COVID-19 and the 1918 Influenza K-12 Policy Responses in Public Schools in New York City

Introduction

Pandemics are widely known to cause untold suffering to humans because they are highly infectious, leaving behind a trail of deaths and disruption of normal life. As a result, places of public gathering such as schools, churches, town squares, theaters, and stadiums become hotbeds of the spread of deadly diseases. In a bid to minimize the devastating effects of pandemics, governments are forced to develop strict containment measures to manage people, especially in public places. Currently, the world is facing the deadly COVID-19 pandemic, which has spread worldwide, causing millions of deaths and disrupting every aspect of human life. Global statistics show that COVID-19 cases are more than 130 million, and this number is set to keep rising, given that the virus is still spreading. While more than 76 million people have recovered, COVID-19 has already claimed more than 2.9 million lives worldwide. These shocking statistics indicate how devastating a pandemic can be to the human race.

Out of all countries in the world, the U.S. is by far the most affected by the current pandemic. The country has about 31 million cases and 561,000 deaths, followed at a far distance by Brazil with about 13 million cases and 351,000 deaths. Even worse, these numbers are still rising despite the recent introduction of the COVID-19 vaccine and various containment policies across the country, such as lockdowns and wearing masks in places of public gatherings. As COVID-19 continues to wreak havoc across the U.S., the federal, state, and local authorities are facing constant pressure from the public to re-open the economy and learning institutions. However, such a step requires the implementation of well-thought-out health policies to curb the spread of the virus, especially in K-12 public schools.

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COVID-19 is not the first pandemic to shake the world. About a hundred years ago, the globe encountered the infamous influenza pandemic in 1918. This virus has been considered a severe respiratory disease in recent history. The 1918 flu spread worldwide between 1918-and 1919, infecting more than 500 million people and claiming at least 50 million lives worldwide. While there is a lack of reliable statistics on the number of Americans that were infected with influenza, estimations show that the pandemics caused approximately 675,000 deaths in the U.S. Unlike the current COVID-19, the mortality rate was higher in younger people than in older individuals during the 1918 influenza pandemic. With no established treatment approach, including vaccination, control efforts globally were confined to non-pharmaceutical strategies such as quarantine, use of disinfectants, isolation, and discouragement of public gatherings.

During the 1918 pandemic, New York City recorded lower mortality rates compared to other large cities in the U.S., particularly its two biggest neighbors, Philadelphia and Boston. The city’s death rate per 1000 individuals was estimated at 4.7 compared with 7.3 in Philadelphia and 6.5 in Boston. Throughout the three waves of influenza from 1918-to 1919, New York City officially recorded 30,000 deaths from the pandemic. Contrastingly, the COVID-19 has by far infected about 1.95 million New Yorkers, resulting in at least 50,500 deaths across the state, and these numbers are increasing daily. As of April 9, 2021, New York City has 865,460 positive cases. Amidst this shocking data, the city faces the challenge of developing preventive measures in public areas, especially in K-12 schools. This paper compares and contrasts the COVID-19 and the 1918 flu K-12 policy responses in Public Schools in New York City. The paper’s aim is to determine what lessons can be drawn from understanding the similarities and differences between 2020/2021 and 1918 education policy responses in urban schools.

Urban K-12 Schools During the 1918 Influenza Pandemic In New York City

When the 1918 flu was detected in America, the U.S. schooling system was facing a sequence of dramatic pedagogical, social, and physical changes. First, public school enrolment had risen substantially since the late 19th century, especially in urban areas, which accounted for about 50% of America’s population. Between 1918-and 1920, school attendance rates were more than 90% in most American states. This increase was attributed to the ratification of the mandatory school attendance legislation by all states in 1918. As a result, school closure in the wake of influenza became a formidable challenge in cultural, social, and legal terms. As more children continued crowding into K-12 schools across America, classrooms started changing significantly. Multi-age single-room settings were replaced with graded classrooms with school board psychologists and teachers administering aptitude and intelligence tests. Such changes echoed the impact of the Progressive era’s values – rationality, science, and efficiency – on the school curriculum. During this era, school conditions and the health of students became a matter of great concern.

