknown exactly where the particular strain of influenza that
        caused the pandemic came from; however, the 1918 flu was firs
        t observed in Europe, America and areas of Asia before spreading to almost every other part of the planet within a matter of months.
        Despite the fact that the 1918 flu wasn’t isolated to one place, it became known around the world as the Spanish flu, as Spain was hit hard by the disease and was not subject to the wartime news blackouts that affected other European countries. (Even Spain's king, Alfonso XIII, reportedly contracted the flu.)
        One unusual aspect of the 1918 flu was that it struck down many previously healthy, young people—a group normally resistant to this type of infectious illness—including a number of World War I servicemen.
        In fact, more U.S. soldiers died from the 1918 flu than were killed in battle during the war. Forty percent of the U.S. Navy was hit with the flu, while 36 percent of the Army became ill, and troops moving around the world in crowded ships and trains helped to spread the killer virus.
    - - The Spanish Flu did not originate in Spain, though news coverage of it did. During World War I, Spain was a neutral country with a free media that covered the outbreak from the start, first reporting on it in Madrid in late May of 1918. Meanwhile, Allied countries and the Central Powers had wartime censors who covered up news of the flu to keep morale high. Because Spanish news sources were the only ones reporting on the flu, many believed it originated there (the Spanish, meanwhile, believed the virus came from France and called it the “French Flu.”)
    - - Scientists still do not know for sure where the Spanish Flu originated, though theories point to France, China, Britain, or the United States, where the first known case was reported at Camp Funston in Fort Riley, Kansas, on March 11, 1918.
        Some believe infected soldiers spread the disease to other military camps across the country, then brought it overseas. In March 1918, 84,000 American soldiers headed across the Atlantic and were followed by 118,000 more the following month.
  - - - Political/authoritative
        
        The public health authorities in both the United States and Europe took up fundamental measures to control epidemics that dated back to Medieval times of the Bubonic Plague. They aimed to reduce the transmission of the pathogen by preventing contact. They framed their public health orders in scientific ideas of their understanding of how the influenza microbe spread through the air by coughing and sneezing, and their conception of the pathogenesis of influenza. Since they concluded that the pathogen was transmitted through the air, efforts to control contagion were organized to prevent those infected from sharing the same air as the uninfected. Public gatherings and the coming together of people in close quarters was seen as a potential agency for the transmission of the disease. The public health authorities believed that good ventilation and fresh air were "the best of all general measures for prevention, and this implies the avoidance of crowded meetings," (BMJ, 10/19/1918). This translated into the controversial and imperative measure of closing of many public institutions and banning of public gatherings during the time of an epidemic.
        
        The rigidity of these regulations varied immensely with the power of the local health departments and severity of the influenza outbreak. In the United States, the Committee of the American Public Health Association ( APHA) issued measures in a report to limit large gatherings. The committee held that any type of gathering of people, with the mixing of bodies and sharing of breath in crowded rooms, was dangerous. Nonessential meetings were to be prohibited. They determined that saloons, dance halls, and cinemas should be closed and public funerals should be prohibited since they were unnecessary assemblies. Churches were allowed to remain open, but the committee believed that only the minimum services should be conducted and the intimacy reduced. Street cars were thought to be a special menace to society with poor ventilation, crowding and uncleanliness. The committee encouraged the staggering of opening and closing hours in stores and factories to prevent overcrowding and for people to walk to work when possible (JAMA, 12/21/1918). Some of the regulations in Britain were milder, such as limiting music hall performances to less than three consecutive hours and allowing a half-hour for ventilation between shows (BMJ, 11/30/1918). In Switzerland, theaters, cinemas, concerts and shooting matches were all suspended when the epidemic struck, which led to a state of panic (BMJ, 10/19/1918). This variation in response was most likely due to differences in authority of the public health agencies and societal acceptance of their measures as necessary. This necessitated a shared belief in the concept of contagion and some faith in the actions of science to allow them to overcome this plague.
        
