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

Back in April 2020, after several weeks of largely staying indoors, many across the United States began to grow weary of what they saw as this unBrave New World. Protests erupted across the country, calling for the lifting of certain coronavirus-related restrictions — mainly the closing of businesses and the forced isolation that health officials insisted were crucial to our safety.

However, eight months later, on December 11, 2020, the Federal Drug Administration authorized the first coronavirus vaccine for emergency use for individuals aged 16 and older. A week later, the FDA approved a second vaccine for emergency use.

In the United States today, anyone 12 years or older has free access to at least one mRNA vaccine. These vaccines have proven to be highly effective against the coronavirus. Their success in reducing disease rates has been so significant that the Centers for Disease Control and Prevention (CDC) declared in May 2021 that vaccinated individuals no longer needed to wear masks, whether indoors or in public. It seemed like the U.S. was on the path to overcoming the coronavirus.

Fast forward to July 27, 2021, and the situation has shifted, partly due to the rapid spread of the highly contagious delta variant. But also, as of July 28, 2021, less than half of Americans (48.8 percent) are fully vaccinated. These factors led the CDC to reverse its mask guidelines from May, now advising even fully vaccinated people to wear masks once more. Unsurprisingly, this has sparked frustration across the country, with some Americans even resorting to burning masks in protest.

A bit of civil discontent during a time of global unrest? A desperate cry for a return to normalcy amidst these extraordinary circumstances? Haven't we experienced something like this before?

"I don't think it's unusual, at all. It tends to occur during the second wave [of a flu epidemic], when people begin asking, 'If it comes back, what was the purpose of all those previous measures?' or 'We've had enough, we can't tolerate this anymore,'" says Nancy K. Bristow, author of "American Pandemic: The Lost Worlds Of The 1918 Influenza Epidemic" and chair of the history department at the University of Puget Sound in Tacoma, Washington.

The Spanish Flu in San Francisco

This brings us to the 1918 influenza pandemic — frequently referred to as the Spanish flu, although its exact origin is still unclear. It infected over 25 million people in the U.S., resulting in about 675,000 deaths, and contributed to a global death toll approaching 50 million. (In comparison, COVID-19 has affected over 35 million Americans, causing over 627,000 deaths, and has claimed nearly 4.2 million lives worldwide as of now.) The flu spread in four distinct waves throughout 1918 and 1919. The initial wave in 1918 was initially believed, by many, to be just another seasonal flu.

San Francisco was one of the hardest-hit cities in the U.S. Early on, city officials took drastic measures, making it one of the first places to enforce strict shutdown orders. Schools and churches were closed, large gatherings were banned, and social distancing and hygiene rules were put in place. (Does this sound familiar?)

In October 1918, the San Francisco board of supervisors mandated that everyone must wear masks in public. Those who refused could face fines or even jail time. The measures seemed effective, as by November, flu cases appeared to be decreasing. San Francisco then eased its strict rules, reopening bars, theaters, and sports clubs, while lifting the mask mandate.

However, just a month later, flu cases spiked again, leading to the reinstatement of the mask mandate in January. Much of the public, including members of "The Anti-Mask League," opposed the measures city officials reintroduced to control the spread of the disease.

The Anti-Mask League

By late 1918, as the second wave of the deadly flu swept through San Francisco, many residents began to push back against the earlier measures health officials had put in place. Some individuals who had complied with wearing masks now objected.

Tim Mak, an investigative reporter for NPR in Washington, D.C., stumbled upon a reference to a group in San Francisco from late 1918 and early 1919 that called itself the "Anti-Mask League." The similarities between the citizens opposing the city’s mask mandate in early 20th century San Francisco and the 21st-century Americans resisting shelter-in-place orders are striking.

"I was just super curious and thought I'd write a couple tweets on it," says Mak, who ended up researching the Anti-Mask League for over four hours and posting dozens of tweets in an incredibly detailed thread in April 2020.

"The more I delved into it, the more I recognized the same patterns we see today. I observed resistance from the business world. I noticed civil libertarians arguing that these public health actions are too repressive, and that if the government can mandate mask-wearing, it could potentially extend its control in many other areas as well."

According to Mak's investigation, at least one person sent a makeshift explosive device to the city's health official. In early April 2020, Dr. Anthony Fauci, the United States' leading expert on the coronavirus, received enough threats to his safety that he was provided with a personal security detail.

The Anti-Mask League Meets

On January 25, 1919, an Anti-Mask League meeting drew 4,500 attendees. Two days later, the group found an ally in Charles Nelson, a member of the San Francisco Board of Supervisors, who declared that mask mandates were an "infringement on personal liberty," adding that it was not in the spirit of democracy to force people to wear masks, especially those who believed the masks posed a threat to their health rather than offering protection.

San Francisco Mayor James Rolph remained largely unmoved by the group's arguments:

As cases began to drop in San Francisco, the mask mandate was lifted. However, by the end of February 1919, the city's influenza cases had doubled, rising from 1,857 in November to 3,213. By the end of the pandemic, around 45,000 residents had contracted the flu, and 3,500 had died from it.

Public Health vs. Personal Rights

The debate over the effectiveness of sometimes seemingly harsh public health measures in 1918 and 1919 mirrors the discussions we face today. Back then, as now, authorities had to balance the well-being of the public with concerns like personal freedom and economic stability.

The events of 1918 and 1919 offer valuable lessons. They provide crucial insights for those who examine the history of pandemics.

"There is excellent research done by historians at the University of Michigan, along with experts at the [Centers for Disease Control and Prevention], who have thoroughly analyzed different cities," says Bristow. "The evidence is clear: cities that acted swiftly with strong measures, and maintained them for the longest period, experienced the lowest death rates."

"The key takeaway is that taking precautions early and with great care is the wisest course of action."

Whether current officials take that advice to heart, and whether the public is willing to follow, could significantly impact the severity of the 2021 coronavirus, regardless of the vaccines available.