The Senior Scene

The mask zeitgeist has shifted, now that President Donald Trump wore one in public. He said on July 1 that he thought it made him look like the Lone Ranger, even though that Western icon wore a mask across his eyes rather than over his mouth and nose — that was for bad guys. Critics have zeroed in on Trump’s Johnny-mask-lately conversion, wondering how many lives might have been saved had he embraced his inner Lone Ranger earlier.

Nevertheless, the topic of masks and wearing them is still hotly debated, often in retail chains as iPhone cameras roll. These videos have prompted questions: Was there resistance to masks during the 1918 pandemic? Did they work? How was mask wearing enforced in the old days?

Quick answers: Yes, there was resistance and defiance, masks worked to limit or stall the spread of disease, and mask-wearing was sometimes enforced with fines, arrests, jail time and, in at least one case, gunfire.

After scouring press coverage on the West Coast during the 1918 flu era, I can say resistance to adopting masks wasn’t universal, but it also wasn’t uncommon. In Seattle, during the influenza’s lockdown period in October and November of 1918, people without masks were banned from public transit and ticketed or fined by members of the police’s masked “Flu Squad.” Headlines had a somewhat negative spin: “Thousands Are Hit with Flu Mask Order,” shouted one in the Seattle Star.

The masks recommended during the 1918 pandemic were made of heavy-duty six-ply cotton gauze. They were thick and no particular joy to wear. People who refused to wear them or couldn’t be bothered were called “mask slackers” or “mask scoffers.” During World War I, the term slacker described people who neglected their patriotic duty, almost as bad as being a draft dodger.

In Walla Walla, the chief of police, John Haven, refused to enforce a state mask mandate. He pointed out that he was going to meet heavy resistance and had no authority to carry out a state directive, only city ordinances. Still, he also openly defied the instructions of the city’s health officer, J.E. Vanderpool, to follow the state health officer’s guidance.

Even as people dropped dead in Walla Walla and rural southeast Washington, business owners pushed to have their establishments — saloons and billiard halls — reopened in defiance of advice from most doctors and health officials. The Walla Walla police chief’s determination not to enforce a state edict is mirrored today by a number of sheriffs in rural Washington who have said they will not enforce Governor Jay Inslee’s mask requirements. The sheriff of modern-day Lewis County told his people, “Don’t be a sheep.”

Yakima was less reluctant to crack down on scoffers and slackers if they were doing business with the public. The city’s sanitation inspector arrested 15 people for “working or transacting business in a public place without wearing gauze masks prescribed by the city health commissioner,” according to a 1918 article in the Spokane Spokesman-Review. The problem was the merchants, not their customers. The business community held that the city had no authority to mandate masks.

Then, as now, health officials were divided on whether masks truly prevented the spread of Spanish influenza. Many understood that the chances of transmission were worse in enclosed public spaces, like churches and movie theaters, but opinion was divided on the efficacy of masks outdoors. Some believed the fresh air fought the flu, and encouraged people to open their windows and let in the bountiful breeze.

Mainstream medical belief held that going maskless could spread contagion. The multi-layered gauze masks appeared to work in reducing new cases, and they proved effective for medical staff treating flu patients.

Other physicians claimed the masks themselves became an unsanitary health hazard if not cleaned and sterilized. Dr. J. C. Bainbridge, a prominent physician from Santa Barbara, Calif., claimed, “The common use of the mask tends to propagate rather than check influenza.” Others simply argued that masks had no effect. However, historians generally believe that social distancing and masks saved tens of thousands of lives since there was little else that proved truly effective, such as vaccines and serums.

Still, divided opinions and often localized health authority meant communities responded differently to the pandemic. Seattle and Spokane, for example, were generally mask-compliant. Spokane, in fact, had trouble keeping up with the public demand for masks, and many of the coverings were hurriedly made and ill-fitting. The Spokesman-Review featured photographs of professional women in masks under the headline, “Women in Business Life Don ‘Flu’ Masks.” There was less enthusiasm in Portland, which didn’t pass a mask ordinance, with one city council member objecting that he would “not be muzzled with a mask like a hydrophobia dog.”

