The Great Pandemic of 1918: State by State

http://www.pandemicflu.gov/general/greatpandemic3.html#wi
Hi all;
I found this article while trying to inform myself of the many unknowns ahead of us.

As you can imagine, (and with all due respect to everyone that may be reading this), I have been doing a ton of research out of concern for CaseyAnne~
~for us all.

When Casey had her TP/AIT (transplant), Dr. Sutherland also had to remove her spleen.
In doing so, she is left with an extremely compromised immune system. (Read "almost none").

She has informed me that she will be remaining home until at least Monday; at which time surely we will ALL know more about what we are ALL about to face in the near future.

*******************************

The Great Pandemic of 1918: State by State

Stories and anecdotes of the impact of the Great Pandemic in individual states were gathered for presentation at Pandemic Planning Summits held in each state.



Alabama State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 22, 2006

That Great Pandemic also touched Alabama.

It first appeared in late September 1918 in Florence, Alabama (in the northwest corner of the state). Just three weeks later, over 25,000 cases of influenza in the state had been reported to the U.S. Public Health Service.

It is impossible to know for sure exactly how many Alabamans were affected by the flu, since regular reports to the U.S. Public Health Service were never made. But it is known that during the last two weeks of October, more than 37,000 cases of the flu erupted in Alabama.

People around the state died by the hundreds.

Health care professionals worked tirelessly, and with limited resources to stem the tide of the rising pandemic. A report sent to the U.S. Public Health Service described the conditions under which physicians in Florence were working:

"...[Doctors were] overwhelmed with work [and] were handicapped by inadequate transportation and two days behind in making calls; many patients . . . had been sick in bunk houses and tents for several days without nourishment, or medical and nursing attention, the sanitary conditions of the bunk houses were deplorable; the mess halls were grossly unsanitary and their operation much hampered by the lack of help; the existing hospitals were greatly overcrowded with patients; and patients were waiting in line several hours for dispensary treatment, and were greatly delayed in obtaining prescriptions at the pharmacy. The epidemic was so far progressed that the immediate isolation of all cases was impossible."

One man, J.D. Washburn served in a medical unit in Alabama during the war and recalled his experience:

"We worked like dogs from about seven in the morning until the last patient of the day had been checked in or out-usually about 10 o'clock that night. The men died like flies, and several times we ran out of boxes to bury them in, and had to put their bodies in cold storage until more boxes were shipped in. It was horrible."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Alabama.



Alaska State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
April 13, 2006

That Great Pandemic also touched Alaska.

When the pandemic flu became rampant in the lower 48 states, Alaska territorial governor Thomas Riggs, Jr. imposed a maritime quarantine and restricted travel to the interior part of the territory. U.S. Marshals were stationed at all ports, trailheads, and river mouths. Schools, churches, theaters, and pool halls were closed.

In Juneau, residents were instructed to "keep as much to yourself as possible." Fairbanks established quarantine stations, also guarded by Marshals. People were checked periodically for flu and, if healthy, were given armbands reading "OK Fairbanks Health Department." Vaccine was imported from Seattle and distributed throughout the area, though it, of course, didn't work. In Native villages, shamans encouraged people to plant "medicine trees" that could protect against influenza.

Unfortunately, despite these precautions, influenza spread throughout the territory. Half of Nome's white population fell ill. Walter Shields, Nome's Superintendent of Education, was one of the first to die. The Alaska Native population in Nome was decimated—176 of the 300 Alaska Natives in the region died.

Elsewhere, entire Native families too sick to feed their fires froze to death in their homes. Many who were brought to a makeshift hospital believed that it was a death house, and so, instead, committed suicide. Spit the Wind, widely considered Alaska's greatest musher, died at the age of 25. He had survived a grueling expedition to the North Pole in which he had been forced to eat his snowshoe lacings, but he couldn't survive the flu.

On November 7th, the governor issued a special directive to "All Alaskan Natives." Natives were urged to stay at home and avoid public gatherings-something anathema to their communal lives. The pandemic swept through communities, killing whole villages. One schoolbteacher reported that, in her area, "three [villages were] wiped out entirely, others average 85% deaths.... Total number of deaths reported 750, probably 25% [of] this number froze to death before help arrived."

Because they were so sick with the flu, many Alaska Natives and others were unable to chop wood or harvest moose' so, after the pandemic had passed, many more died of starvation. Some people were forced to eat their sled dogs, and some sled dogs ate the dead and the dying.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes again, it will strike in Alaska.




Arizona State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
January 6, 2006

The Great Pandemic also touched Arizona.

The leading newspaper of the day was the Arizona Republican. The threat was high enough that it did not publish a paper for a time.

A "Citizens Committee" deputized a special police force and called upon all "patriotic citizens" to enforce anti-influenza ordinances.

Each person had to wear a mask in public. Those who coughed or spat without covering their mouths were arrested. The Republican described "A city of masked faces, a city as grotesque as a masked carnival."

As the disease raged, people took recourse to unusual remedies.

For instance, Arizona had ratified Prohibition earlier in the year (May 1918) and so the state superintendent of public health turned to nearly 10,000 pints of bootleggers' whiskey that had been confiscated by the sheriff's office.

Within two days, news of the loophole traveled across the city, and the sheriff's office was besieged with citizens and doctors alike, all of them seeking the "remedy."




Arkansas State Summit

Opening Remarks Prepared for Delivery
By the Honorable John Agwunobi
Assistant Secretary of Health
Department of Health and Human Services
July 27, 2006

The Great Pandemic also touched Arkansas.

On October 4, 1918, an outbreak was first reported just in Lonoke County. It exploded within days. The following week, the state said, “Serious epidemics have been reported from several points.” Within two weeks of the pandemic’s first appearance, about 1,800 new cases were being diagnosed each day.

One of those afflicted was James Geiger, the U.S. Public Health Service Officer for Arkansas. He downplayed the threat to the state–possibly to avert a panic–even after he caught the flu, and his wife died from it.

Segregation meant that African-Americans suffered cruelly. Many could not receive the care they desperately needed, since they could only be treated by doctors and nurses of the same race. It is clear that African-Americans died in high numbers, although the state did a poor job keeping records of their deaths.

Soldiers also suffered and died from the flu. It is likely that more Arkansans perished from the influenza than from the killing fields of Europe. At least 450 airmen were afflicted at the aviation training facility of Eberts Field in Lonoke County. More than 3,500 soldiers were afflicted at Camp Pike in Pulaski County. To prevent the pandemic from spreading further, the camp was sealed and quarantined. To still the panic, the camp commander insisted that the names of the dead not be released.

No one will know how many finally fell to the great pandemic. Records are incomplete and many rural districts went unreported, yet echoes of the suffering and loss remain.

If a pandemic strikes, it will come to Arkansas.




California State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 30, 2006

That Great Pandemic also touched California.

The first few cases were reported in Belvedere and San Gabriel in Los Angeles County in the last days of September 1918. The next week, more than 500 cases were reported.

In Los Angeles, local health officials were optimistic. They said, "If ordinary precautions are observed, there is no cause for alarm."

They could not have been more wrong. The disease was exploding around the state.

Within two days of issuing that statement, schools and churches were shut down to prevent the spread of the disease. Theaters were closed—sometimes for good—as they could not withstand the loss of revenue.

By the first week of November, more than 115,000 cases and hundreds of deaths across the state had been reported.

Makeshift hospitals were hastily opened to deal with the surge of patients that were overwhelming the health care system.

In San Francisco and elsewhere, mandates compelled the wearing of masks in public on penalty of fines or even imprisonment.

The San Francisco Chronicle reported, "The man who wears no mask will likely become isolated, suspected, and regarded as a slacker. Like a man of means without a Liberty Loan button, he'll be shy of friends."

A rhyme was used to help people remember the ordinance:

Obey the laws
And wear the gauze
Protect your jaws
From septic paws

Though the pandemic began to subside in November, residents still felt its effects through the holiday season. Citizens were still asked to do their Christmas shopping by phone rather than to travel to stores in person. Shopkeepers were even asked not to hold holiday sales, as they might draw crowds.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to California.




Connecticut State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 2, 2006

The Great Pandemic also touched Connecticut.

It struck the week of September 11th, laying low Navy personnel in New London. Just two weeks later, about 2,000 cases of influenza were reported in and around the city.

On September 27th, the Public Health Service declared, "influenza is prevalent throughout the eastern and southern parts of the state and it appears to be increasing." It was. Three days later, 9,000 cases were reported. A week later, that number had doubled. Then it redoubled, and redoubled again. By the end of October, an estimated 180,000 people had been struck by influenza.

By that point, more than 300 people had died here in Hartford. The Hartford Golf Club became an emergency hospital. A Public Health Service officer from Hartford named F.S. Echols fell to the pandemic. A nurse named Beatrice Springer Wilde recounted the tragic story of four Yale students that she treated. They had become ill while traveling and decided to get off the train in Hartford. Their last steps were taken from the train station to the hospital, for within twenty-four hours, all were dead.

People begged for - and sometimes demanded - treatment. The Hartford Courant reported that in the town of New Britain (just south of Hartford) one man blocked the car of a local doctor, insisting that he see his daughter. The physician said that he was too overwhelmed with cases to do so. The standoff continued until the mayor intervened and arranged for a doctor to see the man's daughter.

The people of Boston were not so fortunate. The pandemic was spreading with equal ferocity through Massachusetts, and the situation in Boston was so bad that those there begged the people of Connecticut to send any doctors or nurses that could be spared.

None could be. The emergency was too dire; the pandemic was too overwhelming. The Connecticut Commissioner of Health (John T. Black) was forced to urge doctors and nurses to remain in the state.

At its peak, the pandemic claimed more than 1,600 lives in a single week. But the total number it took in Connecticut will never be known. Reports are incomplete; the pandemic was too overpowering. But its echoes of terror, of suffering, and of loss remain.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Connecticut.




Delaware State Summit

Opening Remarks Prepared for Delivery
By the Honorable Alex Azar
Deputy Secretary of Health and Human Services
February 21, 2006

That Great Pandemic also touched Delaware.

In 1918, Delaware was the fourth-smallest state by population in the U.S., with just under a quarter million people. It also ranked as the second smallest state in the nation by land area, after Rhode Island.

Yet despite its small size, in the fall of 1918, Delaware reported thousands of cases of the Spanish flu, as well as hundreds of deaths from it. Exact numbers of Delawareans affected by the flu will never be known, because regular reports to the U.S. Public Health Service were never made.

Regardless of the numbers, though, Delaware acted to contain the flu just as many other states had. On October 3, 1918, the Delaware State Board of Health met in an emergency session to stem the death toll from influenza. They shut down most of the state:

"Whereas: A very serious epidemic of influenza is now raging in the state of Delaware...to protect the health of the entire citizenship of Delaware...all schools, all theatres, all churches, all motion picture houses, all dance halls, all carnivals, fairs and bazaars, all billiard rooms and pool rooms, all bowling alleys in the entire State of Delaware shall be closed and kept closed until further notice."

This order remained in effect for more than three weeks. Yet even these careful precautions were not enough to control the disease.

As the situation in Delaware worsened, Delaware became so overwhelmed that the Health Department tried to divert influenza patients to Philadelphia hospitals. The flu, however, knew no state lines. Philadelphia was unable to come to Delaware's rescue, as they too were completely overrun by the disease.

Nearby, at Memorial Hospital in New Jersey, Mr. John Kingsman, age 36, died on a Monday afternoon. Days earlier, his 17-year-old daughter died in the same spot, though he never knew it. Those taking care of him could not bring themselves to tell him that-just a week after his mother and stepbrother died in Dover-his teenaged daughter was also dead.

When it comes to pandemics, there is no rational basis to believe that the 21st century will be much different than the past. If a pandemic strikes, it will come to Delaware.




District of Columbia Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 20, 2006

That Great Pandemic also touched the District of Columbia.

The city was crowded with people contributing to the war effort, and so as soon as the first cases appeared, the situation became serious.

That happened around the last week of September. Then the disease spread rapidly. More than 160 cases were reported on October 1. Seven days later (October 8), more than 2,100 people had been attacked by the flu.

The dead began to multiply. Four hundred forty victims of influenza were reported on the second week of October. More than 730 victims were reported the following week.

The DC Health Commissioner, Louis Brownlow, faced a shortage of coffins. He resorted to hijacking a shipment of coffins that were passing through the city en route to Pittsburgh.

In the Sardo funeral home (located in the District), Bill Sardo remembered that:

"From the moment I got up in the morning to when I went to bed at night, I felt a constant sense of fear. We wore gauze masks. We were afraid to kiss each other, to eat with each other, to have contact of any kind. We had no family life, no church life, no community life. Fear tore people apart."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to the District of Columbia.




Colorado State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 24, 2006

The Great Pandemic also touched Colorado.

It first appeared in late September 1918, when some 33 suspected cases were reported at the University of Colorado. It raged across the state through the month of October, sickening those in the valleys, and bringing down residents of high mountain towns.

More than 150 people died in a single week here in Denver. Thousands were afflicted (though actual numbers are unknown).

One of those was Katherine Porter, who would later earn fame and acclaim (including a Pulitzer Prize) for her short stories. One of her best-known works was Pale Horse, Pale Rider, a fictionalized account of her experience in the pandemic.

Porter contracted influenza while working as a journalist for the Rocky Mountain News. She could not be admitted to the hospital at first, because there was no room. Instead, she was threatened with eviction by her landlady and then cared for by an unknown boarder who nursed her until a bed was open at the hospital.

Porter was so sick that her newspaper colleagues prepared an obituary and her father chose a burial plot. Her near-death experience changed Porter in a profound way. She said afterward, "It just simply divided my life, cut across it like that. So that everything before that was just getting ready, and after that I was in some strange way altered."

The lives of countless other Coloradoans were also altered.

Residents of Boulder experienced a quarantine. So did all of those living in the entire San Juan Basin (in the southwest corner of the state). All gatherings were cancelled, including schools, sporting events, and social outings. Voters and judges alike were required to wear surgical masks during the November election. People were even prohibited to gather for funerals.

The city of Silverton (located just north of Durango) lost nearly 10 percent of its population, including morticians. Coffins had to be sent from Durango to accommodate the large numbers of the dead.

The pandemic finally faded, leaving echoes of terror and suffering and loss all across the state.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Colorado.




Florida State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 16, 2006

That Great Pandemic also touched Florida.

In 1918, Florida's statewide population was around five percent of what it is today-under one million people.

Despite this scant population, between mid-October and late November 1918, the state reported thousands of cases of the Spanish flu, as well as hundreds of deaths from it.

The exact numbers of Floridians affected by the flu will never be known, because regular reports to the U.S. Public Health Service were never made.

Numbers or not, Florida reacted to the flu as so many other states did: City ordinances mandated quarantines and the wearing of facemasks in public, public gatherings were banned, and schools and churches were closed.

Yet even these careful precautions were not enough to control the disease, even when they were obeyed.

In the fall of 1918, an Ocala, FL man, Mr. Olson, traveled to Jacksonville, FL for a carpentry job. Jacksonville was inundated with the flu at the time, and despite a citywide quarantine and the use of gauze masks, Olson contracted the flu.

Eager to return to his hometown and family, he slipped past the quarantine and caught a train back home, bringing the virus with him. Within days of his return, he had infected his family, and was bed-ridden with his son. Olson recovered but others were not as fortunate.

In 1919, eight-year-old Carl Lindner shared a room in the Marion County hospital with his five-year-old cousin, Philip Townsend. Both had come down with the flu. When young Philip recovered, he asked the nurses where his cousin was. The only answer the nurses could give was that Carl had already gone home. They did not know how to tell a five-year-old that his cousin was dead.

Within three weeks, Carl's father and maternal grandfather also died from the disease.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Florida.




Georgia State Summit: History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
January 13, 2006

The Great Pandemic also touched Georgia.

It probably arrived during the first week of October 1918, and then spread like a wildfire throughout the state. In just three weeks, from October 19th to November 9th, there were more than 20,000 cases and more than 500 deaths.

Towns and communities were terribly affected.

Augusta was the hardest-hit city in the state. Trained nurses were far too few for the many needs, and they too were struck down by the pandemic. As a consequence, nursing students were put in charge of shifts at a local hospital. Schoolteachers were enlisted to act as nurses, cooks and hospital clerks, at an emergency hospital constructed on a local fairground.

In Athens, the University of Georgia announced that it was indefinitely suspending classes.

