When Mask-Wearing Rules in the 1918 Pandemic Faced Resistance

When Mask-Wearing Rules in the 1918 Pandemic Faced Resistance

The influenza pandemic of 1918 and 1919 was the most deadly flu outbreak in history, killing up to 50 million people worldwide. In the United States, where it ultimately killed around 675,000 people, local governments rolled out initiatives to try to stop its spread. These varied by region, and included closing schools and places of public amusement, enforcing “no-spitting” ordinances, encouraging people to use handkerchiefs or disposable tissues and requiring people to wear masks in public.

Mask-wearing ordinances mainly popped up in the western states, and it appears most people complied with them. The nation was still fighting in World War I, and officials framed anti-flu measures as a way to protect the troops from the deadly outbreak.

WATCH: The Spanish Flu Was Deadlier Than WWI

The first recorded infection was in a U.S. Army private stationed at Fort Riley, Kansas on March 4, 1918. Although the United States and the other nations at war initially suppressed news of the flu (neutral Spain freely reported it, hence the misnomer “Spanish flu”), there was a sense that following these new health precautions was patriotic.

As one Red Cross PSA put it, “the man or woman or child who will not wear a mask now is a dangerous slacker.” This sense of wartime duty—and the fear of being seen as a “slacker”—may have motivated those who complied with mask orders in cities like San Francisco, Seattle, Denver and Phoenix.

Yet even though compliance was high, some complained that the masks were uncomfortable, ineffective or bad for business. Officials were caught in public without masks. And after the war ended, and there was no longer a sense that people should wear masks to keep the troops safe, some dissenters even formed an “Anti-Mask League” in San Francisco.

WATCH: World War I Documentaries on HISTORY Vault

Masks Were Made of Gauze or Even More Porous Material

In 1918, advanced masks like the N95s that healthcare workers use today were a long way off. Surgical masks were made of gauze, and many people’s flu masks were made of gauze too. Red Cross volunteers made and distributed many of these, and newspapers carried instructions for those who may want to make a mask for themselves or donate some to the troops. Still, not everyone used the standard surgical design or material.

“To entice people to get them to wear them, [cities] were pretty lax in terms of what people could wear,” says J. Alex Navarro, assistant director of the Center for the History of Medicine at the University of Michigan and one of the editors-in-chief of The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia.

In October 1918, the Seattle Daily Times carried the headline “Influenza Veils Set New Fashion: Seattle Women Wearing Fine Mesh With Chiffon Border to Ward Off Malady.” These “fashionable” masks and others made from dubious material probably weren’t helping much. Yet there was also debate within the medical and scientific community about whether multiple-ply gauze masks were effective either.

For instance, Detroit health commissioner J.W. Inches said gauze masks were too porous to prevent the spread of the flu among the public. Also, masks are most effective when worn properly, which wasn’t always what happened. In Phoenix, where most people apparently complied with the city’s mask order, some nonetheless poked holes in their masks to smoke—which greatly reduced their effectiveness.

SEE PHOTOS: The 1918 Flu Campaigns to Shame People Into Following New Rules

'Mask Slackers' Faced Enforcement, Punishment

Still, for the small percentage of people who went without a mask entirely, reports suggest their issue had less to do with the science behind them, and more to do with personal comfort.

“You read routinely about people not wanting to wear them because they’re hot and stuffy,” says Nancy Bristow, chair of the history department at the University of Puget Sound and author of American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic. “Some people argue against them because they say that they create fear in the public, and that we want to keep people calm; which I think is really an excuse to critique them because someone doesn’t want to wear them.”










PHOTOS: Innovative Ways People Tried to Protect Themselves From the Flu

Some businesses worried customers would shop less if they had to wear a mask when they went outside, and some people claimed mask ordinances were an infringement upon civil liberties. Yet “more important in terms of critiques,” Bristow says, “is this idea that we’ve heard today as well that they give people a false sense of security.” As she points out, wearing a mask is less effective when people don’t follow other health guidelines too (and especially if some are poking holes in their masks to smoke).

Cities that passed masking ordinances in the fall of 1918 struggled to enforce them among the small portion of people who rebelled. Common punishments were fines, prison sentences and having your name printed in the paper. In one horrific incident in San Francisco, a special officer for the board of health shot a man who refused to wear a mask as well as two bystanders.

This was far different from the treatment San Francisco’s leaders received when they didn’t comply. At a boxing match, a police photographer captured images of several supervisors, a congressman, a justice, a Navy rear-admiral, the city’s health officer and even the mayor, all without masks. The health officer paid a $5 fine and the mayor later paid a $50 fine, but unlike other “mask slackers,” they received no prison time (not to mention no one shot at them).

