Leadership, Lockdowns, and Snake Oil

Otis Historical Archives, National Museum of Health and Medicine

San Franciscans wait in line for flu masks during the Spanish Influenza pandemic of 1918. Then, like now, Americans resisted universal masking policies, doubtlessly elevating the flu's casualty numbers.

If you ever wonder how we ended up here with a pandemic increasingly politicized – split down partisan lines concerning the severity, the news coverage, and even the science – one only has to look at the influenza pandemic of 1918 to gain some perspective.

There have been a lot of comparisons between the two pandemics, but there are many unexplored parallels from which we can still learn. As I wrote back in March, history doesn't repeat, but it does echo.

While many today are enraged over the dismissive response to the coronavirus pandemic by the federal government, the Trump administration is not the first to fail the public during such times — nor is it the first time that the public has been divided over measures to stop the spread of a deadly virus.

In 1918, President Woodrow Wilson had one fixation. It wasn't public health. His focus was the war and how he could maintain public support until its end. In fact, he never once publicly addressed the influenza pandemic — even after he contracted it himself. As 675,000 people died across the United States from the deadly flu strain, he and many public officials remained silent.

As historian John M. Barry, who wrote The Great Influenza: The Story of the Deadliest Pandemic in History, described, "To maintain morale during the pandemic, national public health officials — people who knew the truth — said, 'This is ordinary influenza by another name,' and 'You have nothing to fear if proper precautions are taken.' … Local public health officials all over the country echoed that line."

The Erie Daily Times, like many newspapers across the country, didn't run coverage of the pandemic on its front pages, even as the flu ravaged the city. This lack of proper coverage almost certainly encouraged a false sense of security among the public. Still, Erie's coverage was better than some cities. The daily updates, however buried, did provide valuable and increasingly startling information.

The virus arrived in Erie in September, at the onset of its second wave. By early October, the paper reported that Hamot and St. Vincent hospitals were almost at capacity. Both hospitals stopped accepting patients who were only exhibiting mild symptoms. Dr. John W. Wright, Erie's director of public health, organized the creation of an emergency hospital accommodating 300 patients at the government barracks on Fourth and Cascade streets. Dr. Morris H. Harrison, former superintendent of Hamot hospital, oversaw its operations. All surgeries in the city, except those "absolutely necessary to save human life" were forbidden. Hospital space was to be conserved for the increasing wave of influenza patients.

Dr. Wright's initial actions were swift and authoritative. The city and the county collaborated on a plan and the county appropriated additional funds as needed. The fire department began washing down State Street every night as a "health precaution in the hope of washing germ breeding refuse into the sewers before the germs are blown all over the city." Schools were shut down. Churches were closed and received notice that "any violation of this order will result in such building be placarded and the pastor or other person in charge prosecuted." Many saloons and entertainment venues remained open with strict guidelines, but they were soon shut down. All "street loafers and loiterers" were to be arrested.

Caution was growing, especially as news trickled in about the outbreak in Philadelphia, but so were other ideas, ones which weren't based on the science of the time.

A homeopathic doctor in Pittsburgh made national news when he proclaimed that he had discovered "a cure and preventive" for influenza: a precise mixture of iodine and creosote. It didn't work. 

Where there is one snake oil salesman though, there are hundreds. Local newspapers were filled with advertisements for bogus and unproven remedies.

"Why take a chance when you know Spanish Influenza … [is] waiting for you or yours?" an advertisement for Welsh's Drug Store on Peach Street questioned. "Hudson's Preventative will absolutely prevent disease."

Horlick's Malted Milk claimed it was "endorsed by physicians everywhere" to help with the flu. Tonsiline noted that gargling would "sterilize the throat, which these deadly germs must use as a gateway and breeding ground in entering the body." Hill's Cascara Quinine Bromide was said to outright prevent Spanish influenza if taken at "the first sign of a shiver or sneeze." A cream called Forkola claimed "conclusive proof" of preventing or decreasing the length of sickness if "applied to sensitive membranes of the nose and throat." 

"Nothing you can do will so effectually protect you against the influenza … epidemic as keeping your organs of digestion and elimination active," one laxative advertisement maintained. 

Even dentists were buying advertisements, contending that a healthy mouth could prevent the flu. "Laugh at Spanish Influenza," one State Street dentist advertised. "Get acquainted with Dr. McKelvey and let him keep your teeth and mouth in healthy condition. That is the best prevention."

