Mask advocates during the 1918 flu pandemic. Photo: CDC

Let’s try to sort out the lingering controversy about protective face masks during this Coronavirus pandemic. Do anti-maskers have a point, or is it such an open and shut case that there’s really no controversy at all?

“To mask or not to mask” read a headline in the Los Angeles Times in November of 1918, as a killer flu virus spread across the nation in America’s last pandemic. That’s a good starting point for understanding the ins and outs of face masks.

Back then, when LA city officials proposed to mandate face masks as a public health measure, they were somewhat prepared for vocal opposition, given the recent experience of their sister city farther north, San Francisco, where a cultural and political war raged over the issue.

The virus spread so widely, beginning in March, 1918, that by the following October, it had killed 195,000 Americans, according to epidemic historian Dr. Howard Markel.

In response that year, seven cities across the U.S. adopted mandatory face mask laws. San Francisco, the first to pass one, became known as the “masked city,” where a mask there had to be four layers thick. Most were made of folded gauze. But those without a mask faced a fine of $5 or $10, or 10 days imprisonment.

This particular mask law almost failed to pass, and a sunset provision, requiring this San Francisco ordinance to expire automatically in a mere 30 days from its adoption, assured its passage, but not its popularity.

Resistance to the law gained momentum. The San Francisco Chronicle published complaints that masks infringed on freedom, were too uncomfortable, and were nothing more than “muzzles.” During the Frisco mask law’s short, effective life of 30 days, anger from the public grew to a point where 1,000 people were arrested, with standing room only at city jails. Additional court calendars and police shifts were mustered to meet the emerging rebellion over masks. “Mask courts” were in session daily, and each worked well into the night.

San Francisco’s face mask ordinance expired on Nov. 21, 1918. Though only in effect so briefly, residents and business owners were delighted to see it end. The Chronicle reported that people discarded and stomped on their masks in the streets, which soon were littered with what the paper described as the “relics of a tortuous month.” But by the end of that year alone, across the nation, the flu virus had killed 244,681 people.

Yet the second wave of the virus began so suddenly that the San Francisco board of supervisors proposed to reinstate the hated law. At its mere mention, opposition quickly erupted, to the point where someone tried to bomb the city’s chief health director’s office. The ordinance was reinstated anyway, leading to the formation of an Anti-Mask League, which has been revived during our current pandemic.

Just prior to New Year’s of 1919, San Francisco became one of many communities across America where arrests did little to quell anger at mandatory masks in a pandemic. The mask had become a political symbol, a rallying point for defending freedom in the eyes of many at the time. Then, after a third wave of the virus, an estimated 675,000 Americans died in its wake, with San Francisco one of the hardest hit places, suffering 30 deaths for every 1000 people.

So let’s return to the present Coronavirus pandemic, where opposition to face masks is not voiced to the same extent, but it’s still there. And many will wear them improperly by not covering the nose, for example. Others quietly refuse to wear them at all.

Science, however, has made a far better case for wearing them in 2020, though with a bad start. The CDC along with other prominent experts had initially opined that face masks were only needed by first responders, particularly if it turned out that supplies might be limited.

Health Affairs has published a recent study that gives us further understanding unavailable a hundred years ago, to wit: Covid-19’s growth rate before and after mask mandates in 15 states and Washington, DC. This study found that mask mandates led to a slowdown in COVID-19 growth rate, becoming more apparent over time. In the first five days after a mask mandate, daily growth rate slowed by 0.9 percentage points compared to five days prior to the mandate. At three weeks, the virus’s daily growth rate slowed to a significant two percentage points.

In a study of public wearing of masks as related to death rates in 198 countries, death rates were less where government policies or cultural norms favored mask wearing.

It is clear that masks work best for those who have COVID-19 by protecting them from giving the virus to other people, and secondarily benefit those who wear a mask from catching it.

As explained in the June 26, 2020 posting online of Patient Care, masks are more effective as a “source control” simply because they prevent a person’s larger, expelled nasal or mouth-borne droplets from evaporating into smaller ones that can travel farther. This is particularly important given how the membrane in the eyes can catch the virus from those who do not wear masks.

One can only wish that video technology had been available a century ago to make the case of common sense as well as this video does.

Don’t despair if you live in a community where many choose not to wear masks. You still cut back the chances of getting it by wearing one yourself. It’s all about reducing the chance of catching it. There is no 100% preventative – not even the best vaccine, whenever it becomes available, can do that. It’s all about reducing the the chance of getting it. That’s why we have to be satisfied with “flattening the curve,” and making the choices leading to that.

Wearing a mask, along with hygiene and keeping apart from others a distance if no less than six feet, remains our best defense for now. Of these three precautions, wearing a mask is the most important.

Note as well the recent report from the Institute of Health Metrics & Evaluation: If 95% of the people wear masks in public at all times, no less than 33,000 deaths could be avoided by Oct. 1.

Particularly with the opening of our schools, we need universal compliance with wearing face masks, and wearing them properly. For however long this pandemic endures, we really have no choice.

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Greg Blass
Greg has spent his life in public service since he enlisted in the U.S. Navy as a teenager. He is a former Suffolk County Family Court judge, six-term Suffolk County legislator and commissioner of Social Services. Now retired, Greg is active in volunteer work and is a board member of several charities. He lives in Jamesport. Email Greg