102 Years Later

In the final year of WWI (1918), there was an outbreak of what folks thought was a deadly form of pneumonia at a Kansas US Army training facility. Troops were packed together, in barracks and in the field. The disease rapidly spread to most of the troops there, and those that did not die were sent across the United States by seriously crowded rail and then by ship transportation to Western France, where they disembarked to fight the "Huns." Desperately needed troops. The disease followed wherever they went. And well beyond.

The nature of that disease was deemed classified (“top secret”) by the anti-German allies (even as soldiers on all sides were dropping like flies... an outbreak that rapidly spread to the general population). Even after the War, that classified status was not lifted. Individuals leaking stories about this pandemic were subject to arrest; no newspaper would dare to speak out. News about the pandemic was never declassified during the outbreak. "Liberal" Woodrow Wilson, the man who threw blacks out of the US Civil Service, led the secrecy mandate, and all the allies followed suit. They felt they owed the US for coming to their rescue in WWI. For whatever reason, that “don’t talk about it” tradition seemed to carry over into history books, which uniformly unreported one of the greatest pandemics in world history, one that killed far more people than any other outbreak in history.

Because the second and third waves of the virus were so deadly, exacerbated by the secrecy, most Americans assumed that the outbreak began in Europe and that returning US soldiers brought it back with them. Indeed, one nation, Spain, had been totally neutral during the war. It was the Spanish press that carried accurate stories about this killer pandemic, and where people learned of its severity and the numbers of people all over the world dying from the disease (in multiple waves that did not end until 1920), they traced their knowledge to Spanish sources. Hence, the name "The Spanish Flu," even though Spain was hardly the source of the disease. It is estimated that one-third of the earth’s population had been infected. The death toll was staggering.

Not only did the US government (and its allies against the German coalition) do almost nothing to contain the disease, they made transparency illegal. The decimation of soldiers in the trenches, on both sides, may have hastened the end of the war, but political games exploded the impact of the flu well after the war. While the first wave of the pandemic was horrible, more people died from the second and third waves. There were no vaccines, and medical capacity back then pretty much assured there never would be. The disease simply burned itself out, mutating into a weaker strain as time passed. This “American” flu took almost three years to dissipate on its own. 

The burying the details of this pandemic influenza out of historical pressures is unfortunate. If we really were to take George Santayana’s most famous quote – “Those who do not remember the past are condemned to repeat it” – into a most necessary consideration, understanding the Spanish Flu could be exceptionally valuable in confronting the COVID-19 pandemic before us… in responding to all those protestors and Trump-adherents pressuring their local governments to reopen… way, way, way too early. We don’t even have remotely enough testing to track whether we are winning or losing our battle… and remember that subsequent waves of a pandemic can be much worse than the initial one. And there still is no vaccine or cure.

So, it becomes interesting to look back at how two California cities dealt with this flu 102 years ago. “Los Angeles and San Francisco in the early 20th century were vastly different places than they are now. But they already had distinct cultures and leaders who responded to the great Spanish flu pandemic of 1918 in markedly different ways, thereby producing distinctly different outcomes… The big, striving city on the south coast moved fairly quickly at the first signs of danger — shutting down bars, pool halls, sporting events and more.

“Its rival to the north waited at least a week longer to order closures, as its leaders went mask-happy, betting that their best weapon against the onrushing contagion was face coverings, and going slow on what is now referred to as ‘social distancing.’

“The two great cities charted their disparate paths in the months that followed, straining — amid rudimentary science and massive public pressure — to craft the proper response to the greatest infectious disease emergency in modern memory… Some 102 years later, this tale of two cities offers some cautionary insights as a few states, responding to President Trump’s urging, take steps to open up.

“At the helm in one city was a headstrong public health commissioner, who defied the mayor and City Council to lock down his city, but only so much. The other also had a physician as its chief health officer, but one who relied even less on quarantine-style limitations, grasping, instead, for a dubious solution.

“Yet Los Angeles, San Francisco and 20 other cities across America shared one common failing, a mistake that would spur a ‘double hump’ of contagion. That second surge of influenza infections in 1918 hit both Los Angeles and San Francisco and killed more people than the first wave in other cities, such as Denver, Kansas City, Milwaukee and St. Louis… ‘The really important lesson of 1918 is to keep interventions in place as long as possible,’ said Alex Navarro, assistant director of the Center for the History of Medicine at the University of Michigan. ‘Because once the controls are removed, it’s very difficult to reinstate them.’

“The Michigan center, along with the national Centers for Disease Control and Prevention, compiled and analyzed historical accounts of the 1918 plague. Their research found ‘a strong association between early, sustained and layered use of [non-pharmaceutical interventions] and mitigating the consequences of the epidemic.’

“In Los Angeles, the first signs of trouble arrived in mid-September 1918, when sailors aboard a Navy ship in San Pedro fell mysteriously ill. By the end of the month, 55 students at Polytechnic High School in downtown L.A. had the bug, which eventually killed 675,000 in the United States and an estimated 50 million worldwide.

“The city’s response in the coming months would be crafted largely by a headstrong North Carolinian, Dr. Luther Milton Powers. The doctor managed to remain in power through the tenures of at least half a dozen L.A. mayors… Publicly, city Health Commissioner Powers called the cases ‘alleged influenza,’ but he advised Mayor Frederick T. Woodman in private to prepare a campaign to stop an epidemic in Los Angeles, then a city of fewer than 600,000 souls.

