Omar P. Haqqani, for the Daily News

Dr. Haqqani: Eliminating disparity in health care

The medical community should make every effort to eliminate the impact of racism in health care. Although the disparities are being brought to light by the current pandemic, the problem has been acknowledged in the past. Now is the time for health care professionals to aggressively seek to reverse the impact of negative attitudes and practices that have long been in place.

Causes and effects of racism in health care

There is an alarmingly high national rate of COVID-19 hospitalizations and deaths within the minority community, according to The Centers for Disease Control and Prevention. It is 4.5% higher for African Americans than that of the non-minority population. It also rises for Hispanic or Latino individuals and Native Americans.

Aside from the increases brought to light by the coronavirus, the disparity in general good health can be seen across the board in every medical arena. The higher rates of diabetes, obesity, hypertension and other conditions among minorities have contributed not only to higher coronavirus consequences, but to cardiovascular issues, kidney failure and other dangerous circumstances.

In a report published in the archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health's National Library of Medicine in 2019, unequal access to medical care for minorities is a major factor in fostering health inequities. Other factors in maintaining or widening the gap include a lack of childhood development, a higher rate of poverty, and income inequality between minority workers and non-minority workers. Housing and other social and economic factors are also important in the health care disparity discussion. While they may not all seem related specifically to medical care, they result in inadequate circumstances for minorities.

Lack of preventative care

The economic disadvantages more frequently faced by minorities in childhood and adulthood lead to less consistent medical care. Infrequent checkups and less education about signs of disease increase the odds of major health difficulties. According to the NIH/NLM report, only 3% of all health care money in the United States is spent on preventative care. Many dangerous medical conditions, including cardiovascular issues, are preventable, or at least more controllable when warning signs are detected.

The economic factors of racism decrease the probability of prevention. Because wages are lower, doctor visits are infrequent. Many low paying jobs do not include health benefits. Workers may also resist relinquishing a day's pay to go to a doctor's office for a checkup, as well.

Availability and procedural disparities

The there is also a fracture quality of health care for minorities once a diagnosis is made and treatment is prescribed. The impact of this is obvious in all age groups. Infant mortality rates are higher and life expectancy is shorter in minority communities. In one example of specific treatment recommendations, the Journal of the American Society of Nephrology cites a study that revealed that 35% fewer minority patients who were eligible for kidney transplants received them, versus the non-minority eligible patients.

Steps the medical community must take

Addressing social risk factors among minorities, diversifying the health care work force, improving the availability of health care and providing more avenues to primary care are among the strategies that can help.

There are programs in place that provide outreach into minority and underprivileged communities to provide better health care. Medical institutions should encourage their doctors and nurses to participate in programs that deal with childhood intervention, senior care and assistance to the disabled.

The American Medical Association has acknowledged that bias exists within health systems and peripheral institutions that contribute to the disparities. Health professionals and institutions are being urged to examine and correct it.

Ask Dr. Haqqani

If you have questions about your cardiovascular health, including heart, blood pressure, stroke lifestyle and other issues, we want to answer them. Please submit your questions to Dr. Haqqani by e-mail at questions@vascularhealthclinics.org.

Dr. Omar P. Haqqani is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland: http://www.vascularhealthclinics.org

Originally posted here:
Dr. Haqqani: Eliminating disparity in health care - Midland Daily News

You might not be able to run to the local MMJ outlet to buy a cure-all for COVID-19, but cannabis is still on the menu, with at least two clinical studies underway evaluating CBDs for prevention and treatment of the novel coronavirus.

Even if it is not the panacea the world is looking for, use of MMJ is probably a lot safer than injecting disinfectant into your veins.

While studies for coronavirus therapies are in the infancy stages, some have shown promise blocking the virus, and as an anti-inflammatory agent for those afflicted with the disease. Two such studies, originating in Canada and Israel, have recently caught the attention of medicinal cannabis advocates hoping to further legitimize the herb as mainstream medicine.

The studies are not for an anti-virus vaccine, but as therapies that could enhance primary treatment and "prevention strategies" to deny the virus entry into the body or as an anti-inflammatory treatment that may help prevent acute respiratory distress for those afflicted with the disease.

