Theodore E. Woodward award: non-pharmaceutical interventions employed by major American cities during the 1918-19 influenza pandemic.

A critical question in pandemic influenza planning is the role that non-pharmaceutical interventions (NPI) such as isolation and quarantine, social distancing, and school closure, might play in delaying the temporal impact of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate NPI implementation would decrease the burden on healthcare services and critical infrastructure. These public health measures, however, are often associated with enormous social and economic costs. Therefore, it is imperative to assess past applications of NPIs in order to better understand how they might (or might not) be employed during future pandemics in an effective, legal, ethical manner that inspires confidence and compliance in the public at large.