The San Francisco Bay Area saw reluctant acceptance of masks at first, then massive pushback. A mandatory ordinance, announced in bold headlines on the front page of the San Francisco Chronicle in October 1918, read: “Wear Your Mask! Commands Drastic New Ordinance.” It blared over the mugshots of city leaders masked up like surgeons. Many equated mask compliance with patriotism and the war effort, an appeal that worked for many prior to the end of WW I with the signing of the armistice on Nov. 11, 1918, mid-pandemic on the West Coast.

In Seattle, a similar narrative took hold. Once people were free of their masks, they refused to go back to them, even as flu cases started to rise again. A Seattle Post-Intelligencer editorial in December 1918 warned that reinstating health edicts would spark fear not of the flu, but of an excess of “regulatory zeal.” There was no indication, the editorial opined, that “another shutdown of business and revival of the mask would be tolerated.” Compliant Seattle was done with compliance.

Many observers of the time believed masks helped flatten the pandemic curve. When it came to stifling dissent, however, they proved an ineffective muzzle.

 

Reprinted with permission of Crosscut, a non-profit news site (crosscut.com). Knute Berger, who wrote this article,

is Crosscut’s editor-at-large.

Your country and state are in the middle of a major pandemic. Tough measures are being undertaken as the death toll mounts. Public events are canceled and hospitals are overwhelmed. It’s tough to get a handle on how the spreading virus works, but you throw at it every tool you can think of. Suddenly, in the middle of it all, the chief medical officer in charge is fired. Is it incompetence? No, it’s politics, of course.

That’s what happened in Washington during the Spanish influenza pandemic of 1918-19. The head of the state’s public health effort was Health Commissioner Dr. T.D. Tuttle, an experienced medical man brought in from Montana, where he headed that state’s tuberculosis sanitarium. He arrived in 1915. His job was to steer Washington’s public health course, to contain contagious diseases like typhoid and smallpox, and to advise on sanitary conditions and health-related science and spending. He was, in effect, our state’s Dr. Anthony Fauci, the current director of the National Institute of Allergies and Infectious Diseases. At the time of Tuttle’s hiring, Democratic Governor Ernest Lister indicated that the hire would not be tainted by politics.

As Spanish flu hit the region in the fall of 1918, there was a lot of denial. Health officers at Camp Lewis ( now Joint Base Lewis-McCord) insisted their sick soldiers simply had the plain old flu, even though the Spanish flu was ravaging barracks, camps and Navy ships elsewhere in the country. It soon became clear that it was spreading rapidly in Seattle, where Tuttle was based. In early October, authorities with the city and King County banned public events, mandated masks be worn, and allowed only essential businesses to remain open. Tuttle and Lister later issued a state order to the same effect. It worked well, until the rules were relaxed in November after about six weeks of shutdown. As a result, a second wave of Spanish flu took hold.

At the same time, influenza was spreading around the state. Rural communities were hard-hit. The virus got there late, but often sickened more people. Perhaps urbanites had greater immunity because of exposure. That was one theory. Tuttle and other medical people were baffled by that observation and had other questions: Was the virus contagious when people were asymptomatic? Why did masking seem to work well in San Francisco, while Los Angeles did just as well without masks? A vaccine for pneumonia — a very fatal consequence of the Spanish flu for many — was being used, but was it working? Would the flu come back strong in the winter of 1919-20?

Tuttle tried to find answers and relay the best advice from national public health officials and scientists to local health officials. As is the case today, pushback on some of the remedies was strong. The business community did not like having its doors closed, citizens didn’t like being kept out of moving picture shows or told they couldn’t have dances or hang out in ice cream parlors. Quack remedies flourished.

In December 1918, Tuttle traveled to Chicago for a conference of public health officials — over 900 from all over the country — to find answers. The U.S. had just won World War I and now could turn its full attention to the pandemic.