The Canadian study is a collaboration between the University of Lethbridge, Pathway Rx, a Canadian pharmaceutical research company that develops cannabis therapies and Swysh, Inc., a cannabinoid-based oral health company.

In April, the group released a preclinical study for peer review titled, "In Search of Preventative Strategies: Novel Anti-Inflammatory High-CBD Cannabis Sativa Extracts Modulate ACE2 Expression in COVID-19 Gateway Tissues."

The study looked at hundreds of strains of cannabis and their effect on artificial lung, oral/nasal and intestinal tissue and their ability to modulate angiotensin-converting enzyme 2 (ACE2). According to researchers involved in the study, ACE2 is a receptor required for COVID to enter the cells.

"ACE2 may be the way COVID enters the cell," Heather Moroso, NMD said. "If you make more of it, it's basically like opening more doors for the virus to enter. If you make less or block ACE2, then potentially that's fewer doors for the virus to enter."

If the research proves successful, the resulting medications could be administered in the form of mouthwash, gargle, inhalants or gel caps, according to those involved with the study. Smoking cannabis, on the other hand, might exacerbate lung problems brought on by the virus.

"There is some evidence that smoking in general may make one more vulnerable to COVID," Moroso said.

Researchers say a fraction of the strains that have been tested have shown success in reducing virus receptors by as much as 73 percent.

Studies may have hit roadblocks though, as a lack of clinical trials and insufficient funding has kept the work in its infancy phase.

The Israeli study, a collaboration between InnoCan Pharma of Israel and Tel Aviv University, focuses on products using CBD-loaded exosomes to treat lung inflammation.

The exosomes could be safely administered without adverse reactions, creating a potentially safe delivery system via inhalation for a variety of lung infections in COVID patients. The study focused on CBDs in order to reduce patient impairment that may be caused by higher levels of THC in other forms of the drug.

While the studies represent something of a boon for cannabis advocates, locally, response to the reports is that it's "not ready for prime time."

To begin with, the Canadian study utilized artificial tissue models, so it is not clear if the results would be the same if conducted on living humans.

"The [Lethbridge] paper utilizes tissue models which are very far removed from human, or animal, organs in-situ and hence any conclusions must be taken with great caution," said a retired Tucson neuroscientist who declined to be identified for this report. "In my opinion, the results are extremely preliminary and may not have any relevance to the question at hand: adjunct therapies to combat COVID-19 infection."

There is also a problem of "confirmation bias," which means there may be a subconscious desire for a cannabis "miracle cure" that may lead to a loss of objectivity in processing the results of studies on the drug.

"Everybody wants cannabis to be a cure-all miracle drug," Moroso said, adding that while the state of Arizona does not recognize sleep issues as qualifying conditions, sleep can be an important aspect to stress reduction.

Additionally, during the current state of the pandemic, MMJ can have positive effects on patients experiencing anxiety over their lives and futures, as the economic and health impacts of a global pandemic make the future murky, at best.

"Cannabis can help people suffering from anxiety, depression and post-traumatic stress disorder," Moroso said. "The stress and anxiety of being in isolation; unknown job and family situations; domestic abuse and isolation? I'm not a rocket scientist, but sensible use of the drug can help reduce the anxiety."

See the original post here:
Cannabis and Coronavirus - Tucson Weekly

WEST LAFAYETTE, Ind - As the next step to protect the health and safety of everyone on campus and the community, Purdue University announced today (July 8) that it is formulating plans to require and pay for all West Lafayette-bound students to be tested for COVID-19 before moving into residence halls and attending classes this August.

The program will be led by Dr. Esteban Ramirez, chief medical officer at the Protect Purdue Health Center (PPHC), and was developed in consultation with the Protect Purdue Medical Advisory Team. Dr. Ramirez is an experienced internist and clinical assistant professor at the Indiana University School of Medicine-West Lafayette. Under Dr. Ramirez direction, the PPHC is the Universitys virtual health center launched last week to coordinate the overall workflow of COVID-related case management on campus.

