Will San Francisco Repeat the Mistake of 1918?

By Mario Casillas, Jr.

The San Francisco Bay Area became the first region in the country to establish a shelter-in-place order in response to the looming threat of the coronavirus. This was six weeks ago, which for many feels like a lifetime and what was a looming threat then is now an ongoing catastrophic reality. Public health officials along with governments from the nine county Bay Area collaborated and issued this order to diminish what was believed to be catastrophic loss of life and breakdown of the region’s health care infrastructure as result of COVID-19.

As we enter the sixth week of shelter-in-place, predictions of chaos at levels of a Hollywood action-drama did materialize, but they occurred three thousand miles away. They manifested in real time before our eyes and undermined any intellectual and cultural concepts of America being a first world nation. As the curve begins to flatten so does shelter-in-place compliance. As horrific as the images from New York are they still correlate with notions that this is not happening in our backyard. In a sense this is a collective NIMBYism. This mentality might ultimately have consequences and the Bay Area might experience the same fate as our counterparts on the east coast.

The fundamental question that San Francisco and Bay Area authorities must grapple with is, how soon is too soon? “Epidemiologists and other public health specialists warn against moving too fast.” (Aizenman) Bay Area governments are stuck between a growing economically anxious and stir crazy populous and a scientifically proven possibility of a second wave of COVID-19 infections that could be significantly worse than the initial outbreak. Decisions should not only be based on expert analysis from health officials but in analyses of previous decisions from previous pandemics. Specifically, the Spanish Flu outbreak of 1918. The Bay Area once again is at that turning point as it was in the Fall of 1918.

It is important to understand what the state of the world in the fall of 1918 was. World War I had just ended and there was a sense of jubilation amongst Americans that this horrific act of man had ended. To add to that jubilation, San Francisco city officials had rescinded a shelter-in-place and face mask order that was given as a result of the Spanish Flu pandemic. “As celebrations continued and residents flocked to theatres, restaurants and other public spaces soon thereafter, city officials would soon learn their problems were far from over.” (Clark) It took about two months for the effect of that decision to manifest itself in a catastrophic manner. Cases of the Spanish Flu surged exponentially ultimately causing the previously rescinded order to be earnestly reinstated.

Dates for lifting shelter-in-place orders are approaching and there is growing reluctance especially here in the Bay Area in lifting those restrictions. It appears the impact of decisions during the Spanish Flu pandemic of 1918 are resonating in the psyche of many local government officials. “Mayor London Breed said she took heed of history and implemented an order last week requiring anyone setting foot on the streets of San Francisco, outside their homes, to wear a face covering.” (Clark) The question now is whether Mayor Breed and all the other mayors of Bay Area cities will have a conscious recollection of history and extend shelter-in-place and face protection orders. The region will be approaching that pivotal moment within the next coming weeks.

For the moment, the Breed Administration along with other local governments are in fact moving forward and planning what would be the next appropriate action. “Health officers from across the Bay Area have been meeting to work out the details of shelter-in-place extensions, Contra Costa County Board of Supervisors Chairwoman Candace Andersen said Friday.” (Fracassa) The challenge to any extension must also take into consideration the weariness of the population that does not see the statistics of a flattening curve but the stir craziness of prolonged quarantine. This was a similar challenge to government officials back in early 1919 when containment orders were reissued after a resurgence in Spanish Flu infections.

For the COVID-19 pandemic any directives for the reopening of the society must have structures in place not only to maintain enforcement of hygiene and physical distancing protocols, but to have an infrastructure in place to deal with any hotspots of reinfection. “The consensus view is that states shouldn’t open up unless they have a robust system to detect and quash new flare-ups by testing to see who is infected, tracing their contacts, and isolating and quarantining as needed.” (Aizenman)

In 1918 the combination of the excitement of the ending of World War I and the lifting of containment measures created a celebratory ambiance that ultimately failed and much to the dismay of the population, shelter-in-place and mandatory face mask orders were reinstated. Knowing the history from 1918/1919 Bay Area municipalities especially those in San Francisco, Oakland and San Jose-the Bay Areas largest cities-should be cognizant that infection and death rates while decreasing they are still a reality. According to Mayor Breed, “What that means is another few weeks or even a month of asking you all to comply and to remain at home and to continue to follow the social distancing orders that we put forth…” (Fracassa) Within the next couple of weeks it will be determined whether mistakes in dealing with the 1918 Spanish Flu pandemic will repeat themselves with the 2020 COVID-19 pandemic. Ultimately if lessons were not learned then its quite possible that the San Francisco Bay Area will witness catastrophic loss of life and breakdown of the region’s health care infrastructure.

Aizenman, Nurith. When Is It Safe to Ease Social Distancing? Here’s What One Model Says for Each State. NPR. April 25, 2020. https://www.npr.org/sections/health-shots/2020/04/25/844088634/when-is-it-sade-to-ease-social-distancing-heres-what-one-model-says-for-each-sta

Clark, Dartunorro. San Francisco had the 1918 flu under control. And then it lifted the restrictions. NBC News April 25, 2020. https://www.nbcnews.com/politics/politics-news/san-francisco-had-1918-flu-under-control-then-it-lifted-n1191141

Fracassa, Dominic. SF Mayor London Breed says extension of shelter-in-place order ‘very likely’. San Francisco Chronicle. April 24, 2020. https://www.sfchronicle.com/local-politics/article/SF-Mayor-London-Breed-says-extension-of-15224771.php