In the town of Quitman, stringent rules were established to combat influenza, which touched almost facet of life:

* Public gatherings, including indoor funerals, were prohibited
* Public spitting was outlawed
* The serving of any beverage was prohibited in public places, unless it was poured into sanitary cups or served in glasses that were thoroughly sterilized each time they were used
* The accumulation of dust in places of business was prohibited. Merchants were ordered to keep their floors damp enough to keep the dust down
* All cases of influenza were ordered quarantined. In places where the disease had struck, a placard stating "influenza" had to be displayed

A similar strategy was adopted here in Atlanta. The City Council declared a ban on public gatherings for two months. Schools, libraries, theaters and churches were all closed.

For better ventilation, streetcars were ordered to keep their windows open, except in the rain.

Yet despite all those desperate measures, the pandemic still extracted a terrible toll.

Final casualty figures in Georgia will never be known. After making their initial reports, state officials were simply too overwhelmed to tell the U.S. Public Health Service anything more.




Idaho State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 27, 2006

The Great Pandemic also touched Idaho.

The first cases were reported in Canyon County (northwest of Boise) on September 30th. Within three weeks, the disease was raging all across the state.

Franklin County (located in the southeastern corner of the state) was one of the many areas hit hard by the pandemic. One of the residents, Watkin L. Roe from the Franklin County Citizen newspaper, sent a letter to Surgeon General Rupert Blue (on behalf of "many prominent citizens") reporting that the pandemic had affected about 1,300 of the county's 7,500-8,000 residents and had killed 31.

Mr. Roe wanted the Surgeon General's advice on two points. First, he wanted to know if there was "any virtue in the vaccines and serums which the doctors are using." Second, Mr. Roe and his fellow citizens wondered whether or not to close places of public gathering like schools, theaters and picture shows, since although they feared catching the pandemic, they also feared paralyzing business.

No answer is reported, but similar anxieties were felt across the state.

Messages were sometimes mixed, as people struggled to inform but not to inflame. For instance, a headline of the Rexburg Journal (northeast Idaho) read "NO OCCASION FOR PANIC," even as the same issue included an order from city officials putting the town under quarantine and banning all public gatherings.

The Northern Idaho News of Sandpoint (north-central Idaho), declared that there was no cause for alarm over the flu, but then noted that, as a precautionary measure, schools would be closed indefinitely, and churches, picture shows and all public gatherings of every kind would be prohibited. The newspaper also issued a warning to parents to keep their children away from the railway depots as a precaution against infection.

Though those measures likely helped, many Idahoans were still afflicted.

In the town of Paris (located in the southeast corner of the state), resident Russell Clark remembered that the mortality rate was around 50 percent. Clark said, "There was a feeling of depression and sadness because neighbors . . . were passing away."

The final toll that the pandemic took in Idaho will never be known. But the echoes of suffering and loss remain.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Idaho.




Illinois State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 17, 2006

That Great Pandemic also touched Illinois.

Chicago was then the nation's second largest city and the country's largest rail hub. As a consequence, the disease reached the city quickly. Before the disease reached this city, overconfident public health officers proclaimed, "We have the Spanish influenza situation well in hand now."

Then the disease came.

Influenza was reported in Chicago on September 27th. Within two weeks, it was epidemic throughout the state. Cities like Kankakee and Rockford were as hard hit as rural sections and coal-mining districts.

But Chicago saw the most awful impacts. While the pandemic raged toward its dreadful peak, the city saw an average of 12,000 new cases each week. More than 2,100 Chicagoans died during the second week of October. More than 2,300 died during the third week.

The city ran out of hearses. Signs were posted banning public funerals, and limiting funeral attendees to no more than 10, in addition to the undertaker, the minister, and necessary drivers. No bodies were allowed in churches.

A U.S. Public Health Services Officer named Jo Cobb, who was working at the city's Marine Hospital wrote to a friend, "Our beds were filled as fast as emptied."

Navy nurse Josie Brown, who served at Naval Hospital in Great Lakes remembered:

"The morgues were packed almost to the ceiling with bodies stacked one on top of another. The morticians worked day and night. You could never turn around without seeing a big red truck loaded with caskets for the train station so bodies could be sent home. We didn't have the time to treat them. We didn't take temperatures; we didn't even have time to take blood pressure. We would give them a little hot whisky toddy; that's about all we had time to do. They would have terrific nosebleeds with it. Sometimes the blood would just shoot across the room. You had to get out of the way or someone's nose would bleed all over you."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Illinois.




Indiana State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 23, 2006

That Great Pandemic also touched Indiana.

The pandemic was first recognized within the state on September 20th, 1918. It was reported in Evansville (southwest tip of Indiana) on September 25th, and in Indianapolis five days later. By the week of October 11th, influenza was reported in many places across the state.

People did all they could to slow the spread of the pandemic. In late September, the Indiana State Board of Health issued an order to all county and city health officers warning them of the pandemic, suggesting preventive measures (like the holding of handkerchiefs over the nose when sneezing or coughing), and calling for the exclusion of those with colds from public gatherings.

A week later, the Board of Health imposed a ban on all public gatherings. Churches were open for prayer, but not large services. Public funerals were banned.

Evansville added an anti-spitting ordinance to other measures. The local paper advertised remedies like Dr. Jones' Liniment, Mendenhall's Chill and Fever Tonic, and Father John's Medicine.

Schools were closed in Indianapolis. Citizens were required to wear masks in stores and streetcars, offices and factories, public buildings and theaters. A ban on Halloween parties and gatherings was credited with saving the city from a worse epidemic.

Such measures may have lessened its cruelty. During the pandemic, about 12% of Indianans were afflicted with the flu, compared to about 25% of all Americans.

But the toll across the state was still severe. By the time the pandemic finally passed, at least 150,000 Indianans had been afflicted by the pandemic. About 10,000 had died.

The victims included a Mrs. Estil Graffis and her husband, who lived in Fulton County (north-central Indiana). Estil died on a Wednesday. Her husband followed her the next Monday. Within a week, influenza had made orphans of their three children. Tragic stories like that of the Graffis' were not uncommon across the state.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Indiana.




Iowa State Summit History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 7, 2006

The Great Pandemic also touched Iowa.

The pandemic was already spreading through soldiers stationed in Iowa before it began rising in the civilian population. On October 5th, 1918, the first cases of flu were reported in Des Moines, and on that same day, the Des Moines Tribune reported that local hospitals were refusing any more patients with the flu.

After just 25 confirmed cases among civilians in Des Moines, the Surgeon General suggested the city close theaters and other public places to prevent a pandemic.

It was already too late. Within one week, the Public Health Service reported that there were more than 8,100 new cases of the flu (civilian and military) and more than 70 deaths from it, and the number "appears to be increasing."

The following week, more than 21,000 cases were reported.

In Des Moines, a general quarantine was established for the entire city. Schools were closed. So were theaters, pool halls and other gathering places.

With no classes to teach, teachers were paid to contribute to "sanitary detective work." This meant traveling from door-to-door to survey homes for flu sufferers.

By the time the pandemic finally ran its terrible course, countless people had been afflicted. The final toll that the pandemic took in Iowa will never be known. But the echoes here remain.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Iowa.




Kansas State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
May 31, 2006

That great pandemic also touched Kansas. In fact, it is likely to have begun here. In late January and February of 1918, a physician in Haskell County (located in the southwestern corner of the state), noticed an outbreak of severe influenza cases.

The local paper, the Santa Fe Monitor reported (excerpt from The Great Influenza):

Mrs. Eva Van Alstine is sick with pneumonia. Her little son, Roy, is now able to get up. . . . Ralph Linderman is still quite sick. . . . Goldie Wolgehagen is working at the Beeman store during her sister Eva's sickness.

That list of the afflicted would be terribly lengthened in the fall.

An infected soldier from Haskell County is thought to have carried the influenza with him to Camp Funston, near Fort Riley (about an hour's drive west from Topeka). In mid-March an outbreak there afflicted more than 1,100 soldiers, killing 38.

The disease disappeared for a while, and then returned with a vengeance in the fall. It appeared in Kansas in September, and raged across the state throughout the terrible month of October.

The first official report of the disease came on September 27th. First 1,000 people were afflicted, and then, 10,000. By mid-October, more than 26,000 people had been afflicted by the flu.

A soldier from Camp Funston followed the effects of the pandemic there through letters home. On September 29, he wrote:

We are held up because "influenza," or some such a name, is in the camp. It is some such a thing as pneumonia, and they seem to think it is pretty bad. It is at least bad enough to beat us out of our passes.

A week later, on October 6th, he wrote, "Lots of them go to the base hospital every day and quite a number of them are 'checking in.' There are between 6 and 7,000 cases in the camp."

Two days later he wrote:

I am still playing the part of a "dry nurse," ha-ha. Some name us boys have invented for a gentleman nurse. The roof of our hospital has been leaking in several places and we have been having some time keeping the poor devils dry.

They are keeping our beds all filled with new patients as fast as we send the old ones "home well" or to the hospital, half-dead. There haven't been so many cases the last 48 hours. I sure hope that they all get well soon, for I am sure getting tired of the job. Don't like to stay up every night the best in the world. We put six more of our boys in bed today. We are getting real short-handed.

And still the epidemic raged. In Topeka-and elsewhere-hospitals overflowed. Emergency hospitals were opened at the Garfield School and the Reid Hotel. Two infirmaries connected to Washburn College (in Topeka) were opened. The college gym was transformed into "an observation hospital."

The Secretary of the State Board of Health did all he could to contain the disease-closing schools, churches and theaters; quarantining homes with ill patients; and, limiting the numbers of people in stores and passengers on streetcars.

Yet, the pandemic still took a terrible toll. The final cost will never be known, but echoes of loss remain.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Kansas.




Kentucky State Summit: History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Alex Azar
Deputy Secretary of Health and Human Services
January 20, 2006

The Great Pandemic also touched Kentucky.

Kentucky saw its first cases of influenza during the last week of September 1918. Infected troops traveling on the Louisville and Nashville Railroad stopped off in Bowling Green, KY, where they passed the virus on to a few of the local citizens.

By the time the first week ended, Louisville had already suffered an estimated 1,000 cases of influenza.

The pandemic grew even worse in ensuing weeks. Louisville alone lost 180 people each week from influenza during the second and third weeks after it struck.

On October 6, the Kentucky State Board of Health announced the closing of "all places of amusement, schools, churches and other places of assembly."

Because they were almost certainly simply overwhelmed with combating the disease, Kentucky officials did not even report influenza cases to the U.S. Public Health Service until late October.

At that point, state officials reported more than 5,000 cases of the flu. Over the next three weeks, they reported over 8,000 more.

The state was never able to reliably report the deaths that resulted from the flu in Kentucky, but accounts from residents at the time paint a grim picture.

For instance, in Pike County, Kentucky, a miner named Teamus Bartley called the epidemic, "The saddest lookin' time then that ever you saw in your life."

He and his brother worked at a coal mine when his brother's entire family came down with the disease. Teamus visited his brother every night, and reported on what he saw:

"...every, nearly every porch, every porch that I'd look at had--would have a casket box a sittin' on it. And men a diggin' graves just as hard as they could and the mines had to shut down there wasn't a nary a man, there wasn't a, there wasn't a mine arunnin' a lump of coal or runnin' no work. Stayed that away for about six weeks."

Teamus later said that each night, he saw four or five miners and family members die in the camps.

Even as late as mid-December 1918, Kentucky was so overwhelmed by the disease that a local health officer sent an urgent telegram to Surgeon General Rupert Blue requesting that the U.S. Public Health Service take over the administration of health work until the influenza epidemic had abated.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Kentucky.




Louisiana State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
April 25, 2006

That Great Pandemic also touched Louisiana.

As the pandemic began to spread around the country in 1918, the president of the New Orleans Board of Health announced that the city's climate would prevent a high mortality rate if the flu ever did come to the city. He would be proven tragically wrong.

Though exact dates and numbers are not known for sure, the disease probably came to New Orleans during the first week of September-around the same time the steamship Harold Walker set sail from Boston for New Orleans. The pandemic was already raging in Boston, and so, before the Harold Walker arrived in New Orleans, 15 passengers had been struck, and three had already perished. By the time the Harold Walker docked in New Orleans, those afflicted found they were not alone. The pandemic was already raging in Louisiana.

By the third week of September, thousands were being afflicted. Hundreds were dying.

By the end of October, 14,000 people in New Orleans had been struck by the flu. More than 800 had died.

People were desperate for a cure.

One doctor in New Orleans believed sulfur would "kill the germ." He advised his patients to "put a small amount of sulfur in each shoe each morning, and goodbye influenza." To make sure the sulfur was "working," he told his patients to carry a silver dollar in their pockets. According to the doctor, the silver would change color in reaction to the sulfur emitted by the body.

The sulfur did not work. Few things did.

The pandemic finally ended, but the dreadful memories remained.

A year later, the flu erupted again in New Orleans. By the time it had afflicted just a handful of people, the terror of the previous year was sufficient to trigger alarm. A Public Health Service officer sent an urgent telegram to Surgeon General Blue reporting: "Ten cases influenza...Doctor Kibbe reports spreading rapidly."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Louisiana.




Maryland State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of the Department of Health and Human Services
February 24, 2006

That Great Pandemic also touched Maryland.

It first appeared at Camp Meade on September 17th, 1918. By September 28th, more than 1,700 cases were reported across the state.

At that point, Baltimore's health officer declared, "There is no special reason to fear an outbreak in our city." The next several weeks would prove him tragically, terribly wrong.

Nearly 2,000 cases were reported in the city on October 10th. Sickness often led to death. On the single day of October 19th, 169 people perished because of the pandemic.

Everyone was out sick. There were too few milkmen, too few firefighters, too few telephone operators, and too few gravediggers. The city didn't have enough workers to process death certificates. Because it was illegal to conduct burials without one, bodies and caskets stacked up inside-and outside-funeral homes.

Hospitals were overwhelmed. Flu patients filled six wards at Johns Hopkins. Finally, the hospital had to close its doors. Three staff physicians, three medical students, and six nurses perished with the patients for whom they were providing care.

By the most conservative of counts, at least 75,000 of Baltimore's 600,000 residents were struck by the flu. More than 2,000 died.

Circumstances were just as terrible all across the state. In Salisbury (located on Maryland's eastern peninsula), about 800 of the town's 11,000 residents were struck by the pandemic. Forty-one percent of the population became ill in the town of Cumberland.

The total number of Marylanders who perished in the pandemic will never be known. Reports are incomplete; the pestilence was too overpowering. But its echoes of terror, of suffering, and of loss remain.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Maryland.





Massachusetts State Summit History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 7, 2006

The Great Pandemic also touched Massachusetts.

It first came here, to Boston. On August 27th, 1918, two sailors at Commonwealth Pier reported in sick with influenza. The next day, there were eight. By the third day, influenza had struck nearly 60 people.

That fire soon became an inferno, and within two weeks, 2,000 officers and men had been struck.

On September 8th, a spark of influenza touched Camp Devens, a military camp near Boston with about 50,000 soldiers. The conflagration that erupted is difficult to comprehend.

A physician - known only as Roy - described the situation as it appeared in late September. He wrote:

"This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed....These men start with what appears to be an ordinary attack of . . . Influenza, and when brought to the Hospital they very rapidly develop the most viscous type of Pneumonia that has ever been seen.

Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis (pronounce "Cy-an-no-sis") extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white.

It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up."

The pandemic was just as dreadful for civilians. Scarcely six weeks after it touched the first sailor on Commonwealth Pier, the pandemic was raging all across the state. By October 1st, the Public Health Service estimated that there were at least 75,000 cases in the state, excluding those from the military camps.

At that point, nearly 800 people had already died from influenza here in Boston. Another 200 had perished from pneumonia. By the time the next week ended, nearly 1,300 more Bostonians had died.

By the time the pandemic finally passed, an estimated 45,000 people had perished in Massachusetts. That is about two-thirds of a sellout crowd at a Patriots game, or more than two consecutive sell-outs at Boston Garden.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Massachusetts.





Michigan State Summit

Opening Remarks Prepared for Delivery
By the Honorable Alex Azar
Deputy Secretary of Health and Human Services
April 5, 2006

We are also seeing some of the same symptoms from victims of the 1918 strain in victims of today's H5N1. If the H5N1 strain, or any other strain of animal influenza, were to develop into a pandemic strain, no one would have immunity. Let me tell you a little about how Michigan was affected by the 1918 pandemic.

