Conquering COVID Part 1.3:
“Starkloff Social Distancing Saves Lives Now!”
(aka as the curve becomes critical so does the history lesson)
March 27, 2020

by Mark A. Moyad, MD, MPH

“I am concerned, of course, but I am also incredibly optimistic.”

Howdy! Many people have written so many nice notes about these updates that it has literally made my year! Thank you for your kind comments, but in reality, I am not alone, of course, in this effort. I have to give some quick kudos to some of the folks helping me behind the scenes to get each and every column off the ground. They have been remarkable (Beau, Tim, Terri, Jackie, and James at Us TOO HQ.) I would also like to thank the rest of the academy, my agent, my wife, my children, and last but never least my dog Chauncey! “You like me, you really, really like me”. Okay, sorry but I had an Oscar awards flashback!

I am sure you have heard the often-utilized comment that history will repeat itself unless we learn from it, but many people do not realize this especially applies to medicine and public health! We have to show some deference for public health history and the importance of it to YOU and ME right now! I understand the excitement of medications and vaccines, and of course share in this verve. Yet, it is tough to appreciate the potential life-saving ability YOU have for the next few weeks/months.  We are entering a historic moment in the pandemic curve and when you understand the story then you will understand your important role.  I believe everyone should be following the Starkloff Life Saving Effect until told otherwise! What?

Dr. Max C. Starkloff is our social distancing role model or hero in the world of public health (O’Neil T., St. Louis Dispatch, April 29, 2009; and Belshe RB., Mo Med, 2012;109:119-123)! I know what you are thinking, most of you reading this have never heard of him since he did not have an Instagram or Twitter account or a reality TV show. Let me explain. In 1918, St. Louis was the 6 th largest city in the United States. Dr. Starkloff, MD was the St. Louis Board of Health Commissioner (aka esteemed public health position) and in August of 1918, cases from the now historic influenza pandemic were starting to occur in the New England region, and by September it was national news. However, after just three days of cases being reported in the St. Louis area, in early October there was a hearty discussion to potentially allow the Health Department unprecedented authority to implement closings of various locations throughout the city, and it was granted despite strong opposition! The document or order was signed by the Mayor (Henry W. Kiel) and Dr. Starkloff and it was quick, elaborate, and pithy to essentially close almost everything until further notice. Churches, billiard halls, public funerals, schools, lodges, societies, theaters, taverns, restaurants, pool halls, convention areas… Now, keep in mind, this was only after a few days of cases! The St. Louis population was basically told to immediately start SOCIAL DISTANCING! They did not use this terminology in the proclamation, but again were explicitly told to go home, avoid public situations, protect your nose or mouth with a handkerchief, wash hands regularly… does this sound familiar?! 

Several weeks later, the cases began to decline, and many folks wanted everything reopened, but Dr. Starkloff stood his ground and thought it was still too soon! In early December the epidemic PEAK occurred and by the end of December the closure order was removed and basically almost everything was back in business. Now, other cities were not as quick to act when cases occurred, and public events were still allowed in some cities for longer than were allowed in St Louis by just a few weeks. The result, of the ten biggest cities in the United States, St. Louis had the LEAST NUMBER OF CASES and also the least amount of deaths! Here is just a quick summary of cities during the pandemic and rates of mortality:
  • 2.8 per 1000 residents in St. Louis (lowest among major cities)
  • 7.1 in Kansas City
  • 7.6 in San Francisco
  • 8.0 in Pittsburgh

The goal in St Louis was simply to reduce person-to-person transmission as quickly as possible! What Dr. Starkloff and his team accomplished was nothing short of remarkable, even remaining steadfast against opposition to open everything up prematurely. Today, it is an amazing public health lesson! The smartest thing people can do as the curve steepens and cases are on the rise is practice SOCIAL DISTANCING and physically ISOLATING as much as possible! It is arguably as lifesaving as any other measure provided today! For a temporary period, there is a concentration of infectiousness that needs to be quelled! Now is the time to dilute this concentration of the virus itself! Social distancing or now I call it the STARKLOFF EFFECT (actually I just made that up-trademark to follow along with T-shirts, mugs, posters, doggy water bowls….so please do not use it) or keeping an adequate distance away. The word “stark” in the dictionary does not just mean bare or naked, but it also means “strong” or “powerful” (interesting).

Here is something else remarkable about Dr. Starkloff - he would help educate the public via the local newspaper and he was also known for providing other tips to reduce the risk of pneumonia. He suggested avoiding fatigue and alcohol for example (Starkloff MC., St. Louis Post-Dispatch, September 21, 1918, page 11). Yes, he had the belief as a doctor more than 100 years ago that trying to keep the body as healthy as possible could also be immune healthy! We discussed this in previous reports that Heart Healthy=Immune Healthy, and Starkloff was a pioneer to theorize or express these thoughts as a doctor in a public setting.

There is also a final lesson in this story that often gets missed. Starkloff campaigned earlier against the Mayor in an election and lost, and despite this apparent reported animosity of being political foes, these two individuals worked together during a global and local health crisis to get things done and sign the St. Louis proclamation! Interesting lesson for all of us!

Research is never static! Give it the time it needs, and it can positively impact global health.  Yet, in medicine and public health, there is also a form of unsung research that actually does not need more time to save lives but rather more awareness.  Please show honor and respect for our history and our fellow human beings by adhering to the Starkloff Effect. Keep your distance at the grocery store, gas station, out for a walk, mailbox, mailperson, bank, pickup order...  The Starkloff Effect is another classic and beautiful example of the interdependence of humankind. 

Thank you for reading my latest installment and I wish you and your family the best of health. I am concerned, of course, but I am also incredibly optimistic! I look forward to modern day science and you of course, kicking COVID-19 and cancer in the gluteus maximus! 

All of my best always,

Mark A. Moyad MD, MPH 

Please pay attention to all of the CDC recommendations that can be found at 

Read my previous COVID-19 articles at: