Photos show how San Francisco emerged from a lockdown too soon during the 1918 Spanish flu pandemic, leading to an even deadlier second wave that rampaged through the city


san francisco spanish flu 1918 pandemic

  • San Francisco received national praise for its early, proactive response to the Spanish flu pandemic in the fall of 1918.
  • But when the number of cases tapered off by November 1918, the city relaxed restrictions on the public too early, ultimately leaving San Francisco with one of the highest death rates in the US by the spring of 1919.
  • As another pandemic grips the city a century later, San Francisco’s past decision-making could provide the best guidance for sheltered-in-place residents on keeping the coronavirus disease at bay: be patient.
  • Visit Business Insider’s homepage for more stories.

During the fall of 1918, the city of San Francisco acted quickly when the Spanish influenza hit, implementing a shutdown and enforcing mask-wearing in public.

If that sounds familiar, it’s because San Francisco is one of many Bay Area counties that also took proactive steps in combating the COVID-19 pandemic in 2020. But if San Francisco’s track record of responding to pandemics is any indication, lifting the gates on the lockdown too soon could have disastrous consequences.

Spanish flu infections seemed to dwindle by November 1918, and the city relaxed lockdown orders. When another wave hit San Francisco, much of the public — including “The Anti-Mask League” — resisted the mandates that city leaders re-enacted to help blunt the spread of the disease. The city ended up with nearly 45,000 cases and over 3,000 reported deaths.

It’s a cautionary tale as officials across the US fight to “flatten the curve” against the coronavirus disease by implementing stay-at-home orders and city shutdowns, even as some Americans protest those measures.

Here’s how San Francisco went from serving as a national role model to having one of the country’s highest death rates during the Spanish flu pandemic of 1918 and 1919.

SEE ALSO: Some wealthy Silicon Valley bigwigs have reportedly already scurried to their doomsday shelters in New Zealand

The Spanish flu, called so for its believed origin in Spain, hit San Francisco hard in September 1918 when World War I soldiers began returning home from Europe.

Source: Business Insider

Just as the city was one of the first in the nation to respond to COVID-19 in 2020, San Francisco leaders implemented strict orders to shut the city down early.

Schools, churches, and movie theatres were closed, mass gatherings were banned, and public dancing was prohibited.

Source: The San Francisco Chronicle

On October 25, 1918, the Board of Supervisors ordered everyone to wear a mask in public with violators subject to fines or jail time.

At first, there was widespread compliance with the order. But still, by mid-October, there were more than 500 cases of influenza and 50 deaths in San Francisco. The peak in cases hit on October 25, with 94 residents dying from the disease within a day. 

But then, the number of new cases tapered off by early November, and the city’s proactive steps were seemingly paying off.

Source: San Francisco Chronicle

The mask order was dropped on November 21, and the city reopened, with bars, theatres, and sports arenas welcoming crowds eager for entertainment.

Source: University of Michigan Center for the History of Medicine

As the Chronicle reported, a whistle blew and people poured out onto the streets in celebration, tossing their masks in the process.

“After four weeks of muzzled misery, San Francisco unmasked at noon yesterday and ventured to draw its breath,” The Chronicle wrote. “Despite the published prayers of the Health Department for conservation of gauze, the sidewalks and runnels were strewn with the relics of a torturous month.”


But in early December, there was a surge in cases of the illness.

The city’s public health director, Dr. William Hassler, believed the resurgence of the disease was due to visitors from outside of San Francisco.

He was also adamant that there was scientific proof that mask-wearing crucially helped slow the increase in confirmed cases. He once again began asking for residents to voluntarily wear masks in public, but many did not. 

In fact, city leaders struggled to rein people back in after loosening restrictions on the initial city shutdown.

Source: University of Michigan Center for the History of Medicine

Social distancing is believed to be one of the best ways to counteract the spread of the coronavirus disease, which is transmissible by respiratory droplets.

But back then, officials were convinced that all people needed to do was wear gauze masks to prevent transmission of the disease.

The city began ordering people to wear masks again on January 17. Many found the law to be unconstitutional and resisted, with some being fined or arrested.

“The Anti-Mask League” was formed, with influential residents, a few physicians, and even a member of the Board of Supervisors joining as members.

On January 25, 4,500 people gathered at a roller skating rink for a public event hosted by the league designed to put an end to the law mandating that residents wear masks in public. The league submitted a petition to the city calling for the mask ordinance to end.

“We earnestly pray that the people be granted speedy relief from the burdensome provisions of this measure,” read the submission.

On February 1, the city found the number of infections to have slowed enough to lift the mask order.

But by the end of February 1919, the city’s death count had reached 3,213, nearly doubling from 1,857 in November.

Source: The San Francisco Chronicle

San Francisco ended up being one of the worst-hit major cities in the US, with the city’s death rate due to the flu and pneumonia sitting at 673 for every 100,000 people.

Nearly 45,000 people in the city had been infected with the flu by the end of the winter in 1919.

Fast forward to the 2020 COVID-19 public health emergency, and San Francisco is in a similar position as it was in the early fall of 1918.

The county was one of six in the Bay Area that entered a shelter-in-place order on March 17 to help curb the spread of the coronavirus disease.

Since then, San Francisco — although being among the cities that public health officials ordered shut down due to the disease — has been thrust into the national spotlight for its proactive measures.

San Franciscans are now six weeks into isolating inside, working from home if they’re able to and only leaving for essential needs, like to go grocery shopping or to go for a walk.

On Friday, the city announced it would start enforcing mask-wearing for when people are in public, specifically when they’re in proximity to essential businesses and other residents.

Source: Business Insider

Similar mask-wearing and shutdown mandates are being implemented across the US, spurring protests whose participants argue that their civil liberties are being threatened.

Some business owners, hit hard by the economic fallout, have also spoken out against the shutdowns.

Top of mind for many is when the shutdown will end and when life can return to normal.

But a reopening plan outlined by California Gov. Gavin Newsom on April 13 specified that widespread testing and contact tracing, among other factors, would need to be addressed before that would even be considered.

Source: Business Insider

Staggered social distancing periods have also been mentioned, or alternating between loosening and tightening restrictions for the public as needed.

That’s a feat that San Franciscans during the 1918 pandemic did not comply too well with, which contributed to the city’s high case count.

As much as cabin fever may be setting in for people in the city, San Franciscans can perhaps take a cue from their predecessors that lived through another viral outbreak a century prior and be patient.