Schools, Shops, Churches Close as L.A. Fights a Pandemic.
By Alan Pollack, M.D.
April 7, 2020 | For puublication in the Heritage Junction Dispatch, May-June 2020.
When you think about current events, they are literally history happening now. In the first half of the year 2020, we have been living through an event of such titanic proportions, it is likely to be remembered centuries from now. As of this writing, the lethal coronavirus that causes the COVID-19 disease has infected over 1 million people and killed tens of thousands worldwide. And the worst is yet to come.
The Spanish Flu Pandemic.
But this is not the first time Los Angeles and the world have faced a deadly virus of apocalyptic proportions. The last one to strike was the Spanish Flu of 1918-1919.
Although it was called the Spanish Flu, the real origin of the H1N1 virus, which ravaged the world, is not known for sure. Theories of origin include a British staging and hospital camp in Etaples, France; a possible North American presence as early as 1915; and mostly debunked claims of a Chinese origin.
That same year, World War I was spreading across the globe. Soldiers passed on the influenza as they moved around in the war theaters. In fact, wartime censors squelched news of the virus in the United States, Germany, England and France. This censorship allowed a neutral Spain to appear as the world's hot spot through newspaper reporting.
Suppression of the news, as well as increasing travel capabilities, fueled the advance of the disease. Many soldiers perished as the virus attacked bodies already weakened from malnutrition and chemical warfare. Those who survived infected their fellow soldiers and then family and friends when they returned home.
Emergency Hospital, Brookline, Massachusetts.
Estimates suggest between 50 and 100 million people died worldwide from the Spanish Flu, at a death rate of 2-3 percent of all those infected. Twenty-eight percent of the 103 million people in the United States became infected with the virus, of whom an estimated 675,000 perished.
Just like our COVID-19, the Spanish Flu was tricky in its initial presentation, which hindered efforts to quarantine people in time to prevent the spread to others. Presenting symptoms included bleeding from the ears and mucous membranes, and a petechial rash consisting of red dots. Doctors misdiagnosed many people with diseases such as cholera, dengue fever or typhoid.
Most people who died suffered from pneumonia, or lung hemorrhage and edema. Unlike the COVID-19 disease, the Spanish Flu predominantly killed young adults below age 65, with 50 percent of deaths between 20 and 40 years old. It spared the very young and very old. The young may have been disadvantaged by a more robust immune system that overwhelmed and attacked the patient's own body organs while fighting the foreign organism. Deaths of the very young and old perhaps were lessened by their weaker but adequate immune system responses.
The COVID-19 disease, by comparison, has its worst outcomes in the elderly. Their weakened immune systems still overreact to the virus, causing an antibody attack on the body's own organs, which we call Acute Respiratory Distress Syndrome (ARDS).
There were three major waves of the Spanish Flu pandemic. The first occurred in early 1918 and resembled a typical flu epidemic. By October 1918, the virus had mutated and caused its deadliest peak. After that peak, the incidence of the illness rapidly declined and was virtually over by the next month, with sporadic deaths extending into March 1919.
At its end, the virus infected over 500 million people, one-quarter of the world's population. The Spanish Flu was called the "forgotten pandemic." Its deadly spread was overshadowed by the coexistent news of World War I. Yet, in raw numbers, the Spanish Flu killed nearly as many people as the Black Death (bubonic plague pandemic) of 1347-1351, which obliterated an estimated one-quarter of the world's population.
War Influenza Hospital, Emery Hill, Lawrence, Massachusetts, May 1919.
The Spanish Flu in America.
The illness was seen in the United States as early as January 1918 in Haskell County, Kansas. The first documented case was Haskell County native Albert Gitchell, an Army cook at Fort Riley, Kansas, who presented with symptoms on March 4, 1918.
The second wave reportedly started in September 1918 at the port of Boston, which was seeing many shipments of war machinery and supplies. The return of soldiers fanned the flames of the epidemic in America after World War I ended November 11, 1918.
A shortage of physicians caused by the tolls of war and the influenza exacerbated the epidemic. The shortfall was so acute that medical students still in training had to be recruited to care for the sick. Even President Woodrow Wilson caught the flu while negotiating the Treaty of Versailles to end the war.
The Spanish Flu in Los Angeles.
The Spanish Flu pandemic reached Los Angeles in mid-September 1918 when the first cases occurred on a naval vessel in Los Angeles Harbor. Army and Navy soldiers were placed under precautionary quarantine. Despite those measures, the flu spread to the civilian population on September 22, including dockworkers and other harbor employees. Some of the earliest cases appeared among the students of Polytechnic High School in downtown Los Angeles.
Los Angeles Times, October 13, 1918.
The city of Los Angeles was locked down October 11 when Mayor Frederic Thomas Woodman declared a state of public emergency after 680 new cases of flu had been reported. At-home quarantines were mandated for ill patients. Victims were advised to "stay in bed, keep the room well ventilated, eat enough plain food but not too much, and keep your bowels open." Group meetings were banned including public funerals, and public transportation vehicles were to be disinfected daily. Schools and churches were to be closed. Violators of the new ordinance would be subject to fines of up to $500 or imprisonment up to 6 months.
All movie theaters, concert halls and other entertainment venues were ordered shut down. Ongoing movie productions had to be stopped as actors became ill and infected each other. The flu struck famous Hollywood figures such as Lillian Gish, Mary Pickford and Walt Disney.
