Tag Archives: Disease Control

Public School Pre-Vaccine Public Health Class Circa 1932 – Part 1: Good Citizenship

What did we do to prevent diseases and still carry on with daily life before vaccines existed? Vulnerable populations still existed. Public health measures still existed, even under President Herbert Hoover. So let’s take a gander into the archives of historical texts, starting with my grandmother’s health textbook.

It should be noted, as we are reading a historic text in its context, that my grandmother was a young white woman born in 1925 in Birmingham, Alabama to a doctor that made a point of treating people of all colors. That is not to say this did not occur without discrimination. As I was not alive and never met my great grandfather, I will never know the full story without speculation. My grandmother did explain to me that she attended an all white school. The name of the school her and her brother, William, attended was called “Edgewood” according to her distinctive cursive handwriting on the inside cover. I do not know if this is the same textbook that was used at other schools in the Birmingham area.

Controlling Disease

One distinct aspect of this textbook is the emphasis on good citizenship skills being a necessary requirement for preventing disease. But what is “good citizenship” and how does a health textbook from the 1930s define this?

Earlier in the text, good citizenship is defined as including everything from behavioral expectations and good hygiene to looking out for your fellow man in your daily activities. One prohibition era example of this being moderating consumption of anything that may dull or alter perception, such as alcohol containing medicines. There is an emphasis on “knowing thyself” and having awareness as being an important philosophical concept necessary for good health (see below).

Part of good citizenship seems to be a willingness to understand the concept of doing what is best for the common good, or what is best for maintaining the health and wellbeing of the population at large. This included some rather drastic measures, such as “sanitariums.” I will get to how tuberculosis sanitariums are described in the book in part 2 when we discuss the concept of the common good.

Good Citizenship

What did good citizenship mean? This is discussed throughout the textbook and I have attempted to summarize the concept here. It meant:

  • Not going out in public if you were sick, caring for a sick person at home, or were exposed to someone you later found out was sick until after the isolation period was over. In fact, make a special room in your house that can be converted to a “sick room” to isolate a person if they get sick – make sure it has plenty of windows you can open to keep the room “well-aired” with lots of daylight while it is shut off from the rest of the house.
  • Participating in volunteer groups, such as community service and church groups, that provide resources to keep others from feeling like they can not maintain the actions associated with good citizenship.
  • Keeping yourself clean and encouraging those around you to do the same through regular bathing, hand washing, and laundering of garments. This also included the wearing of aprons and work clothes that would be changed upon entering the home. By changing outfits regularly you kept the “germs” associated with the different parts of your life compartmentalized.
  • During certain times of the year, such as the winter, keep a wash basin by the front door with lye soap for guests and occupants of the home or building.
  • Wearing gloves to keep the hands clean while you are out and about and changing gloves between activities. These should be laundered regularly.
  • Using a handkerchief that is not to be shared for crying, coughing, sneezing, and all other expulsions of bodily fluids from the face. This should be laundered regularly with a disinfectant.
  • Eating healthy, home-cooked food from a clean kitchen, and bringing food of this kind to events. Practicing good hygiene in the kitchen is a must. (There is no mention of hand washing or gloves in the kitchen interestingly, but there is mention of washing vegetables, utensils, plates, and the management of food waste.)
  • Having home activities that keep your family fit and healthy, while bonded together. Suggested sports include examples such as tennis and chopping wood. (I’m not kidding about the chopping wood bit – that’s a sport for family bonding.)
  • Listening to the directions of your public health officials to prevent outbreaks. At the time only one vaccine was available (pertussis), but there were other prevention methods no longer used today.
Chart with information on incubation period and isolation requirements post exposure.

If you were exposed to someone with one of these diseases you had to isolate at home. If you didn’t do that, your parents were being bad citizens.

What is a bad citizen? That’s a more complicated subject and is where we start to delve into problematic areas with how this advice was given. In more modern terms that strip away the problematic content of the past, if you’re actively not helping to keep everyone around you safe and out of harm’s way, you’re a bad citizen.

