Flu Fighter: Dr. Martin Cetron, MD

Air travel today can easily facilitate the spread of diseases around the world with each flight. CDC’s Division of Global Migration and Quarantine (DGMQ) helps protect the health of our communities in a globally mobile world. As director of DGMQ, Dr. Martin (Marty) Cetron is a leader in global health and migration with a focus on emerging infections, tropical diseases, and vaccine-preventable diseases in mobile populations. He says the 1918 influenza (flu) pandemic was “monumental, and as an unprecedented event in human history, it taught us some really important lessons. It had a devastating toll on human mortality, but in addition, it was a chilling reminder of what the battle against microbes and pathogens looks like.” Emergency preparedness matters. “You need a lot of advanced preparation, a lot of coordination across all of civil society, individual communities, and local, state, federal government agencies, and sometimes, global responses.”

Being a Flu Fighter

As director of the Division of Global Migration and Quarantine (DGMQ), Dr. Marty Cetron oversees work to prevent the importation and spread of infectious diseases including pandemic flu. “We realize that the war on infectious diseases is not over, and in fact, it’s an ongoing and continuing battle. In an era of globalization, the challenges are even greater when an infected person can fly anywhere in the world within 24 hours, often in less time than it takes for that individual to develop symptoms of disease,” says Dr. Cetron.

The global spread of the pandemic was remarkably enhanced and facilitated by two factors. “The movement of troops during World War I played a huge role in the spread of the pandemic, even though people were moving much more slowly in that era.” The other factor was the crowding and density of people in close quarters. “With the volume of international travel growing tremendously with more than a billion and half international border crossings occurring every year, it has really changed the way we think about the concept of quarantine and protecting citizens and communities in a globally mobile world,” says Dr. Cetron.

Why the 1918 Pandemic Still Matters

“In our world now, things and people are moving faster than the incubation period for most infectious diseases.” It’s important to look back on the 1918 flu pandemic and conduct historical research to learn how we can prepare for future pandemics. Together with academic researchers, “we combined a historical retrospective look at the 1918 pandemic with the use of contemporary statistical methods to find out how the pandemic unfolded in the course of history,” says Dr. Cetron. “We were able to reconstruct an epidemiologic curve of the pandemic based on weekly mortality rates. What we found was that many cities used non-pharmaceutical interventions (or NPIs) such as isolation of the sick, quarantining people who were exposed, and canceling public gatherings, schools, or other events to help slow the spread of flu,” says Dr. Cetron.

These traditional tools of public health control for infectious disease were key. “As people realized how bad the pandemic was, communities tried to get ahead of the pandemic and aggressively pushed isolation, quarantine, school closures, cancellation of mass gatherings, and cancellation of gathering in churches, restaurants, and bars,” says Dr. Cetron. Published in 2007 in the Journal of the American Medical Association, the historical analysis found that cities that preemptively acted on the first indication of flu with early NPIs had a stronger defense on the pandemic. “Early, sustained, and layered interventions actually reduced the death curve and completely changed the shape of the 1918 pandemic,” says Dr. Cetron.

Planning and Preparation are Critical; Challenges Remain

“What is local, somewhere in a remote part of the globe, can become a globalized threat very quickly,” says Dr. Cetron. CDC understands that preparedness matters. “Executing the right combination of community mitigation strategies, even those that are partially effective in multiple layers, doing them early, and sustaining them, will buy you time to come back with a stronger arsenal,” says Dr. Cetron. He also emphasizes that we continue to create tools to provide a strong defense against the threat of another pandemic. Dr. Cetron emphasized, “If we can’t stop it, we can at least contain it or mitigate it with vaccines, medical countermeasures, NPIs, and the implementation of pandemic preparedness plans.”