In late September 1918, Michigan officials reported to the U.S. Public Health Service that "very few cases have been reported." Two weeks later, however, the state failed to report at all, possibly because the deteriorating conditions had made reporting difficult. By October 18th, officials sent but a terse report, saying "50 deaths [from influenza] had occurred in the State." But, by the 25th, they reported that "from October 1 to 18, inclusive, [there were] 11,983 cases and 258 deaths in Michigan." The pandemic seems to have peaked in Michigan by the end of October, with the week that ended on the 26th seeing 21,541 cases and 922 deaths.

In the Upper Peninsula, a public health nurse named Annie Colon and a physician used a handcar to reach isolated patients in remote logging camps. Colon said, "We worked day and night. We'd ride 20 and 30 miles at night through the deepest woods. We would find ten people all huddled together, fully dressed in a tiny log cabin, and all with fevers over 104 degrees.... We'd hitch a flat car to a handcar with wire, put a board floor on, mattresses over that, plenty over covers and a canvas to cover the top and break the wind, and we'd carry patients 15 or more miles to a decent bed and a chance to live.... Everybody worked hard and long with unselfish spirits."

The elections in Michigan coincided with the peak of the pandemic. The U.S. Senate election turned on a slim majority-less than 4,000 votes, and there certainly were more than 4,000 people laid low with the flu.

In late October in Detroit, an eighteen-year-old boy named John Carrico noted that his father "went on home and remained at home until about three o'clock. When he got back, he called up the Red Cross headquarters and told them to send a nurse out to our house tomorrow morning. He certainly is scared of the Spanish influenza. I never saw anyone so scared as he is. If fright will make you sick, well I do believe he will catch the ‘flu' as sure as anything." Though his father's fears were typical, and many around him did have the flu, he wasn't actually sick.

In Flint, people complained over how many physicians had been drafted. Observing that another doctor in town had been drafted into military service, resident William W. Clark asked, "Should not our citizens as a unit stand behind our board of health in protest to the government against further drafts...until this epidemic has abated?"

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes again, it will strike in Michigan.





Minnesota State Summit: History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
December 14, 2005

Here in Minnesota, the Paulson family was one of the first to be touched. The Paulsons were residents of the town of Wells, about a two-hour drive to the southwest from Minneapolis.

Marie Paulson had sent three of her seven children off to the Great War. On September 14th of 1918, she received word that her 22-year old son Walter had caught pneumonia. Within three days, Walter was dead. A day after Walter was buried in Wells, his brother Raymond fell ill. Raymond would die, and so would his sister, Anna Valerius.

That was just the beginning. On September 25th, the Surgeon General announced that the first cases of influenza had been discovered in Minnesota. Here in Minneapolis, a large number of army recruits who were being temporarily housed at the University of Minnesota became ill.

In less than a week after influenza was first reported, there were more than 1,000 cases in Minneapolis. On October 10th, all public meetings were banned. On the 11th, all schools, churches, theaters, dance halls and billiard parlors were closed.

As in Cedar City, the disease continued to spread. By October 17th, the Minneapolis City Health Commissioner estimated that nearly 3,000 people had died due to the disease.

By the time the pandemic was finally over in Minnesota at the end of 1920, more than 75,000 people had been sickened. Nearly 12,000 were dead.





Mississippi State Summit

Opening Remarks Prepared for Delivery
By the Honorable Alex Azar
Deputy Secretary of Health and Human Services
May 1, 2006

We are also seeing some of the same symptoms from victims of the 1918 strain in victims of today's H5N1. If the H5N1 strain, or any other strain of animal influenza, were to develop into a pandemic strain, no one would have immunity. Let me tell you a little about how Mississippi was affected by the 1918 pandemic.

It appeared to come on slowly in the last days of September 1918. Initial reports included "a few cases...from Montgomery and Leake Counties and suspected cases from Meridian."

The situation quickly worsened. One week after it appeared, Mississippi officials reported to the U.S. Public Health Service that "epidemics have been reported from a number of places in the State," and, "the epidemic is spreading rapidly." By the middle of October, thousands of cases around the state had been reported. And the rates of infection continued to grow.

In fact, in the last days of October, more than 6,000 new cases of the flu were occurring every day-the flu was everywhere, and no one was safe.

In 1918, as today, Brooklyn, Mississippi was the rural home to the Forrest County Agricultural High School. Occupying one of the highest points of land in the neighborhood and situated a mile from the small village of Brooklyn, the school was relatively isolated by nature and their self-imposed quarantine.

Consequently, the flu did not reach the school in the earliest stages of the pandemic. This gave the U.S. Public Health Service Assistant Surgeon General C. Armstrong the opportunity to experiment with a promising new vaccine to inoculate against the flu. This, however, proved unsuccessful.

In early December, the school was forced to shut down as more than 45 percent of the students-both vaccinated and unvaccinated-fell ill.

State health reports said, "It is the consensus of opinion of all who observed these cases that there was nothing special in character which differentiated the unvaccinated from the vaccinated."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Mississippi.





Montana State Summit

Opening Remarks Prepared for Delivery
By Dr. Ken Moritsugu
Deputy U.S. Surgeon General
May 22, 2006

That Great Pandemic also touched Montana.

By the time that Montana officials made their first report to the U.S. Public Health Service on October 4, 1918, the pandemic was already sweeping across the state.

They failed to report for the next two weeks, probably because they were so overwhelmed in combating the disease. By October 21, officials made a report, which although "very incomplete," still told of more than 3,500 cases of flu.

Montanans became desperate as thousands became sick and hundreds died. When traditional medicines failed, residents of Butte turned to the herbal remedies of Chinese physician, Dr. Huie Pock. His patients claimed that the remedies saved lives. If they did, they did not get to nearly enough people.

Loretta Jarussi of Bearcreek, Montana recalled young, healthy people passing through her tiny town, only to be reported dead two days later.

Jarussi said:

People would come along, and...they'd stop and say hello to us. My mother was very friendly. She loved to see those people. She was kind of lonesome there, you know, just us kids and her. So when anybody passed by, she always stayed with them. And, you know, maybe a week later, they'd say so-and-so died, and they had been past our place. So many people had that flu, and young people, and they died.

She also recalled what happened when her father contracted the flu. By the time he took the third dose of medicine prescribed by an Army doctor, he felt certain he was going to die.

He called all the kids around the bed and said, "This is for you," and "You're supposed to do this," and, "This is yours," etc. Then he kind of went into . . . I don't know . . . a sleep, a deep sleep. And Mama thought-she really did-he had died, but he came out of it, and he felt better. But it took two years to get over that.

Loretta's father was far from alone.

On November 1st, Montana officials said that at least 11,500 people had been afflicted with the flu over the past three weeks. The toll could have been higher, since officials admitted that their reports were incomplete.

The final tallies of suffering will never be known, but echoes of suffering and loss remain.

When it comes to pandemics, there is no rational basis to believe that the early yeaWhen it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Montana.





Missouri State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 23, 2006

That Great Pandemic also touched Missouri.

It began burning in both big cities-St. Louis and Kansas City-at about the same time, the first week of October in 1918.

On October 7th, Henry Keil, the Mayor of St. Louis issued a decree closing "all theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions."

Not long afterward (October 17th), the Kansas City Star proclaimed, "A DRASTIC BAN IS ON." It was.

Ordered closed immediately and indefinitely were all schools, churches and theaters. Public gatherings of 20 or more people were all prohibited, including dances, parties, weddings, or funerals. Crowding in stores was banned. Streetcars were forbidden to carry more than 20 standing passengers. Elevators were sterilized once a day. Telephone booths were sterilized twice.

Yet the pandemic continued to burn across the state. And scoundrels and heroes stepped forward to seize the opportunity it wrought.

One Missouri physician wrote to the U.S. Public Health Service offering to sell his miracle influenza cure for the "nominal price of $4.50 per patient." In case the Public Health Service thought that too high a sum, he also offered his services to the Army medical department at a surgeon major's pay.

Meanwhile, students at the American School of Osteopathy in Kirksville, Missouri (in the northern part of the state, about four hours from St. Louis)], graduated early so that they could join the fight against influenza.

Despite all those efforts, the pandemic still took a terrible toll. By the end of October, more than 21,000 Missourians had been stricken. More than 500 had perished.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Missouri.




Nebraska State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of the Department of Health and Human Services
February 23, 2006

That Great Pandemic also touched Nebraska.

No one knows when it first came, but by October 1st, 1918, it was already burning throughout the state.

On October 7th, there were 400 cases of influenza here in Lincoln. Twenty-five hundred more were reported in Omaha (whose population at the time was about 177,000). Rural doctors were taxed to their limit, since by mid-October, some counties were reporting between 250 and 500 cases each day. During the single terrible week when the pandemic peaked (Oct 26th), nearly 21,000 Nebraskans were stricken. Almost 1,500 died.

During the desperate month of October, Nebraskans did all they could to control the contagion. The mayor of Hastings (located about an hour-and-a-half drive west-south-sest from Lincoln) issued an order closing theaters, churches, schools, pool rooms and card rooms. Schools were closed in Omaha. Indoor meetings were banned, and church services were moved outside.

Home remedies were as prevalent as they were ineffective. The Hastings Tribune recorded that some Nebraskans wore garlic amulets. Vick's VapoRub was recommended. So were Vacona, a medicated salve, and something called Dr. Pierce's Golden Medical Discovery.

Nothing worked. By the time that the pandemic finally passed, state doctors estimated that nearly 3,000 Nebraskans had perished because of it.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Nebraska.





New Hampshire State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
May 26, 2006

That Great Pandemic also touched New Hampshire.

It came here from Massachusetts, though no one is exactly certain when. But, by the end of September, influenza was already an inferno.

Here in Concord, a former mayor named Charles Corning reported, "Grippe [influenza] is sweeping over Massachusetts and New Hampshire as fire shrivels the fields, laying out communities and taking a toll of death unprecedented."

He continued, "A heavy sense of anxiety and apprehension like a dismal cloud in midsummer weighs heavily upon us because of the deadly ravages of the so-called Spanish influenza. Funerals jostle one another so the sable procession goes on."

The pandemic caused shortages of essential workers. Thirty to forty percent of the employees at the New England Telephone and Telegraph Company were sick, and so the company took out ads, imploring customers to cut out unnecessary calls and not to ask for the operator.

There were also terrible shortages of doctors and nurses. During the peak of the pandemic (around mid-October), a public health worker from the town of Berlin (located in northeast New Hampshire) reported:

It is hardly possible for me to describe the conditions in this community. I am the only experienced public health worker here with the exception of the staff. Saturday, I cared for forty patients, from four to nine sick in one family. Everything possible is being done. There are only seven doctors in the city.

The final toll that the pandemic took in New Hampshire will never be known. But the echoes here remain.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to New Hampshire.





New Jersey State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
May 31, 2006

That Great Pandemic also touched New Jersey.

The first person to fall victim to the Spanish Flu in New Jersey was a soldier at Fort Dix who had just returned from Europe. It was the ultimate irony: to survive the perils of the battlefields of the Great War, only to fall deathly ill once returning home.

In the fall of 1918, that irony was beginning to play out throughout the country and around the world. Many others would suffer that same cruel fate in the days ahead.

On September 27th, the state health officer announced that the disease "was unusually prevalent" throughout the state. Within the next three days, more than 2,000 new cases were reported.

Scarcely a week later (October 6th) that terrible tally of the afflicted was equaled in a single city-Gloucester City (near Philadelphia).

The speed with which the disease killed was as shocking as the number of people it affected. One insurance agent recalled that, during the pandemic, "deaths were so sudden that it was almost unbelievable. You would be talking to someone one day and hear about his death the next day."

A New Jersey physician said that it was a common experience to speak with someone who appeared to be healthy one day and then come across them a few days later on the autopsy table.

New Jersey battled the disease as well as it could. On October 10th, the state banned all public gatherings.

Some experimented with a new vaccine. When it failed, alternative "medicines" were used, ranging from whiskey to red onions and coffee.

None of them worked.

In Newark, the city's medical community tried a large-scale public education campaign. They sent pamphlets on prevention and treatment to every household. Crowds were avoided and public funerals were banned to prevent the spread of the disease.

But despite these efforts, the disease raged on.

Medical facilities were quickly overwhelmed. The city of Newark purchased a vacant furniture warehouse to be used as an emergency hospital to help handle the overflow. Nurses and physicians were in short supply as well, as so many of New Jersey's healthcare professionals were in the war effort overseas.

Those health care workers who could help worked around the clock to do whatever they could. One physician treated more than 3,000 patients in one month. He recalled:

There was no need to make appointments. You walked out of your office in the morning and people grabbed you as you walked down the street. You just kept going from one patient to another until late in the evening.

Still, the dead bodies accumulated faster than they could be buried. At first, city employees and firemen helped to dig graves. Then teams of horses were used to plough trenches which could be used as mass graves.

On a single day-October 22nd-more than 7,000 new individuals were afflicted, and 366 were lost. Incomplete reports to the U.S. Public Health Service show that by that day, more than 150,000 New Jersey residents had been sickened with the flu. More than 4,400 had died.

By November, the disease finally began to relent, but countless families lay devastated in its wake.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to New Jersey.





New Mexico State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 28, 2006

That Great Pandemic also touched New Mexico.

No one is sure when the pandemic first arrived, though it may have been carried into Carlsbad (southeast corner of the state) by members of an out-of-own circus. On October 4th, there were reports of "a few cases" in "several places." A week later, epidemics were reported in Albuquerque, Gallup (west of Albuquerque), and Carlsbad. And the pandemic continued to spread.

In some cases, Smith and Wesson and Colt stood in the way. Fearing introduction of the disease, armed vigilantes from across the state stopped trains from flu-ridden regions and forced passengers to get back aboard and return from where they came.

Those fears were well founded. The flu was afflicting thousands of New Mexicans, and claiming the lives of hundreds.

But on one occasion, fear proved more fatal than the flu itself.

A Las Vegas (east of Santa Fe) family, the Gardunos, all fell ill with influenza. Mrs. Clara Garduno succumbed to the disease first, and was soon pronounced dead. Health Department officials demanded that she be buried immediately to prevent the spread of the disease, and her husband secured the services of an undertaker.

Because three of her children were also very ill at the time of her death and not expected to survive, Clara's grave was left uncovered to allow prompt burial of the children as soon as they too perished. Two of the children died the next day, and as the undertaker began to bury the children, Frank Garduno asked to see his wife's body one last time.

To his horror, he discovered that his wife had not been dead at the time she was buried after all. In his fear and haste to bury influenza victims, the doctor who had pronounced Clara dead had been mistaken. She had been buried alive, only to suffocate in her coffin.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to New Mexico.





New York State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
July 27, 2006

That Great Pandemic also touched New York.

The first sparks appeared during the last week of September 1918, when some 61 New Yorkers were diagnosed with the Spanish flu.

The pandemic soon became a raging fire. Less than two weeks after it first appeared, more than 2,500 New Yorkers were afflicted. Tens of thousands would follow them to the hospital. Thousands would follow to the morgue.

Nearly 4,000 New Yorkers perished from the pandemic during the first three weeks of October. At the same time, more than 4,500 more died in cities all across the state. In Rochester, 213 perished in one week.

Doctors fell alongside the patients they were caring for. One was Dr. George Gorrill, the superintendent of Buffalo State Hospital. There were far too few caregivers to begin with, for their thin red line had been stretched taut by the demands of World War I.

In an effort to fill those depleted caregivers, the junior and senior classes of the Buffalo Medical School were pressed into service. Shortly afterwards, the sophomore class joined them.

But there were still too few to care for all that had been afflicted. Acting Health Commissioner for the City, Franklin Gram said:

“It was no uncommon matter to find persons who had waited two or three days after having repeatedly phoned or summoned physicians, suffering and dying because every physician was worked beyond human endurance.”

All across the state, entire families were stricken with the disease at once.

In Albany, the Altman family, including nine-year-old Stella, her mother, and her three younger siblings, fell ill. Stella later remembered, “There was no help to be found anywhere; everyone was too busy caring for their own families.” Stella’s mother died, but the children could not attend her funeral, for they were too ill.

The Steins of New York City’s South Center Street were also afflicted. A charity worker who checked in on them found a baby dead in its crib and the remaining seven members of the family seriously ill.

In Brooklyn, a man named Michael Wind was six years old when the flu came to the city. He remembered:

When my mother died of Spanish influenza, we were all gathered in one room, all six of us, from age two to age twelve. My father was sitting beside my mother's bed, head in his hands, sobbing bitterly. All my mother's friends were there, with tears of shock in their eyes. They were shouting at my father, asking why he hadn't called them, hadn't told them she was sick. She had been fine yesterday. How could this have happened?