It’s fascinating how times change. These methods were used to keep schools safe and in session before vaccines (not perfectly – outbreaks definitely still happened).

Anyways, I’ll revisit history again soon. Hope this was as informative for you as it was for me!


If you would like to see more posts like this one, please be sure to like, comment, and/or share this post. This helps me know which posts my readers like the most so I can try and cater my content. As always, thank you for taking the time out of your day to join me.

This post is dedicated to my friend Katrina, and other friends currently dealing with teaching full classrooms over Zoom. Be sure to thank a teacher today.

June 2013 – A Poem

2012 Sespe Condor Sanctuary

I didn’t want to pick out an appropriate picture for this poem. I picked out something calm that reminded me of the opposite of what this day felt like. Many of my poems are flashbulb memories or combinations of flashbulb memories. This poem is the worst day of work I have ever experienced. I don’t know if, in a literary sense, this poem is any good. There are quite a few poems like this I keep hidden: more personal in nature and harder to predict how a reader is going to react. Let me know what you think in the comments or like it. If you do like this poem, share it with your friends so I can get a decent survey of whether or not to post more like it.


June 2013

I watch a woman melt today
Skin sags off a decomposing body
With a sputtering heart
Interstitial fluid melts into
The heated inflated bed
Brain death at 4 o’clock in the afternoon
Her children bicker in the hallway
Her pacemaker trips
Every few minutes

They sign away their rights to sue
Hospital-Acquired Infection List Marathon
As the ventilator sings positive pressure
”So she never woke up from the surgery?”
”No, ” the doctor lies
Through his military smile

I am a phlebotomist and
A disease controller:
Biohazard level 4 room, Sir
Check-in Check-out – a list procedure
[Can’t talk back to the M.D. – Report her!]

I keep my mouth shut
As they beg for hope
Their mother’s dripping on the floor
More Chux! More Chux!
But their sister has to get there
Before they allow us
To turn off the machines.

New Jersey: Are We Flattening The Curve?

New Jersey Surge Approximately 1 Week Behind New York

As of 4 April 2020 more citizens of New Jersey have died of SARS-CoV-2 than died in the 9/11/2001 attacks.

The eastern part of the state of New Jersey abuts New York City, whereas the western part abuts Philadelphia. If we assume that New York City is the reservoir – or major source of infections that spread out into surrounding areas – New Jersey sits between New York City and Philadelphia. They’re shielding in some regards. New Jersey is predicted to be 1 week behind New York’s recent infection surge. Philadelphia may follow, with Pittsburgh 2 weeks after that based on the 1918 model.

Source: https://coronavirus.1point3acres.com/en

The New Jersey Health Department is carefully tracking cases (image below). The majority of deaths and cases have been in the New York City metropolitan area. Cases have shown need for medical intervention – see below.

What Is Preventing The Curve From Flattening?

Factors Unique to New Jersey

Source: https://www.nj.com/coronavirus/2020/04/these-charts-and-map-show-how-coronavirus-pandemic-is-spreading-across-nj-saturday-april-4-2020.html Play with this one – it’s interactive!

New Jersey is a special state. From the Jersey Shore through Hoboken to the rural borders with Pennsylvania and the beautiful southern parks and rural areas along the Atlantic Ocean and bay – New Jersey is a unique state that saw no action during the Civil War, and is filled with a unique mix of immigrant heritage through history. This mix shares deep rooted values in family, multigenerational gatherings, faith, and the importance of extended family as caregivers, making New Jersey vulnerable to coronavirus.

Places of Worship

I get that we need to think about Easter. Stay home if you can. All places of worship are closed in the state of New Jersey.

Social Distancing

Source: https://www.unacast.com/covid19/social-distancing-scoreboard

Parts of the state of New Jersey are taking social distancing very seriously. Parts, surprisingly close to Philadelphia, are not. The tourist areas of New Jersey are taking social distancing more seriously, and have issued advisories urging those with vacation homes not to come.

