Hvad var straffen for at være ulydig mod influenzasikkerhedsforskrifter i 1918 -epidemien?

Hvad var straffen for at være ulydig mod influenzasikkerhedsforskrifter i 1918 -epidemien?

Jeg har undersøgt influenzaepidemien i 1918 og dens virkninger i Oregon. Virksomheder måtte lukke klokken 3:30, influenza -masker skulle bæres, offentlige sammenkomster var forbudt, og husstande smittet med influenza blev sat i karantæne i ti dage. Hvad var sanktionerne for at adlyde disse regler?


Husk på, at verden var i krig, en af ​​likes, som ingen nogensinde havde set, og det meste blev gjort for at støtte den krig. Så de organisationer, der blev startet et par årtier før epidemien, var lamslået i forsøget på at holde mændene på frontlinjen i kamp.

I løbet af 1918-1919, i en verden adskilt af krig, var de multilaterale sundhedsovervågningssystemer, der havde været møjsommeligt bygget i løbet af de foregående årtier i Europa og USA, ikke nyttige til at kontrollere influenzapandemien. Verdenssundhedsorganisationens forfader, Office International d'Hygiène Publique, der ligger i Paris (31), kunne ikke spille nogen rolle under udbruddet. I begyndelsen af ​​pandemien isolerede hærens læger soldater med tegn eller symptomer, men sygdommen, som var yderst smitsom, spredte sig hurtigt og inficerede personer i næsten alle lande. Lektioner fra historien

I Portland Oregon,

Byrådet vedtog beslutningen og placerede influenza på listen over infektionssygdomme, der kunne sættes i karantæne. Portland -politiet og amtvagterne blev opfordret til at hjælpe sundhedsafdelingens tyve betjente med at håndhæve karantænen, selvom private læger blev advaret om, at de ikke havde myndighed til at forbyde patienter at forlade deres hjem. Næste dag havde sundhedsinspektører og politifolk travlt med at placere de hvide og røde plakater på de syges hjem. Straffen for overtrædelse af karantæne - enten at forlade eller komme ind i et opskilt hjem - var en bøde på $ 5 til $ 300 og fem til halvfems dage i fængsel. Influenzaarchive.org

Men i Chicago fandt jeg en artikel, der angiver følgende

På trods af sin tøven bad sundhedskommissær Robertson politichef John Alcock om at få sine betjente til at stoppe alle vedholdende nyser og hoste, der ikke dækkede deres ansigter med lommetørklæder. De krænkere, der lovede at adlyde instrukser i fremtiden, ville blive sluppet løs, men alle, der gav betjenten en vanskelig tid, ville blive anholdt, holdt et foredrag om farerne ved influenza og blev sendt til en dommer for anklage.7 Robertson advarede også teater ledere og ejere for at sikre, at lånere brugte lommetørklæder, eller han ville lukke deres virksomheder ned. Kirker, skoler, teatre, restauranter, sporvogne og andre steder, hvor mennesker samledes, blev beordret til at opretholde korrekt ventilation.8 Foreløbig var dette omfanget af Chicagos kontrolforanstaltninger. Både Robertson og Illinois Influenza Advisory Commission var enige om, at der ikke skulle udstedes en lukningsordre, idet de hævdede, at epidemien "praktisk talt stod stille" i Chicago og den nordlige del af staten.9

Og i Mississippi havde de følgende kode, der trådte i kraft 28. marts 1918:

Enhver, der bevidst overtræder enhver regel eller forskrift, der er bekendtgjort af sundhedsstyrelsen, under denne lovs myndighed, anses for skyldig i en forseelse og straffes ved overbevisning med bøde eller fængsel eller begge dele. Den annoterede Mississippi -kode


Hvordan nogle byer 'fladede kurven' under influenzapandemien i 1918

Social afstand er ikke en ny idé - det reddede tusinder af amerikanske liv under den sidste store pandemi. Sådan fungerede det.

Philadelphia opdagede sit første tilfælde af en dødelig, hurtigt spredende influenzastamme den 17. september 1918. Dagen efter, i et forsøg på at standse virusspredning, iværksatte byens embedsmænd en kampagne mod hoste, spyt og nysen i offentligheden. Alligevel ti dage senere - på trods af udsigten til en epidemi lige uden for døren - var byen vært for en parade, som 200.000 mennesker deltog i.

Influenzasager fortsatte med at stige, indtil skoler, kirker, teatre og offentlige forsamlingslokaler den 3. oktober endelig blev lukket ned. Blot to uger efter den første anmeldte sag var der mindst 20.000 flere.