Tuttle returned from the conference without firm answers. “The character of this disease,” he wrote after getting back, “is that we are in the dark, to a large extent, as to a means that will prevent its spread.” But he knew that the early isolation measures in Washington had helped. He’d seen it work.

The state had moved on from those measures. New Year parties were back on, along with banquets and other holiday celebrations. The Rainier Club reinstated its New Year’s ball after a one-year wartime hiatus. War bond events and celebrations of the Armistice continued. The flu numbers started tracking upward again.

For Tuttle, a looming concern was the upcoming legislative session in Olympia, where people from all over the state would be gathering, often in close press-the-flesh politician and lobbyist mode. A major feature was the Legislative Ball that kicked off the political and social season in the state Capitol. A series of other fancy balls often followed.

In early January 1919, Tuttle told the mayor of Olympia to shut the ball down.

“The trouble with dancing,” Tuttle told The Seattle Times, “is that people get their faces too close together. Influenza, we know, is transmitted from the mouth and nose, and dancing is the most dangerous pastime we know.” That, he knew, was one medical certainty. The Times advised that “those going down to Olympia on festal occasions might as well leave their evening clothes at home this winter.” The Washington Standard newspaper lamented in turn, “For the first time in the history of the territory and state there will be no formal reception and ball welcoming legislators.” The paper hoped for the return of “gaiety” to Olympia’s political and social doings.

The Olympia Chamber of Commerce was none too happy. The town claimed its influenza problems were not that bad. Still, the ball and reception were officially postponed.

Tuttle then sought to limit public gatherings — those who went to the theater could sit only in every other row, for example. People who sneezed or coughed in public were to be removed, and limited quarantines, designated with “Influenza” signs, were considered at homes or businesses where disease lurked. It was less stringent than Seattle’s shutdown had been, but still, Tuttle wanted to demand distancing in a town that thrived on up-close and personal political hobnobbing.

Another controversial Tuttle demand was to suggest limiting the number of people in the Capitol’s House and Senate galleries, cutting the capacity in half and requiring tickets for entry. This would have severely restricted the legislative show for the public.

The Olympia City Council rejected the bans. The Thurston County Health Board, aided by other anti-shutdown politicians, rallied in Olympia’s defense and rejected Tuttle’s rules. The influenza wasn’t so bad there, they claimed — only 75 cases in the first week of January, heading down to fewer than 50 in the second week, and only five fatalities in that time. Tuttle didn’t believe those numbers were sufficient to ignore precautions. Thurston County’s Commissioners declared that they wouldn’t obey rules that didn’t apply to the whole state.

 

Fired after three years

 

A meeting of the state Board of Health was called, and its members officially voted down Tuttle’s plan. In February, Tuttle was fired in executive session, three years into a five-year appointment. Despite Lister’s hope that politics wouldn’t intrude on public health — well, it did. Not only that, but the legislative ball was back on immediately, with a series of other balls to follow. Olympia society was irrepressible.

Tuttle made some enemies in making tough decisions during his tenure, and he was bound to. He lobbied for more public–health spending and was critical of many local communities’ lack of spending on it. But with science up in the air on many issues and people wanting a return to normalcy after the war, shutting down cities was not a way to win popularity. The Times reported that Tuttle was “dropped” in “the interests of harmony.”

The pandemic began winding down, though tragedies were still to come, including the death of the Montreal Canadiens’ star hockey player from Spanish flu during the Stanley Cup finals in Seattle that March. Most of the Seattle Metropolitans and the Canadiens came down with the virus, forcing the cancellation of the finals.

In a report written by the time Tuttle had returned from Chicago, he warned that Washington was still in the middle of the pandemic and expected two or three times as many deaths to come. He was right. By the end of 1918, about 2,000 deaths from the pandemic had been reported; the overall death toll wound up being closer to 6,000 statewide.