Unable to cope, Wind’s father left his children at the Brooklyn Hebrew Orphan Asylum. The Asylum was soon filled with 600 children, most of them orphaned by the flu.

The great pandemic filled not only the orphanages of New York City, but also its hospitals and morgues. More than 90,000 New Yorkers were eventually afflicted. More than 12,000 perished.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to New York.





North Carolina State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 21, 2006

That Great Pandemic also touched North Carolina.

The pandemic appeared in late September of 1918. On September 27th, 400 cases were reported in Wilmington. Additional cases were reported here in Raleigh.

It then spread like wildfire across the rest of the state. By October 4th, influenza was striking people in 24 counties, and epidemic in Raleigh and Wilmington. It burned through Fayetteville not long afterward.

Authorities did what they could to contain its spread. On October 5th, the State Board of Health called on the authorities of communities where the pandemic appeared to "promptly . . . close the school and all public meetings."

However, Dr. W.S. Rankin of the State Board of Health refused to approve the use of rum in emergency hospitals due to lack of evidence that it was effective against influenza. Instead the Board called for treatments of "sunshine and open air." Calomel, a purgative (and insecticide), was also prescribed.

Residents suffered terribly when the pandemic struck.

For instance, Selena W. Saunders, who accompanied a nurse in the textile town of Cramerton (located a few miles west of Charlotte) recalled:

"This new disease . . . struck suddenly, spent itself quickly in a burning three-day fever, often leaving its victim dead. The people lost faith in the remedies they had relied on all their lives, and they became frantic. Some of them locked themselves in their house, and refused to open the door for anyone.... Merchants nailed bars across their doors, and served the customers one-at-a-time at the doorway. We found whole families stricken, with none able to help the others. In one family the mother died without knowing that her son, who lay in the adjoining room, had died a few hours earlier."

In the city of Goldsboro, a resident named Dan Tonkel remembered:

"I felt like I was walking on eggshells. I was afraid to go out, to play with my playmates, my classmates, my neighbors. I was almost afraid to breathe. I remember I was actually afraid to breathe. People were afraid to talk to each other. It was like-‘don't breathe in my face, don't even look at me, because you might give me germs that will kill me.' "

Tonkel added:

"Farmers stopped farming; merchants stopped selling. The country more or less just shut down. Everyone was holding their breath, waiting for something to happen. So many people were dying; we could hardly count them. We never knew from one day to another who was going to be next on the death list."

By the time the pandemic passed, at least 13,000 North Carolinians had perished.

One of the victims was Ernest Carroll, who may have been infected while he was serving soup to those afflicted with influenza at the Tabernacle Baptist Church here in Raleigh. After he passed, Temple Baptist named its kitchen and dining hall after him.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to North Carolina.





Nevada State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 17, 2006

That Great Pandemic also touched Nevada.

In 1918, Nevada's statewide population was less than four percent of what it is today-just 77,000 people. Yet between mid-October and late November, the state reported several hundred cases of the Spanish flu, as well as scores of deaths from it.

The exact numbers of Nevadans affected by the flu will never be known, because regular reports to the U.S. Public Health Service were never made.

Yet Nevadans reacted to the flu as those in so many other states did: City ordinances were passed that mandated the wearing of facemasks in public. All public gatherings were banned. In White Pine County (located in east-central Nevada), a countywide quarantine was enforced for over two and half months to help quell the spread of the pandemic.

Nevada even considered establishing quarantine stations along the state's borders to secure it from the disease.

However, these precautionary measures were not always popular. In Elko County (located in north-east Nevada), a schoolteacher named Eleanor Holland complained to fellow teachers that mandatory mask wearing was a ridiculous burden.

A short time later, she contracted the flu and nearly lost her life. She later recalled, "It didn't seem so funny when I came down with the flu and nearly died. Fortunately, none of the other teachers got it though they all helped take care of me."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. This is not Stephen King. It happened in 1918, and if a pandemic strikes, it will come to Nevada.





North Dakota State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 9, 2006

That Great Pandemic also touched North Dakota.

On September 27, 1918, the Bismarck Tribune reassured readers worried about the Spanish flu, noting, "Doctors believe that if the people of North Dakota exercise ordinary care they need not fear the ravages of this disease."

They could not have been more wrong.

The first official notice that the flu was in North Dakota came to the U.S. Public Health Service in early October, when 75 cases were reported in Rockford in Eddy County (three hours to the northeast of Bismarck).

The onset of the flu was sudden and devastating. In less than a week, an optimistic Fargo Forum headline: "Spanish Influenza Hasn't Hit Fargo," yielded to a report of more than 100 cases.

North Dakotans tried to stem the rising tide of the disease. Schools, churches, and businesses were closed. Public gatherings of any kind were banned. All places of amusement, including dances, theaters, and pool halls, shut their doors. Transporting patients with influenza on trains became a crime.

Nothing worked. And North Dakota's health care community was overwhelmed.

By the second week of October, nearly 6,000 people had been afflicted. Hundreds died. The young and healthy were the worst struck. Of 173 listed influenza deaths in the Fargo Forum, 122 (70%) were between the ages of 18 and 35.

One was Christian G. Lucas, the eldest son of the mayor of the city, who died at the age of 21. Christian was a young man of great promise who wanted to do his part in the war effort. He entered the hospital the very day he received his induction orders from the Naval Aviation Corps.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to North Dakota.





Ohio State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
February 17, 2006

That Great Pandemic also touched Ohio.

It was already raging by the time the first cases were reported to the U.S. Public Health Service on October 4th.

Ohioans reacted like many others across the country in attempting to contain the disease-they banned public meetings, closed the doors of colleges and public schools, and outlawed behaviors thought to spread the disease, such as spitting.

All was to little avail.

As the disease continued to spread, makeshift hospitals were set up to treat the sick. One such auxiliary hospital was the Majestic Theater at Chillicothe, Ohio (located about 45 miles south of Columbus), where there were so many victims that they were described as being, "stacked like cordwood."

The flu-and the fear of it-was everywhere. Advertisers and opportunists used it to sell their goods. It even featured in the popular cartoon, "Polly and Her Pals." It depicted the protagonist wearing a "bacteria bib" and bemoaning the fact that she never caught anything as "fashionable" as the Spanish influenza.

But thousands in Ohio did catch the flu. By the last week of October, Ohio reported 125,000 cases of the Spanish flu. That week, more than 1,500 Ohioans died.

More continued to fall. One Ohioan who died was the father of former (Ohio) Governor Jim Rhodes. Another was a nun, Sister Raphael O'Connor, who died just days before her fifty-eighth birthday while nursing influenza victims.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. This is not Stephen King. It happened in 1918, and if a pandemic strikes, it will come to Ohio.




Oklahoma State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 29, 2006

The Great Pandemic also touched Oklahoma.

The pandemic made its first appearance on September 26th, by bracketing Oklahoma City with simultaneous eruptions in Tulsa (northeast of Oklahoma City) and Clinton (southwest of Oklahoma City). By October 4th, more than 1,200 Oklahomans in 24 counties had been afflicted with the flu.

The pandemic raged through Oklahoma throughout the terrible month of October.

In Tulsa, an emergency hospital was opened under the aegis of the Red Cross. Some 260 Tulsans were eventually admitted. Twenty eventually died.

Here in Oklahoma City, the Food and Drug Administration had to cancel a previously scheduled meeting. Three hundred people in the city were sick with the flu, making anything of the sort simply impossible.

Doctors spent themselves to the limit in helping those afflicted by the pandemic. In the city of Enid (north of Oklahoma City), a patient being cared for by Dr. David Harris remembered him chewing on a snatched drumstick, trailing broth across the bed sheets, and taking a pulse with his free hand.

But despite those exhausting efforts, the pandemic still took a terrible toll in Oklahoma.

No one can be sure of the total losses Oklahoma suffered, but when it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Oklahoma.




Oregon State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 30, 2006

The Great Pandemic also touched Oregon.

No one is certain when it first did so, for by the time the first reports were made in mid-October, the pandemic had already erupted all over the state—from Pendleton (in the northeast corner) to Portland, and from Baker (near Pendleton) to Eugene.

The city of Medford (located in south-central Oregon) became the first to impose a ban on all public gatherings, when E.B. Pickel, the Health Officer, and C.E. "Pop" Gates, the mayor, issued an edict closing "all places of amusements, theaters, moving picture shows,... churches, lodges, schools, and all public meetings of every description where people congregate—same to be in effect until said epidemic has subsided."

When the situation became worse, the city required all residences where someone had been afflicted with the flu to post a blue sign with the words, "Contagious, Influenza" prominently displayed.

Later in the pandemic wave, the Medford City Council issued an order requiring all persons in the city conducting business, riding, or walking the streets, to wear masks. There weren't enough masks at first, so all types of masks "from women's veils to handkerchiefs" were used.

Local Red Cross volunteers made masks for Medford, and they provided vital services in other communities as well. For instance, in Klamath Falls (located west of Medford), Red Cross volunteers not only made masks, they also made pneumonia jackets (of warm flannel), and other needed articles. The need for such supplies was so severe that the Red Cross kept its doors open seven days a week simply to keep up.

One public health nurse reported dire circumstances from the countryside. She declared, "there is no food, no bedding, and absolutely no conception of the first principles of hygiene, sanitation, or nursing care."

There were some stories of success. For instance, a four-year-old from Portland reportedly recovered from the flu after her mother dosed her with onion syrup and buried her from head-to-toe in glistening raw onions—for three full days.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Oregon.





Pennsylvania State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 20, 2006

That Great Pandemic also touched Pennsylvania.

Earlier, I noted John Barry's description of what happened in Philadelphia. Let me give you a fuller picture now.

On September 27th, 1918 Pennsylvania optimistically reported that "comparatively few cases" had been reported among the civilian population. Then influenza took hold.

On October 4th, the state reported that the disease was epidemic in Pittsburgh and Philadelphia. Nearly 15,000 cases were counted in the first 18 days of October, and the dreadful toll continued to climb.

Philadelphia was one of the hardest hit cities in United States. As the disease spread, essential services collapsed. Nearly 500 policemen failed to report for duty. Firemen, garbage collectors, and city administrators fell ill.

The city's only morgue overflowed. It was built to handle 36 bodies, but contained more than 500. Bodies accumulated in the morgue's hallways and lay there rotting. Five supplementary morgues were eventually opened. Convicts were recruited to dig graves. There were never enough coffins, and people would steal them from undertakers when they could.

Public gatherings were banned to restrict the spread of the disease. Streetcars were shut down. Schools, churches, and places of public meeting were closed, and so were theaters and places of amusement.

The human cost was unbearable.

Selma Epp remembered her family's experience with the flu:

"[We] made up [our] own remedies, like castor oil [and] laxatives...everyone in our house grew weaker and weaker. Then my brother Daniel died. My aunt saw the horse-drawn wagon coming down the street. The strongest person in our family carried Daniel's body to the sidewalk. Everyone was too weak to protest. There were no coffins in the wagon, just bodies piled on top of each other. Daniel was two; he was just a little boy. They put his body on the wagon and took him away."

While the disease was raging in Philadelphia, some 50,000 people in Pittsburgh were being afflicted. So were thousands of others throughout the state.

Nearly 24,000 Pennsylvanians died during the first month of the disease. By October 25th, after the first wave of the pandemic had passed, it was estimated that 350,000 people had been struck with the flu (about 150,000 of whom were Philadelphians).

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Pennsylvania.





Rhode Island State Summit: History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
January 13, 2006

All of New England was affected by the pandemic. It was first noted in Massachusetts and then rushed like a wildfire through the rest of the region.

It is not certain exactly when in September of 1918 that the pandemic first reached Rhode Island, but it is certain that the toll was terrible.

One of those it took that sad September was a young sailor named John Stanley Harman. His tragic story was told by the Providence Journal. John was a hospital apprentice in the Naval Reserve. After nursing two men though the flu, he too was struck down.

John lived only 36 hours afterwards. A Miss Alice Wood was at his bedside when he died. She was John's fiancée. They were to have been married on October first.

During the pandemic, Rhode Island experienced shortages of medical personnel. Part of that shortage was due to the pandemic taking down trained personnel. It was also due to the fact that three-quarters of Rhode Island's nurses (230 of 300) had volunteered for national duty during the pandemic's early stages.

Because of the shortage, student nurses took to caring for patients. They were busy. Emergency hospitals were set up in several Rhode Island cities: Pawtucket, Woonsocket, Warwick and Westerly. In Westerly, an abandoned school was turned into a hospital - complete with new wiring and new plumbing - almost overnight.

Many of those not caring for the sick were trying to contain it in other ways. In Providence, as in many other places, there was a debate about whether or not to cancel all public gatherings.

One of the surprising dissents came from Charles V. Chapin, the head of the Rhode Island Department of Public Health and a nationally recognized expert in public health.

Dr. Chapin said that banning all assemblies would do little good since the disease had already spread through the state. He said that the disease would have to take its course - and take with it as many as it would.

The toll was as grim as Dr. Chapin's advice. By the first week of November, the state was reporting "50 deaths per day" to the U.S. Public Health Service. By the time the pandemic flu finally departed, between 2,000-2,500 Rhode Islanders had fallen to it.





South Carolina State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 2, 2006

That Great Pandemic also touched South Carolina.

The first mention of influenza in South Carolina appeared on September 27, 1918 in the state's public health reports. Four days later, a telegram reported 1,500 cases in the state.

By the end of that month, an estimated 80,000 cases had occurred, resulting in some 3,000 deaths.

While overall figures for the state cannot be known for sure, it is clear that thousands of cases each week sprung up in cities around the state during the high points of the pandemic. Columbia, for example, endured 4,427 cases during the second week of October.

Nearby, the disease also struck hard at Camp Jackson. There, the base hospital overflowed with men too ill to stand, and an entire section of the camp became an extension of the hospital. More than 5,000 soldiers were treated for influenza and approximately 300 died from the disease.

Here in Columbia, at the time there were two hospitals: Columbia, with about 100 beds, and Baptist, which had less than 50. With a citywide population of more than 37,000, these hospitals were completely overwhelmed by the pandemic.

Columbia, and all of South Carolina, reacted as many states and cities around the country did:

Schools and businesses were closed, public gatherings were banned-even the state Supreme Court shut its doors. The wearing of gauze masks was strongly encouraged, and institutions with space to spare, such as the University of South Carolina, became auxiliary hospitals.

Eucapine, Vick's VapoRub, and other patent medicines became popular and were touted as cures. The governor even permitted the use of then-illegal alcohol because doctors were advocating its use as a remedy and nothing else seemed to be working.

Even as late as 1920, the pandemic wore on in South Carolina.

On January 26, C.V. Akin, an epidemiological aide stationed in Columbia, sent a telegram to U.S. Surgeon General Rupert Blue:

"Reports indicate existence [of] influenza [in] mild epidemic form [in] South Carolina... No great concern felt but if disease continues spread considerable suffering will be occasioned by total lack nurses who will undertake epidemic duty. [The] Secretary [of the] State Medical Association wishes to know what material help can be expected from service if epidemic becomes serious. Please advise..."

On the same day, Surgeon General Blue responded:

"General relief [for] influenza not available under current epidemic appropriation which provides during this year [for the] control [of] interstate spread only. Consequently [we are] unable [to] render intrastate assistance. Application for nursing assistance should be made direct to local Red Cross chapter or Division Manager."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to South Carolina.





South Dakota State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 9, 2006

That Great Pandemic also touched South Dakota.

In late September, the State reported "a few scattered cases" to the U.S. Public Health Service. Within a week, there were a few hundred. And the virus continued to spread.

Governor Peter Norbeck came down with the disease after a business trip in Lusk, Wyoming, and was admitted to St. Joseph's Hospital in Deadwood (six hours west of Sioux Falls, just 15 miles east of the Wyoming border). The governor survived, but others were not as fortunate.

South Dakotans tried to dam the rushing flow of influenza with preventative measures and sanitary ordinances.

Public gatherings were banned. Churches, theatres, schools, pool halls, and other public places were closed indefinitely. The University of South Dakota closed its doors. All funerals were to be held outdoors to avoid passing the disease among dense crowds.

In Rapid City, spitting on the sidewalks was made illegal. No one was exempt. A city police officer was arrested under the statute and fined $6 for committing the offense-a considerable sum in 1918.

In some cities and towns, pedestrians were even required to carry a doctor's note verifying that they had already had and recovered from the flu and were, therefore, no longer capable of catching or spreading the disease.

