AILSA CHANG, HOST:
Could the reopening of states lead to a second wave of coronavirus infections? If history is any guide, the answer would appear to be yes. Close examinations of what happened in the 1918 flu pandemic are giving some clues as to what could happen in 2020. NPR's Tim Mak has been poring over the history books and joins us now.
TIM MAK, BYLINE: Hey there.
CHANG: All right, so I understand you looked at San Francisco's decisions around face masks during the 1918 flu pandemic. So what do you think the lessons are there?
MAK: So in the fall of 1918, the flu pandemic was sweeping through San Francisco. And under a mask order, 80% of residents there were wearing masks during this first wave of the pandemic. By November, cases begin to decline in the city, and public health officials begin to open up again. People who had been staying inside rushed out to entertainment venues and public gatherings, and they cast off their mask. But this led to an uptick in influenza cases in December of that year. By this time, the population was much more resistant to going back into lockdown and wearing masks in the second wave.
CHANG: Why? What were the objections?
MAK: Well, we see a lot of the same pushback in 1918 as we do today - civil libertarians protesting orders, business groups with concerns about how their businesses will be affected, questions about whether public health measures even work. And we even saw threats against public health officials, which we see, unfortunately, today as well.
In late 1918 and early 1919, the anti-mask sentiment actually coalesced into something organized. Thousands of San Francisco residents protested mandatory masking measures and actually formed what was called the Anti-Mask League in early 1919. But by spring of 1919, cases began to drop, and the pandemic faded in San Francisco. However, San Francisco, because - or at least partly because of some of these protests and pushback and a lack of wearing masks - San Francisco was among the city's worst-hit by the pandemic that year.
CHANG: So interesting - now, I understand that economists are also looking at lockdown measures taken in 1918 and what happened when those lockdown measures were lifted. What have they found so far?
MAK: So Robert Barro, who's a professor of economics at Harvard, has a new working paper out assessing the effects of some of these public health measures during that pandemic a hundred years ago. And what he finds is that things like school closures, prohibition on public gatherings and quarantine did help flatten the curve.
However, he didn't - he also found that it didn't substantially reduce the number of overall deaths in the longer term because, he argues, public health measures were not adhered to long enough. In 1918, 1919, these measures were only implemented for about a period of a month. And he says that the lesson learned here is that to reduce deaths in the coronavirus pandemic in 2020, these sorts of public health measures need to be implemented for longer than a month.
CHANG: And real quick, Tim, I mean, how much should we be relying on history to predict what's going to happen in 2020?
MAK: So, of course, just because something happened in the past does not mean it will necessarily happen in the same way again. The history is both reassuring and alarming. It's reassuring because it tells us that Americans have followed similar patterns before - resisting public health measures during a pandemic - and that America managed to process and get through it. It's alarming because it suggests that there could be very many challenges ahead.
CHANG: That's NPR's Tim Mak.
MAK: Thank you.
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