San Franciscans Were Required to Wear Masks During the 1918 Influenza Pandemic

As the city battled the H1N1 virus, local officials passed ordinances making face-coverings mandatory.

When I was in elementary school, my mother strapped a surgical mask on my head in a last-ditch effort to shield me from my severe seasonal allergies, which had made my life an itchy, teary, nosebleedy nightmare. Despite the hell-ish, springtime despair, I elected not to wear a mask anyway.

It wasn’t that wearing a mask fazed me. Quite the opposite — wearing a face mask is relatively common in the Asian diaspora. It’s a practice that long predates the novel coronavirus.

I was more concerned with the stares, which (for a naive, insecure child) felt even worse than rubbing my face red with Kleenex. Mask-wearing in America isn’t normalized. Even when wildfires cast a haze over San Francisco last year, masks weren’t common. I remember walking down Market Street, wearing an N95 respirator. Breathing without one was difficult (probably because I had undiagnosed asthma at the time). I got the same confused stares I did when I was kid — like no one else could smell the smoke in the air.

In our current fight against COVID-19, face-coverings are bizarrely contentious. To some, wearing a mask is the bare minimum act of altruism in a literal pandemic. Those who disagree are willing to throw temper tantrums in public, ensuring Internet virality.

But the question of whether to wear a mask was a lot less complicated a hundred years ago. At the height of the 1918 influenza pandemic, often referred to as the “Spanish Flu,” the city of San Francisco introduced a law requiring all residents to wear masks in public — twice.

Members of the Democratic Socialists of America and the Coalition on Homelessness distributed air filter masks at City Hall on Monday to call attention to what they said was inadequate efforts by the city to get masks to those living on the streets. Photo courtesy of Joe Fitzgerald Rodriguez/S.F. Examiner

At the time, donning a mask in public was promoted as a form of patriotism. Then-Mayor James Rolph penned an open letter in the San Francisco Chronicle imploring citizens to embrace their civic responsibility to fight the H1N1 virus.

“You are faced with a deadly epidemic,” he wrote. “It is the duty of every person to help stop it… Wear these masks and save your lives and those of your children and your neighbors.”

Even within professional circles, the discourse on masks has done a total 180. Before London Breed issued a decree on April 17 directing most San Franciscans to wear masks while out in public, politicians and healthcare officials were delivering a far more ambiguous message. First, as reports of coronavirus outbreaks multiplied, the World Health Organization and the Centers for Disease Control and Prevention advised people against wearing them, unless they were working healthcare or caring for someone who was sick. The Surgeon General even issued a strongly worded directive against the practice.

“Seriously people- STOP BUYING MASKS!” Dr. Jerome Adams tweeted out from the official account on Feb. 29.

Naturally, like a child told not to touch the stove, people panic-bought and hoarded masks anyway. Some sellers jacked up prices on masks — a particularly selfish act, considering the dearth of masks available to healthcare workers. Locally, medical students in San Francisco put out a call for mask donations. Fashion designers and crafters handy with a sewing machine flocked to the cause, churning out homemade masks made of cloth. At the same time, the number of anti-Asian hate crimes rose, with attackers directing their racism at those wearing masks.

The many and varied official recommendations surrounding masks also prompted questions. What about having a few on hand for personal use? Why can’t we just make more? Are they even effective? 

It turns out that the answers to these questions are complicated. That may be why mask policies continue to evolve. In April, the Trump administration reversed previous recommendations, greenlighting the voluntary use of masks in public. Both the WHO and the CDC now advises wearing cloth face coverings and there is an official government how-to guide on how to make an improvised mask at home. In response, people have been showing off their mask-making creativity — sharing sewing patterns online and posting DIY Tik Tok tutorials.

The Mask Mandate

San Francisco news clippings from 1918 and 1919 (many of which are collected in this University of Michigan report) reveal many similarities between the public’s reaction to the Spanish Flu and the current coronavirus crisis. Articles in The San Francisco Chronicle and SF Weekly’s sister paper, The San Francisco Examiner, show that then, as now, officials recommended against using street cars; schools were closed and public gatherings were cancelled; and hospitals struggled to treat the sick. The Civic Center was even temporarily filled with beds for convalescing influenza patients.

