January 21, 2021

SMH

Santa Maria History

Lessons from San Francisco’s Experience of The Great Influenza

Two days before Halloween, James Wiser took to the corner of Powell and Market streets to deliver his anti-mask screed. It seems that Wiser, a working-class man from San Francisco, was fed up with the state telling him how to live his life. The way he saw it, face coverings — which the city had mandated just a few days prior in an effort to slow the spread of the virus — were “bunk,” and he was determined to let the people know exactly how he felt.

It wasn’t long before the blacksmith drew the attention of authorities. When a city health inspector insisted Wiser follow San Francisco’s mask ordinance or face the consequences, Wiser hit the official with a large sack filled with silver dollars. He was subsequently arrested and charged with disturbing the peace, resisting an officer, and assault.

Joshua Colby Council has a similar story. After arguing with Delta Air Lines staff and a pilot, and causing something of a scene at the Salt Lake City International Airport, Colby, a San Francisco smoke shop owner, was arrested on suspicion of disorderly conduct after refusing numerous requests to cover his face before takeoff.

Comparing these incidents, it’s easy to recognize their similarities. Both feature an aggravated man making a public spectacle of his disdain for public health mandates. But the key difference between the two events — aside from the homemade blackjack wielded by Wiser — is a little over a century.

Wiser’s mask defiance, documented in the Oct. 29, 1918, edition of the San Francisco Chronicle, occurred as the city was struggling through The Great Influenza. Council’s dubious act of civil disobedience went down this fall, the day before Thanksgiving.

On Oct. 19, 1918 — 10 days before reporting on Wiser’s outburst — the Chronicle published a statement from Dr. George Ebright, president of California’s Board of Health, imploring citizens to do their part to slow the spread of the deadly respiratory disease: “Cases … will be limited by the common sense exercised by individuals and authority.”

The proclamation has a familiar ring to it. Earlier this year, on Aug. 3, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, urged his fellow Americans to remain vigilant in the fight against the novel coronavirus: “What we need is to get the message across that we are all in this together.”

Indeed, when examining archived reports of San Francisco’s handling of The Great Influenza — which is estimated to have killed at least 50 million people worldwide — a number of striking parallels to our current moment emerge. Then, as now, numerous vaccines were developed in the hopes of ending the pandemic; then, as now, a vocal anti-mask contingent actively subverted the efforts of public health officials; and then, as now, multiple surges in infections — the result of pandemic fatigue and the natural ebb and flow of the virus — thwarted economic recovery.

Considering The Great Influenza’s lasting impact on San Francisco may shed some light upon how the COVID-19 pandemic will conclude and give us some insight into what awaits us in the near future.

The eventual end of our own pandemic hinges in large part upon the successful distribution and acceptance of a COVID-19 vaccine. Both present significant challenges.

Though two FDA-approved vaccines began shipping in December, problems with temperature control and other logistical hurdles have hindered deployment. Furthermore, as recent history has demonstrated, mass vaccination campaigns are always met by resistance. But while anti-vaxxers are nothing new, their ability to spread disinformation is stronger than ever thanks to the power and ubiquity of social media.

Even after COVID-19 is brought under control, the long tail of the pandemic will linger. The novel coronavirus has dealt a severe blow to the global economy, exacerbated long-simmering political and social tensions, and leaves a trail of fear, anxiety, and death in its wake. None of these wounds will heal overnight — and some will surely continue to fester for years to come.

What Goes Around…

Many Americans will know The Great Influenza by a different name: “The Spanish Flu.” However, scholars of this chapter in history now tend to agree that the racially charged moniker is not only insensitive and intentionally misleading — akin to President Donald Trump’s coinage, “The Chinese Virus” — it is also inaccurate.

The first case of the deadly H1N1 Influenza A virus was recorded by a country doctor in Haskell County, Kansas. In January or February of 1918, Dr. Loring Miner noted that the flu cases he was seeing among the population of farmers he treated were particularly severe. From there, the respiratory disease made its way into local Army and Navy conscripts, who in turn carried it to military bases in the United States, and eventually to the muddy trenches and concertina-choked fields of Belgium and France.

