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San Francisco had the 1918 flu under control. And then it lifted the restrictions.

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San Francisco had the 1918 flu under control. And then it lifted the restrictions.


When the clock struck noon, the masks came off.

It was Nov. 21, 1918, and San Francisco residents gathered in the streets to celebrate not only the recent end of World War I and the Allies’ victory, but also the end of an onerous ordinance that shut down the city and required all residents and visitors to wear face coverings in public to stop the spread of the so-called Spanish flu.

A blaring whistle alerted gratified residents across the city and, as the San Francisco Chronicle reported at the time, “the sidewalks and runnels were strewn with the relics of a torturous month,” despite warnings from the health department to maintain face coverings. As celebrations continued and residents flocked to theaters, restaurants and other public spaces soon thereafter, city officials would soon learn their problems were far from over.

Now, amid the coronavirus pandemic, as President Donald Trump urges the reopening of the country and some states, such as Georgia, move to resume normal business even as new cases emerge, how officials acted during the 1918 flu pandemic, specifically in cities such as San Francisco, offers a cautionary tale about the dangers of doing so too soon.

Alex Navarro, the assistant director of the Center for the History of Medicine at the University of Michigan, which detailed historical accounts of the 1918-19 flu pandemic in 43 cities, told NBC News in a phone interview that officials often acted quickly at the time but restrictions were eased to varying degrees.

“There was a lot of pressure in pretty much all of these American cities to reopen,” said Navarro, whose research was done in conjunction with the Centers for Disease Control and Prevention. “When they removed those restrictions too soon, then many cities saw a resurgence in cases.”

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The center’s research found that cities that used “early, sustained and layered” practices such as social distancing, closing public events and stay-at-home orders “fared better than those that did not.”

‘A lot of stock in masks’

Just two months earlier, in September, the first case of the so-called Spanish flu was identified in San Francisco and city health officials sprung into action.

Dr. William C. Hassler, the city’s health officer, ordered the local man who apparently brought the disease to the city after a trip to Chicago into quarantine to stop the disease from finding another human host, according to the center’s research of reported accounts.

But it was too late as the virus had already begun to make its way through the city. By mid-October, the cases jumped from 169 to 2,000 in just one week. Later that month, Mayor James Rolph put in place social distancing practices and met with Hassler, other health officials, local business owners as well as officials from the federal government to discuss a plan to close the city.

Some officials demurred at the idea, worried about damage to the city’s economy and the risk of causing public panic. Eventually, on Oct. 18, the city voted to shut down “all places of public amusement.”

Image: Praying for Health During Flu Epidemic
The congregation praying on the steps of the Cathedral of Saint Mary of the Assumption, where they gathered to hear mass and pray during the influenza epidemic, San Francisco, California, 1918.Hulton Archive / Getty Images file

City officials also strongly advocated for face coverings, which were at first optional and soon required by a mayoral order — the country’s first at the time, Navarro said.

“They were the one city that put a lot of stock in masks,” he said.

With the pandemic still raging across the globe during World War I, the mask also became a symbol of “wartime patriotism.”

“The man or woman or child who will not wear a mask now is a dangerous slacker,” a public service announcement from the American Red Cross said at the time, according to Navarro’s research.

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