A cartoon in the Dec. 9, 1918, edition of the Fort Wayne Sentinel illustrates the historical lesson from that year’s pandemic to the one raging today.
It shows a sea of shoppers on a busy sidewalk, all wearing face masks but also clustered shoulder to shoulder.
Face coverings could help prevent the spread of Spanish influenza then, but were more effective when paired with other public health measures, such as social distancing, good hygiene and staying home when sick. Hoosiers in the early 20th century generally were aware of all those steps, but often presumed that abiding by one precaution was as good as following them all.
“We know now that if you wear a mask, you should still social distance,” said Thomas Ewing, a professor of history at Virginia Tech who’s studied the 1918 flu pandemic for the past decade. “That’s something they didn’t understand in 1918.”
Ewing and research assistants Jessica Brabble and Ariel Ludwig plan to write a book on the crisis that killed more than 50 million people worldwide a century ago. They’ve also penned essays on their research, including “Flu Masks in Indiana during the 1918 Epidemic,” published this month in the social sciences journal, Items.
The trio studied reports in newspapers, which closely documented “the mystery flu” and the response to it by national, state and local officials.
They found similarities and differences in the public’s acceptance of wearing face masks in 1918, compared to that during 2020’s COVID-19 coronavirus pandemic. For example, some people rebelled against mask orders, and that’s happening today in Indiana after Gov. Eric Holcomb issued a mandate Wednesday for Hoosiers to wear masks in indoor public places and outdoor areas where social distancing isn’t possible.
“There were a handful of objectors,” Ewing said Thursday. Some challenged mask orders as a violation of their civil liberties. A few doctors claimed cloth masks — each made from a two-foot by 30-inch piece of gauze, folded over four times — were unsanitary, though the majority of medical professionals endorsed the practice. Most Americans heeded the calls for people to wear face coverings.
“A lot of people reacted positively,” Ewing said. “They put on masks.”
The public mandates primarily came at the local level. San Francisco, Seattle, Denver, and smaller places such as Ogden, Utah; Lima, Ohio; Stockton, California; and Indiana towns including Indianapolis, Muncie and Fort Wayne all had mask orders imposed during the influenza pandemic, which lasted from fall of 1918 until spring of 1919. Terre Haute enacted several measures, but apparently not on masks.
Oddly enough, some local orders called on people to wear face coverings in public outdoors, but not indoors.
“We know now that your chances of being infected [with coronavirus] are much, much higher if you’re indoors, rather than outdoors,” Ewing said.
Not only that, but the city mask ordinances were in effect for only a matter of weeks. Des Moines, Iowa’s mask order lasted only one day. Arrests were made in several cities, including Fort Wayne.
That northern Indiana city applied its mask order sporadically, as cases went up and down, along with a ban on public meetings. It lifted the order in November 1918, then reimposed it in early December when flu cases and deaths spiked. Fort Wayne made its order widespread, requiring face coverings in all public places — street cars, stores, schools, theaters, churches, public elevators, meetings and offices with three or more workers.
But later that week, the local board of health reversed its mandate and mask wearing was no longer compulsory.
“The best medical minds in the country believe that the wearing of a mask is very efficacious for the prevention of disease, but that headaches and other inconveniences develop,” the board stated in 1918, as quoted in the Virginia Tech study.
Fort Wayne’s deaths that December exceeded many other Indiana towns, even though its numbers were lower in October and November.
Based on the calculation for the rate of deaths per 100,000 people, the entire 1918 pandemic hit Terre Haute hardest. Terre Haute’s rate was 339 deaths per 100,000, followed by South Bend at 296, Evansville 270, Indianapolis 223 and Fort Wayne 214, according to the researchers.
Mask ordinances, because they were so short, probably didn’t affect mortality rates.
In retrospect and with the lessons learned by later pandemics, a public health measure during globally spreading disease — such as the Spanish flu in 1918 and 1919 — needs to be enacted early, in combination with other steps and continued for a sustained time period, Ewing said.
COVID-19, by contrast, seems to be lingering longer than that brutal seasonal flu of 1918, which also had no cure at the time. Mask mandates to combat this novel coronavius would likely have to last beyond just a few weeks to “flatten the curve” until a vaccine or proven treatment is found. Given the pushback already flaring in many places, that may be hard to pull off.
“Sustaining this kind of a public health measure is going to be very difficult,” Ewing said. “But we also have to realize we’re in a different situation than people in 1918.”
In another essay for the BBC this week, Ewing summarized the predicament. “The historical record forces us to ask which trajectory will be more sustainable: a commitment to changing individual behavior to bring lasting improvement in public well-being, or a growing backlash against onerous health regulations that could allow the virus to infect many thousands more victims?” he wrote.
Hoosiers should take any steps possible to avoid repeating the tragic, catastrophic numbers of 1918 in 2020. Learning from history saves lives.
Mark Bennett can be reached at 812-231-4377 or firstname.lastname@example.org.