Newspapers suggested Hood's Sarsaparilla, Pepitron, and Foley's Honey and Tar as cures. They also offered advice to help people avoid the flu, such as:

"When talking to another person stand at least two or three feet away."

"Keep yourself comfortably dressed and eat plenty of wholesome foods."

"Keep your home well ventilated and have plenty of fresh air in it at all times."

But nothing seemed to work. By the time the pandemic finally peaked, thousands of South Dakotans had been afflicted. More than 200 had perished.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to South Dakota.





Tennessee State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
April 10, 2006

That Great Pandemic also touched Tennessee.

It began in late September with "two suspicious cases" being reported in Memphis. Four days later, that number leapt to 95 cases. By the middle of the month, Memphis alone was fighting more than 6,000 thousand cases of the flu and it was spreading from urban to rural areas.

The situation in Nashville was even worse.

At the height of the pandemic, Nashville had scarcely 250 doctors. Many of the physicians succumbed to the flu themselves.

Shortages of essential personnel often compounded the crisis even further. A lack of sanitation workers in the city allowed sewage to accumulate in the streets, raising concerns about other diseases.

Emergency hospitals could not be opened to accommodate the growing numbers of patients because they could not be staffed. Most patients were isolated in their homes and treated there, if they could get medical attention at all.

A physician attending a father in a family of 11 told him that he had contracted the flu from his family. When he asked his patient who would care for them, the father could only reply, "I don't know."

That was true for Tennesseans all across the state.

Those sickened were often left to fend for themselves—neighbors refused to come to the aid of neighbors for fear that they too would be struck.

The disease was indiscriminant, and unpredictable.

One Tennessee physician wrote in his medical journal: "The man who dug his neighbor's grave today might head the funeral procession next week. No telling who would be next."

People fought back with what they had.

All across the state, businesses deemed nonessential were told to close. Schools and churches were shut down and public gatherings were to be avoided whenever possible. The Nashville Street Railway and Light Company was instructed to run their cars with the windows open to allow the cars to air out.

Dr. E.L. Bishop, of the state Board of Health, offered his advice by condemning "promiscuous kissing ...especially that of the nonessential variety." He said, "[a] kiss of infection...may truly be the kiss of death."

One judge authorized the then-prohibited liquor that had been seized by the police for use as a treatment for influenza. The city health officer was promptly inundated with demands for the "remedy." According to the local paper, supplicants "thronged [his]...office and overwhelmed the luckless physician. Business was halted—but there was no halt in the tramp, tramp, tramp of the boys marching up the steps to the office."

The tramp, tramp, tramp of tragedy marched on too.

No one knows how many Tennesseans were afflicted. But in the last two weeks of October, when the pandemic was at its peak, nearly 11,000 people were struck. More than 650 fell. Across the course of the pandemic, one historian estimated that Nashville alone battled some 40,000 cases, and lost 468 people.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Tennessee.





Texas State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 27, 2006

The Great Pandemic also touched Texas.

Reports of pandemic fears preceded the disease into Texas by about two weeks. But by September 23, there were definite accounts of it near Austin and Dallas. On October 4th, 35 counties were reporting the presence of influenza, with anywhere from one to 2,000 cases per county.

The pandemic kept rising. The victims kept falling. And people kept searching for ways to contain the pandemic and sustain themselves through it.

El Paso imposed a quarantine.

The Dallas Morning News declared that surviving the pandemic required "medical attention, good nursing, fresh air, nutritious food, plenty of water, and cheerful surroundings."

The Texas State Board of Health offered schools several suggestions on ways to prevent flu outbreaks.

The Board wrote:

"Every day . . . disinfectant should be scattered over the floor and swept. All woodwork, desks, chairs, tables and doors should be wiped off with a cloth wet with linseed, kerosene and turpentine. Every pupil must have at all times a clean handkerchief and it must not be laid on top of the desk. Spitting on the floor, sneezing, or coughing, except behind a handkerchief, should be sufficient grounds for suspension of a pupil. A pupil should not be allowed to sit in a draft. A pupil with wet feet or wet clothing should not be permitted to stay at school."

But despite those efforts, the pandemic took a terrible toll on Texas. By the end of October, more than 106,000 Texans in the state's urban centers had been afflicted. More than 2,100 had died.

The echoes of fear and loss resounded loudly—so loudly that when 221 cases of influenza were diagnosed in Dallas over a year later (January 25th, 1920), the State Director of Public Health sent an urgent message to Surgeon General Rupert Blue advising him of the situation and asking for his guidance on any other control measures other than the general ones already being applied. The Surgeon General sent back simply, "Service has no additional measure to suggest."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Texas.





Tribal Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
May 18, 2006

Great Pandemic also touched tribes.

A group of Indian students in Lawrence, Kansas were the first to feel its bite, in March of 1918. The pandemic retreated, but then returned with terror in the fall.

Few American newspapers carried stories about what was happening, but by October 14th, the Commissioner of Indian Affairs was requesting aid for those that were falling ill on various reservations.

The Navajo were especially hard hit. Cases of abandonment by relatives were common because the disease was so widespread and so feared. A trader named Joseph Schmedding who entered a Navajo reservation a few weeks after the pandemic erupted, found 30 Indians, young and old, lying dead in abandoned hogans.

In Tuba City, on the Navajo reservation in Arizona, a school was converted into a hospital. The wife of a Navajo trader wrote, “For miles around every good winter hogan was deserted [because of fear of the infection]. The living moved out into the rain and found what shelter they could in deserted camps.”

In Utah, the spread of the disease was helped by the traditional burial practices of the Pahvent Indians (members of the Ute tribe), who were camped near the town of Meadow. One white who visited the camp said, “There were lots of dead bodies in tents and families...around dead bodies...singing and chanting.” Meadow’s only doctor was sick with influenza, and could not and did not treat the Indians in the area.

In Alaska, the pandemic swept through communities, killing entire villages of Eskimos and Alaska Natives. A schoolteacher reported that in her immediate area, “Three [villages were] wiped out entirely, others average 85 percent deaths…. Total number of deaths reported 750, probably 25 percent . . . froze to death before help arrived.”

An Eskimo village near Nome, Alaska was decimated: 176 of 300 died. The disease spread rapidly, and entire families too sick to feed their fires froze to death in their homes. Spit the Wind, a 25-year-old considered Alaska’s greatest musher, died. He had survived a grueling expedition to the North Pole during which he had been forced to eat his snowshoe lacings, before the pandemic caught him.

Many Eskimos and Alaska Natives were so sick that they were unable to chop wood and harvest moose. Consequently, they died of starvation after the pandemic passed.

Final tallies will never be known but it was estimated that about 24 percent of the Indians living on reservations across the United States were afflicted by the pandemic. Of those, nine percent died.





Utah State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 24, 2006

The Red Cross held a fundraiser in Cedar City. The organizers created a goddess of Liberty, and following the statewide practice of wearing masks, also put one on her.

Similar measures were applied elsewhere. All across the state, church meetings, private parties and all public gatherings were cancelled or limited. Spitting was fined. Facemasks were mandatory.

Ogden City was placed under quarantine. No one could come in or out without a note from a doctor. In Panguitch (near Brice Canyon), Margaret Callister, a young child at the time, remembered, "Dead people were all around us, three or four to a family." To keep her and her siblings healthy, Margaret's mother put sacks of herbs around their necks.

In the town of Meadow (south-central Utah), resident Lee Reay remembered:

"No one had ever seen the germs of the disease. No one knew where the germs were coming from. We only knew the germs were carried by air and had gotten inside our house. We plugged up the keyholes with cotton so air couldn't get in, sealed the doors and the cracks around the doors because we thought the outside air was contaminated. One particular family, I remember, closed up every possible avenue of letting fresh air into the house. They even closed the damper on the stove. They plugged up keyholes on the door, sealed windows and stayed inside, re-breathing their own air."

When the town's only doctor became sick, Martha Adams, a local healer gave some herbs to William Reay. He stewed the herbs and added other ingredients (including bacon and honey). The "medicine" was bottled and labeled "Influenza Medicine." Reay's son remembered "it wasn't real medicine, of course, but it made people feel better because they thought it was medicine."

Others tried alcohol. Although Utah was a dry state, health officials allowed doctors to administer it as a preventative.

Public health measures appeared to have a positive impact in places. For instance, the mandatory wearing of facemasks in Park City (on penalty of arrest) was credited with lessening the impact of the pandemic.

But people still died. And because of the pandemic, funerals were limited in size. For instance, the service of LDS Church President Joseph Fielding Smith (who died on November 19, 1918) was attended by just a few family members.

His was just one of many. No one is certain of the final numbers, but thousands of Utahans were afflicted by influenza. Hundreds died.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Utah.





Vermont State Summit: History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
January 12, 2006

The Great Pandemic also touched Vermont.

Vermont was one of the hardest-hit states in New England. The pandemic's arrival was sudden, its spread was rapid, and its toll was shocking.

It is impossible to say with certainty how many people were touched by the flu. Physicians simply stopped reporting new cases to the Public Health Service when they became overwhelmed with treating the sick. Incomplete records of five weeks when the state was battling the flu show that almost 23,000 Vermonters were struck.

Those who were fortunate enough to escape the flu were still struck with the tragic experience of watching friends suffer and loved ones die.

One of those individuals was a man named Frank Eastman. Mr. Eastman worked for a small power company in Montpelier, which would eventually become the Green Mountain Power Corp.

He described the spread of the disease in a diary that he kept at work. On Friday, September 27, Mr. Eastman wrote that nine members of his crew were sick. The very next day, five more had fallen ill. Deaths began to occur about two weeks later. Mr. Eastman recorded, "Carpenter Wiley died this morning and the switchboard operator this afternoon."

By the time the pandemic had run its course through Vermont, countless people had been affected. Almost 1,800 people had died.





Virginia State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 23, 2006

That Great Pandemic also touched Virginia.

Navy personnel in Virginia were afflicted with influenza in early September, though the state did not report those cases for about two weeks.

By the last week of September, the pandemic had taken hold in Newport News and Norfolk, and in Petersburg and Portsmouth. It raged all across Virginia throughout the cruel month of October.

Virginians did what they could to contain it. Schools were closed. Public meetings and weekend parties were banned. Even the State Fair was closed early on account of the flu.

Doctors gave succor and support to all the patients they could, although supplies ran short and many were stricken themselves.

In Alexandria, the town's two doctors visited hundreds of patients a day, dispensing their concocted treatment of atropine capsules (belladonna) and whiskey.

In Richmond, Dr. Bernard Reams resorted to a treatment that had begun to fall from favor in the 1880s—soaking the legs and feet of his patients in scalding water and then swaddling them in blankets until they were red and sweating.

Some Virginians resorted to their own home remedies. For instance, John Brinkley, a sharecropper in the town of Max Meadows (western part of the state, about two hours north of Greensboro), believed that "a little fresh air could be fatal." So he sealed his family in his living room around a fire in a wood stove. For seven days the family remained in the room with the fire. On the eighth day, the house caught fire and the Brinkleys were forced to evacuate.

Fresh air didn't kill Mr. Brinkley's fears. And neither did influenza. But many other Virginians were not so fortunate.

By mid-October, Virginia had seen more than 200,000 cases of influenza. By the end of the year, more than 15,000 Virginians would die.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Virginia.





Washington State Summit

Opening Remarks Prepared for Delivery
By the Honorable Alex Azar
Deputy Secretary of Health and Human Services
April 14, 2006

On September 27th, 1918, Washington officials first reported the presence of influenza, saying that "a number of cases have been reported in the vicinity of American Lake." This official report came ten days after the pandemic actually appeared in the state, when recruits from Philadelphia arrived at the Puget Sound Naval Yard—eleven of the recruits were ill with the flu.

On September 23rd, 10,000 people gathered to witness a review of Washington's National Guard Infantry. Though the camp's medical officer acknowledged there was a minor epidemic underway, he insisted there was nothing to worry about. His miscalculation helped enable the flu to spread. By the 25th, influenza was epidemic in Seattle.

By October 11th, Washington officials reported that "schools have been closed and public gathering prohibited at Seattle, Bremerton, Pasco, Prosser, Sultan, and Port Angeles. On October 7, it was estimated that there were 1,000 cases of influenza at Bremerton." Many of the schools that were closed didn't open until January or March 1919.

By October 18th, it was concluded that "the disease is epidemic at Seattle and Spokane." And, over that week, "7,349 cases were reported." The following week, 5,322 cases were reported.

On October 29th, Seattle made wearing masks mandatory, and the rest of the state followed suit the next day.

In Seattle, the old City Hall and one of the dormitories at the University of Washington became emergency hospitals. Public gatherings were banned, even church attendance. In response to complaints from ministers, the mayor said, "Religion which won't keep for two weeks, is not worth having."

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes again, it will strike in Washington.





West Virginia State Summit: History Supplement

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
January 12, 2006

The Great Pandemic also touched West Virginia

Charleston saw its first cases of influenza on September 28th when 7 cases occurred. Over the next five weeks, there were more than 2,300 cases, and more than 200 deaths.

More cases followed, but they were not recorded. Around the middle of November, Charleston authorities stopped reporting to the U.S. Public Health Service. It's likely that they were simply too overwhelmed.

The crisis was just as acute in Martinsburg WV (located in the northeast corner of the state). So many people were either sick themselves or were caring for people suffering that a local committee estimated that only two out of every ten people were able to attend to their normal duties.

Gravediggers could not keep up with the demands for their services in Martinsburg. For several weeks, gravediggers maintained a backlog of at least two-dozen graves, which needed to be dug each day.

Burials themselves were quick. Funerals were banned, as were all other public meetings, churches were closed and theaters were shut.

The local Martinsburg newspaper published a list of "Some Don'ts that Should be Followed, Don't Worry, Stop Talking about it, Stop Thinking about it, Avoid People who have it."

Such Don'ts were hard to do. For instance, a James Horvatt was brought to trial before the Martinsburg-area county court on September 27, 1918 for allegedly forging a $40 check. Horvatt had contracted the flu while in jail waiting his trial, and was very ill from the disease when he appeared in court.

The disease spread among those who were in the courtroom with him that day. Three lawyers who engaged in proceedings contracted influenza and died within three days after Horvatt's trial was concluded. Three others, the judge, the county clerk and the assistant prosecuting attorney in the Horvatt case, all contracted the disease and came close to death. So did their immediate families.

It was said that nearly every family lost someone. One family that experienced such a loss was that of an infant who would grow up to become one of the Nation's longest-serving Senators. The mother of Senator Robert Byrd was actually a North Carolinian. She died of influenza when he was just one year old, and an aunt and uncle from West Virginia took him in.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to West Virginia.





Wisconsin State Summit

Alex M. Azar II, Deputy Secretary
U.S. Department of Health and Human Services
March 15, 2006

Let me tell you a little about how Wisconsin was affected by the 1918 pandemic.

On October 2nd, 1918, Wisconsin's State Board of Health held a special meeting to discuss the spreading flu. They issued a series of regulations that called for "every physician engaged to treat influenza...to report [this]...to the local health officer."

In Oshkosh, on October 8th, a newspaper headline stated, "Views of doctors on how to handle grip don't agree. All say situation is serious. Some urge prompt closing and quarantines." By then 103 cases had been reported in the area. Each time a case was reported, an influenza placard was placed on the door of the residence. In accordance with state regulations, no one was supposed to enter except nurses, doctors, or clergymen. The placard read: "Warning! Influenza here. This card must not be removed without authority. Milk dealers must not deliver milk in bottles."

It wasn't until October 10th that the State's health officer, Cornelius Harper, ordered all public institutions in Wisconsin closed.

By this time, Neenah had reported its first influenza cases. And the same day, cases in Oshkosh climbed to 163. They reported having a shortage of flowers for funerals. Weeden Drug Company started to advertise for its "Spanish Flu medicines and cures," and the Oshkosh Savings and Trust Company ran several ad campaigns for wills.

Adolf O. Erickson, a hardware storeowner and Sunday school teacher in Winchester, chronicled the flu in his diary. He wrote that a physician injected eight shots of camphor oil directly into his brother's legs and arms to treat the raging temperatures caused by the flu.

On October 22nd, a vaccine from Mayo Hospital was distributed in Oshkosh. It was supplied "gratis." Three inoculations, one a week, were recommended over a period of six to nine months to "confer immunity." Many were vaccinated, but, of course, it proved tragically ineffective.