Through its Protect Purdue initiative, undergraduate, graduate and professional program students will soon be provided instructions and assistance on how and when to get tested for COVID-19, beginning in early August before traveling to campus.

Student test results will be sent to the Protect Purdue Health Center, and those testing positive should not travel to West Lafayette or come to campus for any reason until they isolate for 14 days and are medically-cleared to return by the PPHC.

Failure to complete a COVID-19 test and have those results filed with the Protect Purdue Health Center prior to arrival will affect a students ability to move into a residence hall or begin in-person classes when they resume on Aug. 24. Academic support will be available through virtual consultations with staff specializing in student success to help undergraduate students navigate their continued academic progress if they must isolate because of COVID-19.

For students already on campus or arriving for various early-start programs throughout July, the University and the Protect Purdue Health Center are developing plans to rapidly sample and test individuals through a combination of resources provided by on-campus, local and outside partners.

The University will cover costs of all student testing. Purdue is expecting a potentially record number of freshmen this fall, with a student body of more than 40,000 total.

Our comprehensive Protect Purdue Plan affords us the unique flexibility and adaptability to respond to rising COVID-19 cases across parts of the country and help protect our Purdue community in real time, Ramirez said.

We are committed to facilitating the testing of our students who span the nation and the globe before they return to the residence halls, classrooms and West Lafayette community this August by way of our Protect Purdue Health Center, Ramirez added. "Through these preventative and proactive measures, we take another important step to protect the student body, our faculty, staff, overall campus and members of the local community particularly the most vulnerable amid concerning national trends.

Undergraduate, graduate and professional program students: All students living on campus this fall will be required to be tested for COVID-19 and have a negative test result on file with the Protect Purdue Health Center prior to moving into their residence hall in August.

Those students living off campus also will be required to be tested for COVID-19 and have negative test results on file with the PPHC prior to participating in an on-campus program in August or attending their first in-person class.

Specific instructions will soon be provided on how and when to get tested for COVID-19 in August before traveling to campus, while allowing adequate time for processing and reporting test results before arrival.

For students participating in Early Start, Summer Start and other programs throughout July, as well as students already at Purdue for work, research or classes this summer, special arrangements have been made to test them on campus or in collaboration with local testing partners.

Faculty and staff: Faculty and staff are not required to be COVID-19 tested at this time provided they are not sick, experiencing any symptoms of COVID-19, and have not been exposed to someone who has tested positive for COVID-19.

All faculty and staff, particularly those working on campus this summer and fall, are encouraged to adhere to the components of the Protect Purdue Pledge, particularly monitoring and reporting any signs or symptoms of COVID-19 to the Protect Purdue Health Center by calling 765-496-INFO (4636) or toll-free at 833-571-1043. The caller will be connected to a registered nurse case manager, who will help determine the appropriate course of care, which could include self-quarantine and a COVID-19 test.

Integrated Monitoring and Surveillance Plan: The Protect Purdue Health Center, the single-point health center for all things COVID-19-related for the Purdue community, is staffed with a dedicated team of physicians, registered nurses, case managers, contact tracers and support staff. Ramirez said the PPHC is working closely with the Protect Purdue Health Monitoring and Surveillance Team as well as the Medical Advisory Team to ensure the safety, health and well-being of individuals and the community.

As the semester progresses, the Protect Purdue Health Center will provide ongoing case management, which will include monitoring and testing of both symptomatic individuals and close contacts who might have been exposed to positive individuals. The protocols for testing and contact tracing have been developed in accordance with the guidelines set by the Centers for Disease Control and Prevention and the Indiana State Department of Health.

When the comprehensive Protect Purdue Plan was announced on June 12 for reopening the campus this fall, the University began the capabilities to rapidly assess, sample and test any student, faculty or staff member reporting COVID-19 symptoms and those identified through clinically relevant contact tracing.

About Purdue University:

Purdue University is a top public research institution developing practical solutions to todays toughest challenges. Ranked the No. 6 Most Innovative University in the United States by U.S. News & World Report, Purdue delivers world-changing research and out-of-this-world discovery. Committed to hands-on and online, real-world learning, Purdue offers a transformative education to all. Committed to affordability and accessibility, Purdue has frozen tuition and most fees at 2012-13 levels, enabling more students than ever to graduate debt-free. See how Purdue never stops in the persistent pursuit of the next giant leap atpurdue.edu.

