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Editors' Expressions: Dangerous Slackers

"Editors' Expressions" is a recurring feature in which the EMS World editorial staff ruminates on current news, noteworthy events and everyday happenings with relevance to healthcare and EMS delivery. Feel free to react in the comment box below or e-mail editor@emsworld.com.

Masks became mandatory in my state again July 1. And while I didn’t see any fisticuffs about it over the holiday weekend, let’s say compliance has been less than optimal. That’s included several state police officers who strode unmasked into a downstate coffee shop, intimidated the employee who asked them to don, and cursed the governor.

No idea what our locals might merit, but that San Diego barista got $100,000 worth of GoFundMe after dealing with his comically entitled antimasker, so if that’s the going rate, stand by for my resume.

The mask hate among certain, shall we say, self-concerned members of our community has reached ludicrous new heights even as COVID-19 comes roaring back. It’s not rational, but for Americans it’s also not new: The influenza pandemic of 1918 was also accompanied by a noisy antimask sentiment. In fact, it had a number of parallels to today.

Protect the Troops

The “Spanish flu” pandemic was history’s deadliest flu outbreak, ultimately killing up to 50 million people, including around 675,000 in the U.S.1 Interestingly, the name derived not from a Spanish origin but because the Spanish media were first to report it.

In the U.S. local governments employed containment strategies like closing schools and businesses, encouraging no-spitting rules, and promoting masks in public. Some jurisdictions, mostly in the west, passed ordinances to mandate them.

At first compliance was pretty good—with World War I happening, mask use was framed as a way to protect the troops. It was patriotic: As the Red Cross put it, “the man or woman or child who will not wear a mask now is a dangerous slacker.” Newspapers printed instructions for making them at home, and the Red Cross sold them at ferry terminals.

Problem was, the masks of the time didn’t work very well. Like today’s, they were stuffy and uncomfortable and often worn incorrectly, but they were also frequently homemade from porous materials like gauze that didn’t provide enough filtering. Wearers also poked holes in them to smoke.

The backlash wasn’t quite what it is now, with one exception: the wild west city of San Francisco. There the first flu case was documented in late September 1918, but by mid-October the city had more than 2,000 cases. At first masks were only required for businesses dealing with the public, but on October 25 the requirement expanded to everyone in public or any group of two or more, except for meals. Violators, who included the city’s mayor and chief health officer, were warned, fined, or cited. Initial compliance was estimated around 80%.2

But San Francisco’s ordinance was annulled in less than a month. So when cases started rising again, it imposed another in January 1919. That kicked off the real opposition, including the formation of the Anti-Mask League of San Francisco. Its members included physicians, civil libertarians, and at least one member of the board of supervisors. Some believed masks didn’t work, others that they were an illegitimate affront to individual freedom.

By January 27 the league submitted a petition to the board of supervisors calling to repeal the mask ordinance, and it was lifted February 1. Many other locations’ restrictions were equally as short-lived.

Ultimately authorities concluded masks weren’t terribly effective. The American Public Health Association in December 1918 chose not to recommend them. A 1919 study found masks were used most often out in public, where they were least effective, as opposed to indoors where people socialized. Other research found they were often dirty and worn incorrectly and the laws hadn’t overcome a lack of human cooperation.3

Not the Boss of Me

Those takeaways sound pretty familiar, even if our masks are better. People still doubt their effectiveness. People still generally won’t sacrifice comfort for ambiguous benefit. And people—perhaps Americans in particular—still simply have a cussed streak of resisting smartypants authority.

As influenza historian E. Thomas Ewing concluded in a recent Health Affairs article, “Advocates for masks, especially in countries that prize individual expression and personal rights, must anticipate resistance to these measures, whether they are exhortatory or legal. The arrests for defying mask laws widely reported in 1918 confirm that many people resist changing their behavior if simply ordered to do so. Wearing masks means accepting that community welfare supersedes individual preferences.”

That probably requires our best strategies as the pandemic stretches on also prioritize other measures—distancing, hand-washing, contact tracing. Because I don’t think we’re reasoning or fining our way past the mask truculence. It’s part of who we are—a key element of the American character. This country was specifically founded on the notion of “you’re not the boss of me.”

Throughout much of history that’s served us well. In a pandemic it might be prudent to temper it a bit.

References

1. Little B. When Mask-Wearing Rules in the 1918 Pandemic Faced Resistance. History.com, 2020 May 6; www.history.com/news/1918-spanish-flu-mask-wearing-resistance. 

2. Wikipedia. Anti-Mask League of San Francisco, https://en.wikipedia.org/wiki/Anti-Mask_League_of_San_Francisco.

3. Ewing ET. Flu Masks Failed in 1918, But We Need Them Now. Health Affairs, 2020 May 12, www.healthaffairs.org/do/10.1377/hblog20200508.769108/full/.

John Erich is the senior editor of EMS World.

 

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