Four Oshkosh nurses served in the Red Cross—Myrtle Chapman, Nellie Folkman, Clara Barnett, and Lydia Zwicky—graduates of the training school at Mercy Hospital. They were involved in emergency work at Camp Custer that included caring for patients suffering from influenza. Through their work, all four contracted the flu. Only one, Nellie Folkman, survived.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes again, it will strike in Wisconsin.




Wyoming State Summit

Opening Remarks Prepared for Delivery
By the Honorable Mike Leavitt
Secretary of Health and Human Services
March 10, 2006

That Great Pandemic also touched Wyoming.

It is unclear when it first appeared, but by the end of September 1918, it was already raging across the state.

Communities rallied in response to the epidemic.

In Sheridan, the women of the Red Cross, who had rolled bandages and knit socks in support of the war effort, began caring for influenza victims. An emergency hospital just for influenza victims was set up in the city, yet 18 people still died.

In Thermapolis (located in central northwest Wyoming), religious authorities found themselves hard pressed. A Catholic priest there traveled long distances to care for scattered parishioners stricken with influenza. It was not uncommon for him to return after four-day trips and find that some of those in his flock had died and been buried in his absence.

In Casper, church services were cancelled and funerals were held in the open air. To limit the spread of the disease, everyone was required to wear masks while shopping, and only limited numbers of people were allowed in stores.

Children sent out of the state for schooling became victims in more ways than one. For instance, Alice Dodds, the daughter of a Wyoming rancher, contracted the flu while at a boarding school in Nebraska. Her teachers could not care for her, for they too had the flu. Instead, Alice's parents came to take her home, and Alice later remembered sitting at the train depot, surrounded by people wearing masks.

By the time the pandemic finally passed through Wyoming, thousands of people had been afflicted. It was reported that at least 800 had perished.

When it comes to pandemics, there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Wyoming.

*******************************

Makes you think, doesn't it?

GOD BLESS US EVERYONE.

My love to all.

XOXO
Mama D.

State of the Air: The 2009 Report

http://www.stateoftheair.org/
Click on the above link to find out how the air you breathe is directly affected by OUTSIDE standards. Then maybe stop worrying about a few smokers.
There is always "worse"...

XOXO
Anne

FYI:
I live in Brown County, Wisconsin.
It got an "F".

What's your rating?


********************************

Breathing polluted air can seriously harm your health and even shorten your life.
For 10 years, the American Lung Association has used data from state air quality monitors to produce its annual State of the Air report.

The more you learn about the air you breathe, the more you can protect your health and take steps to make our cleaner and healthier.

FACT: Steps you can take to improve air quality will also help fight climate change.
Drive less.
Don’t burn wood or trash.
Use less electricity.
Make sure your school system requires clean buses.

********************************

http://news.yahoo.com/s/ap/20090429/ap_on_sc/polluted_cities;_ylt=AoMW6nM4M_E4rchjISrzZwjWDrMF;_ylu=X3oDMTE5OGF1ZWUwBHBvcwM1BHNlYwN5bi1tb3N0LXZpZXdlZARzbGsDcmVwb3J0bW9zdGFt

Report: Most Americans in areas with unhealthy air

Tuesday April 28, 2009. Sixty percent of Americans live in areas …
By NOAKI SCHWARTZ, Associated Press Writer Noaki Schwartz, Associated Press Writer – 2 hrs 12 mins ago

LOS ANGELES – Sixty percent of Americans live in areas with unhealthy air pollution levels, despite a growing green movement and more stringent laws aimed at improving air quality, the American Lung Association said in a report released Wednesday.

The public-health group ranked the pollution levels of U.S. cities and counties based on air quality measurements that state and local agencies reported to the U.S. Environmental Protection Agency between 2005 and 2007.

Overall, the report found that air pollution at times reaches unhealthy levels in almost every major city and that 186.1 million people live in those areas. The number is much higher than last year's figure of about 125 million people because recent changes to the federal ozone standard mean more counties recognize unhealthy levels of pollution.

Health effects from air pollution include changes in lung function, coughing, heart attacks, lung cancer and premature death.

"Six out of 10 Americans right now as we speak live in areas where the air can be dirty enough to send people to the emergency room, dirty enough to shape how kids' lungs develop and even dirty enough to kill," said Janice E. Nolen, the association's assistant vice president on national policy and advocacy.

Cities including Los Angeles, New York, Atlanta, Charlotte, Philadelphia, Washington D.C. and Baltimore have seen improvements in air quality over the last decade, the report said.

The Los Angeles-Long Beach-Riverside region of Southern California remained the metropolitan area with the highest levels of ozone pollution, as it has in each of the past 10 reports. Other metropolitan areas considered to have the most ozone pollution included Houston-Baytown-Huntsville and Dallas-Fort Worth in Texas.

The areas with the most short-term particle pollution or soot were Pittsburgh-New Castle, Pa.; and the California areas of Fresno-Madera, Bakersfield and Los Angeles-Long Beach-Riverside.

The cleanest metro area in all categories was Fargo, N.D.

The rankings in the "State of the Air Report" were based on ozone pollution levels produced when heat and sunlight come into contact with pollutants from power plants, cars, refineries and other sources.

The lung association also studied short-term and year-round levels of particle pollution, which is made up of a mix of tiny solid and liquid particles in the air.

********************************

http://www.stateoftheair.org/2009/health-risks/overview.html

State of the Air: 2009 Health Risks Overview

Ozone and particle pollution are the most widespread air pollutants and among the most dangerous. Recent research has revealed new insights into how they can harm the body including taking the lives of infants and altering the lungs of children. All in all, the evidence shows that the risks are greater than we once thought. Recent findings provide more evidence about the health impacts of these pollutants:

* Reducing air pollution has extended life expectancy. Thanks to a drop in particle pollution between 1980 and 2000, life expectancy in 51 U.S. cities increased by 5 months on average, according to a recent analysis.

* The annual death toll from particle pollution may be even greater than previously understood. The California Air Resources Board recently tripled the estimate of premature deaths in California from particle pollution to 18,000 annually.

* Long term exposure to air pollution.especially from highway traffic.harms women, even while in their 50s. Exposure to particle pollution to appears to increase women's risk of lower lung function, developing chronic obstructive pulmonary disease (COPD), and dying prematurely.

* Busy highways are high risk zones. Pollution from heavy highway traffic contributes to higher risks for heart attack, allergies, premature births and the death of infants around the time they are born. New studies looking at the impact of traffic pollution even in cities with generally cleaner air expanded the concern over the health effects of chronic exposure to exhaust from heavy traffic.

* Ozone pollution can shorten life, a conclusion confirmed by the latest scientific review by the National Research Council. New evidence appeared that some segments of the population may face higher risks from dying prematurely because of ozone pollution, including communities with high unemployment or high public transit use and Blacks.

* Truck drivers, dockworkers and railroad workers may face higher risk of death from lung cancer and COPD from breathing diesel emissions on the job. Studies found that these workers who inhaled diesel exhaust on the job were much more likely to die from lung cancer, COPD and heart disease.

Two types of air pollution dominate the problem in the U.S.. ozone and particle pollution. They aren't the only serious air pollutants: others include carbon monoxide, lead, nitrogen dioxide, and sulfur dioxide, as well as hundreds of toxic substances. However, ozone and particle pollution represent the most widespread.

Psychic Dogs and Naked Chickens

http://www.wisconsinhistory.org/odd/archives/002736.asp
Odd Wisconsin Archive
Psychic Dogs and Naked Chickens

Tornado season is here again. Huge storms are crossing the Mississippi as we write tonight, prompting a reminder that everyone needs to be ready when the sirens sound.

On June 12, 1899, there were no sirens when a tornado struck New Richmond, in St. Croix Co. and 117 people died. Because a circus was in town, the town's population swelled as visitors came in from outlying areas. Shortly after the performance ended, the tornado passed through the very center of town, leveling a strip 1,000 feet wide and 3,000 feet long. More than 300 buildings were destroyed and multiple deaths were reported in at least 26 families. Six families had four or more deaths.

Although there were no sirens, there were some mysterious warning signs. Many of New Richmond's animals appeared to sense the tornado coming long before it arrived.

"There was something very remarkable in the actions of animals previous to the storm," Mrs. Boehm wrote the next year in her book about the disaster. "They seemed without exception as far as I could learn to be unrestful, nervous, and incapable of being quieted though cared for and petted more than usual. There was a Jersey-Holstein cow, the property of Mr. Jas. Link. This fine animal kept up a continual mowing for days previous to the cyclone...

"One very large St. Bernard dog. also the property of Mr. Link, exhibited more than ordinary uneasiness. The faithful animal showed more affection than usual, particularly towards his mistress. The animal left home a few hours before the cyclone struck and returned safely the day after. The poor faithful 'Judge' returned to find his master's home in ruins, and to seek in vain for his dead mistress."

She goes on to say that, "I learned that over thirty dogs left their homes like Judge a few hours before the storm and took refuge under an embankment out of the path of the tornado. Next day the poor dogs were seen returning, a few at a time, with heads low on the ground. Likely they were forced by hunger to leave their retreat. Those that did seemed to be seeking their lost owners."

Of course, most animals did not escape the tornado. "Whole flocks of chickens could be seen alive, denuded of feathers... Again, one would see hens deprived of their feathers only in part. One old hen was going around quite lively with one side completely denuded, the other side covered as usual." Large mammals were not as lucky. At least 360 horses died, and the number of cows put out of their misery was too large to be tallied accurately.

You can see a list of Wisconsin's major tornadoes in our online Dictionary of Wisconsin History, and learn more about them by following the links there. A selection of historic photos showing tornado damage is also available at Wisconsin Historical Images.
http://www.wisconsinhistory.org/dictionary/index.asp?action=view&term_id=10467&search_term=torna

For information about how to protect yourself in tornadoes, visit this page provided by the American Red Cross.
http://www.redcross.org/portal/site/en/menuitem.86f46a12f382290517a8f210b80f78a0/?vgnextoid=62a7da30df3ea110VgnVCM10000030f3870aRCRD&vgnextfmt=default

Plan your safe refuge now, before the dog starts pacing and the sirens go off.


*****************************

Love to all

XOXO
Me

Ten Thoughts

Good Evening Everyone-
I miss you.
Yes YOU!
Is it me, or are people disappearing from here?
Maybe it's the weather and many of us are outside where we belong in Spring.
Maybe I don't know where you went or how to get in touch with you.
My email address is Anna_Loves_Life@Yahoo.com - (Or, if you have it, you can always use the Farm one).
They both go to the same inbox. Drop me a line.

Let's see...

#1.
It is Spring- and time for all the little flowers to bloom.

I even found one...
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#2.
Casey drove out today.

A bit of lingering pain, but more energy than I have seen in a long while!

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She had to leave shortly before Miss Kelli picked up Mr Miller.
Soon as Miss Kelli came, so did Miss Michelle!

How cool to be able to sit outside and chat!

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#3.
I had a dentist appointment this morning.

Yes, I have to go back. Oh well.

#4.
I love stuff like this page...
"Rain before 7, Clear by 11" (A bit of weather lore) CLICK HERE.
"The Shepherd's Barometer, or certain rules to judge the weather, grounded on 50 years' experience and observations by an ancient English shepherd, 1812."

#5.
Punk likes to ride fast with her snout out the window.

This makes her jowls flap in the wind.
They make some really funny noises.
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Yet she gives me a funny look if I laugh out loud at her?

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#6.
Mr Miller has been able to come over most days...
Punk and Miller play well together- as long as Punk is willing to share.

hehehe ........... (She's not spoiled, she always smells that way)?

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#7.
Mr Miller has a tendency to pout if/when he doesn't get his way.
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#8.
I believe I shall have many pears this year-
Enough for here, the 2 horses, and for the deer at Gritters place too!
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#9.
I caught this guy on the side of the road, eying some food in the fields
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He flew off when I got out of the car to get a better picture though-
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#10.
Food.
Anyone up for a bowl of homemade (and loaded) baked beans?
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Hope all is well in your little corner of creation.
Have a "wunnaful" Wednesday!
My love to all.

XOXO
Me

free hit counters

Posted to Y! 360, Tuesday April 28, 2009 - 10:40pm (CDT)

What?!? Illness and Sin?!

Rating:	★
Category:	Other

I am a bit more than let down here...

The following are words by someone who is on Caseys friends list...
I am shocked and more than a bit hurt as well-

******************************

I just realized something significant...
The Hebrew answer to unexplained illness is sin.
The Christian answer to unexplained illness is lack of faith.
The secular answer to unexplained illness is psychology.
What they all have in common is that they do not believe that illness might be part of God's plan for some and that there must be something lacking in the one with the illness. They all imply that there is something that the one with the illness must have done to deserve the illness.

Just a thought, nothing more."

******************************

Back to me again...

I have never deleted/chosen/accepted friends by their beliefs in The Almighty. But I found this entry so wrong...

If this is a thought, nothing more, then why the hell is it started with the author realizing "something significant"?

Do people really feel this way?


XOXO
Me

April Thunder

Just so you know why I have become almost invisible.

.
.
Good Morning Everyone;
After days of wishing my head was in the river somewhere, I am back to a bit more normal. (Whatever THAT is)? hehehe

Been reading a few websites; and the later comments and such about different issues.

One that reached out and grabbed me was regarding brushing teeth after throwing up.

DON'T BRUSH YOUR TEETH!

PLEASE REMEMBER THIS IS A HUGE NO~NO!
CLICK HERE to read why if you don't know this yet.

Your dentist will verify all of the info there.

I awoke yesterday morning at the first crack of thunder- about 3AM. A few minutes later my cell phone rang- Casey, also woken.

The storms weren't bad, just really grumbly, and just enough to allow me to sleep a bit and then BOOM I was awakened again and again.
Gave up that fight and went to the annual rummage sale at Sts. Edward and Isidore in Flintville.

Yes, we have a bar, a church and a graveyard. (All sort of 'related' in a very warped way).

They had lots of stuff- 2 huge rooms full of stuff, and a few other rooms with jewelry, collectibles, holiday things, books, etc

I opted to get a few of these cast iron toys/decorations...

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An old nutcracker...
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An old cap gun.
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And a few other cast iron treasures too.
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My dad had an old cast iron Studebaker bank. When it got almost full one could shake a quarter or two out of it. But boy was it heavy!
As were these "finds" of mine. (I bought them, carried them out to the car, and then went back in because I wasn't going to lug them around 'til I was done looking around).

** Please forgive the rather raunchy picture quality- I had the camera settings for another project and never gave it a second thought.

As I pulled out of the yard yesterday, there was a gaggle of seagulls in the field across the street, along with this guy.

Noisy but beautiful...

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.



Taken from about 300 yards away-
One of the sand cranes that return every year...
Imagine running into him in a dark alley!
hehehe
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Not much other stuff going on.
Rain, rain, and more rain.

Know that we need it, but maybe one sunny day between would be nice?
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Enough about Flintville, I hope you are all having sunny days, even if it's raining!

My love to all.

XOXO
Me

free hit counters

Posted to Y! 360, Sunday April 26, 2009 - 06:42am (CDT)

Energy vampires: Fact versus fiction

http://green.yahoo.com/blog/the_conscious_consumer/50/energy-vampires-fact-versus-fiction.html
Energy vampires: Fact versus fiction
By Lori Bongiorno
Posted Thu Feb 26, 2009 2:52pm PST

It's well-known that most electronic devices in our homes are sucking up energy even while they are turned off. But for all the information out there, many questions remain. I got hundreds of reader questions after writing the post What's wasting energy in your home right now. Below are answers to the five most common inquiries:

Which electronic devices waste the most energy when they are turned off but still plugged in?

Set-top cable boxes and digital video recorders are some of the biggest energy hogs. Unfortunately, there's little consumers can do since television shows can't be taped if boxes are unplugged. It also typically takes a long time to reboot boxes.

However, some of the other major consumers of standby power are more easily dealt with: computers, multifunction printers, flat-screen TVs, DVDs, VCRs, CD players, power tools, and hand-held vacuums. The Lawrence Berkeley National Laboratory (LBNL) measured standby power for a long list of products.

While it's true each individual product draws relatively little standby power, the LBNL says that when added together, standby power can amount to 10% of residential energy use.

Why do electronic devices use energy when they are switched off?

Electronics consume standby power for one of two reasons, says Chris Kielich of the Department of Energy. They either have an adapter that will continue to draw electricity, or they have devices (such as clocks and touchpads) that draw power. Anything with a remote control will also draw standby power, she says, since the device needs to be able to detect the remote when it's pushed.