Oregon State University History Professor Christopher Nichols says The Great War played a critical role in the spread of The Great Influenza. Case in point: Kansas’ Fort Riley — in 1918 the largest training facility in the Army — was situated about 270 miles northeast of Haskell County. Many historians believe that infected soldiers carried the virus from Kansas to the Eastern Seaboard and then across the Atlantic. 

By August of 1918, the flu had spread up and down the East Coast and throughout the Midwest. On September 19, Philadelphia went ahead with its planned Liberty Loan Parade — organized to promote the war effort — despite warnings from public health officials. The parade acted as a superspreader event, and thousands of Philadelphians died as a result.

Later that month, San Francisco health officials reported the first known case of the deadly flu in the city. Just as Gov. Gavin Newsom shut down California while New York was experiencing its deadly spring surge of COVID-19 cases, the delay in the spread of the 1918 influenza outbreak to the West Coast gave San Francisco authorities the opportunity to observe and learn from the Midwest and East Coast’s mistakes.

According to Nichols, San Francisco was unique in its response to The Great Influenza — imposing strictly enforced mask mandates and citywide business closures. Perhaps owing to its firm and wide-reaching regulations, San Francisco also saw a large-scale (though short-lived) mask resistance.

Out in Sacramento, the governor and state legislature also took action. In the face of the first wave of influenza, the California State Health Board closed down theaters, libraries, and public auditoriums, but advised that schools remain open, according to the Chronicle.

Then & Now

By the end of October, San Francisco had close to 18,700 reported cases. On Oct. 25, the San Francisco Board of Supervisors passed the first citywide mask ordinance. Those who were found in public without a face covering — labeled “mask slackers” — were fined anywhere between $5 and $100; the collected money went to the Red Cross.

The penalties of 1918 stand in stark contrast to the approach the city is taking this time around. On a single day in October, 110 San Franciscans were arrested for either refusing to wear a mask or wearing it incorrectly. Then-Mayor James Rolph and Dr. William C. Hassler, the city’s public health officer, were fined $50 and $5, respectively, after they were caught without masks while attending a boxing match at the Civic Center.

Nowadays, San Franciscans can get off without wearing a mask virtually scot-free. In November, we saw two high-profile local politicians — Mayor London Breed and Governor Gavin Newsom — disregard COVID-19 public health guidelines, and authorities in many Bay Area cities, including San Francisco, have been reluctant to actually issue fines to those who violate mask mandates.

The Great Influenza also saw its own version of remote learning, called “correspondence school” or “school by mail,” Nichols says. Some indoor schooling proceeded in ventilated settings, with all the windows opened, while some students worked from home — sending and receiving their assignments in the mail.

San Francisco took other active measures to prevent the spread of the flu, such as increased street cleaning, says Nicole Meldahl, the executive director of the Western Neighborhoods Project, a non-profit that preserves the history and culture of western San Francisco.

At one point, San Francisco theaters showed instructional reels on how to prevent and treat the flu before film screenings. Later on, in the spirit of social distancing, residents were told to avoid public transportation during peak commute hours and to steer clear of crowds. 

Initially, churches were allowed to remain open for regular services, but a later resolution was adopted that restricted indoor church services to no more than half an hour. The San Francisco Church Federation willingly complied, going so far as to take out an ad in the Oct. 19, 1918, edition of the Chronicle which reminded San Franciscans “that laws of health are as sacred as the Ten Commandments and should be diligently obeyed.”

The Church Federation and the Health Board urged those infected not to resort to fear and “hysteria,” instead advising that they stay home and call a doctor. 

Churches hosting services in open air during the 1918 flu.

Fear and uncertainty are common themes in the memoirs, letters, and diaries of 1918, Nichols says. At the time — more than a decade before scientists first isolated the Influenza A virus — the public’s understanding of how the flu spread was quite limited.

“They’re afraid to go out; they’re afraid to help their neighbors; they’re not even sure if they will wake up and still be alive,” he says. “They really didn’t understand how the flu was being transmitted. There were rumors it could be spread through the phone, rumors certain behaviors like smoking would help stop the flu. You only knew what the very limited number of people in your orbit were saying.”

