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Published on: September 19, 2025
The open-air treatment of pandemic influenza
Richard A Hobday1, John W Cason
1Department of Architectural Studies, University of Wales Institute, Cardiff, Llandaff Campus, Western Avenue, Cardiff, CF5 2YB, United Kingdom. ra.hobday@virgin.net
Insights
The 1918 Spanish flu pandemic highlights the need for better pandemic preparedness. Simple interventions like fresh air, hygiene, and masks significantly reduced H1N1 virus deaths and infections.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- The 1918 H1N1 influenza pandemic caused unprecedented global mortality.
- Conventional approaches suggest limited interventions were possible during the 1918 pandemic.
- Future influenza pandemics could result in catastrophic global death tolls.
Observation:
- An open-air hospital in Boston demonstrated reduced H1N1 virus impact.
- Patients and staff in this setting experienced lower mortality and infection rates.
- Environmental factors and hygiene practices were key in this observation.
Findings:
- Fresh air, sunlight, stringent hygiene, and reusable face masks mitigated H1N1 spread and severity.
- These measures substantially decreased patient deaths and medical staff infections.
- Evidence contradicts the notion that little could be done during the 1918 pandemic.
Implications:
- Temporary hospitals should be prioritized in public health emergency planning.
- Historical pandemic control measures warrant greater attention for future preparedness.
- Revisiting and implementing non-pharmaceutical interventions can enhance pandemic response strategies.
Abstract:
The H1N1 "Spanish flu" outbreak of 1918-1919 was the most devastating pandemic on record, killing between 50 million and 100 million people. Should the next influenza pandemic prove equally virulent, there could be more than 300 million deaths globally. The conventional view is that little could have been done to prevent the H1N1 virus from spreading or to treat those infected; however, there is evidence to the contrary. 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.
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