        The most frequently discussed and debated public health measure in the journals of the period was the closure of the schools. In Britain the prevalence of the epidemic led to the closure of the public elementary schools (BMJ, 11/30/1918). In France, students with any symptoms and their siblings were to be excluded from school. If three fourths of the students were absent then the whole class was to be dismissed for 15 days (JAMA, 12/7/1918). Some believed closing schools to be a useful measure to control infection but complained that it often occurred too late, after most students and teachers were sick (BMJ, 10/19/1918). In the United States, school closure was not as widely accepted. One article in JAMA said that, "the desirability of closing schools in a large city in the presence of an epidemic is a measure of doubtful value," (10/5/1918). The APHA Committee debated its value too, questioning the effectiveness against the loss of educational standards. Generally, school closure was thought to be less effective in large urban metropolises than in rural centers where the school represented the point of dissemination of the infectious agent. The closing of schools and other public institutions as public health regulations to reduce the epidemic was not universally accepted. One editorial in the BMJ states that "every town-dweller who is susceptible must sooner or later contract influenza whatever the public health authorities may do; and that the more schools and public meetings are banned and the general life of the community dislocated the greater will be the unemployment and depression," (12/21/1918).
        
        he more restrictive methods of infection control issued by public health departments were quarantines and the isolation of the ill. These measures required a sacrifice of individual liberty for the societal good and therefore required a strong public health authority. Both the Illinois and New York State Health Departments ordered that patients must be quarantined until all clinical manifestations of the illness subsided. They held that the danger of the influenza epidemic was so grave that it was imperative to secure isolation for the patient (JAMA, 10/12/1918). The members of the APHA committee agreed in their report, saying that patients with influenza should to be kept in isolation. Because of the strain on facilities, only severe cases were to be hospitalized while mild influenza patients were to remain at home. The APHA also supported institutional quarantines to protect people from the outside world in establishments like asylums and colleges (JAMA, 12/21/1918). The use of institutional quarantines was applied to the many military training camps set up in the United States to prepare soldiers for war. These camps, with masses of men from throughout the country, were prime targets of huge influenza epidemics. The men were kept in strict isolation once ill and entire camps was often quarantined (JAMA, 4/12/1919). These measures were easily implemented in these camps where men were already committed to their country and the authority of the government.
        
        There are a lot of similarities, but also a lot of really fundamental differences.
        
        The population was about a quarter the size of what it is today and infectious diseases were still the main killer of people. It was a world that didn't know viruses very well. The first virus had been identified at the end of the 19th Century. So we had germ theory and people understood that microbes caused infectious diseases, but almost every doctor in the world thought they were dealing with a bacterial disease – and that shapes the whole story.
        
        It means they had no reliable diagnostic test and no really good treatments. It was called many different things, which meant we had a problem counting the dead as well.
        