Influenzaen fra 1918, også kendt som den spanske influenza, varede indtil 1920 og betragtes som den dødeligste pandemi i moderne historie. I dag, da verden går i stå som reaktion på coronavirus, studerer forskere og historikere 1918 -udbruddet for at finde spor til den mest effektive måde at stoppe en global pandemi. Den indsats, der blev gennemført dengang for at dæmme op for influenzaens spredning i byer i hele Amerika - og resultaterne - kan tilbyde lektioner i kampen mod nutidens krise. (Få de seneste fakta og oplysninger om COVID-19.)

Fra den første kendte amerikanske sag på en militærbase i Kansas i marts 1918 spredte influenza sig over landet. Kort efter, at der blev indført sundhedsforanstaltninger i Philadelphia, dukkede en sag op i St. Louis. To dage senere lukkede byen de fleste offentlige sammenkomster og ofre i karantæne i deres hjem. Sagerne bremsede. Ved afslutningen af ​​pandemien var mellem 50 og 100 millioner mennesker døde på verdensplan, herunder mere end 500.000 amerikanere - men dødeligheden i St. Louis var mindre end halvdelen af ​​satsen i Philadelphia. Dødsfaldene på grund af virussen blev anslået til at være omkring 358 mennesker pr. 100.000 i St. Louis mod 748 pr. 100.000 i Philadelphia i løbet af de første seks måneder - den dødeligste periode - af pandemien.

Dramatiske demografiske forskydninger i det sidste århundrede har gjort det stadig hårdere at indeholde en pandemi. Stigningen af ​​globalisering, urbanisering og større, tættere befolkede byer kan lette en spredning af virus på et kontinent på få timer - mens de tilgængelige værktøjer til at reagere er forblevet næsten de samme. Nu som dengang er folkesundhedsindsatser den første forsvarslinje mod en epidemi i mangel af en vaccine. Disse foranstaltninger omfatter lukning af skoler, butikker og restauranter, der sætter restriktioner for transport, der kræver social afstand, og forbyder offentlige sammenkomster. (Sådan kan små grupper redde liv under en pandemi.)

Det er naturligvis en anden historie at få borgere til at efterkomme sådanne ordrer: I 1918 skød en sundhedsofficer i San Francisco tre mennesker, da man nægtede at bære en obligatorisk ansigtsmaske. I Arizona uddelte politiet 10 bøder til dem, der blev fanget uden beskyttelsesudstyr. Men til sidst gav de mest drastiske og gennemgribende foranstaltninger pote. Efter at have gennemført et væld af strenge lukninger og kontroller på offentlige sammenkomster, reagerede St. Louis, San Francisco, Milwaukee og Kansas City hurtigst og mest effektivt: Interventioner der blev krediteret med at sænke transmissionsraterne med 30 til 50 procent. New York City, der reagerede tidligst på krisen med obligatoriske karantæner og forskudte åbningstider, oplevede den laveste dødelighed på den østlige kyst.

I 2007 blev en undersøgelse i Journal of the American Medial Association analyserede sundhedsdata fra den amerikanske folketælling, der oplevede 1918 -pandemien, og kortlagde dødeligheden i 43 amerikanske byer. Samme år offentliggjorde to undersøgelser i Procedurer fra National Academy of Sciences søgte at forstå, hvordan svar påvirkede sygdommens spredning i forskellige byer. Ved at sammenligne dødelighedsrater, timing og folkesundhedsinterventioner fandt de, at dødeligheden var omkring 50 procent lavere i byer, der tidligt gennemførte forebyggende foranstaltninger, mod dem, der gjorde det sent eller slet ikke. Den mest effektive indsats havde samtidig lukket skoler, kirker og teatre og forbudt offentlige sammenkomster. Dette ville give tid til vaccineudvikling (selvom en influenzavaccine ikke blev brugt før i 1940'erne) og mindske belastningen af ​​sundhedssystemer.

Undersøgelserne nåede frem til en anden vigtig konklusion: At afslappende interventionsforanstaltninger for tidligt kan få en ellers stabiliseret by til at falde tilbage. St. Louis var for eksempel så opmuntret af den lave dødelighed, at byen ophævede restriktioner for offentlige sammenkomster mindre end to måneder efter, at udbruddet begyndte. Et udslæt af nye sager fulgte snart. Af de byer, der holdt interventioner på plads, oplevede ingen en anden bølge af høje dødsfald. (Se fotos, der fanger en verden, der er standset af coronavirus.)

