The contrary Russian flu: London 1890-1892

Influenza epidemics tend to impact the poorest populations living in dense, unhealthy conditions more than the wealthier living in healthier, less dense surroundings. This study shows how the relationship between influenza mortality and the wealth of London's population during the Russian Flu pandemic of the early 1890's contradicts this conventional wisdom. This analysis examines London's 1890, 1891 and 1892 epidemic waves statistically and geographically, comparing wave flu mortality to population wealth, density and healthiness metrics. Correlation analysis shows that flu mortality directly correlates with wealth in all three waves; and inversely correlates with both population healthiness and density metrics. Some deficiencies exist in the 130-year-old data that pre- clude applying 21st-century rigor to the data analysis. For example, the causative agent of the flu was unknown at the time causing significant misidentification of causes of deaths. Nevertheless, analysis of the spatial association of flu mortality with population wealth using Lee's L statistic shows areas of both high mortality and high wealth in the wealthy areas east of the City of London, supporting the counterintuitive results of London's experience. This study does not seek to explain the reasons for these unexpected outcomes; however, the results suggest that today's metropolitan and regional planning authorities need to account for unexpected nuances in contingency plans for potential epidemics based upon best practice recommendations from appropriate national authori- ties. These plans need to consider previous local experience and must have a mechanism/process in place to detect and react to observed departures from the 'expected.'