What the 1919 Anti-Mask League Can Teach Us About Public Health

Here Red Cross workers are seen making anti-influenza masks for soldiers in camp in Boston, Massachusetts. National Archives

Back in April 2020, after several weeks of mostly sheltering in place, some people across the United States were starting to tire of what they saw as this unBrave New World of ours. Protests across America were calling for an end to some coronavirus-breaking measures — the closing of businesses and the enforced isolation, mainly — that health officials insisted were keeping us safe.

But eight months later on Dec. 11, 2020, the Federal Drug Administration approved the first coronavirus vaccine for emergency use for those 16 and older. A week later, the FDA approved a second vaccine for emergency use.

Today in the United States, everyone 12 and older has access to at least one mRNA vaccine at no charge. The vaccines have shown remarkable efficacy against coronavirus. The vaccines have been so successful at lowering rates of disease in the U.S. that the Centers for Disease Control (CDC) and Prevention announced in May 2021 that vaccinated individuals no longer had to wear masks in public or indoors. It looked like the U.S. was on its way to beating coronavirus.

Fast forward to July 27, 2021, and things have changed, partly because the highly contagious delta variant strain of coronavirus is surging. But also because as of July 28, 2021, less than half of all Americans (48.8 percent) are fully vaccinated against coronavirus. These two things combined led the CDC to reverse its mask guidelines from May, suggesting now even the fully vaccinated need to mask up again — and not surprisingly, a lot of Americans are very unhappy, some even resorting to burning masks in protest.

A little civil unrest in a period of unrest for all of civilization? A loud plea for a return to normalcy during these abnormal times? Haven't we been here before?

"I don't think it's uncommon, by any means. It usually comes in that second round [of a flu epidemic], when people say, 'Well, if it comes back, then what was the point of all those measures you had before?', or 'We've had enough of this, we can't stand it any longer,'" says Nancy K. Bristow, author of "American Pandemic: The Lost Worlds Of The 1918 Influenza Epidemic," and the chair of the history department at the University of Puget Sound in Tacoma, Washington.

The Spanish Flu in San Francisco

That brings us to the 1918 influenza pandemic — often called the Spanish flu, though its origin remains uncertain. It infected more than 25 million people in America, killing some 675,000 of them on its way to wiping out nearly 50 million people worldwide. (COVID-19, by comparison, has infected more than 35 million Americans, killing more than 627,000, and has killed nearly 4.2 million worldwide to date.) The flu spread in four waves throughout 1918 and 1919. The first came in 1918 and was thought, by many, to be just another seasonal flu.

One of the hardest hit places in the U.S. was San Francisco. Initially city leaders cracked down hard and it was one of the first cities to implement strict orders to shut down the city. Schools and churches were closed, and large gatherings were banned. Social distancing was mandated, as were hygiene measures. (Sound familiar?)

In October 1918, the San Francisco board of supervisors ordered everyone to wear masks in public. Violators were subject to fines or even jail time. The measures appeared to work. By November, flu cases seemed to be on the decline, and San Francisco relaxed its strict orders, reopening bars, theaters and sports clubs, and revoking the mask ordinance.

However just a month later, cases of the flu spiked, and in January the mask ordinance was reinstated. But much of the public — including "The Anti-Mask League" — resisted the mandates that city leaders re-enacted to help blunt the spread of the disease.

The Oakland Municipal Auditorium was used as a temporary hospital with volunteer nurses from the American Red Cross tending the sick during the influenza pandemic of 1918.
National Archives

The Anti-Mask League

In late 1918, as that second wave of the deadly flu tore through San Francisco, many residents pushed back against earlier measures that health officials adopted. Some of the population who had worn masks before now objected.

Tim Mak, an investigative reporter for NPR in Washington, D.C. came across a mention of a group in San Francisco in late 1918 and early 1919 that called itself the "Anti-Mask League." The parallels between those citizens opposing the city mask ordinance in early 20th century San Francisco and the 21st-century Americans balking against shelter-in-place rules are striking.

"I was just super curious and thought I'd write a couple tweets on it," says Mak, who ended up diving into the Anti-Mask League for more than four hours and tapping out dozens of tweets on it in an impressively detailed thread in April 2020.

"The more I looked into it, the more I saw the same human elements that I see today. I see pushback from the business community. I see civil libertarians saying that these public health measures are too oppressive, and that if the government can be oppressive in forcing people to wear masks, it can be oppressive in any number of other ways as well."

At least one individual, according to Mak's research, sent a rigged up explosive device to the city's public health official. In early April 2020, the U.S.'s top expert on the coronavirus, Dr. Anthony Fauci, faced enough threats to his safety that a personal security force was assigned to him.

An emergency flu hospital staffed by U.S. Navy Hospital corpsman was set up in the San Francisco Civic Center to help care for those stricken by the influenza.
Underwood Archives/Getty Images

The Anti-Mask League Meets

An Anti-Mask League meeting Jan. 25, 1919, drew 4,500 members and, two days later, the group found a sympathetic ear in Charles Nelson, a member of the board of supervisors for the city and county of San Francisco. Nelson declared that the masks were an "infringement of our personal liberty and that it was not in keeping with the spirit of a truly democratic people to compel people to wear the mask who do not believe in its efficacy, but rather that it is a menace to their health."

San Francisco Mayor James Rolph was not nearly as swayed:

Do you think I am going to stultify myself here against the wishes of 99 ½ percent of the doctors; against the officials of the army and navy? The people felt a great relief when the masking ordinance was put in effect ... We should give our minds to serious matters instead of fighting the little inconvenience occasioned by the wearing of a mask for the protection of the general public.

As the cases eventually declined in San Francisco, the mask ordinance was rescinded. But by the end of February 1919, the city's cases of influenza had doubled from its November count of 1,857 to 3,213. By the time the pandemic was over, an estimated 45,000 San Franciscans contracted the flu and 3,500 died of it.

Public Health vs. Personal Rights

The effectiveness of sometimes draconian-seeming public health measures was as much of a debate in 1918 and 1919 as it is today. Then, as now, officials end up weighing the health of the public against things like personal liberty and economic stability.

But 1918 and 1919 can inform us. They do inform those who study the history of pandemics.

"There's very good research done by historians at the University of Michigan and people at the [Centers for Disease Control and Prevention] who have done a close analysis of different cities," Bristow says. "It's very clear that those cities that closed early and had a robust and intensive closure in place, and kept it on the longest, had the lowest death rate.

"It's clear that acting with great caution makes the most sense."

Whether officials today heed that lesson, and whether a restless public does so, may go a long way into determining how deadly the coronavirus of 2021 is, vaccines and all.