RAPID: A comparison of the 1918 influenza pandemic and COVID-19 in Missouri: implications for current mitigation strategies in rural versus urban locations

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This RAPID project will compare epidemic patterns and Missouri residents’ responses in the 1918 influenza pandemic to those occurring at present during the COVID-19 pandemic, with primary attention paid to urban-rural differences. The research will increase understanding of how life situations in urban versus rural settings affect epidemic disease experiences and will provide knowledge of important community characteristics that put residents at greater risk during the current pandemic. The study will also shed light on which characteristics of a region have been stable over long periods of time and which are aspects of modern life and perhaps more malleable. The research is therefore time-sensitive because the investigators will expeditiously communicate project findings relevant to the current pandemic to the Missouri Department of Health and Senior Services. In addition, this project will provide student training in data collection and first-hand experience in conducting research to help deal with an unforeseen and serious public health event. A new coronavirus, SARS-CoV-2, to which humans possess little underlying immunity, has been spreading throughout the globe. In this pandemic setting, rural regions may face challenges that are not present in urban areas. As there is currently no vaccine, it is critical to devise effective strategies quickly, to protect rural regions from echo waves of the virus that may circulate over the next few years. The world experienced a similar situation in 1918-19 when a new, lethal strain of influenza began to infect humans. Although there are significant differences between these two pandemics, the viruses have similar modes of transmission and overall impacts on human communities. Understanding the experiences and responses of rural citizens to these two pandemics provides important insights that may lead to new public health strategies that are more tailored to the needs of rural residents during major disease outbreaks. The project involves in-depth comparative analysis of mortality and morbidity patterns during the 1918 influenza pandemic and the present COVID-19 pandemic in the state of Missouri. Analysis will focus on data aggregated at the county level and will determine county characteristics (e.g., population density, number of hospitals, household composition, proximity to large urban area, ethnic composition, mobility patterns) that are associated with death and/or illness rates during the two pandemics. Historical data from the Missouri 1918 influenza pandemic will be examined to identify control strategies used in different counties during the pandemic, determine their effectiveness, and assess whether they would be of use during the present pandemic. This in turn can aid in the development of potential strategies that public health authorities can add to the arsenal already being used in rural counties.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.