In the early 20th century, most urban schools in the U.S. were in poor conditions in terms of facilities, health, and hygiene. Classes were characterized by inadequate sewage systems and plumbing, under-ventilated corridors and basements as well as poor lighting. Thus, it became necessary to turn attention to school sanitation and restructuring programs to make schools more conducive and safer for children. Various cities, such as New York and Boston, instituted school corps, entailing medical inspectors whose responsibilities were to visit public schools to assess the children’s health status and entire classroom. New York City was the first urban area in the U.S. to start the nursing program in schools in 1902. It is reported that as the program spread across the five boroughs of the city, attendance increased to 18,844 in 1905 from 65,294 in 1903. Each nurse served between 2-5 schools and could properly examine and provide care to children weekly. During the Progressive age, awareness of the significance of school sanitation and pupils’ health took center stage.

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As the 1918 pandemic struck America, most parts of urban America opted for public school closure as part of containment measures. Surprisingly, the cities of New York, New Haven, and Chicago decided to keep their public schools open to extend and amplify existing school disease surveillance and medical inspection programs. At the onset of the flu, New York City’s K-12 schools accounted for close to 1 million students, out of whom 750,000 dwelled in unsanitary and crowded tenements. These conditions were notorious for accelerating the spread of contagious diseases. As a result, the city’s health commissioner, Dr. Royal S. Copeland, and Dr. Josephine Baker, head of the Department of Health Bureau, believed that schools provided a safer environment for students living in tenements. Particularly, Copeland argued that “If the schools were closed, at least 1,000,000 would be sent to their homes and become 1,000,000 possibilities for the disease.” The logic behind keeping the urban schools open in the city was that children would be under the watchful eyes of trained teachers as well as routine and thorough medical inspection from nurses.

The urban schools in New York City responded to the 1918 flu in numerous ways. First, as part of the medical and health surveillance policy, teachers were required to conduct a basic inspection of their pupils and report those who showed indicative signs to school health authorities. Children demonstrating symptoms of a respiratory condition, such as sneezing, runny noses, coughing, or red eyes, would be taken to an isolation facility for professional screening. If feverish, the students were supposed to go home accompanied by a representative from the department of health who assessed the home conditions to ascertain whether they were suitable for care and isolation. Whenever homes fail to meet the required standards, symptomatic pupils would be referred to a hospital facility. Subsequently, school medical inspectors and nurses were mandated to follow up on the teachers’ reports and visit the homes of absentee students to check whether they or their relatives were sick. Moreover, the city’s health department instructed relatives of the children to recuperate at home to ensure that they seek medical services from either a public medical doctor or a family physician at no charge.

New York City’s response to the 1918 flu functioned fairly efficiently due to several reasons. First, various stakeholders committed to the fight against influenza worked in laudable harmony. For instance, the American Public Health Association and the Red Cross formed an Emergency Advisory committee. In addition, a nursing board headed by Lillian Wald coordinated home-based care. The Women’s Emergency Advisory Committee oversaw volunteer campaigns at the grassroots. Second, the city derived substantial benefits from its distinguished and longstanding Progressive school hygiene program and lessons drawn from responses to previous outbreaks such as cholera, diphtheria, and polio. Finally, despite making a controversial decision, Copeland’s leadership prowess enabled the city’s public schools to minimize the impact of influenza as he maintained a demeanor that projected a sense of reasonable assurance. Essentially, due to the city’s significant investment in the improvement of sanitary and health conditions at K-12 schools, physicians and nurses have gained the requisite skills to deal with influenza.

Urban K-12 Schools During the COVID 19 Pandemic In New York City

The current New York City school system is considered the largest school district in America. According to a 2019 report by the city’s Department of Education (NYCDOE), the K-12 has more than 1.1 million students enrolled in public schools, surpassing Los Angeles, the second-largest school district, with more than 500,000 students. Out of the 1.1 million, those learners in Pre-K, elementary school, middle school, and high school are 73,904, 488,000, 237,488, and 327,109, respectively. In terms of ethnic composition, Hispanics account for the largest portion with 46%, followed by blacks, Asians, and whites at 25.5%, 16.2%, and 15.1%, respectively. In 2016, the state-approved Common Core standards to guide students in their learning process from Pre-K through to high school. The purpose of the city’s K-12 public school system is to prepare learners for transition to higher learning institutions and career readiness.

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The COVID-19 pandemic has negatively affected New York City’s public education system due to a series of lockdowns and partial re-opening. As a result, most K-12 students have since been forced to learn from home, disrupting learning and development for thousands of learners. The school closures that commenced in March 2020 have significantly reduced learning and instructional time, impeding student performance. Empirical findings suggest that reduction of school time is connected to poor performance among students. Moreover, the more frequently learners fail to attend classes, the worse their academic outcomes. The interruptions caused by the COVID-19 have increased opportunity gaps connected to unequal access to shelter, food and nutrition, health and insurance, financial relief initiatives, and health insurance. Consequently, children from disadvantaged families are on the receiving end. Moreover, the use of technology to facilitate online learning has been characterized by uneven access to internet connections and necessary devices such as laptops and tablets. This digital gap has made it difficult for some students to engage in online learning during the ongoing pandemic.

