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To the Editor: Nonpharmaceutical interventions implemented in the United States during the 1918-1919 influenza pandemic are worth revisiting, as was done by Dr Markel and colleagues.¹ Lessons from the past may mitigate future influenza pandemics. However, this pandemic occurred in a very particular moment of history.

World War I was ending, and migration patterns (particularly of military personnel) need to be taken into account when analyzing this event. It would have been interesting to know city-to-city variations according to the number of military personnel returning home and whether this had any association with the bimodal pattern shown in certain cities. In parts of the world where the war had little impact, like South America, influenza mortality was much lower than in the Northern hemisphere.²

During war, migration patterns have to be taken into account, not only with respect to birds potentially infected with viruses capable of being transmitted to humans . . . [Full Text of this Article]

Jacobo Dib Jr, MD
dib.j@hotmail.com
Gastroenterology Unit
Department of Medicine
Hospital de Lidice
Caracas, Venezuela

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