Does everything suck energy when it's plugged in and turned off?

No. If your coffeemaker or toaster doesn't have a clock, then it's probably not using standby power, says Kielich. Chances are your hair dryer and lamps (although they may have a power adapter for the dimmer) are not drawing standby power either, she says. Devices with a switch that physically breaks the circuit don't consume standby power.

Will switching things on and off shorten their life?

Probably not, says Kielich. You'd have to turn devices on and off thousands of times to shorten their lives. The real downside, she says, to unplugging electronics is that clocks and remotes will not work, and you do have to reset everything.

Can you ruin batteries by unplugging battery chargers and causing batteries to completely discharge?

It could be a possibility, says Kielich. Her advice: Don't let batteries get completely drained. But you don't need to have things like hand-held power vacuums and drills plugged into the charger when it's 100% charged, or even 50% charged.

Power Strip FAQs

Plugging electronics into a power strip and turning it off when you're not using it is a widely prescribed solution for curbing vampire power. Here are answers to common questions:

* Power strips draw energy when they are turned on, but not when they are switched off.
* Any decent power strip should have surge protection, according to Kielich. Flicking your power strip on and off will not create a power surge capable of damaging electronic devices. In fact, it will protect devices from other surges.
* Several readers were worried about the possibility of fires caused by plugging too many things in at once. If you plug in the allowed number of devices, then power strips are safe, says Kielich. Just don't plug your power strip into another power strip, or you run the risk of creating an overload.


Environmental journalist Lori Bongiorno shares green-living tips and product reviews with Yahoo! Green's users.

What Is Your Most Embarrassing Moment?

Good Morning Everyone!
I know it is 'cheating' somehow, no blog of my own today; but I have to share this little "story" with you...
Thank you Darla!

Besides, you all still have to recover from those malnourished pictures of CaseyFace.

From my email...

***

A 3-year-old tells all from his mother's restroom stall.
Written By Shannon Popkin

My little guy, Cade, is quite a talker. He loves to communicate and does it quite well. He talks to people constantly, whether we are in the library, the grocery store or at a drive-thru window. People often comment on how clearly he speaks for a just-turned-3-year-old. And you never have to ask him to turn up the volume. It's always fully cranked.
There have been several embarrassing times that I've wished the meaning of his words would have been masked by a not-so-audible voice, but never have I wished this more than last week at Costco.

Halfway, through our shopping trip, nature called, so I took Cade with me into the restroom. If you'd been one of the ladies in the restroom that evening, this is what you would have heard coming from the second to the last stall:

''Mommy, are you gonna go potty? Oh! Why are you putting toiwet paper on the potty, Mommy? Oh! You gonna sit down on da toiwet paper now?  Mommy, what are you doing? Mommy, are you gonna go stinkies on the potty?''

At this point I started mentally counting how many women had been in the bathroom when I walked in. Several stalls were full ... 4? 5? Maybe we could wait until they all left before I had to make my debut out of this stall and reveal my identity.

Cade continued: ''Mommy, you ARE going stinkies aren't you? Oh, dats a good girl, Mommy! Are you gonna get some candy for going stinkies on the potty? Let me see doze stinkies, Mommy! Oh...Mommy! I'm trying to see In dere. Oh! I see dem. Dat is a very good girl, Mommy... You are gonna get some candy!''

I heard a few faint chuckles coming from the stalls on either side of me. Where is a screaming new born when you need her?  Good grief. This was really getting embarrassing. I was definitely waiting a long time before exiting.
Trying to divert him, I said, ''Why don't you look in Mommy's purse and see if you can find some candy. We'll both have some!''

''No, I'm trying to see doze more stinkies...Oh! Mommy!''

He started to gag at this point.

''Uh - oh, Mommy. I fink I'm gonna frow up. Mommy, doze stinkies are making me frow up!! Dat is so gwoss !''

As the gags became louder, so did the chuckles outside my stall.. I quickly flushed the toilet in hopes of changing the
subject.. 
I began to reason with myself: OK. There are four other toilets.  If I count four flushes, I can be reasonably assured that those who overheard this embarrassing monologue will be long gone.

''Mommy! Would you get off the potty, now? I want you to be done going stinkies! Get up! Get up!''

He grunted as he tried to pull me off.
Now I could hear full-blown laughter.
I bent down to count the feet outside my door. 

''Oh, are you wooking under dere, Mommy? You wooking under da door? What were you wooking at? Mommy? You wooking at the wady's feet?''

More laughter.
I stood inside the locked door and tried to assess the situation....

''Mommy, it's time to wash our hands, now. We have to go out now, Mommy.''
He started pounding on the door.. 
''Mommy, don't you want to wash your hands? I want to go out!!''

I saw that my wait 'em out' plan was unraveling. I sheepishly opened the door, and found standing outside my stall, twenty to thirty ladies crowded around the stall, all smiling and starting to applaud.

My first thought was complete embarrassment. Then I thought, where's the fine print on the 'motherhood contract' where I signed away every bit of my dignity and privacy?
But as my little boy gave me a big, cheeky grin while he rubbed bubbly soap between his chubby little hands, I thought, I'd sign it all away again, just to be known as Mommy to this little fellow.

***
Shannon Popkin is a freelance writer and mother of three
She lives with her family in Grand Rapids, Michigan, (where she no longer uses public restrooms).
***

So what has been YOUR most embarrassing moment? hehehe
(I promise not to tell anyone)!  <:-0

Have a great day! 

XOXO
Me

The truth about the Health Care Plan

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Feb/The-Path-to-a-High-Performance-US-Health-System.aspx


The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way

February 19, 2009 | Volume 105

Authors: Commission on a High Performance Health System
Contact: Cathy Schoen cs@cmwf.org

This report from the Commonwealth Fund Commission on a High Performance Health System offers recommendations for a comprehensive set of insurance, payment, and system reforms that could guarantee affordable coverage for all by 2012, improve health outcomes, and slow health spending growth by $3 trillion by 2020—if enacted now to start in 2010. Central to the Commission’s strategy is establishing a national insurance exchange that offers a choice of private plans and a new public plan, with reforms to make coverage affordable, ensure access, and lower administrative costs. Building on this foundation, the report recommends policies to change the way the nation pays for care, invest in information systems to improve quality and safety, and promote health. By stimulating competition and delivery system changes aimed at providing more effective and efficient care, the policies could yield higher value and substantial savings for families, businesses, and the public sector.

Executive Summary

The time has come for comprehensive health reform that will put the nation on a path to a high performance health system. This report by the Commonwealth Fund Commission on a High Performance Health System presents an integrated "system" approach to change. It proposes a set of policies that would provide affordable health insurance for all, designed to support a set of payment and system reforms. In combination, the policies would provide a catalyst for an innovative delivery system capable of providing better access and improved population health while significantly slowing the growth of health spending.

The nation's health and economic security are at risk: rising costs are putting pressure on families, businesses, and governments, and sharp increases in the number of uninsured and underinsured are leaving millions without access to care or essential financial protection when sick. The U.S. health care system is already the most expensive in the world, by far, and total health spending is projected to double by 2020—rising from a projected $2.6 trillion in 2009 to $5.2 trillion by 2020 to consume 21 percent of the nation's economic resources (gross domestic product). To achieve more affordable coverage and ensure access for everyone in the country, we must change the way health care is delivered and the way we pay for care. We must focus on value. Despite having centers of excellence, our health care system falls short. It fails to produce the outcomes and care it could, wastes resources, often fails to provide the right care at the right time, and delivers unacceptably wide variations in quality and safety. Unless we move to a high performance delivery system and improve the value of care that is delivered, efforts to expand coverage will be difficult, if not impossible, to sustain over time.

The United States needs to be on a different path, one guided by a positive vision of what should be possible and by policies leading to outcomes we should expect. This is a historic political opportunity—with a majority of the public seeking profound change and a new administration and Congress taking office—for taking bold steps to ensure the health security of all.

In this report, the Commission recommends an integrated set of policies to extend coverage to all by: establishing a national insurance exchange that offers a choice of private plans and a new public plan; requiring everyone to have coverage, with income-related premiums to make coverage affordable; and instituting insurance market reforms that focus competition on outcomes and value. On this foundation, payment policies would change the way we pay for care to enhance the value of primary care and move from fee-for-service to more "bundled" methods of paying that encourage coordinated care and hold providers accountable for improving health outcomes and prudent use of resources. Investment policies would accelerate the spread and use of health information technology and establish a center for comparative effectiveness to enhance knowledge and appropriate use of evidence-based care. Population health policies would promote health and disease prevention, with benchmarks and goals to spur a culture of innovation and continuous improvement.

This integrated approach could achieve access for all, improve population health, and provide more positive patient experiences. Moreover, an analysis of specific policies consistent with this approach indicates that they could slow the growth in national health spending by a cumulative $3 trillion through 2020, compared with current projections (Exhibit ES-1)—if we start now.

Path Report Figure 1

Designed to extend affordable insurance to everyone and create a foundation for essential payment and system reforms, the insurance framework would achieve near-universal coverage, ensure access and continuity, and lower premiums (Exhibit ES-2).

The Commission's Strategic Vision

The Commission has identified five essential strategies for comprehensive reform:

* Affordable coverage for all.
* Align incentives with value and effective cost control.
* Accountable, accessible, patient-centered, and coordinated care.
* Aim high to improve quality, health outcomes, and efficiency.
* Accountable leadership and collaboration to set and achieve national goals.

Together, these strategies comprise the framework for this report with recommendations for policies that would move from concept to action.
Taking the Path: Commission Recommendations

The Commission offers the following set of recommendations to move onto a path to a high performance health system. The Commission believes all the recommendations are desirable, many necessary, but none on its own sufficient to achieve high performance. Designed to move forward quickly with a sense of urgency, the comprehensive reforms include significant changes that would introduce a new dynamic and more positive path over the next decade. With cost pressures mounting and coverage eroding, the stakes are high. Starting now is crucial.

1. Affordable Coverage for All: Ensure Access and Provide a Foundation for System Reform
To build on the current mixed private and public coverage system to extend affordable health insurance to all with a strategy designed to ensure access and continuity and provide a foundation for payment and system reforms, the Commission recommends policies that:

* Establish a health insurance exchange that offers an enhanced choice of private plans and a new public plan. This new public plan would offer comprehensive benefits with incentives for disease prevention and payment methods that reward results. It would build on Medicare's claims administrative structure and national provider networks. The exchange and new public plan would be open to all, including large employers.
* Require individuals to have coverage and employers to offer coverage or contribute to a trust fund for insurance, sharing responsibility to pay for insurance for all.
* Provide income-related premium assistance to make coverage affordable.
* Expand eligibility for and improve payment under Medicaid and the Children's Health Insurance Program to improve affordability and access. Eliminate Medicare's two-year waiting period for the disabled.
* Set a minimum benefit standard to ensure access and adequate protection from the financial burden of obtaining needed health care.
* Reform health insurance markets to improve insurance efficiency, access, and affordability by prohibiting premium variation based on health and guaranteeing offer and renewal of coverage to all regardless of health status.

By moving from fractured to continuous insurance coverage, these reforms would lower insurance administrative costs and provide a foundation for more coherent and effective payment and system reforms. All payment reforms would apply to current public programs (i.e., Medicare and Medicaid) and to the new public plan offered through the exchange to the under-65 population. Market reforms would focus competition among insurers on improving health outcomes and adding value. Businesses, patients, and families could choose among an array of national and regional private plans and the nationwide publicly sponsored option.

2. Aligned Incentives and Effective Cost Control: Payment Reform to Enhance Value
Change the way we pay for care to reward high quality and prudent stewardship of health care resources and to encourage reorganization of care so that it is well-coordinated and responsive to patients' needs. To move away from the current fee-for-service payment system toward one that emphasizes value rather than volume, the Commission recommends policies to:

* Strengthen and reinforce patient-centered primary care through enhanced payment of primary care services and changing the way we pay for primary care to encourage the adoption of the medical home model to ensure better access, coordination, chronic care management, and disease prevention.
* Promote more effective, efficient, and integrated health care delivery through adoption of more bundled payment approaches to paying for care over a period of time, with rewards for quality, outcomes, and patient-centered care, as well as rewards for efficiency tied to high performance.
* Correct price signals in health care markets to better align payments with value.

3. Accountable, Accessible, Patient-Centered, and Coordinated Care: Organize and Redesign the Delivery System to Improve Patient Experiences
Move from the current fragmented health care delivery system to one that is patient-centered, accessible, and organized so that patients and families can navigate care easily and one that holds providers accountable for high-quality, effective care across the continuum of care and over time. To move toward a delivery system in which everyone has a personal source of care that is accessible, coordinates care, and is accountable for obtaining the best health results, the Commission recommends policies that:

* Have patients designate a personal source of care that meets standards of accessibility, quality, and coordination and can serve as a medical home.
* Facilitate appropriate care and manage chronic conditions through integrated delivery systems that provide a continuum of care or provide funding and technical assistance for statewide and community efforts to support and connect primary care and more specialized resources in informal or virtual networks.
* Develop provisions in which providers participating in a hospital-physician organization receiving bundled payments would be eligible for medical liability coverage on favorable terms.

4. Improved Quality and Health Outcomes: Invest in Infrastructure and Public Health Policies
Invest in infrastructure to improve the availability, quality, and usefulness of information for health care decision-making by patients, providers, and payers and encourage a culture of continuous learning. To achieve these goals the Commission recommends actions that would:

* Accelerate adoption and use of health information technology (HIT) by establishing system standards, requiring electronic reporting of clinical information, and providing start-up funding for a national health information network so information follows the patient and is available to providers and patients.
* Support and inform better health care decision-making by establishing a Center for Comparative Effectiveness and Health Care Decision-Making, encouraging shared decision-making based on evidence, and using recommendations to develop value-based benefit designs that preserve choice but encourage appropriate care.
* Provide more transparent information to guide and drive innovation by requiring all-population, all-payer quality, patient experiences, and cost data with benchmarks of top performance.

Invest in improving population health with the goal of lowering the rates of preventable illness and improving health outcomes for chronic conditions with efforts to:

* Target public health initiatives on prevention of illness, including expansion of immunizations that are demonstrated as effective and public health actions and tax incentives and other initiatives to reduce obesity and decrease tobacco use and promote healthy lifestyles.
* Design health insurance benefits to encourage and support preventive care and essential care for chronic conditions, with positive incentives for patients to engage in health promotion and keep existing chronic conditions under control.
* Intensify the focus on preventing and managing chronic conditions, including incentives for more coordinated care and setting goals to improve outcomes for chronic conditions that account for the bulk of health care needs and spending.

5. Accountable Leadership and Collaboration: Coordinated Efforts to Improve the Health System
Leadership, new national policies, and collaboration among the public and private sectors will be necessary to set and achieve national goals for high performance. To provide accountable leadership and foster collaboration, the nation will need to establish mechanisms to set and achieve national goals, enable public programs to serve as prudent purchasers of care, and ensure coordination of practices and policies that cut across public programs and private sector activities. In addition to insurance reforms, we need national leadership to:

* Set performance targets and provide incentives and technical assistance to meet them.
* Authorize public programs, including Medicare, to be more active purchasers of high-value health care for their beneficiaries, rather than passive payers. This would include implementing and facilitating the adoption and rapid spread of innovative payment policies to elicit a more effective, efficient, and responsive delivery system.
* Establish a national insurance exchange that would operate at national, state, and regional levels to allow participation of regional private health plans and integrated delivery systems
* Establish a Center for Comparative Effectiveness and Health Care Decision-Making.
* Set national standards to accelerate adoption and use of health information technology and a national health information network.


Estimated Impacts

Using a set of policies to illustrate concepts proposed by the Commission, this report analyzed the potential impact of those policies. The findings indicate that if all were implemented in 2010, it would be possible to extend affordable coverage to all and improve population health, while simultaneously reducing the growth in national health spending by a cumulative $3 trillion by 2020 compared with current projections.* This substantial sum is the accumulation of incremental savings each year, with a reduction in the projected annual rate of growth in national health expenditures from 6.7 percent to 5.5 percent. Notably, even after this substantial reduction, national health spending still would exceed the projected annual growth in gross domestic product (GDP). Although the percent of GDP spent on health care would be lower in 2020 than what is currently projected—18.4 percent of GDP compared with the projected 20.8 percent—it would account for a higher share of the U.S. economy than in 2009 (16.9 percent).