Today, as we near a full year of the COVID-19 pandemic, misinformation still abounds. While some continue to spread the long-debunked idea that wearing a mask can actually make you sicker, others continue to exercise a manic level of caution — wiping down packages and changing out of outdoor clothes, even though the science suggests the chance of contracting the novel coronavirus from surfaces is extremely low.

Then, as now, Americans found crafty ways to amuse themselves in the face of their generalized anxiety. In 1918, before the advent of television, people passed their time reading.

“The vendors on street corners and newspaper magazine shops were sold out regularly, and subscriptions to stuff that would be delivered to your door went way up,” Nichols says.

At the time, a newspaper might print as many as three editions a day. Magazines and serial literature — published in sequential installments — were also popular reading materials.

Other activities, like early versions of board games and multi-piece puzzles, were popular, Nichols says, as were in-home musical instruments.

Indoor sports like boxing, bowling, and billiards were called off, but outdoor sports like baseball, football, swimming, golf, hunting, and tennis were permitted.

“Nothing to do but take the situation gracefully,” one San Franciscan told the Chronicle when asked about restrictions on indoor sports. “I realize that it is a necessary precaution, and in the long run we’ll be all the better off for it.”

The ways San Franciscans coped with The Great Influenza are reminiscent of the ways we’re coping with COVID-19. A photo taken in 1918 shows three well-dressed — and masked — adults onboard a boat somewhere in the San Francisco Bay. One of the adults, a man, is playing stick-up with two women, their hands raised, in an act of pandemic playfulness. 

“Maybe it’s me projecting a bit, but it felt like we’re all kind of under the gun here and that people are just out and about, trying to be as goofy as possible to let off some steam,” Meldahl says. “As with today, people are people just trying to do what they can given their limitations.”

A Long Shot

On Oct. 29, 1918, 50,000 doses of the Leary-Park influenza vaccine arrived in San Francisco from Boston. The vaccine was administered over the course of three doses, spaced out at 24-hour intervals. Some individuals who received the vaccine reported a slight headache or fever, but others reported no side effects at all, according to the Chronicle

Another treatment, the Rosenow vaccine, emerged in November and was administered to members of the US Army and Navy.

Millions of vials of vaccines were distributed throughout the country, but there was no clear consensus on how effective these treatments actually were at protecting against the virus. Health officials in different states were making a range of different claims, including that the vaccine was prophylactic; that it prevented pneumonia but not the flu; or that it mitigated extreme cases of the flu but couldn’t prevent a mild case, Nichols says. 

A healthcare worker receives the COVID-19 vaccine in San Francisco. Photo by SFGOV

According to UC San Francisco Professor of Microbiology and Immunology Raul Andino-Pavlovsky, an effective flu vaccine — the same one that’s still in use today — wasn’t developed until the 1940s when it was realized that influenza is caused by a virus and not a bacterium, as previously thought. Even then, widespread use of the flu vaccine wasn’t achieved until the 1990s.

Both the Leary-Park and Rosenow vaccines are regarded to be ineffective as they did not protect against the influenza-causing virus. Though it is suggested that these vaccines may have been successful at reducing the rate of pneumonia following influenza infection.

Trail of Suffering

At exactly noon on Nov. 22, 1918, after a month of mandatory “muzzled misery,” a whistle was blown, the bells of St. Patrick Church rang out, and San Franciscans tore their gauze masks from their faces, flinging them into the streets. The pandemic had officially ended.

Or so many thought… 

It had been about a month since the Leary-Park vaccine was deployed and San Franciscans were ready to return to normal. During the first wave of The Great Influenza, Meldahl says San Francisco residents were “not thrilled” but “pretty much on board” with the restrictions. But when a new wave of the flu struck San Francisco in early 1919, flu fatigue — much like the pandemic fatigue we’re seeing now — took hold.

“When it resurged by the middle of January 1919, people were exhausted, they were no longer willing to go along [with restrictions],” Meldahl says. 

There was also, Meldahl says, a “prioritizing of politics over the pandemic.” Mayor Rolph took no responsibility for the resurgence, and — wanting to appease local business owners — did not recommend that the city shut down for a second time.