Mask-Wearing Declines After the War

San Francisco’s first masking order began in October and ended in November after the World War I armistice. In January, when flu cases began to surge again in San Francisco, the city implemented a second mask order. This time, the resistance was much more intense. A group of dissenters that included a few physicians and one member of the Board of Supervisors formed the “Anti-Mask League,” which held a public meeting with over 2,000 attendees.

Navarro speculates the resistance to San Francisco’s second mask order may have been more intense because the country was no longer at war, and some residents didn’t feel the same sense of patriotic duty they had before. In any case, the city was an outlier. It doesn’t appear that there were similar leagues or protests in other cities.

Nancy Tomes, a distinguished professor of history at Stony Brook University who has written about public health measures during the 1918-1919 flu pandemic says while there were pockets of resistance to mask-wearing in 1918 and 1919, it was not widespread.

And, unlike handkerchiefs and paper tissues, which Tomes says people began to use more regularly because of the pandemic, mask-wearing did not catch on in the United States after the ordinances ended. It’s still difficult to say how effective mask-wearing on its own was in 1918 and 1919. What is clear is that communities that implemented stronger health measures overall fared better than those that didn’t.

“Today we can look back and see that they flattened the curve and the communities that did enforce much stricter regulations and for a longer period of time and began earlier had lower death rates,” Bristow says. “But they didn’t have that data tabulated yet, so I think in the aftermath it wasn’t as clear that what they had done had been effective.”

Read more:

Why the Second Wave of the 1918 Spanish Flu Was So Deadly

Spanish Flu - Symptoms, How It Began & Ended

Amid 1918 Flu Pandemic, America Struggled to Bury the Dead

Why October 1918 Was America's Deadliest Month Ever

Pandemics That Changed History: Timeline












The Anti-Mask League.

As the contagion moved into its second year, so did the skepticism.

On Dec. 17, 1918, the San Francisco Board of Supervisors reinstituted the mask ordinance after deaths started to climb, a trend that spilled over into the new year with 1,800 flu cases and 101 deaths reported there in the first five days of January.

That board&rsquos decision led to the creation of the Anti-Mask League, a sign that resistance to masks was resurfacing as cities tried to reimpose orders to wear them when infections returned.


Everyone wore masks during the 1918 flu pandemic. They were useless.

People called them “flu fences” and “chin sails.” Gala attendees fastened theirs with gaudy earrings. Smokers cut flaps in them, and movie houses gave them away with tickets.

During the influenza pandemic of 1918, officials often advised Americans to wear face masks in public. Doctors believed that masks could help prevent “spray infections,” according to historian John M. Barry in his book, “The Great Influenza: The Story of the Deadliest Pandemic in History.” Enforced by local health officials, the facial coverings grew routine. Often, Red Cross chapters fashioned and distributed the masks that were “seen everywhere and would become a symbol of the epidemic,” Barry wrote. Americans used the masks as a method of retaining some normalcy during a pandemic that killed at least 675,000 Americans and 50 million people worldwide. It was the only aspect of the catastrophe discussed with any humor.

If directed to wear a mask, homemade worked. “Take a piece of gauze the size of a sheet of typewriter paper,” said instructions in the Atlanta Constitution. “Fold it twice, so that it will fit an envelope. Then attach strings to the four corners and tie these strings at the back of the neck. The mask covers the nose and mouth, so that the wearer breathes through four thicknesses of gauze. A clean handkerchief is just as good as the gauze.”


Mask resistance during a pandemic isn’t new – in 1918 many Americans were ‘slackers’

We have all seen the alarming headlines: Coronavirus cases are surging in 40 states, with new cases and hospitalization rates climbing at an alarming rate. Health officials have warned that the U.S. must act quickly to halt the spread – or we risk losing control over the pandemic.

There’s a clear consensus that Americans should wear masks in public and continue to practice proper social distancing. While a majority of Americans support wearing masks, widespread and consistent compliance has proven difficult to maintain in communities across the country. Demonstrators gathered outside city halls in Scottsdale, Arizona Austin, Texas and other cities to protest local mask mandates. Several Washington state and North Carolina sheriffs have announced they will not enforce their state’s mask order.

I’ve researched the history of the 1918 pandemic extensively. At that time, with no effective vaccine or drug therapies, communities across the country instituted a host of public health measures to slow the spread of a deadly influenza epidemic: They closed schools and businesses, banned public gatherings and isolated and quarantined those who were infected. Many communities recommended or required that citizens wear face masks in public – and this, not the onerous lockdowns, drew the most ire.