Eventually, some cities (although not Erie) passed ordinances making it illegal to sell unverified cures, even threatening prosecution.

The flu spread quickly throughout Erie: 177 new cases were reported in a single two-hour period one mid-October morning, larger than any single entire day before it. Multiple deaths were being reported daily. The health department blamed the spread on the mild weather which was "causing people to be careless in the matter of looking after their health."

A second emergency hospital soon opened at the Elk's Club on Eighth and Peach streets. Those who recovered were urged to stay quarantined for an additional two to seven days after their fever broke.

By Oct. 26 though, Dr. Wright seemed optimistic. He reported "no material change in the influenza situation in Erie" and that "the disease is not on the increase." He stressed still that people remain vigilant and avoid congregating.

"Many questions are being asked as to when the closing rule will be abrogated," Dr. Wright said. "It is impossible for us to answer this question at the present time." He applauded churches, schools, and businesses who were cooperating and warned those who were violating the lockdown orders.

"[T]hose guilty of such offences can rest assured that punishment will follow their unloyal and illegal actions," he said.

On Nov. 8 (one month after Erie's first Spanish influenza-related death was reported), he announced the reopening of some churches and schools, but maintained that saloons and places of amusement would remain closed. Flu cases had decreased over the previous day, but only slightly to 97 new cases and five deaths.

"Go to church tomorrow," a church advertisement read the next day. "It will help you during the week."

Meanwhile, the war's end was imminent. Erie Chief of Police William Detzel informed residents that they would "be notified of the news [of armistice] by the ringing of fire bells and the blowing of shop whistles, which will give them an opportunity to get to the main streets and Perry Square in ample time to join in the celebration and take part in the informal parade."

Mayor Miles B. Kitts did not mention influenza or safety measures, only stating, "While we expect the greatest enthusiasm, let it be understood that law and order must at all times during this celebration be maintained as usual."

When the armistice was announced on Nov. 11, there was laughing, crying, and singing as "thousands thronged the streets" of downtown Erie.

Soon after, the emergency hospitals were closed. Perhaps, many thought, the worst of the pandemic was behind Erie.

Then on Nov. 13, the paper reported an increase of 108 new cases and twelve deaths. The following day, it spiked to 200 new cases. The board of health met on Nov. 15 to discuss the surge.

"This shows conclusively that the flu still has a good hold in this community," Dr. Wright determined. Despite another ten deaths, the board decided against shutting down the city again.

That weekend, even with seven more deaths, new cases inexplicably decreased to 25. It seemed possible that the worst had now passed, that the 250 total deaths so far in the city might be the end of it.

The numbers skyrocketed to 379 new cases on Nov. 19. The newspaper reported on the serious conditions once again within the hospitals. 

"The serious lack of nurses has become one of the greatest problems confronting the city and some way of relieving this must be found in the next twenty-four hours," the paper stated. Some were sick. All were overworked.

Even though the health department had decided not to reinstate the lockdown, they did not take any responsibility for the surge, saying it was "directly chargeable to carelessness on the part of the people of the city."

Dr. B.F. Royer, Pennsylvania's state health commissioner, threatened to shut the city back down. Dr. Wright asked for 48 hours. Royer agreed.

"So it is up to the people of Erie," the Daily Times read. "Either they must take care not to aid in the spread of the disease or else the ban will go on."

Every place in the city would close if the state ordered it, Dr. Wright warned. If city residents wouldn't comply and stop the spread, then the "strictest ban that this city has ever seen" would be enforced.

On Nov. 21, there were 230 more cases and the paper reported "there was nothing encouraging in the flu situation locally." The state's lockdown was expected. The spread was worse than it had ever been in Erie. Hamot was "threatening to refuse all charity patients" unless they received funds requested from City Council, while St. Vincent affirmed they would continue to accept all patients regardless of finances but they were "packed to capacity."

Dr. Wright announced two days later that his board wouldn't shut down the city, but he passed more restrictions on congregating and again urged citizens to act responsibly. He had wanted at least a "partial ban," but the health board instead reasoned that "if ordinary common sense is used by the people of the city, they will avoid the flu."

On Nov. 26, with nine more daily deaths, Dr. Royer again sent a letter imploring the board to shut the city down. One health board member called it "nonsensical." Locking down the city after the ban was lifted three weeks earlier would be met "with considerable opposition."