Media contact: Tim Doty,doty2@purdue.edu

Original post:
Purdue will require all students to be tested for COVID-19 before start of the fall semester - Purdue News Service

By: Reuters | Geneva, London | Published: July 4, 2020 6:39:32 am There is no proven vaccine against the disease now, while 18 potential candidates are being tested on humans.

The World Health Organization (WHO) should soon get results from clinical trials it is conducting of drugs that might be effective in treating COVID-19 patients, its Director General Tedros Adhanom Ghebreyesus said on Friday.

Nearly 5,500 patients in 39 countries have so far been recruited into the Solidarity trial, he told a news briefing, referring to clinical studies the U.N. agency is conducting.We expect interim results within the next two weeks.

The Solidarity Trial started out in five parts looking at possible treatment approaches to COVID-19: standard care; remdesivir; the anti-malaria drug touted by U.S. President Donald Trump, hydroxychloroquine; the HIV drugs lopinavir/ritonavir; and lopanivir/ritonavir combined with interferon.

Earlier this month, it stopped the arm testing hydroxychloroquine, after studies indicated it showed no benefit in those who have the disease, but more work is still needed to see whether it may be effective as a preventative medicine.

Mike Ryan, head of the WHOs emergencies programme, said it would be unwise to predict when a vaccine could be ready against COVID-19, the respiratory disease caused by the novel coronavirus that has killed more than half a million people.

While a vaccine candidate might show its effectiveness by years end, the question was how soon it could be mass produced, he told the U.N. journalists association ACANU in Geneva.

There is no proven vaccine against the disease now, while 18 potential candidates are being tested on humans.

WHO officials defended their response to the virus that emerged in China last year, saying they had been driven by the science as it developed. Ryan said what he regretted was that global supply chains had broken, depriving medical staff of protective equipment.

I regret that there wasnt fair, accessible access to COVID tools. I regret that some countries had more than others, and I regret that front-line workers died because of (that), he said.

He urged countries to get on with identifying new clusters of cases, tracking down infected people and isolating them to help break the transmission chain.

People who sit around coffee tables and speculate and talk (about transmission) dont achieve anything. People who go after the virus achieve things, he said.

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WHO sees first results from coronavirus drug trials within two weeks - The Indian Express

Geneva/London The World Health Organization has updated its account of the early stages of the COVID-19 crisis to say it was alerted by its own office in China, and not by China itself, to the first pneumonia cases in Wuhan.

The U.N. health body has been accused by U.S. President Donald Trump of failing to provide the information needed to stem the pandemic and of being complacent towards Beijing, charges it denies.

On April 9, WHO published an initial timeline of its communications, partly in response to criticism of its early response to the outbreak that has now claimed more than 521,000 lives worldwide.

In that chronology, WHO had said only that the Wuhan municipal health commission in the province of Hubei had on Dec. 31 reported cases of pneumonia. The U.N. health agency did not, however, specify who had notified it.

WHO chief Tedros Adhanom Ghebreyesus told a news conference on April 20 that the first report had come from China, without specifying whether the report had been sent by Chinese authorities or another source.

But a new chronology, published this week by the Geneva-based institution, offers a more detailed version of events.

It indicates that it was the WHO office in China that on Dec. 31 notified its regional point of contact of a case of viral pneumonia after having found a declaration for the media on a Wuhan health commission website on the issue.

The same day, WHOs epidemic information service picked up another news report transmitted by the international epidemiological surveillance network ProMed based in the United States about the same group of cases of pneumonia from unknown causes in Wuhan.

After which, WHO asked the Chinese authorities on two occasions, on Jan. 1 and Jan. 2, for information about these cases, which they provided on Jan. 3.

WHO emergencies director Michael Ryan told a news conference Friday that countries have 24-48 hours to officially verify an event and provide the agency with additional information about the nature or cause of an event.

