People balked at masks in 1918, too. Then the arrests started

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In October of 1918, with a lethal influenza spreading in San Diego, the health board asked the City Council to pass a law requiring people to wear face masks in public. San Francisco had just adopted such a measure, the first in the country, as the death toll from the so-called Spanish Flu climbed. A half-dozen other cities — Seattle, Denver, Indianapolis, Pasadena, Oakland, Sacramento — soon followed. But the council here balked. Some members doubted masks would help. Others said they would interfere with “the fresh air and sunshine” so crucial to a healthy lifestyle. They worried citizens would be harassed by overzealous police officers. The council voted instead to make masks optional and ignored pleas to re-consider from the city’s health officer, who said the epidemic here — about 550 cases had been reported, including 20 deaths — could be corralled if everyone covered their faces. What happened next may sound familiar to those watching the current COVID-19 pandemic: The number of cases kept rising, eventually sickening about 4,500 more people in San Diego (a city of 75,000 residents then) and killing an additional 350 over the next three months. How much difference early and widespread mask-wearing might have made is hard to gauge. The city eventually passed a mask ordinance, in early December, and police began arresting violators and hauling them into court. Hundreds eventually were fined $5. But subsequent research, published in the Journal of the American Medical Association in 2007, showed that U.S. cities that adopted a variety of public-health measures in the initial stages of the 1918 pandemic, and kept them in place, had better outcomes. The report’s authors recommended that “non-pharmaceutical interventions” be considered in planning how to mitigate future outbreaks. Why that lesson failed to take hold in America this time is a question academics and public-health experts are exploring in earnest. Why didn’t more cities adopt social-distancing earlier? Why did some open too soon? Why do some people (about 14 percent, according to a recent Gallup poll) refuse to wear masks? Why does the United States, with 4 percent of the world’s population, have 25 percent of the novel coronavirus cases? “In 1918, the people fighting the flu pandemic really didn’t know what to do, because they’d had no experience with something like that,” said Joseph Gabriel, a historian of medicine at Florida State University. “Today, we actually do know what to do, and we’re not doing it.”

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