*These estimates are based on an extensive modeling effort by The Lewin Group. Lewin used specifications developed to reflect each component of the Commission’s recommendations. The results based on those specifications drew from available evidence as to their potential impact on those who would be affected and their behavioral responses. The Lewin Group is one of the leading health care and human services consulting firms in the United States, with more than 35 years of experience serving organizations in the public, nonprofit, and private sectors. The Lewin Group is a wholly owned subsidiary of Ingenix, which in turn is owned by UnitedHealth Group. The Lewin Group maintains editorial independence from its owners and is responsible for the integrity of any data that it produces for the Fund.

The policies included in the analysis interact and are mutually supporting. All contribute to the net cumulative effect on potential savings and improvement in value (Exhibit ES-3). Each slows the rate of growth in national health spending compared with current projections. (See summary for policies used for purposes of modeling coverage and cost estimates.)

Path Report figure 3

These estimated impacts are contingent on their effectiveness in stimulating change in the way providers, patients, and insurers (both public and private) behave, and how they react to the new opportunities the proposed policies would create. The Commission developed the set of policies with a vision of potential dynamic change—a chain of events that interact over time. A central feature is the insurance exchange structured to expand choice of plans in the context of market rules that prohibit competition on the basis of risk selection. This design could promote competition based on value to drive innovation among insurers and better organization of care. The public plan plays a central role in harnessing markets for positive change.

The effectiveness of these reforms depends on payers becoming more prudent purchasers. Transforming Medicare into a more active purchaser of care—with innovative payment methods that move away from fee-for-service to more bundled payments and mechanisms to hold providers accountable—could stimulate and support changes in behavior that improve performance. Comprehensive insurance with premium differences reflecting value and cost-sharing, aligned with effective care and better outcomes, would provide patients with incentives to seek high-value care and promote appropriate use of resources.

Success will require that key stakeholders join together to make difficult decisions and undertake the steps necessary to transform the health care delivery system and move along the path to high performance.

Impact on Health Insurance Coverage
The insurance framework proposed by the Commission includes the creation of a new national insurance exchange that would offer private insurance plans and a new public plan option, expansion of existing public programs, market reforms, provisions for affordability, and requirements that all have coverage to reach universal participation. By establishing a new public plan available nationwide, the framework would also provide the basis for a new competitive dynamic in insurance markets and provide a strong foundation for payment and system reforms.

The insurance expansion would achieve near-universal coverage. The number of uninsured would drop from an estimated 48 million in 2009 (16 percent of the U.S. population) to 4 million by 2012 (1 percent of the population), with nearly everyone insured over the next decade (Exhibit ES-2). Absent new directions, the number of uninsured is projected to rise to 61 million or more by 2020.

By building on existing insurance coverage, this framework would permit individuals to keep their current coverage if it works for them while providing new choices through the insurance exchange, including a range of private plans and the new public plan. Small employers in particular would be able to offer their employees a choice of multiple plans. Large employers would gain a nationwide plan plus employee choice of regional plans. All those enrolled through the exchange would be able to keep their coverage as jobs or circumstances changed. The exchange could be open in stages to allow reasonable time to set up. In the modeling, the exchange starts out by opening to small firms and individuals, opens to midsized companies in two years, and opens to all employers by 2014. With the advantages of continuity and choice, including a public plan option, the modeling estimates that over time most of the privately insured market (about two-thirds) would elect to receive coverage through the exchange.

The new public plan option would provide a less expensive alternative for the uninsured and underinsured than what is currently available in the individual and small business insurance markets. Savings would derive from significantly lower administrative costs and use of Medicare's reformed provider payment rates. Estimates indicate premiums for the public plan would be at least 20 percent below those currently available for a comparable benefit package in the private market (Exhibit ES-4). The availability of the public plan option would thus provide a catalyst for private plans to innovate and reexamine the way they operate and pay for care.

Path Report Figure 4

With the flexibility to establish more integrated care networks and a variety of payment policies, private plans—by focusing on quality and value—could compete with each other and outperform the public plan, if they innovate. Provisions could encourage multipayer synchronization to ensure coherent policies and reduce administrative complexity. The goal is more vigorous, innovative, and value-driven competition focused on outcomes and a more streamlined, efficient health insurance financing system.

Impact on Care, Quality, and Outcomes
Changing the way we pay for care to align incentives with value is critical. The payment reforms proposed by the Commission would enhance the value of primary care and change the way we pay to stimulate care delivery through patient-centered medical homes with the capacity to provide access, coordinate care, and use information systems and teams to manage chronic conditions. Moving to more bundled payments, with provisions for accountability for outcomes, would align incentives with the value rather than volume of care delivered and would support hospitals, physicians, and other clinicians working together to care for patients. Building a solid infrastructure of information systems and programs to enhance prevention of disease and promote population health would emphasize innovation to meet current and future community health needs.

The Commission envisions a health system that provides patients with personal sources of care who know their medical history, ensures timely access, helps coordinate care, and uses essential clinical information to provide the right care with an emphasis on health and disease prevention. Payment and information systems would stimulate and support a patient-centered care system that is coordinated, accessible, and safe.

With a focus on prevention and improving outcomes for chronic disease, the nation could achieve substantial improvements in population health with policies that align incentives with the provision of right care and prudent use of resources, provide clinicians with information system tools and decision support, and build and expand public health programs. We should aim for healthier, more productive lives through prevention of disease, earlier intervention, and effective management of chronic conditions, including people with multiple comorbidities. In addition, more effective and humane care for people with late-stage diseases could address the huge variations in care.

By setting targets and implementing policies that meet and raise benchmarks of top performance, we have the opportunity to save lives, improve the quality of life and care experience, lower safety risks to patients, and prevent the onset of disease and complications. As illustrated by key indicators from the Commission's National Scorecard on U.S. Health System Performance, improving average performance to targets or benchmarks set by current top performers by 2020 would achieve substantial gains in population health and patient experiences (Exhibit ES-5).

Path Report figure 5

Impact on Providers
While slowing expenditure growth to 5.5 percent per year is a significant change from recent years, hospitals, physicians, and other providers' revenues would continue to experience growth each year. This growth would be only marginally slower than what is currently projected, as revenues continue to increase due to medical advances and an aging population (Exhibit ES-6). Payment reforms would support and provide incentives for practice innovations and more productive resource use.

Path Report figure 6

Distribution of Impact Across Major Payer Groups
All major sectors would benefit from improved health and from slower growth in spending, compared with projected trends. By 2020, the cumulative reduction in the growth of national health spending compared with trends of $3 trillion would be distributed across the major groups that pay for health care: the federal, state, and local governments; private employers; and households (Exhibit ES-7).

Path Report figure 7

Most of the savings would accrue to individuals and families as a result of slower growth in premiums and out-of-pocket spending, federal premium assistance, and expansion of public programs to make insurance affordable. The savings would accrue across all income groups, including higher-income households. State and local governments would also realize substantial savings relative to current projections.

Employers who currently provide insurance and their employees would also realize significant savings as a result of lower premiums and more equitable sharing of the costs of family coverage across all employers. Over time, new system savings would offset costs for employers and workers as premium growth slows, with net cumulative employer savings of $231 billion by 2020.

As the central source of financing for coverage expansions, the federal government's costs would increase during early years to make coverage affordable. The insurance design specified for modeling also provides federal funding to offset state and local costs of expanding Medicaid and raising Medicaid payment rates to Medicare levels. As a result, there would be an increase in net federal government spending during the decade. With system reform policies in place, however, the net federal cost of insurance expansion and investing in the care system declines rapidly. By 2020, payment and system reform savings would offset nearly all the increase in annual federal spending compared with baseline projections (Exhibit ES-8). Over the 2010 to 2020 period, the net federal budget outlays are estimated to be $593 billion—with most incurred in the first five years.

Path Report figure 8

The Commission did not specify a plan to finance the federal expansion. As the report discusses, there are a number of ways to pay for such costs, with net gains to all as the nation invests in a healthier and more secure future. As state governments, households, and employers all save significantly, policies could recapture some of the savings or modify design features to finance federal support of insurance for all.
Conclusions

Moving forward on a comprehensive reform agenda and making significant progress quickly require major changes. In a care system that touches so many lives and generates over $2 trillion in revenue per year, such changes will be very difficult to make. Yet, if we fail to act now with bold reforms, the situation we face in the future will be much worse.

The insurance design, including the exchange and new public plan, seeks a dynamic, competitive strategy that retains a mixed private and public insurance system, with the best of what each sector has to offer. The challenge will be achieving a balance in which the public and private plans compete within market rules or regulations that stimulate innovation and outcomes in the public interest. It will be important to develop a mechanism to set the price point and payment policies in a nonarbitrary fashion. The goal should be to provide incentives and support for high-quality and efficient care systems, with rational public and private insurance payment policies. The Commission will continue to explore and address this issue in upcoming reports.

It will take time and flexibility to develop innovative payment reforms to stimulate the kinds of delivery system changes needed. Currently, public programs like Medicare, the Civilian Health and Medical Program of the Uniformed Services, and the Federal Employees Health Benefits Program set payment policies in multiple ways. If the new public plan and Medicare are to support improved performance, they will need the authority and flexibility to act on behalf of beneficiaries, with targets set by Congress and the President. This will also require accountability for preserving and enhancing access and health outcomes. A new national health council, Medicare board, or other mechanism will be necessary to enable Medicare and the new public plan to serve as prudent purchasers, to facilitate and spread innovative payment policies, and to collaborate with private and other public payers within a multipayer system.

Significant reform will also be needed to change the way we pay for care to focus on value and to set up a national exchange in which all insurers agree to accept everyone and charge the same premium, regardless of health. Providing positive incentives for patients to seek high-quality, effective care and assess alternatives will require investment in information systems, public reporting, and support for evidence-based medicine and mechanisms for applying that evidence.

Overall, moving on a path to high performance will require that we, as a nation, reach consensus that the status quo is not acceptable. It will require bold action on behalf of the greater good of the population, health outcomes, and economic security. Successful implementation of effective policies will require leadership with authority to act and collaboration across sectors to achieve targets and goals.

The results presented in this report underscore several key themes and build on the Commission's earlier analysis of strategies to achieve a high performance system:

* We should aim high. Better access and health outcomes, along with slower cost growth, are possible. It is urgent to start now. The consequences of maintaining the status quo—in terms of both human and economic costs—put the nation at risk. Early action has the potential for substantial cumulative benefits. Delay increases the magnitude of the problems. We cannot afford to continue on our current path.
* A comprehensive system approach is essential. We need to simultaneously expand coverage and take bold action to improve quality and efficiency. There is no "magic bullet" that can alone address rising costs, access, and quality. A coherent set of policies aimed at misaligned incentives, an information deficit, and structural flaws that drive costs up and drag outcomes down is necessary to improve.
* Better information is a key to improved performance. We need to invest for the future. Improving the health system requires a clinical information system to support patients and clinicians; better evidence on the effectiveness of treatments, drugs, and devices; and information to compare performance at the national, community, and provider levels.
* Insurance provides an essential foundation for payment and system reforms. If designed to ensure access and improve insurance efficiency, coverage expansion provides a base for payment and system changes that create more consistent signals and drive delivery systems to higher performance. Benefit design can provide incentives for preventive care and essential care for chronic disease. Less fragmented coverage enables purchasing leverage for change. Universal coverage, coupled with payment and system reforms, would provide a catalyst for significant gains in value.
* Value means more than savings. Higher value includes improvements in quality, equity, access, and healthy lives, in addition to savings. The potential to improve health outcomes, not just savings, should drive decisions for the future.
* Achieving high performance will require all stakeholders to take part in solutions and come together to focus on the gains for patients and the nation. Expanding coverage to everyone, improving performance, and achieving national health system savings will not be easy. It will require a shift in the way we pay for and deliver care, as well as major insurance reforms. Payers and providers must address current payment inequities and reach consensus on reforms to support efficient, high-value care.
* Leadership is critical. Building consensus requires leadership and public-private collaboration. Successful implementation of effective policies requires leadership with authority to act and collaboration across sectors to achieve targets and goals.

As a nation, we all gain by moving in new directions to expand coverage and implement payment and system reforms, with a focus on improving health, patient experiences, and value. The stakes are high if we fail to act.

Windows of opportunity for real health reform do not stay open for long. While the challenge is daunting, it is imperative that our new federal leadership move swiftly to change direction and put the U.S. health system on the path to high performance.
Summary of Policy Modeling Specifications for Coverage and Cost Estimates

Coverage

* National Health Insurance Exchange. Offers businesses and individuals a choice of private plans and a new public plan, phased in by size of firm with all eligible by 2014. Premium of the public plan would be community rated within broad age bands. Benefits are similar to the standard option in the Federal Employees Health Benefits Program. The plan would use Medicare's claims administrative structure and reformed payment methods and rates.
* Individual Mandate. All individuals are required to obtain coverage.
* Affordability. Premiums are capped at 5 percent of income for low-income individuals and 10 percent of income for those in higher-income tax brackets.
* Shared Financial Responsibility. Employers are required to provide coverage or contribute to a trust fund. The example used in the model included 7 percent of payroll, up to $1.25 an hour.
* Medicaid/SCHIP Expansion. All individuals with incomes up to 150 percent of the federal poverty income level are eligible for Medicaid acute care benefits. Medicaid provider payment rates are raised to Medicare levels. The federal matching rate is increased to offset state costs.
* Medicare. The two-year waiting period for coverage of the disabled is eliminated. Medicare beneficiaries are offered a supplement with the same acute care benefits as in new public plan and premium affordability provisions.
* Insurance Market Reforms. Require community-rate premiums (age bands permitted) and guaranteed issue and renewal of policies. Premium and insurance information would be publicly available on the Web.

Payment Reform: Aligning Incentives to Enhance Value

* Enhance Payment for Primary Care. Increase Medicare payments for primary care by 5 percent and apply differential updates for primary care and other care.
* Encourage Development and Spread of Patient-Centered Medical Homes. Provide payment per patient in addition to fee-for-service to practices qualified to provide patient-centered care. Reduced premiums and cost-sharing available to patients who designate a primary care practice as their medical home. Shared savings would be distributed on the basis of performance.
* Bundled Payments for Acute Care Episodes. Expand acute care payment to include services during the hospital stay and 30 days post-discharge in a global fee. The policy would be phased in, starting with inpatient services in 2010, then post-acute care in 2013, and hospital inpatient and outpatient physician care in 2016.
* Correcting Price Signals. Modify payments by: 1) slowing the rate of Medicare payment updates in geographic areas with high costs; 2) reducing prescription drug costs by having Medicare pay Medicaid prices for drugs used by dually eligible beneficiaries and determining Medicare payments for unique drugs with effective monopolies based on prices paid in other countries; and 3) resetting benchmarks for Medicare Advantage plans in each county to projected per-capita spending under traditional Medicare.

Investing in Information Infrastructure

* Accelerate the Adoption and Use of Health Information Technology. Require all providers to report key health outcomes electronically by 2015 to qualify for payment updates. Provide funding to support health information networks and assistance for safety-net providers and small practices through a 1 percent assessment on insurance premiums and Medicare outlays.
* Center for Medical Effectiveness and Health Care Decision-Making. Create a mechanism to develop information on the clinical and cost-effectiveness of alternative treatment options. Fund the Center with a .05 percent assessment on insurance premiums and Medicare and Medicaid spending. Use the information in benefit designs with higher out-of-pocket costs or differential pricing depending on comparative effectiveness and include physician-patient shared decision-making.

Promoting Health and Disease Prevention

* Reduce Tobacco Use. Increase federal taxes on tobacco products by $2 per pack of cigarettes. Use revenues to fund public health programs and insurance expansion.
* Reduce Obesity and Alcohol Use. Establish a new tax on sugar-sweetened soft drinks of 1 cent per 12-ounces to finance state obesity prevention programs, and increase the federal excise tax on alcohol by 5 cents per 12-ounce can of beer, with proportionate increases on other alcohol products. Use funds for prevention and insurance expansion.

Methodology Note: Modeling the Commission recommendations required detailed specifications for each of the policy approaches. The above specifications were used for illustrative purposes. Recognizing that multiple policy variations are feasible for key policy reforms, the Commission endorses the strategic approaches rather than the specific policy parameters used to model potential effects. The main report provides further detail. The Lewin Group technical report, The Path to a High Performance U.S. Health System: Technical Documentation, is available online at www.Lewin.com for data and parameters used to estimate 2010–2020 impacts.
Citation

The Commonwealth Fund Commission on a High Performance Health System, The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way, The Commonwealth Fund, February 2009