Officials wearing gauze masks inspect Chicago street cleaners for the flu, 1918. (Bettman/Getty Images)

In mid-October of 1918, amidst a raging epidemic in the Northeast and rapidly growing outbreaks nationwide, the United States Public Health Service circulated leaflets recommending that all citizens wear a mask. The Red Cross took out newspaper ads encouraging their use and offered instructions on how to construct masks at home using gauze and cotton string. Some state health departments launched their own initiatives, most notably California, Utah and Washington.

Nationwide, posters presented mask-wearing as a civic duty – social responsibility had been embedded into the social fabric by a massive wartime federal propaganda campaign launched in early 1917 when the U.S. entered the Great War. San Francisco Mayor James Rolph announced that “conscience, patriotism and self-protection demand immediate and rigid compliance” with mask wearing. In nearby Oakland, Mayor John Davie stated that “it is sensible and patriotic, no matter what our personal beliefs may be, to safeguard our fellow citizens by joining in this practice” of wearing a mask.

Health officials understood that radically changing public behavior was a difficult undertaking, especially since many found masks uncomfortable to wear. Appeals to patriotism could go only so far. As one Sacramento official noted, people “must be forced to do the things that are for their best interests.” The Red Cross bluntly stated that “the man or woman or child who will not wear a mask now is a dangerous slacker.” Numerous communities, particularly across the West, imposed mandatory ordinances. Some sentenced scofflaws to short jail terms, and fines ranged from US$5 to $200.

Collage of newspaper headlines related to the previous year’s influenza pandemic, Chicago, Illinois, 1919. Headlines include ‘Police Raid Saloons in War on Influenza,’ ‘Flu Curfew to Sound for City Saturday Night’ and ‘Open-Face Sneezers to Be Arrested.’ (Chicago History Museum/Getty Images)

Passing these ordinances was frequently a contentious affair. For example, it took several attempts for Sacramento’s health officer to convince city officials to enact the order. In Los Angeles, it was scuttled. A draft resolution in Portland, Oregon led to heated city council debate, with one official declaring the measure “autocratic and unconstitutional,” adding that “under no circumstances will I be muzzled like a hydrophobic dog.” It was voted down.

Utah’s board of health considered issuing a mandatory statewide mask order but decided against it, arguing that citizens would take false security in the effectiveness of masks and relax their vigilance. As the epidemic resurged, Oakland tabled its debate over a second mask order after the mayor angrily recounted his arrest in Sacramento for not wearing a mask. A prominent physician in attendance commented that “if a cave man should appear…he would think the masked citizens all lunatics.”

In places where mask orders were successfully implemented, noncompliance and outright defiance quickly became a problem. Many businesses, unwilling to turn away shoppers, wouldn’t bar unmasked customers from their stores. Workers complained that masks were too uncomfortable to wear all day. One Denver salesperson refused because she said her “nose went to sleep” every time she put one on. Another said she believed that “an authority higher than the Denver Department of Health was looking after her well-being.” As one local newspaper put it, the order to wear masks “was almost totally ignored by the people in fact, the order was cause of mirth.” The rule was amended to apply only to streetcar conductors – who then threatened to strike. A walkout was averted when the city watered down the order yet again. Denver endured the remainder of the epidemic without any measures protecting public health.

In Seattle, streetcar conductors refused to turn away unmasked passengers. Noncompliance was so widespread in Oakland that officials deputized 300 War Service civilian volunteers to secure the names and addresses of violators so they could be charged. When a mask order went into effect in Sacramento, the police chief instructed officers to “Go out on the streets, and whenever you see a man without a mask, bring him in or send for the wagon.” Within 20 minutes, police stations were flooded with offenders. In San Francisco, there were so many arrests that the police chief warned city officials he was running out of jail cells. Judges and officers were forced to work late nights and weekends to clear the backlog of cases.

Many who were caught without masks thought they might get away with running an errand or commuting to work without being nabbed. In San Francisco, however, initial noncompliance turned to large-scale defiance when the city enacted a second mask ordinance in January 1919 as the epidemic spiked anew. Many decried what they viewed as an unconstitutional infringement of their civil liberties. On January 25, 1919, approximately 2,000 members of the “Anti-Mask League” packed the city’s old Dreamland Rink for a rally denouncing the mask ordinance and proposing ways to defeat it. Attendees included several prominent physicians and a member of the San Francisco Board of Supervisors.

