{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:04:27Z","timestamp":1777665867942,"version":"3.51.4"},"reference-count":34,"publisher":"American Public Health Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p> The global influenza pandemic that emerged in 1918 has become the event of reference for a broad spectrum of policymakers seeking to learn from the past. This article sheds light on multiple waves of excess mortality that occurred in the US state of Michigan at the time with insights into how epidemics might evolve and propagate across space and time. We analyzed original monthly data on all-cause deaths by county for the 83 counties of Michigan and interpreted the results in the context of what is known about the pandemic. Counties in Michigan experienced up to four waves of excess mortality over a span of two years, including a severe one in early 1920. Some counties experienced two waves in late 1918 while others had only one. The 1920 wave propagated across the state in a different manner than the fall and winter 1918 waves. The twin waves in late 1918 were likely related to the timing of the statewide imposition of a three-week social distancing order. Michigan\u2019s experience holds sobering lessons for those who wish to understand how immunologically na\u00efve populations encounter novel viral pathogens. <\/jats:p>","DOI":"10.2105\/ajph.2020.305969","type":"journal-article","created":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T21:02:45Z","timestamp":1612990965000},"page":"430-437","source":"Crossref","is-referenced-by-count":14,"title":["Pandemic Reemergence and Four Waves of Excess Mortality Coinciding With the 1918 Influenza Pandemic in Michigan: Insights for COVID-19"],"prefix":"10.2105","volume":"111","author":[{"given":"Siddharth","family":"Chandra","sequence":"first","affiliation":[{"name":"Siddharth Chandra is with the Asian Studies Center, James Madison College, and Department of Epidemiology and Biostatistics (by courtesy), Michigan State University, East Lansing, MI. Julia Christensen is with James Madison College, Michigan State University. Madhur Chandra is with the Ingham County Health Department, Lansing, MI, and Department of Epidemiology and Biostatistics, Michigan State University. Nigel Paneth is with the Department of Epidemiology and Biostatistics and Pediatrics, Michigan..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Christensen","sequence":"additional","affiliation":[{"name":"Siddharth Chandra is with the Asian Studies Center, James Madison College, and Department of Epidemiology and Biostatistics (by courtesy), Michigan State University, East Lansing, MI. Julia Christensen is with James Madison College, Michigan State University. Madhur Chandra is with the Ingham County Health Department, Lansing, MI, and Department of Epidemiology and Biostatistics, Michigan State University. Nigel Paneth is with the Department of Epidemiology and Biostatistics and Pediatrics, Michigan..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhur","family":"Chandra","sequence":"additional","affiliation":[{"name":"Siddharth Chandra is with the Asian Studies Center, James Madison College, and Department of Epidemiology and Biostatistics (by courtesy), Michigan State University, East Lansing, MI. Julia Christensen is with James Madison College, Michigan State University. Madhur Chandra is with the Ingham County Health Department, Lansing, MI, and Department of Epidemiology and Biostatistics, Michigan State University. Nigel Paneth is with the Department of Epidemiology and Biostatistics and Pediatrics, Michigan..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel","family":"Paneth","sequence":"additional","affiliation":[{"name":"Siddharth Chandra is with the Asian Studies Center, James Madison College, and Department of Epidemiology and Biostatistics (by courtesy), Michigan State University, East Lansing, MI. Julia Christensen is with James Madison College, Michigan State University. Madhur Chandra is with the Ingham County Health Department, Lansing, MI, and Department of Epidemiology and Biostatistics, Michigan State University. Nigel Paneth is with the Department of Epidemiology and Biostatistics and Pediatrics, Michigan..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"844","reference":[{"key":"bib1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70323-2"},{"key":"bib2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1001134"},{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.1353\/bhm.2002.0022"},{"key":"bib4","doi-asserted-by":"publisher","DOI":"10.3201\/eid1209.05-0979"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2672.2001.01492.x"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511586576"},{"key":"bib7","first-page":"1","volume":"20","author":"Moxnes JF","year":"2008","journal-title":"Microb Ecol Health Dis"},{"key":"bib8","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2017.12.005"},{"key":"bib9","doi-asserted-by":"publisher","DOI":"10.4054\/DemRes.2015.33.11"},{"key":"bib10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1750-2659.2009.00125.x"},{"key":"bib11","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2011.02.048"},{"key":"bib12","doi-asserted-by":"publisher","DOI":"10.3201\/eid1510.080811"},{"key":"bib13","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268809002088"},{"key":"bib14","doi-asserted-by":"publisher","DOI":"10.1086\/511989"},{"key":"bib16","unstructured":"Office of the Secretary of the Division of Vital Statistics, The Commonwealth of Massachusetts. 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