Ryan added that the Chinese authorities immediately contacted the WHO as soon as the agency asked to verify the report.

WHO chief Tedros Adhanom Ghebreyesus told a news briefing that the organization should soon get results from clinical trials it is conducting of drugs that might be effective in treating COVID-19 patients. | AFP-JIJI

Trump has announced that his country, the main financial contributor to WHO, will cut its bridges with the institution, which he accuses of being too close to China and of having poorly managed the pandemic.

The WHO denies any complacency toward China.

Also Friday, Tedros told a news briefing that the WHO should soon get results from clinical trials it is conducting of drugs that might be effective in treating COVID-19 patients.

Nearly 5,500 patients in 39 countries have so far been recruited into the Solidarity trial, he said, referring to clinical studies the U.N. agency is conducting.

We expect interim results within the next two weeks.

The Solidarity Trial started out in five parts looking at possible treatment approaches to COVID-19: standard care; remdesivir; the anti-malaria drug touted by Trump, hydroxychloroquine; the HIV drugs lopinavir/ritonavir; and lopanivir/ritonavir combined with interferon.

Earlier this month, it stopped the arm testing hydroxychloroquine, after studies indicated it showed no benefit in those who have the disease, but more work is still needed to see whether it may be effective as a preventative medicine.

Ryan, the WHOs emergencies program chief, said it would be unwise to predict when a vaccine could be ready against COVID-19, the respiratory disease caused by the novel coronavirus that has killed more than half a million people.

While a vaccine candidate might show its effectiveness by years end, the question was how soon it could be mass produced, he told the U.N. journalists association ACANU in Geneva.

There is no proven vaccine against the disease now, while 18 potential candidates are being tested on humans.

WHO officials defended their response to the virus that emerged in China last year, saying they had been driven by the science as it developed. Ryan said what he regretted was that global supply chains had broken, depriving medical staff of protective equipment.

WHO emergencies director Michael Ryan | Pool via REUTERS

I regret that there wasnt fair, accessible access to COVID tools. I regret that some countries had more than others, and I regret that front-line workers died because of (that), he said.

He urged countries to get on with identifying new clusters of cases, tracking down infected people and isolating them to help break the transmission chain.

People who sit around coffee tables and speculate and talk (about transmission) dont achieve anything. People who go after the virus achieve things, he said.

On the sidelines ACANU briefing, another top WHO official said almost 30 percent of genome sequencing data from samples of the COVID-19 virus collected by the body have shown signs of mutation, but there is no evidence this has led to more severe disease.

I think its quite widespread, said Soumya Swaminathan, WHO chief scientist.

The U.N. agency has so far collected 60,000 samples of the disease, she said.

Scientists at Scripps Research this month found that by April the mutated virus accounted for some 65 percent of cases submitted from around the world to a major database.

The genetic mutation in the new coronavirus, designated D614G, significantly increases its ability to infect cells and may explain why outbreaks in northern Italy and New York were larger than ones seen earlier in the pandemic, they found in a study.

Maria Van Kerkhove, technical lead on the COVID-19 pandemic at the WHO, said at Fridays briefing the mutated strain had been identified as early as February and had been circulating in Europe and the Americas.

So far, there is no evidence it leads to more severe disease, she said.

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WHO says it was first alerted to coronavirus by its office, not China - The Japan Times

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As Canada continues to reopen, some grocery stores, salons and other businesses have implemented temperature screening an approach that uses a touchless scanner to measure a persons body temperature in an attempt to prevent the spread of the novel coronavirus.

The process was made mandatory for all air travellers in Canada in mid-June. Any passenger who shows a fever on two measurements, taken 10 minutes apart, will be asked to rebook after 14 days.

However, some experts wonder whether the step is effective given a person can shed the COVID-19 virus without having a fever or any change in body temperature. The tool often used to measure temperature has also been shown to be unreliable.

READ MORE: Temperature screening not always reliable to mitigate coronavirus risk, experts say

For those reasons, temperature screening has not been recommended by Canadas chief public health officer Theresa Tam. In fact, she quickly shut down the approach when more businesses began implementing the practice in May.