Source: https://www.unacast.com/covid19/social-distancing-scoreboard

The C in decrease in average distance traveled is not surprising with a rural population in the state. As I do analyses on state like Arizona and Montana I will argue against that measure because in Montana we’ve been doing social distancing since before it was cool, but we have to drive 5 hours to get anywhere.

Overall, New Jersey, keep up with the social distancing and work on the Philadelphia side of things hopefully.

New Jersey and 1918

In 1918 the Influenza Pandemic spread out from Philadelphia to New York City, not from New York City to Philadelphia. Due to this lack of congruency and the increase in connectedness of both cities via mass transit, it is more likely that New Jersey will see 1-2 peaks entirely dependent on those of New York City and Philadelphia. The visibility of that separation is entirely dependent on the state of New Jersey flattening the curve between those two outbreaks.

Is New Jersey Really Showing No Signs of Slowing?

I decided to break this down into 2 milestones: 100 cases and 1000 cases. I then compared the growth in cumulative cases to present from each.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing – We can see that there are changes going on. Do you like the new style of graph? Tell me in the comments. I can go back and update other posts.

Based on the growth of cumulative cases since the 100th case, New Jersey has had 2 changes in their cumulative growth since their 100th case (I round up due to reporting error). On 20th March 2020 and 26th March 2020 something happened. Given that SARS-CoV-2 has an incubation period of up to 2 weeks, what events could have caused these surges?

20th March 2020 was when New Jersey ordered limitations on business operations. And look at how that curve flattened. It’s almost as if there was a huge testing backlog. If we look 2 weeks prior to that, New Jersey only had 4 reported cases of coronavirus on 6 March 2020. More likely social distancing behaviors began when the first cases were being diagnosed on 6 March and it requires a full two weeks to see the impact of this change in behavior. On 26th March 2020 NJ.com reported that as of that day the number of SARS-CoV-2 cases of unknown origin outnumbered those of known origin in every county of New Jersey. It is more likely that the change in the graph is associated with the state ordered limitations.

Based on the model above, New Jersey is predicted to reach 100,000 cases as of the 12th of April, 2020. This does not take into account the backlog of tests nor daily processing capabilities of labs for these tests.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit#gid=245520383

If we look at just the cumulative cases since the 1000th case, the 100,000th case is predicted closer to 15th of April, 2020. This does indicate curve flattening because this milestone is being pushed out.

Healthcare Systems Overwhelmed

Patients from New Jersey are heading to Philadelphia and New York hospitals for treatment in addition to those in New Jersey. New Jersey’s healthcare resources:

This means that the citizens of New Jersey are acting as vectors of disease to the Philadelphia and New York City areas (or anywhere else they are traveling). But there’s a reason patients are seeking help elsewhere.

According to NJ.com, “State Health Commissioner Judith Persichilli said 12% of all hospitalizations in the state are now due to COVID-19. Of those, 41% require ventilators to stay alive.”

That said, centers specializing in pediatric covid-19 patients are becoming available. There are at least 144 pediatric patients in the state at this time.

To help prevent the spread of coronavirus, rules are being implemented in maternity wards that ban expectant partners from being present during the birth. This is in line with the rules adopted across the country banning visitors.

Milestone Forecasting

In 100 years we gained the ability to monitor the disease, albeit imperfectly, and make predictions. Disease forecasting based on mathematical predictions was used primarily in agriculture when I was in school. With agriculture, we use satellite imagery to look for indications of disease by looking at light reflection/absorption patterns. Crazy right?

I discussed forecasting in the post about New York. Ask questions and I can go into the mathematics of these models more.

Are we at the peak yet?

No. New Jersey will likely have 1 – 2 peaks – one shared across New York City and Philadelphia. The separation between these two peaks will depend on social distancing, hygiene practices, and the adoption of publicly wearing masks. We can examine milestones and projections for changes overtime to try and guess when these will be – if we reach a peak before Philadelphia has reached its peak, then yes, there will be a second peak for New Jersey. Milestones can be used in the process of forecasting for making quick decisions.