The Daily Times reiterated that the flu could be prevented with "common, ordinary sense" and if people "do not stay away from crowds it is their own fault if they are taken ill."

The state ordered Erie closed that evening. The mayor released a statement affirming he would comply with the state, but added that this would be an extreme hardship on Erie businesses.

"Let it be understood that in my official capacity I desire to do everything possible to prevent sickness of this kind and to save the lives of our people," Mayor Kitts wrote. "I take the stand that had the homes in which this epidemic occurred been originally quarantined this epidemic would have been stamped out in a few days."

Many city business leaders were enraged by the order. Richard P. Dailey, a saloonkeeper at Fourth and State streets, immediately filed an injunction against the state and local health departments in defiance of the order. Prominent local attorney Charles H. English advised all businesses in the city to disobey the order outright.

Statements at the injunction contended that Dr. Wright had "double-crossed" the city, that Dr. Royer had "gone far beyond his legally constituted authority," and that the advice of "reputable physicians familiar with the situation" was being ignored. Then, without evidence or further explanation, they made an ominous, conspiratorial accusation that there were "sinister influences working in the dark and at secret meetings and entirely for selfish designs."

The meaning of that final statement is open to interpretation, but the injunction was granted, paving the way for businesses to remain open. Dr. Royer decided against further action. It would be up to local authorities to deal with it.

"Business men of the city were elated," the paper reported. Most businesses remained open, although a handful of churches spoke out against the injunction, believing it threatened public health and that "business and money should [not] be weighed against health and human life."

As Valerie Myers quoted in her comprehensive 2018 story for Erie Times News, one minister proclaimed during a sermon, "This is a contest between dollars and human lives. We are making laws a farce for the benefit of the saloons and the Christmas sales."

Local authorities devised new tactics to combat the virus, forcibly quarantining the infected and placarding posters outside of their homes until cleared by a physician. 

Saloons were meanwhile emboldened. Many illegally stayed open past their agreed upon closing time of 11 p.m., which was revealed to police after a midnight fight between two women inside a State Street establishment.

By the end of November, daily new cases were still in the triple digits and daily deaths were still accumulating. When new reported cases inexplicably began to decrease in early December, the director of public safety investigated. Many doctors, it appeared, were not reporting their flu cases, protecting their patients from having their homes placarded. 

After a warning, more accurate reporting came in the very next day with a stunning 139 new cases reported just on the morning of Dec. 5. Another nine grisly days would pass before new daily cases fell below 100. 

Pamphlets were printed and distributed throughout the city in multiple languages: "Keep away from the cougher, sneezer and spitter who does not use a handkerchief. Keep out of crowds whenever possible. ... Walk instead of using the street car ... Be temperate in eating and drinking, and always wash your hands and face immediately upon reaching your home, and before eating food of any kind."

Over the following weeks, the virus ran its course. By the end of the year, 504 Erie residents were dead.

Of course, science has come a long way since 1918. Within weeks of our current pandemic, China sequenced the full genome of the novel virus and made it available to the world. Treatments for respiratory diseases no longer include whisky, enemas, or bloodletting. We now have antibiotics. Hospitals are far more sophisticated and sterile, while also having medical specialists that didn't exist a century ago.

Despite the medical and scientific advances though, nearly 150,000 people have died in the United States due to the coronavirus since late February. As history demonstrates, leadership matters during crises like these. The day-to-day decision-making needed during a crisis is important. Whatever mistakes Dr. Wright may have made in Erie during the 1918 pandemic, the answers were never crystal clear, especially with people's lives and livelihoods at stake depending on his course of action. Above all though, he tried, and one can imagine an even more grim outcome had he not. 

Wilson's administration ignored the problem, passing the responsibility on to states and local health boards. Today, the current administration is utilizing a similar strategy: providing minimal and sometimes conflicting guidance to states while also publicly downplaying the severity of the pandemic and undermining the advice of, and even publicly discrediting, its own health experts. 

"Clearly we are not in control right now," Dr. Anthony Fauci recently testified.

As SARS-CoV-2 continues its silent spread and the public continues to be divided over even the most basic science, it remains to be seen how long before we regain control again.

Jonathan Burdick runs the historical blog Rust & Dirt. He can be reached at jburdick@eriereader.com.