Public Health Interventions and Mortality During the 1918 Influenza Pandemic: Evidence from Digitized Death Certificates

We use newly digitized individual-level death certificate data with detailed information on the location, date and cause of death to investigate the effects of city-level non-pharmaceutical interventions (NPIs) on mortality during the 1918 influenza pandemic. We collect information on the timing and nature of NPIs for cities in Ohio and Massachusetts with populations over 25,000 and focus on four cities that did not adopt any NPIs during the height of the pandemic. Using a synthetic control design to compare death rates in these cities with a composite of other similar cities who did implement NPIs, we find that the pneumonia and influenza (P&I) death rate was more than twice as high during the fall of 1918 in the no-intervention cities as in the comparison cities.