The more you actually understand this virus, the more you begin to know that temperature-taking is not effective at all, Tam said in a ministerial update that month.

Tam said the likelihood of screening someone who was symptomatic was relatively inefficient in comparison to those who were asymptomatic.

If we have a significant number of asymptomatic or pre-symptomatic people, that also even reduces the effectiveness even more.

Dr. Susy Hota, the medical director of the Infection Prevention and Control and Medical Device Reprocessing department at the University Health Network in Toronto, agrees.

"There really are a lot of limitations to temperature checks, and I'm not really convinced that they're worth investing in for this purpose," Hota said.

READ MORE: Canada to screen air travellers for fever amid coronavirus pandemic: Trudeau

There are also inaccuracies with the temperature probes used for this purpose, Hota said.

She worries they can give patrons and business owners a "false sense of security."

Temperature screening is typically not an effective way to detect COVID-19 when used on its own, and that's because of the way the virus spreads.

"When we talk about the issue of pre-symptomatic shedding and transmission, we're talking about people who have no symptoms yet so no fever," Hota said.

"Once you've developed the fever, we know what we're dealing with ... but in the pre-symptomatic phase, a temperature check won't help."

Problems can also arise from the touch-less temperature probes currently being used in airports, grocery stores and by other businesses.

"It's a variable that ... isn't infallible," said Dr. Leighanne Parkes, infectious disease specialist and microbiologist at the Jewish General Hospital in Montreal.

"It depends on the instrument that we're using, the ambient temperature, (if) the instrument is calibrated correctly, is the individual coming in from a hot outside or a cold outside?"

All these things come into play when a temperature probe is used, making true measures hard to come by.

READ MORE: You might be wearing your mask, gloves wrong. How to use PPE properly

There are also other reasons a person's body temperature could be elevated that don't have to do with COVID-19.

Medication, certain pre-existing conditions, weather and what you were doing immediately prior to having your temperature checked are all factors that can affect your body temperature, Hota said.

"It is possible that your ambient temperature and what you were doing before ... might register a higher temperature than you really would have otherwise," she said.

However, Parkes believes temperature screening could be helpful when it's "bundled" with other preventative health measures.

"If you have an adequately calibrated machine, you're [testing the person's temperature] indoors using appropriate techniques and ... you're also symptom-screening for things that are not fever, and risk factors including contact, those altogether can pick up some of the most high-risk cases," Parkes said.

Temperature screening should be considered just one layer in a "pyramid of prevention," she said.

"It's not a replacement for the other means that we have in place, such as social distancing, masking in public spaces, adequate ventilation, adequate environmental cleaning ... all those things combined."

Although temperature screening may not accurately detect COVID-19, it's still within the rights of a business to deny you service on the grounds of a high temperature.

This is because employers and employees have the right to a safe working environment.

"You can't be denied entry on grounds of race or religion ... because that's discrimination, but if your temperature is above some arbitrary scale, then you can be denied entry," said Bernard Dickens, professor emeritus of health law and policy in the faculty of law, faculty of medicine and Joint Centre for Bioethics at the University of Toronto.

READ MORE:Planes, salons and grocery stores: Companies that require masks in Canada

"It's a security ground ... to protect the staff who work in the facility. They have a right to a safe working environment, and the store is responsible for the safety of its employees."

Basically, any business can make conditions for who they serve as long as they don't discriminate [and they're not] in violation of the human rights code.

For this reason, you can refuse to take a temperature test, but the store can refuse your entry upon doing so.

"You have no right to go into the store ... because the store can set reasonable conditions [for protection]," Dickens said.

Questions about COVID-19? Here are some things you need to know:

Symptoms can include fever, cough and difficulty breathing very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

In situations where you can't keep a safe distance from others, public health officials recommend the use of a non-medical face mask or covering to prevent spreading the respiratory droplets that can carry the virus.

For full COVID-19 coverage from Global News, click here.

With files from Global News' Emerald Bensadoun

Meghan.Collie@globalnews.ca

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Can I refuse a temperature check? What to know about the COVID-19 screening tool - MSN Canada

INDIANAPOLIS Dr. Herman G. Morgan, the 33-year-old secretary of the Indianapolis Board of Health, presented the situation in simple terms.