Poster of a Red Cross nurse wearing a gauze mask over her nose and mouth – with tips to prevent the influenza pandemic. (The National Library of Medicine/NIH)

It is difficult to ascertain the effectiveness of the masks used in 1918. Today, we have a growing body of evidence that well-constructed cloth face coverings are an effective tool in slowing the spread of COVID-19. It remains to be seen, however, whether Americans will maintain the widespread use of face masks as our current pandemic continues to unfold. Deeply entrenched ideals of individual freedom, the lack of cohesive messaging and leadership on mask wearing, and pervasive misinformation have proven to be major hindrances thus far, precisely when the crisis demands consensus and widespread compliance. This was certainly the case in many communities during the fall of 1918. That pandemic ultimately killed about 675,000 people in the U.S. Hopefully, history is not in the process of repeating itself today.

J. Alexander Navarro, Assistant Director, Center for the History of Medicine, University of Michigan

This article is republished from The Conversation under a Creative Commons license. Read the original article.


Mask resistance during a pandemic isn't new – in 1918 many Americans were 'slackers'

We have all seen the alarming headlines: Coronavirus cases are surging in 40 states, with new cases and hospitalization rates climbing at an alarming rate. Health officials have warned that the U.S. must act quickly to halt the spread – or we risk losing control over the pandemic.

There’s a clear consensus that Americans should wear masks in public and continue to practice proper social distancing. While a majority of Americans support wearing masks, widespread and consistent compliance has proven difficult to maintain in communities across the country. Demonstrators gathered outside city halls in Scottsdale, Arizona Austin, Texas and other cities to protest local mask mandates. Several South Carolina sheriffs have announced they will not enforce their state’s mask order.

I’ve researched the history of the 1918 pandemic extensively. At that time, with no effective vaccine or drug therapies, communities across the country instituted a host of public health measures to slow the spread of a deadly influenza epidemic: They closed schools and businesses, banned public gatherings and isolated and quarantined those who were infected. Many communities recommended or required that citizens wear face masks in public – and this, not the onerous lockdowns, drew the most ire.

In mid-October of 1918, amidst a raging epidemic in the Northeast and rapidly growing outbreaks nationwide, the United States Public Health Service circulated leaflets recommending that all citizens wear a mask. The Red Cross took out newspaper ads encouraging their use and offered instructions on how to construct masks at home using gauze and cotton string. Some state health departments launched their own initiatives, most notably California, Utah and Washington.

Nationwide, posters presented mask-wearing as a civic duty – social responsibility had been embedded into the social fabric by a massive wartime federal propaganda campaign launched in early 1917 when the U.S. entered the Great War. San Francisco Mayor James Rolph announced that “conscience, patriotism and self-protection demand immediate and rigid compliance” with mask wearing. In nearby Oakland, Mayor John Davie stated that “it is sensible and patriotic, no matter what our personal beliefs may be, to safeguard our fellow citizens by joining in this practice” of wearing a mask.

Health officials understood that radically changing public behavior was a difficult undertaking, especially since many found masks uncomfortable to wear. Appeals to patriotism could go only so far. As one Sacramento official noted, people “must be forced to do the things that are for their best interests.” The Red Cross bluntly stated that “the man or woman or child who will not wear a mask now is a dangerous slacker.” Numerous communities, particularly across the West, imposed mandatory ordinances. Some sentenced scofflaws to short jail terms, and fines ranged from US$5 to $200.

Passing these ordinances was frequently a contentious affair. For example, it took several attempts for Sacramento’s health officer to convince city officials to enact the order. In Los Angeles, it was scuttled. A draft resolution in Portland, Oregon led to heated city council debate, with one official declaring the measure “autocratic and unconstitutional,” adding that “under no circumstances will I be muzzled like a hydrophobic dog.” It was voted down.

Utah’s board of health considered issuing a mandatory statewide mask order but decided against it, arguing that citizens would take false security in the effectiveness of masks and relax their vigilance. As the epidemic resurged, Oakland tabled its debate over a second mask order after the mayor angrily recounted his arrest in Sacramento for not wearing a mask. A prominent physician in attendance commented that “if a cave man should appear…he would think the masked citizens all lunatics.”

In places where mask orders were successfully implemented, noncompliance and outright defiance quickly became a problem. Many businesses, unwilling to turn away shoppers, wouldn’t bar unmasked customers from their stores. Workers complained that masks were too uncomfortable to wear all day. One Denver salesperson refused because she said her “nose went to sleep” every time she put one on. Another said she believed that “an authority higher than the Denver Department of Health was looking after her well-being.” As one local newspaper put it, the order to wear masks “was almost totally ignored by the people in fact, the order was cause of mirth.” The rule was amended to apply only to streetcar conductors – who then threatened to strike. A walkout was averted when the city watered down the order yet again. Denver endured the remainder of the epidemic without any measures protecting public health.

