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Dr. Starkloff is credited for closing all A cautionary tale from a third city
public venues and prohibiting public
gatherings of more than 20 people in San Francisco enforces the use of masks
October 1918. When a flu outbreak at
a nearby military barracks first spread During the 1918/1919 influenza pandemic,
into the St. Louis civilian population, public health officials in San Francisco
he immediately ordered the closing put their full faith behind gauze masks.
of all schools, shuttered movie theaters California governor William Stephens went
and pool halls, and banned all public so far to declare that it was every American
gatherings. There was pushback from citizen’s patriotic duty to wear a mask.
business owners; however, the mayor San Francisco leaders eventually enacted
and Dr. Starkloff held their ground. this law, and any citizen caught in public
When the anticipated increase in infections occurred, thousands without a mask—or wearing one improperly—was
of sick residents were treated at home by a network of volunteer arrested, charged with disturbing the peace, and fined
nurses. Because of these precautions, St. Louis public health $5, a steep sum at that time.
officials were able to flatten the curve and keep the flu epidemic
from exploding overnight as it did in Philadelphia and completely In reality, the gauze masks that city officials claimed were
overwhelming the city’s capacity to treat patients. 99 percent resistant to influenza were barely effective.
San Francisco’s relatively low infection rates in October
In a 2007 analysis of 1918/1919 influenza pandemic death 1918 were more likely due to well-organized campaigns
records, the peak death rate resulting from the flu in St. Louis was to quarantine all naval installations before the flu arrived,
just one-eighth of Philadelphia’s. Still, St. Louis didn’t survive the as well as their efforts early in the pandemic to close
epidemic unscathed, and this city that bills itself as the Gateway schools, ban social gatherings, and temporarily shut
to the Midwest was hit hard in the late winter and spring of down all places of public amusement. Pretty much,
1919 when this deadly flu returned for its third and final wave. government-mandated social distancing.
Even so, without the precautions recommended by Dr. Starkloff,
the death toll would have been so much higher. On November 21, 1918, a whistle blast signaled that San
Franciscans could finally take off their masks, and the
residents were more than happy to do so. However, the
What future generations can learn city’s luck ran out when the third wave of the flu struck in
from the past about social distancing January 1919. Believing masks had saved them in 1918,
The 1918/1919 influenza pandemic businesses and theater owners fought back against
affected people around the globe. public gathering orders, and San Francisco ended up
With one-quarter of the US and suffering some of the highest death rates in the nation.
one-fifth of the world infected, it A 2007 study found that if San Francisco officials had
was impossible to escape the illness. retained all of its anti-flu protections through the spring
Those lucky enough to avoid infection of 1919, they could have reduced deaths by 90 percent.
had to comply with public health
ordinances intended to reduce
the spread of the disease;
however, the pandemic’s wartime As we fight the global COVID-19 pandemic, it’s the duty of the
arrival may have helped as much world’s citizens to do what we can to help reduce the spread
as it exacerbated the virus’ spread. of infection and ease the burden on our collective healthcare
systems. The medical community has stepped up as it always
Nations were already attempting to has and is on the front lines of this battle. Our lives—and theirs—
deal with the effects and costs of WWI, and the public was more depend on the ability to stay ahead of this pandemic so our
accepting of government authority, which enabled public health healthcare system isn’t overwhelmed and researchers have
departments to step in and implement restrictive measures. the time and resources to develop a vaccine.
People had been putting the needs of the nation ahead of their
personal needs and were already accepting strict measures and We’re in this together, and we’re stronger together.
limitations imposed by rationing and the draft. The medical and
scientific communities who were already in overdrive treating Martha Abell Shrader
the wounded were well-positioned to develop new theories SCC Soft Computer
and apply them to prevention, diagnostics, and the treatment
of influenza patients.

1 In a March 13, 2020 article in Wired magazine, Covid-19 Is Not the Spanish Flu, writer Ferris Jabr disputes a widely cited statistic about death rates in the 1918/1919 influenza pandemic that has
become pervasive and questions how this ended up in the research literature in the first place. Nonetheless, there is no question that this pandemic killed a large portion of the population at that time,
and to this day, researchers continue to unlock the clues as to why this particular influenza strain proved to be so deadly. https://www.wired.com/story/covid-19-is-nothing-like-the-spanish-flu/
2 Calling the 1918/1919 influenza pandemic the “Spanish Flu” smacks of xenophobia and is no different from referring to COVID-19 as the “Chinese virus.” To this day, we still do not know for sure
where the disease started; however, it most certainly did not start in Spain. Pathogens do not recognize borders, and in an increasingly mobile world, we are all part of this fight against contagious
diseases. We live on a microbial planet, and the only way to stay ahead in the battle against pathogens is to stand behind the researchers, scientists, and medical community from around the globe
and give them our continued support.
3 The origins of this influenza variant are not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created
a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a victim of this pandemic and is now being genetically characterized.
4 World War I claimed an estimated 16 million lives. The total number of lives lost due to this pandemic are widely disputed; however, many believe that the influenza epidemic that swept the world in
1918/1919 killed an estimated 50 million people. One fifth of the world’s population was infected by this deadly virus. Within months, it had killed more people than any other illness in recorded history.