“By Oct. 11, the mayor had declared a state of emergency. Commissioner Powers ordered most public gathering places — including movie houses, theaters and pool rooms — closed as of 6 p.m. that night. Adding a peculiarly L.A. flavor, Powers told the city’s ascendant movie moguls they would have to stop filming mob scenes, according to the Michigan archive.

Even though its first influenza cases appeared about the same time as those in L.A., San Francisco’s board of health did not vote to shut down “all places of public amusement” until a week later, Oct. 18. The city did not include churches in the shutdown, leaving that to their leaders’ discretion.

“The importance of acting promptly might not have been obvious in 1918. But this week, UC Berkeley biostatistician Nicholas Jewell and his daughter Britta, also an epidemiologist, calculated the enormous advantage of early social isolation. In the current pandemic, a one-week advance, nationally, in social distancing could have cut the total United States death count from something around 60,000 to 23,000, they projected…

“L.A. theater owners protested that the shutdown should be even broader, to stop the virus more quickly. They demanded the closing of shops and department stores. But Powers thought such a comprehensive shutdown would be impractical. The stores remained open.

San Francisco’s leaders eventually also closed a significant number of public facilities, but they obsessed on a singular response to the disease: face masks. That response came courtesy of the city’s health officer, Dr. William C. Hassler. He had first gained acclaim after the Great Earthquake of 1906, for helping fight off a rat infestation and fears of bubonic plague that menaced the city.

“Hassler came to believe that face masks would help San Francisco tamp down the influenza, which experts [incorrectly] theorized had been brought back from Europe by soldiers returning from World War I. It was later determined that the flu originated from an H1N1 virus, with genes of avian origin… The doctor began by ordering barbers to wear the coverings, quickly expanding the order to workers at rooming houses, banks, drugstores and shops, the University of Michigan archive says.

“By Oct. 25, the Board of Supervisors required every resident and visitor to the city to wear a mask. The Red Cross pronounced that ‘the man or woman or child who will not wear a mask now is a dangerous slacker.’ California Gov. William Stephens concurred, calling it a ‘patriotic duty for every American citizen.’.. The vast majority complied, with those who did not usually being fined $5. Eventually, ‘slackers’ were jailed, and San Francisco’s lockup soon filled with the malefactors. Even with less rigorous restrictions, new influenza cases had declined enough that, by Nov. 13, 1918, Hassler recommended reopening San Francisco…

“Los Angeles went in a different direction. Despite repeated attempts by Mayor Woodman and others, the City Council refused to order Angelenos to wear masks, with the exception of health workers and those known to be in contact with influenza patients. (It didn’t hurt that the U.S. surgeon general had questioned the usefulness of masks.)…

“Church leaders demanded to be able to restore group worship, but the city insisted that indoor services be put off. And civic groups fought (somewhat successfully, back then) to get hotel rooms set aside for the poor and infirm.

“Most significant, L.A. had gone into semi-quarantine a week before San Francisco and stayed shuttered longer, reopening public facilities Dec. 2. That meant L.A.’s controls (if not its face masks) stayed in place 16 days after San Francisco lifted restrictions; after beginning seven days earlier, it was a 23-day isolation advantage.

“Both locales would soon learn that they had not been cautious enough. A quick jump in cases in Los Angeles led to a re-closing of schools, which did not open again until January 1919. San Francisco saw its own spike in influenza deaths and ordered the public to put their masks back on as of Jan. 10. They could not cast them off again until February.

“The media may have been more rudimentary in those days, but politicians already knew something about spin. San Francisco’s Dr. Hassler soon proclaimed that San Francisco ‘was the only large city in the entire world to check its epidemic so quickly.’… But the U.S. Public Health Service disagreed. San Francisco had suffered more than all other major American cities, with a death rate from the Spanish flu approaching 30 per 1,000 people. The later CDC review showed that both of California’s landmark cities suffered ‘second humps’ of infection, though San Francisco’s was more severe.

“The researchers examined ‘excess’ death rates, the number who died of influenza above the normal yearly expectation, in 50 cities. L.A.’s rate was 494 excess deaths per 100,000 residents, lower than that of many other American cities. With its shortened public distancing requirements and preoccupation with masks, San Francisco suffered 673 excess deaths per 100,000… A century later, leaders in Los Angeles and San Francisco continue to act independently, if somewhat more uniformly than their precursors.” James Rainey and Rong-Gong Lin II writing for the April 20^th Los Angeles Times.

San Francisco did it wrong, LA a tad less wrong… But both cities seriously screwed up. Today, Donald Trump and those red state governors succumbing to public pressure to reopen way before the medical community believes prudent are even more dramatically and totally wrong. They are sending an engraved invitation to COVID-19 to bring on more sweeping killer waves of the disease that will eventually reach into every remaining nook and cranny of American life. Probably before the November election. How are those leaders going to be held responsible for the deaths they cause? How will they have to pay? If at all?

            I’m Peter Dekom, and succumbing to unfounded public pressure, against the advise of those who really know, is a sign of exceptionally weak and incompetent leadership, especially when the death tolls are ultimately calculated.