In Seattle, streetcar conductors refused to turn away unmasked passengers. Noncompliance was so widespread in Oakland that officials deputized 300 War Service civilian volunteers to secure the names and addresses of violators so they could be charged. When a mask order went into effect in Sacramento, the police chief instructed officers to “Go out on the streets, and whenever you see a man without a mask, bring him in or send for the wagon.” Within 20 minutes, police stations were flooded with offenders. In San Francisco, there were so many arrests that the police chief warned city officials he was running out of jail cells. Judges and officers were forced to work late nights and weekends to clear the backlog of cases.

Many who were caught without masks thought they might get away with running an errand or commuting to work without being nabbed. In San Francisco, however, initial noncompliance turned to large-scale defiance when the city enacted a second mask ordinance in January 1919 as the epidemic spiked anew. Many decried what they viewed as an unconstitutional infringement of their civil liberties. On January 25, 1919, approximately 2,000 members of the “Anti-Mask League” packed the city’s old Dreamland Rink for a rally denouncing the mask ordinance and proposing ways to defeat it. Attendees included several prominent physicians and a member of the San Francisco Board of Supervisors.

It is difficult to ascertain the effectiveness of the masks used in 1918. Today, we have a growing body of evidence that well-constructed cloth face coverings are an effective tool in slowing the spread of COVID-19. It remains to be seen, however, whether Americans will maintain the widespread use of face masks as our current pandemic continues to unfold. Deeply entrenched ideals of individual freedom, the lack of cohesive messaging and leadership on mask wearing, and pervasive misinformation have proven to be major hindrances thus far, precisely when the crisis demands consensus and widespread compliance. This was certainly the case in many communities during the fall of 1918. That pandemic ultimately killed about 675,000 people in the U.S. Hopefully, history is not in the process of repeating itself today.

This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts.

The University of Michigan Center for the History of Medicine received funding from the US Centers for Disease Control and Prevention for a portion of its research on the 1918 influenza pandemic. J. Alexander Navarro was a member of that team of researchers.


Mask court

The penalty for violators was $5 to $10, or 10 days’ imprisonment.

On Nov. 9, 1,000 people were arrested, The San Francisco Chronicle reported. City prisons swelled to standing room only police shifts and court sessions were added to help manage.

“Where is your mask?” Judge Mathew Brady asked offenders at the Hall of Justice, where sessions dragged into night. Some gave fake names, said they just wanted to light a cigar or that they hated following laws.

Jail terms of 8 hours to 10 days were given out. Those who could not pay $5 were jailed for 48 hours.


During the 1918 flu pandemic, masks were controversial for "many of the same reasons they are today"

As Election Day nears, the role of masks during the coronavirus pandemic has become highly politicized while health experts have emphasized how masks can reduce spread, mask rules across the country have varied and so has the response from Americans.

More than a century ago, during the 1918 flu pandemic, there were some similar feelings about masks.

As Americans were celebrating victory in World War I in the fall of 1918, the masks on returning troops showed that the U.S. was losing another war against the so-called Spanish Flu.

Masks were controversial back then "for many of the same reasons they are today," said Nancy Tomes, a history professor at the State University of New York at Stony Brook.

The pandemic in 1918 got "really, really bad," she told "CBS This Morning" co-host Anthony Mason. "We refer to it as the Big One among historians of medicine."

About 675,000 Americans would die, nearly a third of them in a single month. The Red Cross spread the slogan "wear a mask, save your life," and nurses began to make them for the public.

Coronavirus Crisis

Two gauze masks used in the 1918 pandemic are in the collection of the Oakland Museum of California.

"They're pretty transparent," associate curator Erendina Delgadillo said. "So it wasn't an ideal material, but it was definitely better than not wearing anything."

One of the centers in the fight against the 1918 pandemic was the Henry Street Settlement in New York City.

"Its founder Lillian Ward played a critical role in organizing the pandemic response in New York City," Tomes said.

Masks were never officially mandated on the East Coast, Tomes said, but other health rules were often aggressively enforced, including arresting people for spitting.

"There was a definite effort to up the ante. In prosecuting, they called them sanitary infractions," Tomes said.

The U.S. outbreak had started on a Kansas Army base and the campaign to stop it was tied to the war effort.

Wearing a mask became a patriotic gesture.

"If you refuse to wear a mask, you could be called a slacker," Tomes said. "A slacker was not quite like a traitor, but it was someone who was dragging their patriotic feet."

San Francisco was the first city to mandate masks.

"Ten percent of the population was infected between 1918 and 1919," Delgadillo said.

In just a day, the San Francisco Chronicle reported that 100 people were charged with "disturbing the peace" for failing to wear masks. Their sentence was 10 days in prison or a $5 fine, about $80 today.