The availability of technology has greatly altered responses to the current pandemic. In modern-day America, most students have access to the internet and a smartphone or a personal computer. In addition, the rapid growth of social media platforms has created a norm where online communication has become fundamental, especially for the younger generation. Since the COVID-19 hit America, schools have been utilizing such platforms as Zoom and Google Classroom. The city’s authorities are working relentlessly to ensure that they distribute digital devices to over 300,000 needy students as the city tries to cope with the new remote learning system. While students, parents, and teachers are preparing for the shift to virtual classrooms, it is quite evident that the availability of technology has negatively affected the fight against the COVID-19. For instance, the state government has diverted its attention from improving physical classroom conditions to supporting online learning. As a result, key education stakeholders are preoccupied with developing a new curriculum when they should be creating tangible policies for school resumption.

The NYCDOE has utilized various strategies to address disruptions caused by the COVID-19 pandemic in K-12 schools. Since the start of school closures in the city, the NYCDOE has been using remote learning, where students meet with their teachers virtually through video conferencing platforms such as Zoom and Skype. The major logic behind remote learning is to minimize disruption of the K-12 education system after the imposition of restrictions on public places to contain the spread of COVID-19. When the New York state government announced the commencement of phase re-opening, the NYCDOE introduced hybrid/blended learning, allowing students to combine in-person and remote learning. Hybrid learning requires some students to attend school in person and the rest to join the teaching session virtually. The NYCDOE has made it compulsory for students to follow the hybrid model to avoid absenteeism unless under special circumstances, such as when someone has been put on quarantine or is caring for a sick relative. However, blended learning requires more staffing for in-person and online forms of school, making its implementation difficult across the city.

In consultation with the Center for Disease Control and Prevention (CDC), New York City’s NYCDOE has adopted numerous health policies to fight the potential increase in COVID-19 infections among public school students. For instance, each school across the city is required to host weekly COVID-19 mandatory screening for a randomly chosen 20% of staff and children as part of the NYCDOE’s strategy to ensure the safety of all schools. However, mandatory testing is only conducted on students who have submitted consent forms. For common preventive measures, everyone within the school setting is required to wash their hands with soap and water, cover their noses while coughing or sneezing, and wear masks whether outdoors or indoors. In the same vein, staff and students are instructed to maintain a social distance of six feet between themselves and others. In case someone experiences such symptoms as difficulties breathing, coughing, sore throat, and fever, the NYCDOE recommends that an individual should stay at home or seek medical attention by calling 311. Additionally, any student or staff diagnosed with COVID-19 is supposed to self-isolate for ten consecutive days since the confirmation date. All these guidelines demonstrate NYCDOE’s commitment to making schools COVID-19 free.

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Impact of the Introduction of COVID-19 Vaccine on the Fight Against the Pandemic

After the recent rollout of COVID-19 vaccination by President Joe Biden, there has been a heated debate over the re-opening of all public schools, creating a great divide between opposers and proponents. The conflicting opinions emanate from the fact some people feel that it is not yet safe to resume normal learning, while others believe that the vaccine will offer a quick solution to the prevailing situation. For instance, despite various public schools being opened across the state of New York, students have not reported back as expected as their parents remain reluctant due to safety concerns. On the other hand, the CDC admits that in-person learning can be resumed safely. The agency has already provided back-to-school guidelines applicable to all American states. However, some of the recommendations have raised concerns over their viability. For instance, the requirement to keep six feet social distance between learners may be untenable as many institutions lack the needed extra space for expansion. Moreover, the guideline that the class in which a positive case occurred should quarantine for two weeks may significantly disrupt the school’s normal activities.

The rush to re-open public schools after the unveiling of the COVID-19 vaccination can have harmful ramifications. For instance, despite the ongoing vaccination program, health experts have warned that there are indications that the third wave of the pandemic is about to hit America. Moreover, New York City is ranked among the cities that have been most affected by the pandemic. Out of more than 8,000,000 New York City residents, it is only 2,586,000 have received at least one dose of the vaccine as of April 9, 2021. These figures indicate that the appropriate time to resume normal learning in K-12 schools is not yet. Even worse, the NYDOE has revealed the administration of the COVID-19 jab will be on a priority basis. Furthermore, the agency has instructed that it is the only eligible staff who will be vaccinated. Given that the pandemic is indiscriminate, it is highly likely that the vaccination is not going to yield much success in COVID-19 prevention until almost everyone has received the injection.