“Citizens are seeing a double standard — they’re being told to wear masks and stay indoors, yet none of the businesses are being told to,” Meldahl says.

After a second mask ordinance was issued, an anti-mask league was formed in San Francisco, headed by an attorney named Emma C. Harrington. Notably, Harrington was also a suffragist and the first woman to register to vote in San Francisco after women’s suffrage was granted in California in 1911.

Harrington aligned herself with disgraced former San Francisco Mayor Eugene Schmitz, who was found guilty of extortion and bribery in 1907 while still in office. According to The San Francisco Examiner, Schmitz was the featured speaker at the Anti-Mask League’s first major gathering held at the downtown Dreamland Rink. The event drew 2,000 people — “none of them wearing masks, of course,” Meldahl says.

“At the core of that is what we see today, where public health officials [are] trying to combat what people saw as an autocratic attack on their constitutional rights,” Meldahl says. “People were upset because they felt the masks hampered their individual liberty, and forming this league was preserving American democracy.”

The Anti-Mask League is significant in San Francisco’s history, though it was extremely short-lived. After its formation in January, the city’s mask ordinance was ended on Feb. 1, 1919. 

One year later, on Feb. 6, 1920, the Chronicle reported that the influenza could finally be declared “on the wane.” That year-long timespan marks “the transition from flu as pandemic to flu as seasonal flu,” Nichols explains. Because so many people had already been exposed to the virus, herd immunity began to develop. 

So how did The Great Influenza end without an effective vaccine? Not with a bang, but with much wheezing.

Those who were infected either died or recovered and developed immunity. It appears that the influenza had become less virulent, so hospitals were no longer flooded with critical cases, and the public also learned to deal with the seasonal flu by practicing preventive measures like covering coughs and sneezes, Nichols says.

But just as COVID-19 has been seen to pose long-term health consequences, so did the flu of 1918. 

“Influenza is bad but the results may be infinitely worse,” noted an edition of the Chronicle published in March of 1920. “[It] is responsible for broken constitutions and bodies racked and ravished by almost every chronic and fatal disease known to doctors.”

Even though San Francisco’s closure policies and mask orders were effective, it was still one of the worst-hit cities on the West Coast, with a total of 45,000 cases of the flu and 3,000 flu-related deaths.

One marked difference between COVID-19 and the 1918 influenza is that, with the former, the risk for severe illness increases with age, but with the latter, healthy Americans — in the age range of roughly 18-45 — were disproportionately affected. So while some scholars have labeled the 1918 pandemic a piece of forgotten American history, others disagree with the assessment.

“It’s present in the lives of generations after […] because you lost wage earners, you lost parents, you lost brothers and sisters — you weren’t losing grandparents so much as you were losing the next generation of people,” Nichols says. “It hit this healthy, young generation. So if they got through it they remember the flu because it was miserable. And if they didn’t, they often left a trail of suffering in their wake.”

Dr. Jason Kindrachuk, an expert in outbreak preparedness and an assistant professor in the Department of Medical Microbiology & Infectious Diseases at Canada’s University of Manitoba, has published research about The Great Influenza. When asked about what the end of the COVID-19 pandemic will look like, Kindrachuk points to the gradual eradication of Smallpox and Ebola. 

“People ask me, ‘Is there going to be a big celebration where everything comes to an end?’ I don’t think it’s going to be that way,” he says. “It’s going to be a slow move back to what our perceived normal was. It’s not going to be a definitive day where we take off our masks.”

History Lessons

An estimated 50 million people died worldwide during The Great Influenza. In studying and writing about this time, Kindrachuk says he believes there are lessons from the 1918 pandemic that we didn’t appreciate, like the fact that “history will repeat itself.”

“In 1918, we didn’t have vaccines, the supportive care, the antibiotics, all of these things have made a rampant difference for us, and yet we’re still struggling,” Kindrachuk says. “Yes, we are getting to the point where there’s light at the end of the tunnel, but we have to think about the fact that this is not going to be the last pandemic.”

Watching pandemic history repeat itself has been both fascinating and “depressing” to witness, according to both historians Nichols and Meldahl.