"And then here in San Francisco, there was an Anti-Mask League that formed in early January," Delgadillo said. "The chairman was this woman named Mrs. E.C. Harrington. She was a suffragist. She was a lawyer. &hellip She put out a call in the San Francisco Chronicle asking for her fellow citizens who objected to this mask mandate as really similar to the arguments now actually."

They argued the ordinance was unconstitutional and that masks had not been proven effective. Some 2,000 people turned out for a rally at the Dreamland skate rink.

Other cities would mandate masks, including Denver, Seattle, Oakland, Sacramento and Phoenix. They were met with resistance too, but one major difference then was it wasn't political.

"There was disagreement between the various politicians about which businesses should get closed down, but the decision to mask or not to mask never became identified with a specific political party," Tomes said.

Although the materials used for masks in 1918 were less effective than those used today, according to Tomes, masks did lower the number of deaths when coupled with other measures like social distancing.

In New York today, like in 1918, Henry Street Settlement is still very much a hub for pandemic response, delivering tens of thousands of masks and other resources to the community.


1918 pandemic lasted 2 years

Cincinnati police officers are pictured circa 1918 wearing gauze masks much like those being worn more than 100 years later.

In 1918, a raging influenza pandemic had grasped the nation. Around the country, organizations urged citizens to wear protective masks, open windows and doors, and stay home when possible. Sound familiar? Americans in 2020 are dealing with the same challenges from more than 100 years ago.

Just like mask mandates for COVID-19, protective measures had to be taken in 1918 in most American cities to prevent further spread of the virus. According to the one Cincinnati doctor, “Army doctors have found the ‘gauze face mask’ very useful in preventing infection.”

Although not as wide spread as the 2020 COVID-19 pandemic, masks in 1918 were still an important part of the public health’s response to influenza. Public spitting in streets was also outlawed in some states. Other practices included the closing of businesses, especially those that involved high contact between customers and owners.

Mask mandates were set in place around the country, some more strongly enforced than others. In San Francisco, a fine of $5 was charged to non-compliant citizens and violators were charged with disturbing the peace. The same fine today would be equivalent to more than 85 dollars. This San Francisco law eventually led to the creation of the Anti-Mask League, a group of angry business owners and citizens uncomfortable with the city ordinances.

To most citizens, wearing a mask was an act of patriotism. With so many soldiers having just returned from World War I, the Red Cross and government officials framed mask wearing as a way to protect troops from the viral attack. A sense of duty accompanied every citizen who wore a mask. As one Red Cross public service announcement said, “Every man, woman, or child who does not wear a mask is a dangerous slacker.”

Not everyone wore his or her masks for the right reasons. Upper class ladies used sheer, mesh masks as fashion accessories to flaunt their wealth and style. The material of the masks was hardly effective in preventing disease, but this way they would not be fined for failure to wear a mask. Other people poked holes in their masks so they could smoke. The effectiveness of masks was both under-researched and under-reported in 1918. The public’s knowledge of the virus and its transmission methods was lacking, resulting in a higher spread of influenza.

Over a century ago, the 1918 pandemic, what some called the “The Spanish Flu” and others “The Grip” changed the face of modern medicine forever. In Highland County, the disease some notable parallels to the current pandemic in 2020.

The first instance of the flu in Ohio likely came from soldiers coming back from the war. The men happily returned from Europe, bringing with them the deadly virus to their wives and children back in America. The result was a massive pandemic even reaching to Highland County, where overwhelmed citizens panicked as their friends and family became ill.

There were numerous waves to the 1918 H1N1 pandemic. The first was very mild and resulted in very few deaths. The second wave, however, had symptoms that were actually very similar to COVID-19. Coughing, fever, and occasionally gastrointestinal disturbances were observed. The second wave of influenza targeted healthy, younger adults, turning the skin blue and filling their lungs with fluid until they died only hours or days after showing symptoms. In just one year, the U.S. life expectancy plunged a dozen years.

In the end, the pandemic lasted more than two years, the worst of it coming in the fall of 1918. By the end of 1920, the flu had infected more than 500 million people, about one-third of the world’s population. The impact of the virus can still be seen today in the health care advances brought on by the tragedy. Today we can look back at the 1918 pandemic and learn some important lessons for facing COVID-19.

Sources: https://www.history.com/news/1918-spanish-flu-mask-wearing-resistance and https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/historical-images.htm.

Cincinnati police officers are pictured circa 1918 wearing gauze masks much like those being worn more than 100 years later.