I 1918 fandt undersøgelserne, at nøglen til udfladning af kurven var social afstand. Og det forbliver sandsynligvis sandt et århundrede senere, i den nuværende kamp mod coronavirus. "[T] her er en uvurderlig skattekiste af nyttige historiske data, der kun lige er begyndt at blive brugt til at informere vores handlinger," skrev Columbia University epidemiolog Stephen S. Morse i en analyse af dataene. "Lærdommerne fra 1918, hvis der blev taget godt hensyn til dem, kan måske hjælpe os med at undgå at gentage den samme historie i dag."


Lærdom fra 1918 spansk influenza: Da maskerlove udløste protester i USA

Et spansk influenza -offer i St Louis, USA. (Kilde: Wikimedia Commons)

I 1918, da amerikanerne havde travlt med at hjælpe de allierede magter i Første Verdenskrig, der rasede i hele Europa, blev de hjemme plaget af en dødelig influenzaepidemi. Den spanske influenza er registreret for at have dræbt ti gange flere amerikanere end blev dræbt af tyske bomber og kugler i krigen.

Den spanske syge ankom til Amerika på et tidspunkt, hvor massetransport, masseforbrug og krigsførelse havde åbnet offentlige rum, hvor smitsomme sygdomme kunne spredes. En af de mest udbredte og ødelæggende epidemier i det 20. århundrede, influenza var også ankommet på et tidspunkt, hvor medicinen havde avanceret med spring og grænser. Historikeren Nancy Tomes forklarede i sin artikel, "" Destroyer and Teacher ": Managing the Masses under influenza -pandemien 1918–1919, hvordan influenzapidemien i 1918 var “Let at forstå, men svært at kontrollere.

Influenza blev først rapporteret i marts 1918 på en hærbase i Kansas, hvor tæt på 100 soldater var blevet smittet. Inden for en uge voksede antallet af sager fem gange. Da tusinder af soldater indsat til krigen flyttede over Atlanterhavet, spredte influenza sig med dem. Lokale myndigheder iværksatte et stort antal foranstaltninger til at kontrollere dens spredning, herunder nedlukning af skoler, forbud mod offentlige sammenkomster, ingen spytning og lignende. Den eneste foranstaltning, der blev til et debatpunkt, var den obligatoriske brug af masker. Dengang, som i dag, havde der været en intens debat om nytten og bekvemmeligheden ved at bære masker. Borgere forsømte forordningen, udviste trods og nogle organiserede også protester, der ligesom i dag var politisk motiverede.

Obligatoriske masker for alle – En første gang lov under den spanske influenza

Praksis med at dække næse og mund som en sanitær praksis spores tilbage til det tidlige moderne Europa. Under udbredelsen af ​​Bubonic-pesten bar læger en næbformet maske fyldt med parfume. Årsagen bag at bære denne maske var troen på, at smitsomme sygdomme spredte sig gennem skadelige forurenende stoffer i luften eller miasma. Parfume-fyldte masker antages at være i stand til at beskytte dem, der bærer den. Denne praksis begyndte dog at dø ud af det 18. århundrede.

En gravering af en pestlæge i Marseille lavet i 1721 CE (Kilde: Wikimedia Commons)

Brugen af ​​ansigtsmasker, som det gøres i dag, kan spores tilbage til 1880'erne, da en gruppe kirurger udarbejdede en strategi for at stoppe bakterier fra at komme ind i sår. Johann Mikulicz, leder af operationsafdelingen ved University of Breslau (nu Wroclaw, Polen), begyndte at bære en ansigtsmaske, som han beskrev som "Et stykke gaze bundet af to snore til hætten og fejer hen over ansigtet for at dække næse og mund og skæg." "Ansigtsmasken stod for en strategi for infektionskontrol, der fokuserede på at holde alle bakterier væk, i modsætning til at dræbe dem med kemikalier," skrev biolog Bruno J Strasser og historiker Thomas Schlich i deres forskningsartikel, 'En historie om den medicinske maske og stigningen i bortkastningskultur'.

Men indtil influenzaepidemien 1918-1919 var brugen af ​​ansigtsmasker begrænset til operationsstuerne. Den spanske influenza indledte en ny æra i ansigtsmaskernes historie, da læger, patienter såvel som indbyggere i Amerika for første gang blev bedt om at bære masken uden for deres hjem.

Mandat masken – En patriotisk handling

Maskeregleregler kom først op i de vestlige stater. I slutningen af ​​efteråret 1918 var syv byer i USA kommet med obligatoriske maskerlove, herunder San Francisco, Seattle, Oakland, Sacramento, Denver, Indianapolis og Pasadena, Californien. Det var imidlertid San Francisco, der var i spidsen for maskerlovene.