In November 1918, Indianapolis and the rest of the world were in the grips of the worst influenza pandemic in history. Less than two months had passed since the city's newspapers reported the first cases among soldiers stationed at the Indiana School for the Deaf and Fort Benjamin Harrison.

Morgan's Board of Health issued sweeping orders in early October 1918, similar to those the city imposed in March and April 2020 in the fight against the COVID-19 pandemic.

Schools and churches closed. Businesses and theaters shut down. Public meetings were banned. Streets emptied.

Newspapers.com

By November, Indianapolis began reopening and its citizens gathered in celebration of victory in World War I, leading to another rise in cases, according to Bill Beck, a current member of the Marion County Historical Society's board of directors.

"Flu cases had spiked late the week before in the wake of the Armistice celebrations on Monday, Nov. 11, and the Board of Health reacted by trying to get ahead of the curve," Beck said.

Morgan determined it was time for citizens to wear masks in public or risk the city shutting down for a second time.

"The board of health has placed on the individual and, to a larger extent, his employer, the matter decided of whether business shall continue in Indianapolis," Morgan said in the Indianapolis Star on Nov. 20, two days after the mask requirement was announced. "If there is a tendency on the part of the public to disregard the health regulation, the only resort is to close up all business houses and public gathering places."

No ordinary flu

The H1N1 flu, also known as the Spanish Flu and La Grippe, was both rapid and violent.

Fueled by soldiers moving around the globe at the end of World War I, the Centers for Disease Control and Prevention estimates the flu infected one-third of the world's population and killed at least 50 million people worldwide, including 675,000 Americans.

The author John H. Barry wrote in his book "The Great Influenza" the first confirmed cases appeared on March 4, 1918, at Fort Riley, Kansas. It finally subsided in the summer of 1919 after arriving in three waves. The second wave in the fall of 1918 was the most severe.

Newspapers.com

In his book, Barry described the swiftness with which the virus struck its victims and the horrifying symptoms many experienced.

"Symptoms were terrifying," Barry wrote. "Blood poured from the noses, ears, eye sockets; some victims lay in agony; delirium took others away while living."

The Indianapolis Star reported on Nov. 24 that 3,266 Hoosiers died statewide from the flu in October, and 3,020 children became orphans. The illness struck the youngest and strongest adults the hardest.

"More than 53 percent of the 3,266 persons who died of influenza-pneumonia in Indiana during October were between the ages of 20 and 40 years," the Star reported.

Beck said his grandfather was a mortician in Indianapolis during the pandemic.

My dad remembered never seeing his father that whole fall because he was so busy burying people," Beck said. This thing was so lethal that people would basically come down with it one morning and be dead the next morning."

'But we gotta do it'

With cases rising, on Nov. 18, the Indianapolis Board of Health announced an order requiring face masks, along with the closure of all schools.

In that evening's edition of The Indianapolis News, Morgan said masks "should be made of cheese cloth, surgeon's gauze or other porous material." The News reported the board considered re-closing the city, but first wanted to attempt the mask order.

"The board said the order requiring the wearing of masks was adopted in the hope that thereby the necessity for a renewal of the general closing order would be avoided," the News reported. "It is up to the business men and the managers of business houses, theaters, poolrooms, barber shops and all other public places to see to it that persons without masks are barred. Places which violate this ruling will be closed."

Newspapers.com

In a Nov. 20 piece headlined, "All Dressed Up Like a Horse, With a Goshawful Nosebag--but We Gotta Do It," Indianapolis Star columnist Mary E. Bostwick described the scene in offices and streets as people acclimated themselves to wearing face masks.

"On the street, the masks were seen yesterday at intervals, although not frequently enough to keep the unmasked citizens from snickering at their brethren who were going around with their faces all under cover," Bostwick wrote. "But the mask wearers did not care. No one could tell who they were anyway."

While she found some humor and ridiculousness in the situation, in the end, Bostwick concluded the mask order was necessary.

