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Can we draw up the drawbridge and keep influenza out? « Back to Blogs

The 1918-19 influenza pandemic affected American Samoa and Western Samoa very differently. American Samoa was subject to quarantine during the pandemic and there were no deaths on the island. Western Samoa did not have a quarantine – it had a great deal of infections and a great deal of deaths. (1)

The two Samoa’s are less than 100 km apart. The quarantine imposed on American Samoa was a maritime one. Australia also had a quarantine, and this lessened the impact of the pandemic in this country also. So, if there was an influenza pandemic today, could we simply draw up the drawbridge and keep influenza out?

Hegel famously said that “we learn from history that we do not learn from history”. Is this also true of learning from the 1918 influenza pandemic? There are certain things that we can learn from past pandemics, but we should also remember that the world has changed a great deal in the past hundred years.

In this regard, maritime quarantine will simply not work today because of air transport (it didn’t work in many countries one hundred years ago anyways). But are there modern equivalents to the maritime quarantine. One equivalent may be screening at airports. However, that doesn’t seem to work well either. You can ask people if they have any symptoms of Influenza or take their temperature – but neither of these methods are effective at ruling in or ruling out influenza. There are a variety of reasons for this. Some people can be infected and contagious, and yet have no symptoms. Others may have suspicious symptoms and yet not have influenza. (2)

Are there other ways of drawing up the drawbridge? One of the iconic images of the 1918 pandemic is that of people wearing facemasks in public. Wearing facemasks in 1918 did not seem to work and, even today, the public don’t tend to like wearing or being forced to wear facemasks. The other barrier method is hand-washing. But this does seem to work and to be more socially acceptable.

Doctors and other healthcare professionals could play a role here also – by washing their hands in front of patients and showing them how to wash their hands properly. But this will require openness and communication, and willingness to put guidelines into practice, and to teach and learn. (3) It is the opposite of drawing up the drawbridge.

Written by Dr Kieran Walsh


1. Short KR, Kedzierska K, van de Sandt CE. Back to the Future: Lessons Learned From the 1918 Influenza Pandemic. Front Cell Infect Microbiol. 2018 Oct 8;8:343.

2. Priest PC, Jennings LC, Duncan AR, Brunton CR, MG. Effectiveness of border screening for detecting influenza in arriving airline travelers. Am J Public Health. 2015 Oct;105 Suppl 4:S607-13, S600-6.

3. Walsh K, Sandars J, Kapoor S, Siddiqi K. Getting NICE guidelines into practice: can e-learning help? Clinical Governance: An International Journal 2010; 15: 1 pp6-11.

Competing interests

Kieran Walsh works for BMJ which produces a range of resources on infectious and non-infectious diseases.


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