123. Déjà vu all over again

I just reread the San Francisco pages in Alfred Crosby’s America’s Forgotten Pandemic: The Influenza of 1918. It was first published in 1976, a second edition in 2003, the year that SARS-CoV-1 was identified.

San Francisco had an aggressive chief of their Board of Public Health, Doctor William Hassler, who organized the city’s health care systems into districts; established one hospital to isolate and deal with flu patients; closed schools and churches; recruited medical, dental, and nursing students and some teachers to care for patients; used quarantines and promulgated a city-wide mask mandate with punishment for violators. 

Waves of the flu passed—I think there were three major waves in 1918; we are in the middle of a third or fifth wave of our pandemic now—and history and commerce went on. Stores and churches reopened, masks were thrown aside, and crowds gathered to celebrate the Armistice on November 11, 1918, and, even as flu cases began to rise again, to shop for and celebrate Christmas and the New Year. 

Efforts to rein in the new surge with masks and anti-crowding measures failed miserably as the citizenry had had enough of restrictions and fought to retain their now-new freedoms. Merchants wanted to make up for lost sales with a robust holiday shopping season. Christian Scientists and Civil Libertarians claimed that masking was “subversive of personal liberty and constitutional rights.” Ninety percent of San Franciscans ignored the new mask mandate. 

The wave subsided in San Francisco and across the nation. Crosby says, in his preface to the 2003 edition, when AIDs was circling the globe and SARS 1 had newly emerged, that we don’t know entirely why, and that “we don’t know yet what made the 1918 virus so dangerous.”

He also says that in a world with three times the population clustered in ever larger cites, with faster travel, a “population of the animals with which we exchange flu viruses… vastly larger than they were in 1918,” history is likely to repeat:

“There is a bitter pill of a joke currently circulating among infectious disease experts. The nineteenth century was followed by the twentieth century, which was followed by the . . . nineteenth century.”

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