"Whether we want to or not, we positively must not go anyplace indoors with our faces undressed," she wrote. "And if we get to chortling raucously at somebody so adorned, remember we look just as funny ourselves."

Newspapers.com

Still, same as today, there were those who fought against the mask order.

While the penalty for violating Marion County's order that is scheduled to go into effect Thursday is a fine of up to $1,000, the city treated "mask slackers" harshly in 1918. On Nov. 22, The Indianapolis Star reported three men were arrested in a hotel lobby after they refused to wear masks.

"They were released at the City Prison on their own recognizance," according to the Star.

As objections to wearing masks continued, Morgan spoke about the importance of following the order. In the Star on Nov. 24, he pleaded with citizens to wear masks in order to prevent the city from being shut down for a second time.

He emphasized the wearing of masks "is not a pet whim of any member of the health department" and that "the cooperation of the majority of people is absolutely necessary to make any preventative measure a success."

In full, Morgan said:

This was not for the purpose of causing an inconvenience to the public, as some conscientious objectors have stated, but to prevent infection from being transferred from one individual to another. The wearing of gauze masks is not a pet whim of any member of the health department. This method of preventing cross infection has been successfully used in a number of cities and has been used by surgeons for years to prevent droplet infection from reaching the field of operation. The mask has been adopted by military hospitals in both the general and infectious wards. Medical literature is full of data which proves conclusively the efficiency of this method.

When a community is confronted with a serious epidemic, the cooperation of the majority of the people is absolutely necessary to make any preventative measure a success. This is not a time for destructive criticism, petty jealousies or all-time 'knockers,' but an occasion for every individual to aid in the enforcement of the preventative measure to end that disease and death may be reduced to a minimum.

A turn for the better

At the beginning of the following week, however, Morgan was pleased with the results of the city's mask campaign. He urged caution, but with infection rates decreasing, on Nov. 25, the Board of Health rescinded the city's mask order. Schools remained closed until Dec. 2.

"This measure enabled the board to bridge over a very alarming influenza situation and to reduce the chances of cross-infection," Morgan said in The Indianapolis News on Nov. 25.

Morgan, who led the Indianapolis Board of Health for 33 years until his death in 1946, added that the wearing of masks allowed the city to continue business and retain at least a semblance of normalcy.

"It prevented a large number of persons from being deprived of employment, a situation that would have developed if a closing ban on all forms of business had been established," he said. "While the mask recommendation was met with some opposition, the spirit of cooperation in the beginning was all that could have been expected and enabled the board to cut short the present epidemic."

Newspapers.com

By the time flu pandemic passed, Indianapolis had a rate of 290 deaths per 100,000 people, one of the lowest among U.S. cities, according to the "Influenza Encyclopedia," produced by the University of Michigan Center for the History of Medicine and Michigan Publishing.

Bill Beck, of the Marion County Historical Society, said he and Dr. William McNiece, the Historical Society's president, estimate 950 people in Indianapolis died from the flu in October, November and December 1918.

I get the impression that both the state board of health and the county board of public health were very proactive," Beck said.

Being proactive will be a necessity in the days, weeks and months ahead in the current battle against COVID-19, which has killed at least 132,000 Americans, including more than 2,500 Hoosiers.

"This pandemic has not gone away," current Indianapolis Mayor Joe Hogsett said last week while announcing a face mask mandate. "And across the country, we are seeing examples of what can happen when a city lets its guard down."

If there is a singular lesson we can apply from Morgan's campaign against the influenza pandemic of 1918 to the coronavirus pandemic of 2020, it is that the path toward defeating a virus leads only through cooperation and collective will.

This virus obeys the laws of physics. It obeys the laws of chemistry. It obeys the laws of biology," Beck said. "It couldn't care less about anything else. You have to just keep your focus on the virus. You don't focus on anything else, you focus on the virus.

The Indiana Medical History Museum will host a virtual presentation featuring Bill Beck and Dr. William McNiese titled "The 1918 Pandemic: Indianapolis Confronts the 1918 Spanish Influenza" at 2 p.m. Sunday, July 12.

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In 1918, Indianapolis required masks during the fight against 'The Great Influenza' - WRTV Indianapolis