        There were no commercial aeroplanes, so the fastest way you could get around was by ship or by train. Henry Ford had invented his Model T motor car, but they were still the preserve of the rich, as were telephones. And illiteracy was much higher than it is now, which had an impact because the main way that news was transmitted was by newspapers. In illiterate populations news travelled much more slowly and was often distorted.
      - The Committee of the American Public Health Association (APHA) issued a report outlining appropriate ways to prevent the spread and reduce the severity of the epidemic. They noted first that the disease was extremely communicable and "spread solely by discharges from the nose and throats of infected persons." They sought to prevent infection by breaking the channels of communication such as droplet infection by sputum control. They believed that infection occurred by the contamination of the hands and common eating and drinking utensils. Thus they called for legislation to prevent the use of common cups and to regulate coughing and sneezing. They wanted to initiate education programs and publicity on respiratory hygiene about the dangers of coughing, sneezing and the careless disposal of nasal discharges. They aimed to teach people the value of hand-washing before eating and the advantages of general hygiene (JAMA, 12/21/1918). Public Health Departments issued Flu Posters to educate the community and reduce the spread of infection. The members also noted that the response should vary according to the type of community and the living conditions. Measures were to be adapted to rural or metropolitan areas, with a centralized coordination to enforce compulsory reporting and canvassing for cases.
        Public Health agencies applied the principles of contagion to methods of hygiene and a regard for ventilation in their suggestions for reducing the spread of the illness and preventing disease. They held that well ventilated, airy rooms promoted well-being, (BMJ, 11/16/1918). Preventative measures built upon the same ideas of transmission and the germ theory of disease. These ideas were practiced in the hospitals as special influenza wards for influenza patients were created and the number of beds per ward was decreased to reduce the transmission of the disease. Those with complications such as pneumonia were separated from the rest to prevent the others from progressing to this more fatal state (BMJ, 11/2/1918). Sheets were hung between the beds to mimic isolation in limited closed quarters to provide a cubicle for each patient. No patient was allowed to leave their bed until they were fever free for 48 hours. In the military camps, soldiers were instructed to eat 5 feet apart in the mess halls. Head to foot sleeping was also implemented to reduce the sharing of air space (JAMA, 4/12/1919). One camp used these ideas of prevention via ventilation and boasted of their results. They claimed their rampant influenza epidemic terminated once men were kept out in the open with sunlight or in open, airy halls and prevented from gathering (JAMA, 12/14/1918).
      - One of the key aspects of prevention was the use of disinfection and sterilization methods. The practical prevention guidelines utilized the recent developments made by Lister and others of the necessity antiseptic conditions. All bedding and rooms were to be periodically disinfected to kill whatever pathogen pervaded them. In naval ambulance trains this was executed by washing down the train with a weak izal antiseptic solution (BMJ, 11/23/1918). The produced sputum, thought to be riddled with the microbe, was to be destroyed. In one hospital the sputum cups were emptied and disinfected twice daily, while nasal discharges were collected in paper napkins. An antiseptic hand solution was placed conveniently for those on duty in the influenza ward (JAMA, 4/12/1919). One French report also suggested that the staff of influenza wards should wear blouses inside the ward and remove them when leaving (BMJ, 11/2/1918). These disinfection procedures of prevention utilized scientific ideas of germ theory to reduce transmission.
        The gauze mask was another prevention method using similar ideas of contagion and germ theory. In the United States it was widely accepted for use in hospitals among health care workers. The face masks consisted of a half yard of gauze, folded like a triangular bandage covering the mouth, nose and chin (BMJ, 11/2/19118). These gauze masks acted to prevent the infectious droplets from being expelled by the mouth and from the hands, contaminated with microbe from being put to the mouth. The barrier from the hands was thought to be more important than the barrier from the air. The mask was also worn in some regions by the general population. In San Francisco the gauze masks were made a requirement of the entire population in a trial ordinance. This was later expanded to include San Diego in December. This rhyme was a popular way to remind people of the ordinance.
  - - - The 1918 influenza pandemic, also known as the Spanish flu, killed an estimated 50 million worldwide, including 675,000 in the U.S., according to the CDC. The pandemic occurred in three waves: the spring of 1918, fall of 1918, and winter and spring of 1919. In the midst of World War I, the federal government had limited resources to fight it.
        An estimated 30% of U.S. physicians were engaged in military service, so Congress passed funding in October 1918 to recruit doctors and nurses. At the time, there were no vaccines or lab tests to detect the virus, which meant government officials relied on “non-pharmaceutical interventions” such as quarantine, isolation and limits on public gatherings.
        These measures were mainly implemented by state and local governments. Meanwhile, Barry said, local officials were not transparent with their constituents about the severity of the pandemic, costing them credibility and causing more public fear and panic.
        In Chicago, for example, the mortality rate at one hospital reached nearly 40%, yet the city’s public health commissioner proclaimed, “Worry kills more people than the epidemic,” according to research published in 2005 by the Institute of Medicine.
      - Social
        
        The 1918-1919 pandemic eventually killed an estimated 50 million people around the world, and some
        675,000 people in the United States. That’s despite the fact that many countries, including the US, o
        utlawed large public gatherings, canceled school, and required masks and other protective gear in
        certain situations. However, just as is the case today, Pambuccian said part of the problem was that
        the adoption of precautions was not universal.
        
