The factors that drive spatial heterogeneity and diffusion of pandemic influenza remain debated. We characterized the spatiotemporal mortality patterns of the 1918 influenza pandemic in British India and studied the role of demographic factors, environmental variables, and mobility processes on the observed patterns of spread. Fever-related and all-cause excess mortality data across 206 districts in India from January 1916 to December 1920 were analyzed while controlling for variation in seasonality particular to India. Aspects of the 1918 autumn wave in India matched signature features of influenza pandemics, with high disease burden among young adults, (moderate) spatial heterogeneity in burden, and highly synchronized outbreaks across the country deviating from annual seasonality. Importantly, we found population density and rainfall explained the spatial variation in excess mortality, and long-distance travel via railroad was predictive of the observed spatial diffusion of disease. A spatiotemporal analysis of mortality patterns during the 1918 influenza pandemic in India was integrated in this study with data on underlying factors and processes to reveal transmission mechanisms in a large, intensely connected setting with significant climatic variability. The characterization of such heterogeneity during historical pandemics is crucial to prepare for future pandemics.

As hospitals became overwhelmed during the Covid-19 pandemic in March-May in New York, Cardiology and Electrophysiology (EP) departments rapidly developed protocols for case selection as well modifying the practice of managing the cases. This process involved applying the American Heart Association (AHA) and Heart Rhythm Society (HRS) Guidelines for triaging the cases based on acuity, postponing the elective cases and modifying the way Cardiac Implantable Electronic Devices (CIEDs) interrogation. Procedural revisions were necessary for the workflow in the electrophysiology laboratory and that involved modifying the EP suite to accommodate a Covid procedure room, a decontamination equipment area and repurposed room for recovery in the context of personnel (EP attendings and fellows) and the main recovery area being diverted to Covid-19 ICU. The anesthesiology team had an integral and essential role in this process. This article describes in detail the collaborative planning, preparation and implementation of electrophysiology practice at one of the major tertiary centers in New York. It describes the type of EP procedures performed during mid-March to mid-May at this center, the decision process in case selection, anesthetic management and outcomes and the comparison with the previous year. Recommendations by the AHA/HRS as well as American Society of Anesthesiology (ASA) were considered in the multidisciplinary collaborative approach to patient care and personnel safety.

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