Revisiting Open Air Treatment During a New Pandemic

[Rebeccare]

I was recently reading this article, written in 2009, on the use of open air treatment during the 1918 pandemic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/. It's partly of interest to me because I don't live terribly far from Boston and where Camp Brooks (the hospital in the paper) was located. And it's interesting to me to see what lessons the authors gleaned from this response to the 1918 pandemic, and whether any of those lessons are being applied today (some are, some aren't). Here's what Camp Brooks looked like:

Back in that time period, the it was common practice to treat tuberculosis patients by keeping them outside in the fresh air. Additionally, the first flu victims in Boston were sailors, and the doctor in charge of Camp Brooks had observed that those who were housed in parts of the ship with better ventilation tended to have better outcomes. This idea that good ventilation could promote healing, combined with overcrowded hospitals, meant that an open-air tent hospital made good sense to public health officials of the day.

And it seemed to be a successful hospital, too. Only 36 of 351 patients treated there died (which apparently was a very good survival rate given the circumstances--many hospitals had fatality rates closer to 40%). And of the 154 people working in the hospital, only 8 became sick. According to the article:

Records from an “open-air” hospital in Boston, Massachusetts, suggest that some patients and staff were spared the worst of the outbreak. A combination of fresh air, sunlight, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff. We argue that temporary hospitals should be a priority in emergency planning. Equally, other measures adopted during the 1918 pandemic merit more attention than they currently receive.

Having clean hands and wearing face masks are now familiar measures to all of us, although they were fairly revolutionary at the time. Their face masks consisted of five layers of gauze, which were changed every two hours.

The article does suggest that treating patients in the open air could be of benefit in pandemics like this one:

Whether the patients at Camp Brooks or other temporary hospitals were spared the worst of the influenza pandemic because they slept in the open is uncertain. The apparent success in reducing the number of infections and deaths reported at this open-air hospital may simply have been caused by patients and staff experiencing levels of natural ventilation far higher than in a conventional hospital ward. Significantly, the minimum amount of ventilation needed to prevent the spread of infectious diseases such as severe acute respiratory syndrome (SARS) and tuberculosis is unknown. Much more fresh air may be needed than is currently specified for hospitals, schools, offices, homes, and isolation rooms.

It also suggests that there could be both physical and psychiatric benefits to treating patients in the sun:

The patients at Camp Brooks recovered in direct sunlight when available. This may have kept infection rates down, because laboratory experiments have shown that ultraviolet radiation inactivates influenza virus and other viral pathogens and that sunlight kills bacteria. In addition, exposure to the sun's rays may have aided patients’ recovery, because sunlight is known to promote healing in other conditions such as septic war wounds. There is evidence that heart attack victims stand a better chance of recovery if they are in sunlit wards. Depressed psychiatric patients fare better if they get some sun while hospitalized, as do premature babies with jaundice. In one study, patients in hospital wards exposed to an increased intensity of sunlight experienced less perceived stress and less pain and took 22% less analgesic medication per hour.One advantage of placing patients outside in the sun is that they can synthesize vitamin D in their skin, which they cannot do indoors behind glass. Rickets, the classic childhood disease of vitamin D deficiency, has long been associated with respiratory infections; it has been hypothesized that low levels of vitamin D may increase susceptibility to influenza.

There are certainly a lot of practical obstacles to having an open air hospital today: denser urban areas, sophisticated electronic equipment, being farther away from an ICU if a patient begins to fail, etc. But I do wonder if there will be any opportunities in our current pandemic to study whether allowing those who are less severely ill to convalesce outdoors has any benefit. Apparently Bellvue hospital in New York City has a 'tuberculosis balcony.' Maybe it could be put back into use?

 

[Hufsamor]

 

[andyguitar]

Thanks for posting all that @RebeccaRe They were popular in the UK at that time too and my Grandad stayed in one. He did'nt have TB or flu, he got injured during the battle of the Somme in the first world war. Stayed there for months. Had a good time!

 

[Rufous McKinney]

I had family living in downtown New York City during all this TB stuff....in the early 1930s. My first cousin died of TB and left cousins who never knew- why their mom died.

My mother was terrified to go to NY City and stay with these relatives. I heard tales of rats, and the one bathroom on each floor. That you did not want to ever enter.

My own mother also tests po sitive for TB...and was sent to TB camps as a child.

 

[lenora]

And my mother was in a turberculin sanitorium for an entire year because the Drs. were convinced that she carried TB. She was held at Ellis Island when she arrived, but that was just for 3 days.

As it turned out, she had a disease called bronchiectasis, (not bronchitis) common in England b/c of the smog, but unknown here. When she was 5 mos. pregnant with her 5th child she had an entire lung and a partical lobe of another removed. She weighed 90 lbs. (She was very, very petite anyway.) She recovered, although she had a huge scar that went from the top of her chest, around her waist and up the back side of her back. My sister was born OK, thankfully. TB was feared horribly and was a death sentence. A lot of the those Sanitoriums had sleeping porches built onto them and the rich often bought the homes in the northeast. Personally, I think I'd just think about the germs and that would be enough to keep me away. My mother coughed so hard that there would be blood hanging from all over the bathroom walls...how she ever survived, I'll never know, but I'm thankful that she did.

 

[Wolfcub]

I certainly think that what helped me get over coronavirus quite quickly was the lovely weather, and that I had the windows open all day, did get outside into the garden, and live in a lovely rural area.

It didn't only have a physical benefit but helped my mind space too.

Then when I was "convalescing" I could take little walks in the back field and the orchard to build up a bit of strength.

 

[lenora]

That sounds lovely, Wolfcub, I wish I had a huge garden to walk in. I do have a garden, but after my fall of last year, I'm reluctant to walk in it. Besides, I'm sure it isn't the size of yours, anyway.

Today, the cardinals have taken over again. That makes me happy, although I do miss the wrens, swallows and so many of the smaller bird world. Having the windows open is a real treat. Unfortunately, we live in the city and it's just not something that can be done here. I need my strength built up, there's no denying it, and I'd bette start before I lose it altogether. Yours, Lenora

 

[andyguitar]

I need my strength built up, there's no denying it, and I'd bette start before I lose it altogether. Yours, Lenora

Just do a little bit every day and you will slowly get back to normal.

 

[lenora]

Thanks, Andy, you're right....a bit each day and little by little things return to their new normal. It's really quite amazing how quickly the body weakens and it's in our own best interest to keep it as strong as possible. The way things are now, it's going to take me a big of time to regain my lost strength...after all, it has been mos. & mos. with one nasty thing after the other. I'll do it though, what are the alternatives?

Thanks for the rah-rah....every bit helps.

Yours,


Lenora