The slope is changing. If we look at only the last few days, we have moved farther out how long it takes to reach that 100,000th cumulative case milestone to the 14-15th of April 2020. The acts of individuals allows us to flatten this curve more.

With the actions of every day people, such as social distancing, staying at home, adopting public mask wearing, and hygiene awareness, we can flatten the curve.

If you currently live in New Jersey, I love you, please stay safe, and isolate if you can.

TL;DR

  • New Jersey’s Peak is Following New York. If the curve does not flatten more, we could hit 100,000 cases by around 14-15th of April 2020 unless things improve.
  • At this time it does not look like New Jersey is hitting a peak. New Jersey is kind of flattening the curve. There will be 1-2 peaks dependent on New Jersey’s ability to flatten the curve in between New York and Philadelphia’s peaks.
  • To help flatten the curve: practice social distancing, stay at home, adopt public mask wearing, and remember hygiene awareness. We can flatten the curve. Flattening the curve now will hopefully protect New Jersey when Philadelphia peaks later.
  • People are still sick with heart disease, cancer, bacterial infections, influenza, autoimmune disorders, tumors, and everything else under the sun and because the medical system is overwhelmed, those people aren’t getting sufficient care.

Thank you to anyone that reads this. Without you I’m just shouting into a void.

Pennsylvania: Are We Flattening The Curve?

Pennsylvania Department of Health Declares There is “No Sign of Slowing”

As of 12:01 AM 4 April 2020 Pennsylvania exceeded the 10,000 case milestone.

The majority of cases in Pennsylvania are in the Philadelphia and Eastern Pennsylvania region along the Boston-Washington commuter corridor. As this is a major thoroughfare connected to New York, Connecticut, and New Jersey, and transit systems only recently began reducing service along this route, this is not a surprise.

source: https://theburgnews.com/news/positive-covid-19-cases-exceed-10000-in-pennsylvania-almost-1600-new-cases-today

The Pennsylvania Health Department released the following statistics on positive SARS-CoV-2 cases within the state:

  • Nearly 1 percent are aged 0-4
  • Nearly 1 percent are aged 5-12
  • 1 percent are aged 13-18
  • Nearly 8 percent are aged 19-24
  • 41 percent are aged 25-49
  • Nearly 29 percent are aged 50-64
  • Nearly 20 percent are aged 65 or older.

There have been no pediatric deaths, unlike Illinois.

What Is Preventing The Curve From Flattening?

Philadelphia vs. Pittsburgh

A few factors are unique to Pennsylvania, one such being the presence of a large religious population known for participating in religious exemption. In the broader southeastern corner of the state, outside of Philadelphia (the eastern bottom edge of the state) these populations live beautiful lives.

In the western part of the state, an additional area is being hit – Allegheny County, home of Pittsburgh. Pittsburgh has its own unique culture. It is a very social city where strangers talk to each other and it is not hard to make friends if you want to go out. Social distancing presents a challenge here. We also run into the poverty and rural hospital problem in western and central Pennsylvania.

Places of Worship

At this time places of worship in Pennsylvania are continuing to operate. Recently, places of worship are coming under scrutiny as major sources of coronavirus infection. I will be addressing this more in another post.

Adoption of Social Distancing

Source: https://www.unacast.com/covid19/social-distancing-scoreboard

Unacast has rated Pennsylvania as a C- based on two factors.

Source: https://www.unacast.com/covid19/social-distancing-scoreboard 25-40% Decrease in Average Distance Traveled Per Person; 60-65% Decrease in Non-Essential Travel To Non-Home Location

The majority of trouble is in small towns in rural areas. This is not surprising, but it is important to those that we need to behave as though coronavirus is spreading through an asymptomatic or minimally symptomatic reservoir host. This means that all it takes is one person in town and the whole town could get COVID-19 very quickly.

