What convinced Americans during the 1918 Flu Pandemic to wear masks?

Figure 1. Men being escorted away from a building in 1918 San Francisco because they were not wearing masks.

With the Covid-19 pandemic still raging and resurging in the United States, public health officials are encouraging people to wear masks to limit the spread of the virus. In some parts of the United States, there has been hostility to this. Similarly, the 1918 so-called Spanish Flu pandemic also faced similar hostility in places to wearing masks. Public health officials then turned to a variety of tactics to get people to wear masks then that might help encourage some to wear masks in modern epidemics.

The 1918 Flu Pandemic and Masks

Figure 2. Masks being shown as fashion items, with some ways suggested makiing the masks useless.

By the autumn of 1918 in the United States, it was clear the flu pandemic was becoming out of control and that surging cases across the country required public health officials to issue direct guidance for people to wear masks. For some states, masks were seen as part of policies such as social distancing, washing hands, and general cleanliness to avoid the spread of the virus. Some cities in the Western United States, including some cities now where we see hostility to wearing masks, passed laws that required masks to be worn at all times by the autumn of 1918. This included Phoenix, San Francisco, and even Juneau, Alaska (Figure 1). Punishments ranged from fines to imprisonment in cities. While most punishments for not wearing a mask were fines, prison sentences did occur. There was one infamous incident in San Francisco, where a special officer hired by the Board of Health to enforce mask wearing, shot a man who had earlier refused to wear a mask; two bystanders even were hit by the shooting. In another case in San Francisco, at a boxing match attended by many dignitaries from the city and government, a photographer shot a photo of that night and the well known individuals present. That photograph led to many officials being shamed for not wearing masks. People who were caught not wearing masks included a congressman, a court justice, a Navy rear-admiral, a health officer and the mayor. This led to fines for these officials and public shaming, although none of these individuals were imprisoned as others had been. Nevertheless, most people or places that had rules requiring masks generally had no major issues or incidents. Only after substantial declines in deaths and infections did most of these cities that passed mask-wearing laws gradually removed the requirement about masks.

Masks in 1918, however, have been criticized for being ineffective or at least limited in preventing spread of the 1918 virus. The American Public Health Association in December 1918 concluded that wearing mask should be compulsory for medical staff, barbers, dentists, and other occupations that come into close contact with other individuals. However, it found masks were not always beneficial, but that mainly had to do with the materials they were made from or incorrect use of masks. Thus, the board recommended that only workers in close contact wear them and others who wish to do so should be instructed on the proper way in making and wearing masks. A later study in 1927 did, however, show that those who wore masks generally did help to limit the spread of the 1918 virus. The study also determined there were many misconceptions of what masks were for and this was part of the problem. Masks should be presented to the public as devices that help infected people from spreading their infection, whereas many people saw them differently and took them to even be a stigma. The study recognized also there is likely hostility in wearing masks in countries emphasizing individual freedom. The study made clear that masks should be presented as something that should be worn because it reflects the presence of a serious disease where public and community health is more important than individual rights at a given time.

Other Efforts Related to Masks

Not all cities passed such laws requiring masks in 1918, but there were still efforts to get people to wear masks. One effort attempted to get people to wear masks by stating that the effort was patriotic since it helped prevent the spread of the virus to US soldiers, who were severely impacted by the pandemic both in the US and in Europe while serving. This seems to have worked as it appealed to people's patriotism and feeling of supporting the war effort. There were still some dissenters and even an Anti-Mask League was formed in San Francisco. Other cities, such as Seattle, did try appealing to people's fashion sense as a way to get people to wear masks. One newspaper, Seattle Daily Times, even created a headlines titled: “Influenza Veils Set New Fashion: Seattle Women Wearing Fine Mesh With Chiffon Border to Ward Off Malady." The idea of calling them veils, rather than masks, was intended to get people to feel they were more of a fashion item, perhaps similar to how some masks today are relatively decorative (Figure 1). Perhaps also the newspaper took liberty with interpreting them as a new fashionable trend. Some ways suggested by newspapers, however, made masks useless, despite any positive intentions these newspapers had (Figure 2). Finally, embarrassing people was another tactic used, with some places having the local newspaper print the names of people who were caught not wearing a mask.

Complaints and Concerns

The standard complaints people did give in 1918 on why they did not wear masks did vary, besides the main reason being that some saw them as impinging on their personal freedom. One of the most common complaints was they were hot and stuffy. Some businesses worried masks would limit sales, as people would not want to wear them so they would not go outside and shop. Others pointed out that mask were ineffective. Many of these complaints had merit, although they could have been remedied or at least minimized, such as wearing masks properly to make them more comfortable and effective as well as providing information as to why they were being used for public health. For instance, people were caught making holes in their masks so they could smoke, negating the utility of a mask. Protests did spring up, including those organized by anti-mask groups such as the Anti-Mask League, but generally people complied with either laws requiring masks to be worn or followed due to public pressure and sense of duty.

Summary

The 1918 flu pandemic offers us valuable insights into efforts to get people to wear masks as well as common complaints against them. Similar to today, American society debated their utility and looked at issues of personal freedom and comfort. While many concerns and issues faced are familiar to us, people also were creative in attempting to get people to follow community health practices. This ranged from punishment, to embarrassment, appealing to patriotism, or making wearing masks a more positive experience such as fashion sense. While these tactics were not always effective, they did also generally get people to mostly wear masks at least in parts of the United States such as in the West.