Tuttle did not remain jobless, however. He was immediately put to work at the U.S. Public Health Service in Tacoma, and then on April 1 he was appointed the head epidemiologist of the state of Kansas, where many believe the Spanish flu began.

He had a long and successful career in public health thereafter in western states. He survived the pandemic despite running into Olympia’s determination to party amid a plague.

 

Wear the mask. Please. For everyone’s sake.

Governor Jay Inslee and state Secretary of Health John Wiesman made that clear when they announced a mandatory face covering order for Washington.

The order, which took effect June 26, was in response to reports of COVID-19 cases increasing.

“As necessary economic activity increases and more people are out in their communities, it is imperative that we adopt further measures to protect all of us,” Inslee said. “Until a vaccine or cure is developed, this is going to be one of our best defenses.”

Every Washingtonian must wear a facial covering when in a public space, as mandated by the public health order signed by Wiesman. This includes indoor spaces as well as outdoor public spaces where individuals can’t maintain social distancing.

On July 7, businesses were given authority to receive service to non-masked customers.

Keeping your face covered when venturing outside the home is a crucial weapon in the fight against the coronavirus, as recommended by the national Centers for Disease Control and Prevention (CDC).

“The science is clear that when we use face coverings, we limit the spread of droplets being passed on to others when we talk, cough or sneeze. While some of us are wearing face coverings in public, we must increase usage to best control the virus. Washington’s strategy to restart the economy and get people back to work will only be successful if, together, we act safely and follow health recommendations,” Wiesman said.

Along with the responsibility of wearing a mask comes some discomfort (especially in hot weather) and social problems. Organizations such as AARP and the American Speech-Language Hearing Association have advice for dealing with the inconveniences and doing what’s best of public health.

Fabric matters.

When it comes to being comfortable and avoiding being too warm or sweaty, a light, breathable material like cotton can keep your face cooler than medical and N95 masks made from synthetic materials, and can be effective in preventing contagion. AARP reports that researchers have found that all-cotton tests best for mask material, but up to 40 percent polyester will do the job.  Lighter, softer cotton coverings can also help you avoid chafing, heat rash or inflaming a skin condition like eczema or dermatitis, says Carrie Kovarik, an associate professor of dermatology at the University of Pennsylvania and a member of the American Academy of Dermatology’s COVID-19 task force.

Stay dry.

Cotton traps less air and moisture than standard medical and industrial masks, and it’s more absorbent, but if it gets damp due to breathing and sweating it can be less effective in filtering respiratory particles, not to mention uncomfortable and abrasive to the skin.

Jennifer Vanos, a biometeorologist at Arizona State University who studies the effects of heat on health, tells AARP, “Try to stay in well-ventilated locations to keep air and vapor mixing, which can help evaporate any extra water and also keep the rest of your body feeling cooler,”

More than one.

If your mask gets icky and sticky, swap it for another. On especially hot and humid days, pack multiple masks, Vanos says. And when changing masks, follow the other CDC safety recommendations when, such as avoiding crowds and washing or sanitizing your hands, AARP notes.

Remember the hard of hearing.

With COVID-19 cases on the rise, the American Speech-Language-Hearing Association (ASHA) is providing advice for people with and without hearing loss to help everyone communicate while their faces are covered.

Masks can make communication difficult, especially for the approximately 48 million Americans with hearing loss. This is because covering up can:

• Muffle voices, making it more difficult to understand.
• Take away a person’s ability to read lips and see facial expressions, which help people better understand what they’re hearing.
• Be physically uncomfortable for people who wear hearing aids or cochlear implants.

To remedy those problems, ASHA  suggests, among other things, using a mask with a clear panel over the mouth or using a clear face shield (when appropriate), talk a little louder (but don’t shout) and a little slower, use your hands and your body language, and ask if there’s anything you can do to make communication easier for the other person.

For people who wear hearing aids or cochlear implants, ASHA suggests securing your device with wig tape or other non-damaging material (such as a cloth headband, removing your mask in a safe place and checking it to make sure it’s working, and using a mask that has four string ties instead of ear loops.