Pittsburgh and Delayed Outbreak

In 1918, Pittsburgh’s influenza outbreak was a full 3 weeks behind that of Philadelphia’s. Pennsylvania was one of the hardest hit states during 1918, and Allegheny County was no exception. Let’s remember how even within the past 10 years, new, previously unknown mass graves from 1918 are still being found throughout the state, and particularly in western Pennsylvania [1, 2, 3].

Is Pennsylvania Really Showing No Signs of Slowing?

I decided to break this down into 2 milestones: 100 cases and 1000 cases. I then compared the growth in cumulative cases to present from each.

source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing

Based on the growth of cumulative cases since the 100th case, Pennsylvania is predicted to reach 100,000 cases as of 14th of April, 2020.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing

If we look at just the cumulative cases since the 1000th case, the 100,000th case is predicted closer to 12th of April, 2020.

So, yes, the health department is 100% correct. Pennsylvania is showing no signs of slowing.

Healthcare Systems Overwhelmed

The healthcare system in Philadelphia is overwhelmed, but not for the initial reasons one might think. Out of state patients from New Jersey and New York are heading to Philadelphia hospitals for treatment. This does reduce the resources available for those living in the local area. This also introduces additional vectors of disease to the Philadelphia area.

To better address the growing need to hospitals, cities are attempting to reopen those that have closed, particularly in poorer areas. There is an empty hospital in Philadelphia that the city is attempting to reopen. One massive barrier is that the building is privately owned by a California investment banker. This is only one hurdle.

Large hospital networks across the country are shifting spending while furloughing employees in preparation for outbreaks, including patient care workers. This is also occurring in Philadelphia. The argument for reducing staff is one of finances and the increased costs of each coronavirus patient amid bidding wars for supplies. These privately owned large hospital networks operate in multiple states, resulting in the shifting of resources affecting those where the outbreaks will eventually hit next.

Milestone Forecasting

In 100 years we gained the ability to monitor the disease, albeit imperfectly, and make predictions. Disease forecasting based on mathematical predictions was used primarily in agriculture when I was in school. With agriculture, we use satellite imagery to look for indications of disease by looking at light reflection/absorption patterns. Crazy right?

I discussed forecasting in the post about New York. Please ask questions and I can go into the mathematics of these models more.

Are we at the peak yet?

No. Pennsylvania will likely have 2 peaks – one for each major city. We can examine milestones and projections for changes overtime to try and guess when these will be. Milestones can be used in the process of forecasting for making quick decisions.

At this time Pennsylvania is projected to hit its 100,000th case on 14th of April 2020. That said – this is a graph based on many data points that can be broken up.

There’s a lot of hope in that graph shape if you think about how much impact the actions of individuals can have. The slope can change and extend out that milestone if everyone starts taking this seriously. If we look at only the last few days, we have moved closer how long it takes to reach that 100,000 cumulative case milestone to the 12th of April 2020.

With the actions of every day people, such as social distancing, staying at home, adopting public mask wearing, and hygiene awareness, we can flatten the curve.

This post is dedicated to my friends currently in Pittsburgh, Pennsylvania. I love you. Please stay safe. I owe all of you hugs the next time I see you.

TL;DR

  • Pennsylvania is not flattening the curve. If the curve does not flatten more, we could hit 100,000 cases by around 12th of April 2020 unless things improve.
  • At this time it does not look like Pennsylvania is hitting a peak. There will likely be 2 peaks
  • To help flatten the curve: practice social distancing, stay at home, adopt public mask wearing, and remember hygiene awareness. We can flatten the curve. Flattening the curve now will hopefully protect Pittsburgh later.
  • People are still sick with heart disease, cancer, bacterial infections, influenza, autoimmune disorders, tumors, and everything else under the sun and because the medical system is overwhelmed, those people aren’t getting sufficient care.

Thank you to anyone that reads this. Without you I’m just shouting into a void.