The vaccine is not likely to help students to learn efficiently if schools are opened. First, the social distancing measures provided by the CDC do not allow classes to be occupied to full capacity. Such a challenge points to the fact that some students will still have to learn remotely. Even worse, racial disparities have marred New York City’s K-12 system since the start of COVID-19. For instance, a 2020 report by The New York Times revealed that 12,000 more white students reported back to school compared to the black students, despite the latter being more overall. This inequality is more likely to be reflected during the vaccination program, indicating that the jab will not enhance learning in schools; it will not be administered equally among students. Additionally, the eligibility restrictions put in place by the New York state government continue to slow the process of vaccination. With such restraints, the opening of schools might lead to an upsurge in COVID-19 cases even with the presence of the vaccine.

Changes in New York City’s Public Schools Since 1918

Substantial changes have occurred in New York City’s public schools since 1918 in terms of health policies. Between 1918-and 1921, most American states passed laws concerning health and physical education for all school children. In New York City, the school-based health screening and inspection continued until the 1930s, when discovered that teachers’ involvement led to the duplication of the Health department’s efforts. In the mid-1930s, the National Education Association (NEA) and American Medical Association decided to develop a clear definition of schools’ role in the provision of health services. Teachers were given the role of informing parents about health problems and advising on the necessary time to take their children to a physician. On the other hand, the health department was to execute screenings and inspections, provide immediate care, establish a healthful setting, and refer pupils to hospitals or professionals who could deal with more complex issues. While the coordination between educational and medical sectors persisted, clear boundaries started manifesting in terms of the scope of health services in schools.

The idea of discouraging the provision of primary health care in public schools became the foundation for the shaping of school medical services in the mid-20th century. While health education was viewed as an integral role of schools, teachers acted as a link between health practitioners and students. Characteristically, school nurses were responsible for immunization, referral, screening, follow-up, record-keeping, and first-aid. Sometimes, the nurses would work under the direction of part-time doctors. Over the years, school-based medical services were institutionalized into the school system’s bureaucracy, removing them from the medical community’s purview. Eventually, school health workers’ roles and health policies were being progressively prescribed by individuals with an educational rather than a medical background. This period saw a constant reduction in the treatment and diagnostic part of school medical services.

Between the 1960s and 1970s, the concerns for children’s health and welfare led to the likelihood of restoring treatment and diagnostic services in public schools. Essentially, The Great Society and War on Poverty initiatives increased the federal government’s involvement in K-12 schools, making new social and health funds available. Relevant laws passed during this period include but are not limited to Medicaid, Head Start, Community Health Center Program, and Child Nutrition Act. The most effective legislation was the Elementary and Secondary Education Act, which increased the number of school nurses significantly and introduced a new nursing position, the school nurse practitioner. This nursing role became instrumental in the treatment of students who required healthcare. While the Great Society programs led to a substantial increase in the funding of public-school health, most programs were largely designed for special and disadvantaged populations.

From the 1980s to the present, policymakers have focused their attention on the schools’ potential to address health and social issues. The main idea behind this move is to expand the scope of school health policies to deal with diseases that are caused by social factors, such as substance abuse disorder among adolescent students. For instance, the NYCDOE has recognized the importance of addressing mental health problems by introducing The School Mental Health Program in every public school. Moreover, the health sector has made great achievements in terms of health indicators as well as therapies and clinical interventions such as antibiotics and vaccines. Thus, such diseases as polio, cholera, diphtheria, tuberculosis, and measles that concerned the school hygiene movement’s leaders a century ago are no longer serious issues in the current public school system.

Demographics: Comparison

It should be noted that there are also several major differences in the cases of the 1918 and the 2020s pandemics, as well as the policies introduced to handle both diseases. The demographics that were targeted in each case are the first and by far the most noticeable discrepancy between the two cases under analysis. Although the residents of New York were targeted both times, the age groups that the policy in question singled out specifically as the most vulnerable group were quite different from each other. Namely, the 2019-2021 pandemic regulations for the academic environment aimed at safeguarding the students of all ages and ethnic backgrounds, which is why they require particularly strong safeguarding strategies and techniques with an emphasis on diversity and the search for a homogenous approach that will allow encompassing the needs of every student.