Mask Resistance During a Pandemic Isn’t New — in 1918 Many Americans Were 'Slackers'

We have all seen the alarming headlines: Coronavirus cases are surging in 40 states , with new cases and hospitalization rates climbing at an alarming rate. Health officials have warned that the U.S. must act quickly to halt the spread – or we risk losing control over the pandemic.

There’s a clear consensus that Americans should wear masks in public and continue to practice proper social distancing. While a majority of Americans support wearing masks, widespread and consistent compliance has proven difficult to maintain in communities across the country. Demonstrators gathered outside city halls in Scottsdale, Arizona Austin, Texas and other cities to protest local mask mandates. Several Washington state and North Carolina sheriffs have announced they will not enforce their state’s mask order .

I’ve researched the history of the 1918 pandemic extensively. At that time, with no effective vaccine or drug therapies, communities across the country instituted a host of public health measures to slow the spread of a deadly influenza epidemic: They closed schools and businesses, banned public gatherings and isolated and quarantined those who were infected. Many communities recommended or required that citizens wear face masks in public – and this, not the onerous lockdowns, drew the most ire.

In mid-October of 1918, amidst a raging epidemic in the Northeast and rapidly growing outbreaks nationwide, the United States Public Health Service circulated leaflets recommending that all citizens wear a mask. The Red Cross took out newspaper ads encouraging their use and offered instructions on how to construct masks at home using gauze and cotton string. Some state health departments launched their own initiatives, most notably California, Utah and Washington.

Nationwide, posters presented mask-wearing as a civic duty – social responsibility had been embedded into the social fabric by a massive wartime federal propaganda campaign launched in early 1917 when the U.S. entered the Great War. San Francisco Mayor James Rolph announced that “conscience, patriotism and self-protection demand immediate and rigid compliance” with mask wearing. In nearby Oakland, Mayor John Davie stated that “it is sensible and patriotic, no matter what our personal beliefs may be, to safeguard our fellow citizens by joining in this practice” of wearing a mask.

Health officials understood that radically changing public behavior was a difficult undertaking, especially since many found masks uncomfortable to wear. Appeals to patriotism could go only so far. As one Sacramento official noted, people “must be forced to do the things that are for their best interests.” The Red Cross bluntly stated that “the man or woman or child who will not wear a mask now is a dangerous slacker.” Numerous communities, particularly across the West, imposed mandatory ordinances. Some sentenced scofflaws to short jail terms, and fines ranged from US$5 to $200.

Passing these ordinances was frequently a contentious affair. For example, it took several attempts for Sacramento’s health officer to convince city officials to enact the order. In Los Angeles, it was scuttled. A draft resolution in Portland, Oregon led to heated city council debate, with one official declaring the measure “autocratic and unconstitutional,” adding that “under no circumstances will I be muzzled like a hydrophobic dog.” It was voted down.

Utah’s board of health considered issuing a mandatory statewide mask order but decided against it, arguing that citizens would take false security in the effectiveness of masks and relax their vigilance. As the epidemic resurged, Oakland tabled its debate over a second mask order after the mayor angrily recounted his arrest in Sacramento for not wearing a mask. A prominent physician in attendance commented that “if a cave man should appear…he would think the masked citizens all lunatics.”

In places where mask orders were successfully implemented, noncompliance and outright defiance quickly became a problem. Many businesses, unwilling to turn away shoppers, wouldn’t bar unmasked customers from their stores. Workers complained that masks were too uncomfortable to wear all day. One Denver salesperson refused because she said her “nose went to sleep” every time she put one on. Another said she believed that “an authority higher than the Denver Department of Health was looking after her well-being.” As one local newspaper put it , the order to wear masks “was almost totally ignored by the people in fact, the order was cause of mirth.” The rule was amended to apply only to streetcar conductors – who then threatened to strike. A walkout was averted when the city watered down the order yet again. Denver endured the remainder of the epidemic without any measures protecting public health.

In Seattle, streetcar conductors refused to turn away unmasked passengers. Noncompliance was so widespread in Oakland that officials deputized 300 War Service civilian volunteers to secure the names and addresses of violators so they could be charged. When a mask order went into effect in Sacramento, the police chief instructed officers to “Go out on the streets, and whenever you see a man without a mask, bring him in or send for the wagon.” Within 20 minutes, police stations were flooded with offenders. In San Francisco, there were so many arrests that the police chief warned city officials he was running out of jail cells. Judges and officers were forced to work late nights and weekends to clear the backlog of cases.

Many who were caught without masks thought they might get away with running an errand or commuting to work without being nabbed. In San Francisco, however, initial noncompliance turned to large-scale defiance when the city enacted a second mask ordinance in January 1919 as the epidemic spiked anew. Many decried what they viewed as an unconstitutional infringement of their civil liberties. On January 25, 1919, approximately 2,000 members of the “Anti-Mask League” packed the city’s old Dreamland Rink for a rally denouncing the mask ordinance and proposing ways to defeat it. Attendees included several prominent physicians and a member of the San Francisco Board of Supervisors.

