Pandemic disease policies- Mask Mandates

Key Vocabulary: Pandemic

Question Focus Document: San-Francisco Anti-Mask Meeting announcement

Compelling Policy Question: What outcomes should policy makers consider when making pandemic disease policies, the consequences of restricting, or of not restricting citizen's daily lives?

Pandemic Disease Policy Case Study:

San Francisco Board of Supervisors Mask Ordinance, 1918 (excerpts/link to original text)

section 1. during the period of the epidemic of the so-called spanish influenza, which is now prevalent in the city and county of San Francisco ... every person appearing on the public streets in any public place, or in any assemblage of persons, or in any place where two or more persons are congregated, except in homes where only two members of the family are present, and every person engaged in the sale, handling or distribution of foodstuffs or wearing apparel, shall wear a mask or covering, except when partaking of meals, over the nose and mouth...

….

Section 3. Every person who shall violate any of the provisions of section 1 of this ordinance shall be deemed guilty of a misdemeanor and shall be fined not less than $5, not more than $100, or shall be imprisoned in the County Jail for a period not exceeding 10 days, or by both said fine and imprisonment.

Historic Context:

With the start of World War One in 1914, the mobilization of soldiers all around the world began, including the United States in 1917. The mobilization of the soldiers and the movement of large numbers of troops made it easy for a viral disease to spread rapidly. Historians and Virologists disagree on the origin of the "Spanish Influenza", with some arguing it began in China, and others arguing it began in Kansas at Fort Riley.

Despite the debate over where the virus began, the deadly virus began to rapidly spread around the world. In the Spring of 1918 there was a "first wave" of the Spanish Influenza which did not prove too be to deadly, but during a second wave in the fall of 1918 people were dying within hours of showing symptoms. As the Pandemic swept across America many States and cities began passing measures to stop the spread of the disease.

On October 17, 1918, the Board of Health reported 1,654 cases in San Francisco. By the end of the month there were over 7,000 cases in the city. While the Board of Health initially only issued public advice on social distancing and self-quarantine if sick, on October 18 all schools, churches, bars, and businesses were closed to limit public mingling.

On October 22 Bill Number 5068, “The Mask Ordinance,” was signed by San Francisco Mayor James Rolph.

Section #1 Guiding Question: Why do some people believe the Government should create restrictions for a citizen's daily life in response to pandemic diseases?

In 1918, San Francisco’s mayor, James Rolph, published an announcement in the San Francisco Chronicle titled “Don Masks”, which said…

(excerpts/link to original)

TO THE PEOPLE OF SAN FRANCISCO: You are face to face with a deadly epidemic. Already it has begun to make its record of death in our city. It must be stopped! It is the duty of every person to help stop it.

The Board of Public Health has left no stone unturned to find the best means of fighting the growing death lists: Its word to the public is, “Wear Masks.” As Mayor, I request every man, woman and child in San Francisco to take this advice of the health authorities. Wear these masks and save your lives and those of your children and your neighbors.

The Italian Supreme Command has printed on every gas mask: “Who leaves this mask behind dies.” You run that chance if you fail your city now and do not wear a mask. Masks may prevent half or more of the sickness and death with which we are confronted. Every mask will cut down our possible total of 50,000 cases and 1,500 deaths.

This proclamation has the concurrence of the Board of Public Health, the Red Cross, the State Council of Defense, organized labor, organized associations of merchants, charitable organizations and other public bodies. Conscience, patriotism, and self-protection demand immediate and rigid compliance.

On December 21, 1918, the Journal of the American Medical Association published a report by a Special Committee of the American Public Health Association titled, “Influenza”, which stated…

(Excerpts/link to original document)

The present epidemic is the result of a disease of extreme communicability.

…

Evidence (shows) ... influenza is given off from the nose and mouth of infected persons.… (I)t is taken in through the mouth or nose of the person who contracts the disease….

If … influenza is spread solely through discharges from the noses and throats of infected persons ... into the noses and throats of other persons … (then) preventative action logically follows the principles named below...

1. Break the channels of communication by which the infective agent passes from one person to another.

…

1. By preventing droplet infection. The evidence offered indicates that this is of prime importance.

In 1918, the Red Cross ran an advertisement in the San Francisco Chronicle titled, "WEAR A MASK and Save Your Life!".

In 1918, the U.S. Public Health Service created a poster titled, "Coughs and Sneezes Spread Diseases - As Dangerous as Poison Gas Shells".

In 1918, Chicago's Commissioner of Health, John Dill Robertson, released a poster for theaters to display titled "Influenza Frequently Complicated with Pneumonia is Prevalent at this Time Throughout America.

In October of 1919 the North Carolina State Board of Health published two cartoons titled "The Way the Germans Did It At Chateau-Thierry," and "The Way North Carolinians Do It At Home," in their The Health Bulletin

The first cartoon states: "During the recent war approximately 1000 men from North Carolina were killed in battle."

The second cartoon stated, "During the epidemic last fall and winter 13,644 North Carolinians laid down their lives to a "spit-borne" disease--influenza!"

The Fort Wayne Sentinel ran a cartoon titled "The Main Objectors" on Dec. 6, 1918.

The Illustrated Current News from New Haven, Connecticut published an illustrated announcement in 1918, which was titled "To Prevent Influenza".

The Topeka Daily State Journal ran an image of a Red Cross nurse wearing a mask accompanied by text, which said...

Red Cross Nurse wearing a "flu" mask.