“Even with the vaccines rolling out, we’re still using early 20th century techniques to try to combat this — masks, social distancing, closure policies,” Nichols says. “We know what works, we’re just not pulling it off. On that level, it’s depressing as a historian. We know the lessons, we’re just not applying them.”

Nichols suggests that our key takeaway from the 1918 influenza might not come from how the end of the pandemic played out, but in what followed afterward.

Just as President Trump has used racially insensitive terms to discuss COVID-19, racist language and imagery were prevalent during the 1918 pandemic. Editorial cartoons appeared that demeaned Spaniards, perpetuating the idea of the “Spanish Flu.” Soon after the end of the pandemic, in 1924, the United States imposed severe limits on immigration.

“Partly it comes out of the flu moment,” Nichols explains. “This racial politicized language of the ‘other’ — other people, other groups — was weaponized to fight the flu and to fight the war, but it’s also weaponized against immigrants afterwards.”

Now, as then, xenophobic rhetoric has emerged as a sociological symptom of the pandemic. Reports of prejudice toward and racially motivated attacks against Asian Americans are on the rise, and will likely persist.

A cartoon from a 1918 edition of the SF Examiner criticizing the “influenza español.”

However, even as resurgent nativism and isolationism worked to close the United States off from the rest of the world, the decade following The Great Influenza is nevertheless referred to as The Roaring Twenties, the Jazz Age, and The New Era. It was a time characterized by jubilant social gatherings, artistic creativity, and scientific innovation. It gave birth to the Harlem Renaissance, saw baseball emerge as our national pastime, and fostered the growth of social clubs and organizations that brought Americans together. All of this is a part of that pandemic’s legacy.

“It is part of how we understand the cultural impetus for gathering,” Nichols says. “You can see the ’20s as developing out of this wartime and pandemic experience.”

What’s Next?

With the FDA recently issuing approval to both the Pfizer and Moderna vaccines, and with California’s COVID vaccination plan already underway, Dr. Anthony Fauci has said the US could return to some sense of pre-COVID normalcy by mid-fall of 2021. But that’s only if between 75-85 percent of the country gets vaccinated, and current projections from the Pew Research Center show that only 60 percent of Americans plan to get the vaccine.

“If you have a vaccine that is 90 percent, effective, like Pfizer and Moderna, that’s great news,” Andino-Pavlovsky says. “But if only 10 percent or 20 percent of the population believes in this vaccine, your vaccine is only 10 percent effective.”

So what happens if we don’t get enough people vaccinated to reach the necessary levels of herd immunity?

“We continue to have these pockets of outbreaks and local transmission,” Kindrachuk says. “We don’t want to be living in this world where even with a vaccine, we still have to distance and mask, so if — at the very least — we can get people to get vaccinated, and we’re able to suppress these transmission rates down to […] as close to zero as we can get, we can get back to some normalcy.”

Right now, one of the biggest threats to ending the COVID-19 pandemic is the rapid spread of online misinformation. That’s left scientists like Kindrachuk navigating unfamiliar waters.

“It’s been really the meeting of a pandemic with the dawning of the age of social media,” Kindrachuk says. “As a scientist, we haven’t necessarily been trained on how to communicate with the public or how to communicate our results and the expertise and understanding we have. Our best weapon is to provide good information.”

As for how the end of this pandemic will play out in San Francisco, it’s nearly impossible to say. Hesitantly speculating on different future possibilities, Andino-Pavlovsky says we might have a seasonal coronavirus just like our seasonal flu. The rosiest scenario, however, is that transmission is reduced enough as a result of widespread vaccinations and vigilant social behaviors like continued mask-wearing and social distancing to the point where there are no more COVID-19 cases in six months or a year’s time.

Comix Experience owner Brian Hibbs holds a hand-drawn sign reminding folks to wear masks on May 18, 2020. Photo by Kevin N. Hume

The most likely, however — the one that Andino-Pavlovsky is betting on — is that the first-generation vaccines, such as Pfizer and Moderna’s, will be effective at limiting transmission, but still require tweaking. As such, Andino-Pavlovsky theorizes that we may need to wait until the second or third-generation vaccines arrive before we can truly declare the end of this pandemic.

So for now, it’s probably best that we hold off on the church bells and refrain from throwing our masks in the street.