It is difficult to ascertain the effectiveness of the masks used in 1918. Today, we have a growing body of evidence that well-constructed cloth face coverings are an effective tool in slowing the spread of COVID-19. It remains to be seen, however, whether Americans will maintain the widespread use of face masks as our current pandemic continues to unfold. Deeply entrenched ideals of individual freedom, the lack of cohesive messaging and leadership on mask wearing, and pervasive misinformation have proven to be major hindrances thus far, precisely when the crisis demands consensus and widespread compliance. This was certainly the case in many communities during the fall of 1918. That pandemic ultimately killed about 675,000 people in the U.S . Hopefully, history is not in the process of repeating itself today.

J. Alexander Navarro is the Assistant Director at the Center for the History of Medicine, University of Michigan. This article originally appeared on The Conversation under a creative commons license. Read the original here.


This "Do's and Don't's" List From the 1918 Pandemic Proves We've Learned Absolutely Nothing in 100 Years

Almost exactly 100 years ago, the entire world faced a different pandemic: the Spanish Flu. The H1N1 virus spread throughout the world, and approximately 675,000 people in the U.S. died.

COVID-19 might be a different virus, but the spread of a deadly pandemic feels eerily similar for those who are aware of the Spanish Flu ordeal, which was thought to have reached American soil in 1918. Another positively uncanny fact is that people were having the same exact arguments way back then as they are now when it comes to wearing masks and social distancing. Just take a look at this list of "Do&aposs and Don&apost&aposs" for how to act during the pandemic of 1918.

Number one: WEAR A MASK. Sure, some of them (like gargling) are a little strange, but the gist is the same then as it is now Wear a mask, wash your hands, "respect the quarantine regulations," "avoid crowds," and one more reminder. "DO NOT NEGLECT YOUR MASK."

But it&aposs the highlighted section that really gets me and others. It&aposs probably the reason this tweet has over 5,000 retweets and 10,000 likes. Even 100 years ago, we had to plead with each other to believe experts even if you don&apost understand the science, to heed the advice of scientists and other authorities on the matter, and to reject the idea that you are somehow "special" or exempt from these rules. 

American exceptionalism was seemingly as much an issue then as it is now. And that&aposs so disheartening. We had 100 years to improve our behavior and learn our lesson it&aposs literally one of the reasons we all learn history in school — to prevent ourselves from repeating the same mistake. But alas, here we are: Begging people not to go to football stadiums or concerts while staring at pictures of people gathering in huge crowds back in 1918. 

Olga Jonas, a senior fellow at the Harvard Global Health Institute, told The Harvard Gazette, "There have been many books and papers written about the 1918 flu pandemic, and one of the main themes is how quickly it was forgotten, how fast it disappeared from the political discourse. I guess the lesson is to never forget because forgetting doesn’t lead to positive public health outcomes."

We can&apost let this pandemic go the way of the 1918 pandemic, which was largely unexamined in a lot of ways after it happened. Obviously, pandemics aren&apost so rare that we can&apost learn from the ones that have already happened. 

There are a lot of similarities in the way the 1918 pandemic and COVID-19 have acted so far. But as Mari Webel and Megan Culler Freeman wrote for The Conversation, "COVID-19 has been hard to predict." Although we must learn from the 1918 pandemic, we can&apost assume that the trajectory of COVID-19 will follow the same trends. 

We have to remain vigilant even if it seems like things are getting better. We have to continue to wear masks and social distance and wash our hands because those things work. It&aposs only when we become too lax about those safety measures that infection rates get out of control.

Webel and Freeman write, "COVID-19 cases are unlikely to come with the predictability that discussions of influenza &aposwaves&apos in 1918-19 might suggest. Rather, as SARS-CoV-2 continues to circulate in nonimmune populations globally, physical distancing and mask-wearing will keep its spread in check and, ideally, keep infection and death rates steady."

We cannot control what the actual virus will do. But we can control how we react and how we treat each other. The actual pattern of the pandemic may differ from 100 years ago, but the things that we can do to mitigate the spread are the same. Wear a mask, wash your hands, social distance.

And we seem to be making largely the same mistakes when it comes to how we, as individuals part of a larger society, responded. It&aposs way past time to learn how to be a considerate and responsible citizen, how to live to protect others as much as yourself. We didn&apost do it 100 years ago, and we&aposre not doing now. But we can still learn from our mistakes.