How U.S. Cities Tried to Halt the Spread of the 1918 Spanish Flu

In the late summer of 1918, the second devastating wave of Spanish influenza arrived on the American coast. Carried by First World War doughboys returning from Europe, the newly virulent virus first spread from Boston to New York and Philadelphia before traveling west to infect panicked populations from Saint Louis to San Francisco.

Without a vaccine or even a known cause of the epidemic, mayors and city health officials had to improvise. Should they close schools and ban all public gatherings? Should they force every citizen to wear a gauze face mask? Or would closing major financial centers in wartime be unpatriotic?

When it was all over, the Spanish flu has killed an estimated 675,000 Americans among the 20 to 50 million people worldwide. Some American cities are doing much worse than others, and looking back over a century later, there is evidence that the earliest and best organized responses have slowed the spread of the disease – at least temporarily – while cities that dragged their feet or let their guard down paid a heavier price.

Philidelphia parade

In mid-September, the Spanish flu was spreading like wildfire through military and naval facilities in Philadelphia, but Wilmer Krusen, director of public health in Philadelphia, assured the public that the stricken soldiers suffered only from the old-fashioned seasonal flu and that it would be confined before infecting the civilian population.

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On November 21, a whistle signaled that the San Franciscans could finally take off their masks and San Francisco Chronicle describes “sidewalks and tunnels … strewn with relics of a tortuous month”.

But San Francisco’s luck ran out when the third wave of the Spanish flu hit in January 1919. Believing masks were what saved them the first time, companies and theater owners fought back against orders public gathering. As a result, San Francisco ended up suffering from some of the highest Spanish flu death rates nationwide. The 2007 analysis found that if San Francisco had kept all of its flu protections in the spring of 1919, it could have reduced deaths by 90%.

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