A gauze mask is one of the things designed to help fight the wave of Spanish influenza that is causing hundreds of deaths all over the country. These masks, made out of gauze, are for the victims of the "flu" to wear. The mask is placed over the nose and mouth to prevent the spread of this germs. The Red Cross and other organizations are doing all they can to fight the epidemic.

Section#2 Guiding Question: Why do some people believe the Government should not restrict a citizen's daily life in response to Pandemic Diseases?

On January 12, 1919, Dan McKenzie wrote a note to the editor of the San Francisco Chronicle which said...

Why wait for an ordinance?

Editor The Chronicle-Sir: In today’s “Safety Valve” columns a contributor who signs himself William J. Brown states in regard to the masking ordinance that “nine out of ten people are now and have been in favor of masks.” If that be so, why under the blue canopy of heaven, don’t they wear ‘em? There’s no law against doing so, is there? Not at all. What doctors don’t know about this epidemic of influenza, would fill a decent-sized library. And yet they have the “gall” to force us to wear masks as a preventive , when no two authorities in the United States are agreed as to the cause, let alone the prevention or cure of the disease.

January 13, 1919, a letter to the editor of the San Francisco Chronicle was sent by “A LOVER of FRESH AIR” titled “Perhaps the Flu Germ Dislikes Fresh Air” Their letter said... (source)

Editor the Chronicle-Sir: Medical men claim that a large percentage of the population of this country are carriers of tuberculosis germs. The medical fraternity has impressed upon us for twenty years past that bad air is harmful to consumptives and that fresh air is the best preventive and cure. Now we are told to wear masks and breathe foul air, and that there is going to be an epidemic of tuberculosis after the flu. In view of all this, does it not seem that Germany alone could benefit by an enforced wearing of masks in the United States? The death rate in San Francisco, where masks were worn, was almost double that of Los Angeles, where masks were not worn. This would seem to confirm the statements of those who oppose the masks as dangerous. I was glad to hear two doctors with American names and accents speak against the reenactment of the mask ordinance at the Health Committee meeting last Wednesday night. But where are our American doctors? Why don’t they come forward?

A letter titled “HE MUST BE A MISOGYNIST” was written to the San Francisco Chronicle on January 13, 1919. The writer, who signed their name as “Whiskers”, said... (excerpts/link to original)

Editor The Chronicle-Sir: I have worn a mask for over forty years, in the shape of a short beard, that nature intended every man to have, and never suffer from any throat or nose troubles of any kind. The human beard is the best kind of a mask ... it is better than any gauze mask for catching microbes. Men with beards are notoriously healthy: This is common knowledge; and several reliable undertakers have assured me that none so far have died of the “flu”.... Most men would be improved in their personal appearance by possession of a well-kept beard, in fact with some it is a distinct asset. Take for instance, the well known Supervisor, who strenuously opposed the “flu” mask ordinance.... Why don’t the Supervisors pass a beard ordinance?

In 1919, a letter signed by Mrs. A. E. T. was sent to the Editor of the San Francisco Chronicle titled “Breeding Places for Germs”. The letter read...

Sir: Let me voice my sentiments regarding the “flu” masks. Instead of forcing the public to wear the masks the Board of Health directors ought to go around and take note of some of the dirty street corners. For instance, the northwest corner of Powell and Market streets. It’s the filthiest corner in the whole city, and it is places like this that such diseases breed. The spitting and dirty refuse on that corner is a disgrace, and a good flushing nightly would be a great help in warding off the present epidemic.

In 1918 a cartoon by an unknown artist titled “Who Laughed?” was published in the Los Angeles Times.

Harry Larimer's regular cartoon series "Bringing up Father in Fort Wayne" from the Fort Wayne Sentinel on December 7, 1918, focused on mask wearing.

The Crane & Company printing company from Topeka Kansas took out an advertisement in the Topeka State Journal newspaper on October 23, 1918.

What was the result of the debate, and what were the consequences?

In San Francisco, opposition to the Mask Mandates made it hard to put into place the first and second mask mandates, and made it hard to force people to abide by the mandate. Because the first mandate was short-lived, cases surged quickly, and San Francisco was slow to restart the mask mandate. See the infographic below for a visual representation of the differences between San Francisco and other cities.

The State of Kansas, and many other States around the United States required schools, restaurants, theaters, etc. to close in order to slow the spread of the "Spanish Influenza". These decisions were all made by State and Local officials. The Federal Government did not require the quarantining of people, even though they legally had the power to do so. The Federal Government did pass H.J. Res. 33, which authorized the spending of $1,000,000 to help fight the spread of the disease.

A study done by a group of medical researchers on 43 different U.S. cities' policies during the Spanish Influenza pandemic titled "Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic" found that "The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality, lower peak mortality rates, and lower total mortality. The conclusion of the research was that nonpharmaceutical interventions such as social distancing, school closures, and shutting down of public places saved lives. The researchers generated this suggestion: "In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.

Some researchers believe as many as fifty million people across the world were killed by the "Spanish Flu" pandemic, including an estimated 675,000 Americans.

Riley D. Champine from National Geographic made an infographic based on the data from the JAMA study of MARKEL H, LIPMAN HB, NAVARRO JA, ET AL. National Geographic Source Link

A chart of deaths in major cities, showing a peak in October and November 1918

Graph courtesy of the National Museum of Health and Medicine) - Pandemic Influenza: The Inside Story. Nicholls H, PLoS Biology Vol. 4/2/2006.