In the early stages of the epidemic, hoarders proliferated at the stores, emptying the shelves of flu remedies known at the time. All public schools were closed down by the middle of October. Actors and non-actors alike fled from the city to pursue their interests in less crowded rural domains.
Despite the lockdown ordinance of October 11, the Los Angeles Times sought to prevent public panic, stating: "Don't get rattled. It is well to keep soberly in mind at this time the fact that fear kills almost as many people every year as disease. Because a few cases of Spanish influenza have been reported, it does not follow that every swollen tonsil or weeping nostril is caused by this new form or grip. Now is the time to sit tight and not rock the boat."
Advice to the public from the City Health Commissioner Dr. Luther Milton Powers included: "Avoid the person who coughs or sneezes without covering his mouth and nose with a handkerchief. Avoid the person who spits where it will spread disease. He is dangerous as well as indecent. When you cannot avoid crowded places, keep your mouth shut and breathe through your nose. Do not spit on sidewalks, floors, streetcars or places where germs will spread. Boil your handkerchiefs after they are washed."
Dr. Powers was quoted in the Times the next day: "It is expected that there will be deaths while the epidemic lasts. Most of the cases, fortunately, are of a mild nature. The rapidity with which we bring this condition under absolute control depends upon the extent to which the public cooperates with the health department in preventing spread of contagion."
Spanish Flu Controversies.
As with today's COVID-19, the issue of using masks by the public was controversial. On October 23, California Gov. William D. Stephens called on residents of the state to wear gauze masks voluntarily when outside. Mayor Woodman agreed with the governor's recommendation, but his City Council did not. The council did decide, however, to recommend but not mandate masks, except for those required by the state to wear them, including persons with flu symptoms, their close contacts, and health care workers.
The City Council's mandate of business closures angered theater owners, represented by the Los Angeles Theater Owners' Association. They argued their venues had been unfairly forced to close while other businesses remained open. In their opinion, only essential businesses like grocery and drug stores should be allowed to operate. Their stated goal was to speed up the resolution of the epidemic and to be treated more fairly as compared to other non-essential enterprises.
The council deferred the decision to City Health Commissioner Powers, who declined the request due to his perception of its impracticality. The conflict between the theater owners, Powers, and the City Council continued throughout late November with one faction advocating the ongoing looser restrictions and another faction pushing the theater-owner requests for aggressive and more extensive closures.
Most of the Los Angeles public, however, willingly followed the ordinance restrictions. They were already used to restrictions placed on them due to the World War.
Los Angeles Times, October 24, 1918.
Decline of the Spanish Flu.
Los Angeles Times, October 25, 1918.
By the end of World War I in November, flu cases were declining, and city residents became more lax in their flu avoidance. Thousands of people crowded into a park in downtown Los Angeles to celebrate the armistice ending the war. Flu restrictions were stopped by Los Angeles officials, including reopening movie theaters, on December 3, 1918.
The L.A. Times reported: "From the depression of closed theaters and other places of amusement, closed churches and assembly halls, presence of occasional face masks and frequent warning signs, the city reacted yesterday to the spirit of gladness. People who have been staying closely at home for weeks joined the throngs downtown; even the outside places sent in large numbers of folk to participate in the abolishment of the 'funless' season. Up and down Broadway, and on the other retail streets, the crowds surged each way. Stores were filled with shoppers, and the Christmas trading rush was fully on. Theaters attracted long lines of patrons, hungry for the divertissement of motion picture and vaudeville. Long lines of people reached out into the corridors at the Public Library. The cafes and cafeterias did a rushing business. Everywhere it was apparent that the ban was removed and that the people were eager to take advantage of this condition."
But a resurgence in cases one week later caused schools to close down again and selective quarantine restrictions to be put back in place. Public gatherings were allowed to continue, and businesses remained open unless they had employees with the flu. Restrictions ended in January 1919 with schools reopening by early February.
Historians and health officials later credited Los Angeles for instituting rapid and consistent measures to combat the flu. Their diligent efforts resulted in a lower death rate than cities such as San Francisco, which was slower to battle the virus.
The City of the Angels ultimately survived the worst epidemic in its history to take on the roaring 'Twenties, the St. Francis Dam disaster, the Great Depression and World War II.
Now, just over a century later, we find ourselves in similar circumstances.
Alan Pollack, M.D., is a practicing physician and president of the Santa Clarita Valley Historical Society.
Los Angeles Times, February 9, 1919.
Los Angeles Times, February 9, 1919.
"How Did L.A. Cope With The Influenza Pandemic Of 1918?" By Hadley Meares, LAist, March 25, 2020.
"Closed Movie Theaters and Infected Stars: How the 1918 Flu Halted Hollywood" by Hadley Meares, The Hollywood Reporter, April 1, 2020.
"Spanish Flu: The Pre-Coronavirus Pandemic That Killed Millions in 1918" by Jacob Shelton, History Daily, March 4, 2020.
"The American Influenza Epidemic of 1918-1919: Los Angeles, California," Influenza Encyclopedia, University of Michigan Center for the History of Medicine, n.d.
"Spanish Flu," by the Editors of History.com, October 12, 2010; updated March 27, 2020.
"The Influenza Pandemic of 1918" by Molly Billings, Stanford University, June 1997; modified February 2005.
"The 1918-1919 Influenza Epidemic in Los Angeles" by N. Pieter M. O'Leary, The Historical Society of Southern California: Southern California Quarterly, Vol. 86 No. 4 (Winter 2004), pp. 391-403.
Los Angeles Times: October 11-13, 1918; October 17, 1918; December 3, 1918; February 9, 1919.