Barberer iført masker under epidemien (Kilde: Wikimedia Commons)

Den 18. oktober beordrede byens sundhedsofficer, Dr. William C. Hassler, at alle barberere skulle bære masker, når de var i kontakt med deres kunder, og bad ekspedienter, der kom i kontakt med offentligheden, også om at bære dem. I de følgende dage tilføjede han hotel- og bankmedarbejdere, kemikere, butiksbetjente og alle andre, der betjener offentligheden, på listen. Borgere fik også mandat til at bære masker offentligt. 'Maskeforordningen' den 22. oktober gjorde San Francisco til den første by, der pålagde brugen af ​​ansigtsmasker, der havde fire lag. Byen blev hurtigt omtalt som den 'maskerede by'.

Da Amerika på det tidspunkt stadig kæmpede med krigen, indførte lokale myndigheder foranstaltninger til at kontrollere spredningen af ​​sygdommen med et strejf af patriotisme. Ordren fik indtryk af at beskytte tropperne mod udbruddet. Derfor udtalte en offentlig meddelelse fra Røde Kors: "Manden eller kvinden eller barnet, der ikke vil bære en maske nu, er en farlig slacker." Borgmester James Rolph i San Francisco meddelte på den anden side, at "samvittighed, patriotisme og selvbeskyttelse kræver øjeblikkelig og stiv overholdelse" af maskeordren.

Brevholder i New York by iført en maske under influenza. (Kilde: Wikimedia Commons)

'At maskere eller ikke at maskere'- Modstand og håndhævelse

Som i 2020 oplevede forordningen om at bære masker også i 1918 fast modstand fra flere amerikanere. Følgelig blev overtrædere af maskelove idømt en bøde på $ 5 eller $ 10 eller blev idømt 10 dages fængsel.

Professor E Thomas Ewing skrev på BBC -magasinets websted, History Extra, og forklarede, at de fleste overtrædelser af maskeforordninger skyldes "Ligegyldighed, uvidenhed eller bekvemmelighed." "I San Francisco havde de fleste af de 110 anholdte den første dag masker om halsen, hvilket tyder på, at deres afslag mere handlede om bekvemmelighed end principiel modstand mod reglerne," han skrev.

Der var også dem, der hævdede, at maskerne var skadelige for deres sikkerhed. Ewing leverede en anekdote af en mekaniker i Tucson, Arizona, der indrømmede ikke at have en maske på og hævdede "Det var ikke sikkert at gøre det, da det ville have forstyrret hans syn og gjort sig ansvarlig for skader fra maskinen." I Santa Barbara, Californien, reagerede en læge, Dr. J. Clifford på hans anholdelse ved at erklære, at han ikke troede på at bruge masken, da den ikke gjorde noget for at kontrollere spredning af epidemien.

I november 1918 fik indbyggere i San Francisco lov til at fjerne deres masker, da deres sundhedsafdeling meddelte, at epidemien var forbi. Byen fejrede med største glæde. ”Tjenere, barkeeps og andre blottede deres ansigter. Der var drikkevarer i huset. Isbutikker delte godbidder ud. Fortovene var oversået med gaze, "relikvierne fra en torturistisk måned", skrev journalisten Christine Hauser i en artikel i New York Times.

Festlighederne var dog korte, da antallet af influenzatilfælde i løbet af uger steg igen, og i december 1918 blev maskeforordningen genindført. Som reaktion på denne pålæggelse blev der oprettet en selvstændig 'anti-maske' liga. "De samme mennesker, der fejrede deres bare-befriede" befrielse ", da de fik lov til at fjerne ansigtsmasker i november 1918, organiserede nu protester mod tilbagevenden af ​​denne folkesundhedsforanstaltning," skrev medicinhistorikeren, Brain Dolan, i sin artikel, 'Unmasking History: Who was behind the Anti-Mask League Protests during the Influenza Epidemic 1918 in San Francisco?'

Det første, gruppen gjorde, var at indkalde til et offentligt møde med den hensigt at distribuere andragender, der bad om afskedigelse af bysundhedsofficer, William Hassler og true borgmester Rolph med tilbagekaldelse, hvis han ikke efterkom borgernes krav.

Dolan foreslog, at 'anti mask' -ligaen var mere politisk motiveret end medicinsk. Præsidenten for ligaen, E.C. Harrington, havde sammen med andre vigtige medlemmer politiske motiver bag opfordringen til Rolphs afgang.

