Infectious Respiratory Disease

Classroom Activities

Activity 1: 

The first activity is a is a notice and wonder and is designed to introduce students to the drastic changes we saw in our global health during times of pandemics.  The Life Expectancy Graph²⁹ will be displayed for the class to see.  They will then, in groups, write down as least two things they notice and two things they wonder about the graph.  Once groups have written down their ideas, they will be shared with the class and recorded for all to see.  As responses are being recorded make sure to emphasize the drop in life expectancy for 1919 and 2021 and lead a discussion on why these drops occurred.  Next, give students a short background on Influenza and specifically the 1918 Pandemic as given in the “Content” section.  Do not discuss the mortality rates by age group for either pandemic as that will be included in a later activity 4.

Activity 2:

The second activity will have students explore two datasets from the 1918 Pandemic to better understand the importance of mean and median.  Have students first look at dataset 2, this works well using the vertical non-permanent surfaces (VNPSs) teaching strategy, by giving each group of students a printout of the dataset and attaching it to a vertical surface.  Student’s will first discuss in their groups what observations they have about the data.  Then assign different groups a specific year from the dataset to calculate the mean and median.  Once all groups have found their numbers for their dataset engage in a group discussion about the changes between both the means and medians in dataset 2 between the 4 years, also note the comparison of the mean and median in each year, noting that they are approximately equal (this will be important in activity 3).  Repeat the same activity for dataset 3 (optional).  Note during discussion that in dataset 3 California and Pennsylvania had the largest change in mortality rates between 1915 and 1918. In 2019 Colorado and South Carolina had exceptionally large mortality rates compared to the other states, how extreme values effect data will be discussed in activity 6 (outliers).

Figure 2 (a. Dataset 2 and b. Dataset 3)

Figure 2a is life expectancy from birth, by country, during the 1918 Influenza Pandemic (Spanish Flu), from 1917 to 2020.  Figure 2b is Influenza mortality rates during the Spanish Flu pandemic in select US states in 1915, 1918 and 1919 (per 100,000 people). *"1915" data is from 1916.  **"1915" data is from 1917.

Activity 3:

The third activity will have students creating boxplots and histograms from the data in dataset 2 and 3.  This will allow better visual representation of the differences in years in each dataset.  This activity works well using vertical whiteboards to created graphs where each group is assigned the same year in each dataset as they did in activity 2.  If students are unfamiliar with boxplots or histograms a prior review lesson on how to create each will be helpful.  During discussions note the differences in years and between states and countries visually as was discussed through median and mode in activity 2.

Activity 4:

This forth activity has students gain understanding on how the distribution of data changes.  They will learn how left or right skewed data looks in a histogram, and what that means for the mean and median.  The activity will start with students looking at dataset 4 which is the mortality age distribution for the 1918 Pandemic, by gender.  Students will create histogram using statistical software (I recommend GeoGebra) and calculate and compare the mean and median, also with statistical software, since calculating mean and median of a complex frequency graph is beyond what is taught at this level.  Have students do this for both the male and female data.  During the discussion for this part of the activity make sure to talk about the large mortality rate for the ages between 20-40 and how this was unique for an influenza outbreak.  Discuss how this dataset is skewed right for this dataset.

The next dataset students will look at is dataset 5.  Have students look at this dataset first before telling them where the data came from. Discuss with students how this dataset belongs to age mortality of COVID-19.  Give a small history of Coronaviruses and summarize the general timeline for COVID-19.  Then have students make histograms as well as calculating the mean and median of this data to show how the data is skewed left.  Statistical software recommended.

Figure 3 (a. Dataset 4 and b. Dataset 5)

Figure 3a is the excess mortality from 1918-20 by age for male and female.  The percentage is an estimate due to figures obtained from graph, in parenthesis is the range of the data value.  Figure 3b is Number of coronavirus disease 2019 (COVID-19) deaths in the U.S. as of June 14, 2023, by age. 

Activity 5:

This fifth activity will have students gain understanding of how to determine variability in data.  They will start with relooking at dataset 3 (figure 2b).  Students will use a statistical software to calculate the mean and median of each year of dataset 3, noticing that the mean and median are roughly equal.  When the mean equals the median, the data is approximately normal so the standard deviation (SD) will be the method used for determining variance.  Have students notice how the SD changes drastically between the years, showing how much death rates varied by country and how that variability increased during the peak of the 1918 Pandemic.

Next, students will look at Dataset 6 (Figure 4) for both males and females.  This time noting that the median and median are not consistently equal for each set.  Since the mean and median are not equal in each set it means there is skewness in the data and the interquartile range (IQR) is a more appropriate tool for determining variability.  Have students calculate the IQR for both male and females for both years.  Again, using statistical software is recommended.  Note how the IQR is larger in 1919 for both genders than in 1918.  Discuss the increase in variance of death by age group in 1919 vs. 1918.

Figure 4 (Dataset 6)

Figure 4 is mortality rates by age and sex for 1918 and 1919, per 1000 people (states exclude Hawaii).

Activity 6:

In the sixth activity students will determine outliers for dataset 3 and dataset 1.  Have students determine outliers Dataset 3 by hand.  Have them discover that only 1919 has an outlier.  Discuss what the outliers mean and how the show the extreme deaths in Pennsylvania and California compared to other states that same year. For dataset 1, have them determine outliers using statistical data, due to its set size.  GeoGebra will only show outliers in a boxplot so a good extension could be having students determine the outlier range by hand by being given Q₁, Q₂, Q_3, and Q_4.  Have them note the increase in outliers when more countries’ death rates are considered for the years between 1917-1919.