In turn, the 1918 pandemic and the legislation designed to curb its rates seemed to be directed primarily at students belonging to migrant families as the most vulnerable group. Also quickly turning into a pandemic and affecting New York specifically, the Spanish flu of 1918 spread particularly rapidly among immigrant learners, which could be explained by the poor conditions and maintenance of the specified academic establishments due to the lack of financial support. Therefore, while the core issue of pandemic swiping the global population is very similar to that one of 2019, the vulnerable groups are significantly different in ethnic backgrounds. Moreover, given the fact that the schools were in such a bad condition due to the lack of care and support for migrant children, young students from rural backgrounds could be considered as the group exposed to the highest risk as opposed to the current problem of aging people from urban areas being under the greatest threat. Nevertheless, the general focus of both policies remains mostly the same, with the needs of learners prioritized.

New York City’s public schools were considered safer for learners to stay in in 1918 than today because of numerous reasons. First, children who came from tenement homes were highly exposed to infectious diseases, including the influenza pandemic, because of overcrowding and unsanitary conditions. In the early 20th century, New York City had made massive investments in personnel, infrastructure, and programs to support the health and wellbeing of students in the K-12 public school system. In addition, schools were safer during the 1918 flu as students were frequently screened, and the sick ones would be attended to by a school nurse who would also conduct follow-ups by visiting their homes. Presently, nurses cannot monitor sick students by doing home visits without acquired consent, as that would be considered a violation of their right to privacy. Furthermore, modern public schools might not be as safe as they were in 1918 because there lack continuous disease surveillance and medical inspection programs. Such initiatives played a significant role in ensuring the preparedness of the school health department in times of a disease outbreak.

Unlike in 1918, homes are now considered safer than public schools. This change is partly because living conditions across the city have significantly improved due to the lessons drawn from the tenement homes. Through government subsidies and collaborations with community groups and businesses, thousands of housing units have been rehabilitated to meet the standards of the New York City Department of Health. Moreover, most poor families in the city are currently living in decent homes, creating a healthful environment for children. In addition, homes are more likely to be safer because some public schools in the city do not have nurses. Since the 1930s, New York City’s successive authorities have gradually cut expenditure on public education, negatively impacting school health programs. This move has significantly reduced resources for such activities as physical education as well as the number of nurses in the city’s K-12 schools. As a result, most parents would require their children to stay at home during this pandemic as they are highly unlikely to get the necessary medical assistance at school.

Lessons Learned

In retrospect, the 1918 pandemic has provided the U.S. authorities with a number of lessons to learn; specifically, in relation to the current coronavirus pandemic and the methods of approaching it, the issue of preparedness needs to be mentioned first. While it would be understandably unreasonable to expect what would nowadays count as a sophisticated system of pandemic prevention from a 1918 healthcare system, basic tools for identifying a threat and noticing a pattern in the early spread of the disease would have given the New York population a significant advantage. Particularly, the school environment would have been reassessed, and the role of social distancing, as well as the temporary closure of schools, would have been deemed as an important step in preventing the development of the disease in learners.

Indeed, considering the response produced to the rapid growth in the number of victims of the coronavirus among students in 2019-2021, one must give the state authorities credit for emphasizing the role of remote learning as an early measure for containing the development of coronavirus. Although the specified step has not contributed significantly to the management of the issue since other factors, such as social distancing among adults and the increase in awareness rates, were not taken with due diligence, the changes in the approach toward the management of pandemic in 1918 and 2019 are quite evident. At the same time, similarities between the observed situation and the problems within the present-day New York setting are also quite striking, especially in connection to the awareness issue. Specifically, the lack of understanding of what was driving the rapid spread of flu in 1918 and the failure to embrace the significance of precaution measures toward the prevention of pandemics in 2019 are eerily similar to each other.

Additionally, the importance of ensuring that vulnerable groups are protected first has been learned due to the drastic outcomes of the 1918 flu. Since the specified occurrence involved deaths of multiple migrant children, the fatal outcomes have shown that children must be categorized as one of the groups that are likely to face the greatest risk at the time of a pandemic. Therefore, the need to address the safeguarding needs of the specified population must be one of the key priorities for local healthcare authorities and state officials. The effects of the specified harsh lesson could be observed in the 2019 pandemic case, when social distancing was introduced into the academic setting immediately, with all schools transferring to the remote education mode. Although the described step has introduced multiple challenges to the management of lessons and communication between students and teachers, its necessity was justified by the fact that the 1918 flu pandemic affected children and adolescents first, specifically in the school setting, causing the virus to spread rapidly and affect a tremendous number of students.