A century later, not much has changed.

Just as a running list of public orders have trickled in during the coronavirus pandemic, official directives were also issued in a piecemeal fashion in 1918 San Francisco. First, the city’s health officer, Dr. William C. Hassler, ordered barbers and clerks to wear masks while working with clients. Then, he ordered “hotel and rooming house employees, bank tellers, druggists, store clerks, and any other person serving the public” to do the same.

Fay King’s mask cartoon. Photo courtesy of SF Examiner

Just a week later, on Oct. 25, the Board of Supervisors passed an ordinance that required all San Franciscans to wear a mask in public and when in the company of other people. The only exceptions were when individuals were alone or eating a meal.

People did not enjoy wearing masks, and many of them were made of less than ideal materials, like chiffon instead of the recommended surgical gauze. Like now, there was a mask shortage, and homemade linen masks were suggested as an alternative. 

Those who failed to comply with the mask ordinance were actually arrested by San Francisco police. Some “mask slackers” were fined $10. Others were thrown in county jail, leading to crowding. (Not exactly ideal given what we now know about the benefits of social distancing.) 

Ironically, Mayor Rolph and health officer Hassler were both caught without a mask while attending a boxing match at the Civic Center. They were fined $50 and $5 respectively.

The End?

San Francisco firehouses blew every whistle they had on Nov. 21, 1918, promptly at noon. The collective siren, ringing throughout the city, signaled the end of the mask ordinance. 

People cast off their masks and threw them into the street, glad to be rid of the “nuisance” — to not be “shot up and tied down,” according to Annie Laurie, a reporter for the SF Examiner

”Take off your flu mask as quick as you can and smile, smile, smile,” Laurie wrote. “That’s the song for these days.” 

The song wouldn’t last long. Just two weeks later, the mask ordinance was back on after a resurgence in influenza cases. The mask ordinance wouldn’t end until Feb. 1 of the next year, 1919.

Do Masks Work?

If you ask my mother whether or not she bought surgical masks when I was a child, her mind draws a blank. “I honestly can’t remember,” she says, even though the memory of pushing a shopping cart in a parking lot, our faces both masked, is as clear as day to me. 

Not exactly social distancing. Photo courtesy of SF Examiner

No one else was wearing one at the time. We must have only ever bought one box, and, perhaps out of lack of use and social conditioning, we never decided to buy another. 

Back then, they were just unimportant. But now, masks have become one of the most controversial objects of the coronavirus pandemic (besides toilet paper and sourdough bread). When this article was originally published, the WHO and the CDC were in disagreement over whether masks were effective. And now, just two months later, the discourse masks has flipped entirely: Mask-wearing is the new norm and a requirement within San Francisco city lines.

Various studies argue for masks’ effectiveness in the battle against an epidemic, showing that masks can be helpful in blocking respiratory droplets that come towards us — or out of us. But it also depends on the type of mask and the precautions people are taking: Do you have an N95 respirator with a taped-off valve or a cloth mask? Do you know how to put on and take off a mask properly? Are you reusing your masks? Are you washing or disinfecting your masks afterwards?

While Hassler applauded San Francisco for being the “only large city in the entire world to check its epidemic so quickly,” later data showed that he was wrong. “S.F. Hardest Hit by Big Cities by Influenza,” the Examiner reported. It’s unclear whether or not the mask ordinances helped the city stem the pandemic.

While mask-wearing is now widely regarded as an effective measure for preventing coronavirus’ spread, masks are not a substitute for social distancing. Even as we continue this century-long debate, there’s at least one thing the public can do to minimize the spread of COVID-19: keep your distance.

Grace Z. Li covers arts, culture, and food for SF Weekly. You can reach her at gli@sfweekly.com or follow her on Twitter @gracezhali.

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