We can destroy the flu by wearing a mask too?
Flu Masks Failed In 1918, But We Need Them Now
May 12, 2020
10.1377/hblog20200508.769108
Masks failed in 1918 to control the spread of influenza, but lessons learned from this epidemic should inspire us to wear masks in response to COVID-19.
Advocates of “
Masks for All” can learn from the 1918 epidemic: Although masks did not prevent the spread of influenza, understanding why they failed provides further evidence that wearing masks in public only works in conjunction with broader efforts to change behavior, interactions, and attitudes.
Flu Masks In 1918
The lessons from the 1918 influenza epidemic for local, state, and federal health officials are clear: Masks must be constructed and worn correctly, wearing masks in public must be part of a comprehensive social distancing strategy, masks are essential for certain care-taking occupations, and the psychological benefits of seeing everyone wearing masks helps raise awareness about disease transmission.
From the earliest recognition that a more deadly form of influenza was spreading quickly in fall 1918, US public health authorities recommended masks for doctors, nurses, and anyone taking care of influenza patients. Newspapers provided instructions on “
How to Make Masks at Home” and published photographs of
masked nurses. Masks were just one of the “
non-pharmaceutical interventions” or “
social distancing” policies, to use modern terms, adopted to contain the epidemic, along with
closing schools,
prohibiting public gatherings, and advising
changes in personal behavior.
The transition from recommending masks for health care providers to encouraging and even requiring masks in public happened gradually and inconsistently. Most famously,
San Francisco, California, along with other Western cities such as
Seattle, Washington,
Juneau, Alaska, and
Phoenix, Arizona, passed laws requiring masks in public. Violators could be ticketed, fined, and imprisoned. Within weeks, however, as the number of cases and deaths decreased, recommendations and even regulations to wear masks were relaxed and then eliminated.
Evaluating The Use Of Masks
Did masks prevent the spread of influenza? Experts reviewing evidence from 1918 concluded that flu masks failed to control infection. In December 1918, the
American Public Health Association recommended that the “wearing of proper masks” should be compulsory for medical staff, occupations such as “barbers, dentists, etc.,” and “all who are directly exposed to infection.” The committee also found, however, that the evidence “as to beneficial results consequent on the enforced wearing of masks by the entire population at all times was contradictory,” and thus the committee did not recommend “the widespread adoption of this practice.” The committee did recommend that persons “who desire to wear masks” should be “instructed as to how to make and wear proper masks, and encouraged to do so.”
In 1919, Wilfred Kellogg’s
study for the California State Board of Health concluded that mask ordinances “applied forcibly to entire communities” did not decrease cases and deaths, as confirmed by comparisons of cities with widely divergent policies on masking. Masks were used most frequently out in public, where they were least effective, whereas masks were removed when people went inside to work or socialize, where they were most likely to be infected. Kellogg found the evidence persuasive: “The case against the mask as a measure of compulsory application for the control of epidemics appears to be complete.”
In a
comprehensive study published in 1921, Warren T. Vaughn declared “the efficacy of face masks is still open to question.” The problem was human behavior: Masks were used until they were filthy, worn in ways that offered little or no protection, and compulsory laws did not overcome the “failure of cooperation on the part of the public.” Vaughn’s sobering conclusion: “It is safe to say that the face mask as used was a failure.”
In 1927, Edwin Jordan’s definitive study, published in the
Journal of the American Medical Association as a series of articles and then as a
book, determined that masks were effective when worn by patients already sick or by those directly exposed to victims, including nurses and physicians. Jordan also acknowledged, however, that “masks are uncomfortable and inconvenient, as anyone who has worn them can testify” and require a great deal of “discipline, self-imposed or other.” Jordan came to a more guarded conclusion: “The effect of mask wearing throughout the general community is not easy to determine.”
Learning From History
Yet even though this scientific consensus rejected masks as effective in 1918, we can learn from history how to respond to COVID-19 and future outbreaks of infectious diseases.
First, most Americans in 1918 misunderstood the purpose of wearing a mask. The primary purpose of wearing a mask is not to prevent a healthy person from getting sick, but rather to prevent people already infected from contaminating others through casual contact. The #masks4all movement has adopted an effective slogan that should be circulated as widely as possible: “My mask protects you. Your mask protects me.”
Second, the review of practices in 1918 demonstrates masks must be worn correctly and consistently, fully covering the nose and mouth, with sufficient layers to prevent the spread of droplets. Advocates for masks in 2020 can use this historical lesson to argue that masks must be worn properly, or they will not achieve their objectives.
Third, wearing masks is a collective declaration that a serious disease requires that the behavior of the entire population must change. In this sense, the seeming ubiquity of masks in historical photographs from 1918 can reinforce the message that preventing transmission is a community effort requiring substantial changes in behavior.
Fourth, 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.
Finally, masks must be combined with other forms of social distancing. In 1918, people in masks frequently behaved in ways that defeated their purpose. Photographs of
soldiers,
students, and even
football players wearing masks yet without physical distancing illustrate why this tool alone will not prevent infection. Maintaining social distancing should accompany mask wearing when feasible and sustainable.
We need to learn the right lessons from the failure of flu masks in 1918. Masks can work if we wear them correctly, modify behavior appropriately, and apply all available tools to control the spread of infectious disease.
via:
https://www.healthaffairs.org/do/10.1377/hblog20200508.769108/full/
. You can still spread and contract the virus, even though you are vaccinated:
bushed his shyt.. Kusher gets on TV talking about “our” PPE stockpile as in theirs