Another critical lesson that the 1918 flu has produced and the outcomes of which can be traced in the current approach toward managing the Covid-19 pandemic in relation to students is the avoidance of targeting a specific demographic to blame for the increase in the pace and rate of the pandemic. Namely, considering the 1918 situation, one will notice immediately that migrant children were singled out specifically as the potential cause and source of the disease spreading across the city. Although the intent in the specified scenario was hardly malicious and, instead, represented a combination of racial indoctrination and the willingness to safeguard students as promptly as possible, it still represented a glaring oversight and opened a plethora of possibilities for bullying and ostracizing migrant children and their parents. In turn, when managing the 2019 pandemic, the authorities have been deliberately focusing on mitigating the effects of the coronavirus by bringing the community together as opposed to creating additional tensions between different groups representing it. Granted that the enhancement of social distancing did not contribute to the rise in unity, the promotion of IT- and ICT-based connectivity, primarily with the help of tools such as Zoom, has led to keeping the New York community together without ostracizing and blaming a specific group.

Finally, the role of having critical resources available was amplified after the 1918 pandemic. The 1918 case has shown that unless the efforts of healthcare organizations are divided between promoting patient awareness and creating a vaccine that will help to combat the disease, the chances of surviving the pandemic become desperately low. Specifically, the tremendous mortality rates observed in New York during the 1918 pandemic were also predicated upon the slow response that the specified health emergency received from healthcare organizations. Additionally, the fact that little to no research was conducted to collect the information about the nature of the pandemic and the means of preventing it from further expansion also indicates the absence of an adequate management strategy. Compared to what can be observed in the New York setting presently in regard to the Covid-19 pandemic and the management of students’ needs, one must note an impressively prompt response among state officials and healthcare organizations, including the detailed guidelines concerning the methods of reducing the exposure to the virus and the information concerning the key symptoms. The described change in the direction that the management of the pandemic has taken since 1918 has shown that the 1918 occurrence has taught people about the importance of keeping the rates of health literacy and awareness among the target demographic high.

At the same time, some of the lessons have not been internalized, as the current situation with the rates of Covid-19 cases spiraling out of control. For instance, the lack of urgency and the failure to convey the urgency and the severity of the problem can be seen as the main problem that was carried from the 1918 pandemic into 2019 one. Specifically, the inability to utilize the strategies that would help to change people’s attitudes toward the threat of Covid-19 and, therefore, affect their behaviors, including the avoidance of crowded spaces, social isolation, and wearing masks to reduce the rates of Covid-19 spreading across the state should be listed among the foundational mistakes made by the New York healthcare administration.

Conclusion and Recommendations

Overall, the 1918 pandemic has produced quite a range of lessons for healthcare authorities and state officials to consider when addressing the issue of student safety and the management of health concerns. Specifically, the issue of building awareness as the core for the management of the pandemic must be noted as the core knowledge elicited from the 1918 experience. Additionally, the importance of immediate physical isolation of potential victims of the pandemics appears to have been internalized since, similarly to other states, and New York has quickly transferred to remote education for all students.

However, a substantial number of lessons that the 1918 flu pandemic provided have not been internalized, which has led to a rise in the exposure to the disease and the resulting disturbingly high rates of mortality in the state. Specifically, the need to promote active and immediate change in behaviors, as well as the use of the tools for convincing the target audience and their parents in the factual presence of a threat, appears to have been dismissed by New York authorities. Although the immediate response of local authorities and healthcare experts was quite commendable, the selected strategy was not enough to persuade the target demographic to avoid social gatherings. Therefore, the observed outcomes of the policy implementation indicate that the appropriate response strategy should include the tools that allow changing the behaviors of the target audiences and, in the case at hand, their parents so that vulnerable groups could be fully protected.

Among the key recommended approaches, the use of ICT devices for keeping the target demographic or their legal guardians informed and aware of the main threats and the means of identifying and mitigating them should be prioritized. Along with the implementation of evidence-based research so that a vaccine could be developed promptly, the focus on maintaining awareness and encouraging health literacy will help to keep the rates of pandemic progression contained. Thus, the importance of destroying the myths surrounding health management during a pandemic, specifically, the tendency to diminish the extent of the problem and the failure to provide specific standards for reducing the threat, identifying the symptoms, and addressing healthcare services if the symptoms are revealed.

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