        “[T]hese measures were not implemented at the same time or for the same duration in different cities, nor were they uniformly followed,” he writes.
        
        In his paper, Pambuccian reviews existing scientific literature about the earlier pandemic, and compares it with known facts and projects related to the current pandemic.
        
        Cities like San Francisco, St. Louis, Milwaukee, and Kansas City were proactive in their safety measures, Pambuccian writes, and it is believed that their swift action cut transmission by as much as 30-50%. Those cities also had lower peak mortality and lower total mortality.
        
        “The duration that these ‘social distancing’ measures were kept in place correlated with a reduced total mortality burden,” he writes. “Although we still have no known effective therapy or vaccine prevention for this coronavirus, and the world is a quite different place than it was 100 years ago, the efficacy of the measures instituted during the 1918-19 pandemic gives us hope that the current measures will also limit the impact of the COVID-19 pandemic.”
- - - - 90% of children get the TB vaccine
    - - The Tuberculin Testing and Attested Herd Scheme, and increasing consumption of pasteurised milk, helps to prevent animal to human transmission of Bovine TB
      - A survey of 50,000 children showed an 80% reduction in infection rate following the BCG vaccination, leading to its introduction in secondary schools in the UK. At the time, those most at risk of TB in the UK were young adults in industrialised settings.
      - In 1970, there was the first outbreak of drug-resistant TB in the US.
    - - millions of people a year die to tb
    - - This was the century when everything was to change for TB. At the start of the century there was still no treatment but by the end of the century a number of drugs were available and TB could effectively be cured. It was though also the century when the problem of drug resistant TB was first identified.
        
        In 1900 it was estimated that the death rate for TB for white Americans was between 190 and 200 per 100,000. Among black Americans the comparable figure was 400 deaths per 100,000.24
        
        Around 1908 a new use was found for Tuberculin. But this was not for the treatment of TB, but instead it was for the diagnosis of TB.25 The test was named after the French physician Charles Mantoux
        
        Then in 1921 the BCG vaccine was used for the first time in humans.
- - - - HIV stigma is negative attitudes and beliefs about people living with HIV.
        It is the prejudice that comes with labeling an individual as part of a group that is believed to be socially unacceptable.
        Here are a few examples:
      - Believing that only certain groups of people can get HIV
      - Making moral judgments about people who take steps to prevent HIV transmission
      - Feeling that people deserve to get HIV because of their choices
    - - What are the effects of HIV stigma and discrimination?
        
        HIV stigma and discrimination affect the emotional well-being and mental health of people living with HIV. People living with HIV often internalize the stigma they experience and begin to develop a negative self-image. They may fear they will be discriminated against or judged negatively if their HIV status is revealed.
        
        “Internalized stigma” or “self-stigma” happens when a person takes in the negative ideas and stereotypes about people living with HIV and start to apply them to themselves. HIV internalized stigma can lead to feelings of shame, fear of disclosure, isolation, and despair. These feelings can keep people from getting tested and treated for HIV.
      - What causes HIV stigma?
        
        HIV stigma is rooted in a fear of HIV. Many of our ideas about HIV come from the HIV images that first appeared in the early 1980s. There are still misconceptions about how HIV is transmitted and what it means to live with HIV today.
        
        The lack of information and awareness combined with outdated beliefs lead people to fear getting HIV. Additionally, many people think of HIV as a disease that only certain groups get. This leads to negative value judgements about people who are living with HIV.