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Abstract
New York City approached the 1918 influenza epidemic by making use of its existing
robust public health infrastructure. Health officials worked to prevent the spread
of contagion by distancing healthy New Yorkers from those infected, increasing disease
surveillance capacities, and mounting a large-scale health education campaign while
regulating public spaces such as schools and theaters. Control measures, such as those
used for spitting, were implemented through a spectrum of mandatory and voluntary
measures. Most of New York City's public health responses to influenza were adapted
from its previous campaigns against tuberculosis, suggesting that a city's existing
public health infrastructure plays an important role in shaping its practices and
policies during an epidemic.