Et århundrede senere, da borgmester i San Francisco, London Breed beordrede byens indbyggere til at "bære ansigtsbeklædning i vigtige virksomheder, i offentlige faciliteter, under transport og under udførelse af væsentligt arbejde", opstod der igen en heftig debat om maskernes effektivitet og gennemførlighed. . Ikke overraskende studeres byens begivenhedsrige historie med maskerlove til lektioner. Dolan forklarede lektionerne fra sammenligningen – ”Som med dette historiske eksempel ser vi, at det er næsten umuligt at håndhæve fuldstændig overholdelse af en foranstaltning, der radikalt ændrer social adfærd natten over. Forsøgene på at overtale flertallet til at overholde i dag ser imidlertid ud til at give bedre resultater end tidligere i at kontrollere spredningen af ​​sygdomme. Det er her, vi kan trøste os med ikke at ligne fortiden. ”


H.L. Mencken om 'Numskull' -præsidenter, den spanske syge og depressionen

Hele efteråret 1918, mens den berygtede, akerbiske Baltimore -journalist H.L. Mencken fuldførte Det amerikanske sprog , den spanske influenzapandemi tog fat i landet. Der blev vedtaget love mod at spytte sporvognsmærker blev badet i antiseptisk opløsning, men intet kunne dæmpe influenzaens fremskridt. Få behandlinger var tilgængelige. Influenzavaccinen eksisterede ikke, antibiotika var endnu ikke opfundet. Hver dag fyldte søjler med nekrologer papirerne. Flere amerikanske civile døde af virussen, end amerikanske tropper døde i første verdenskrig. "Alt, der kunne ses fra vores hus, var begravelser," huskede Menckens bror. Uden for deres hjem på Hollins Street i West Baltimore kunne den sørgelige lyd af vogne høres på nærliggende Lombard Street, der bragte dagens døde til de yderste kirkegårde.

Menckens litterære partner, teaterkritikeren George Jean Nathan, havde mistet sin bror i influenza, så havde mere end 20 af deres andre venner. Det var ikke ualmindeligt, at Mencken så mere end 50 kister stablet i et skur på Union Station i Washington, DC. Han blev ved med at arbejde på sin bog, men følte sig trist og mistænkte, at han muligvis selv bekæmper sygdom, selvom det i hans tilfælde sandsynligvis var hø feber.

Journalister blev bedt om at skrive positive historier for at øge den offentlige moral. Takket være præsident Woodrow Wilsons nyoprettede komité for offentlig information tog pressen et stærkt nationalistisk standpunkt i deres tone og emne og hældte mod optimismen. Af stor opbakning til denne opgave var spionageloven, som indeholdt nogle af de mest restriktive sanktioner mod publikationer i amerikansk historie. Der var sanktioner på $ 10.000 og 20 års fængsel for negativ dækning. Udvalgets fokus var krigen, men influenzadækningen blev også påvirket.

For Mencken, en forkæmper for Bill of Rights, var sådanne restriktioner skandaløse. Det meste af hans fokus blev brugt på at skrive om neutrale emner, men han var ofte i stand til at indsætte "et par slik til ytringsfrihed" og borgerrettigheder. Mencken var en stor beundrer af det medicinske etablissement og havde skrevet om folkesundhedsspørgsmål år før han fulgte den maksimale forsker Thomas Henry Huxley, der kæmpede for "sandheden, som den kunne opdages og fastlægges - sandheden, der sætter mænd fri. " Et par redaktører var for bange for at udskrive hans spalter.

"Vi har haft så mange præsidenter, der var tydelige numskulls, at det glæder alle at overveje en med en aktiv cortex," klagede Mencken engang. I fremtiden vil "landet forblive sikkert nok til alle praktiske formål, så længe det er i hænderne på en mand med karakter, ærlig, galant og mild og modereret af en sans for humor." Karakter er det, vi leder efter hos ledere, skrev Mencken: "forsikringen om, at de vil handle på en bestemt måde i enhver ny situation, og at det vil være en ærlig, beslutsom og uselvisk måde."

Men Menken levede for at se endnu en præsident undlade at opfylde denne standard i en krise. For Mencken var "Hoover -busten" et af de mest nysgerrige fænomener, der nogensinde er set i amerikansk politik. Først bemærkede han, at præsident Herbert Hoover var blevet betragtet som "en slags superpolitiker", endda en "antipolitiker," i stand til at håndtere landets forretninger "på en mere ærlig og kompetent måde end de professionelle" "til en klasse af skinnende, overfladiske go-getters, der blev meget værdsat" under den forgyldte alder. Så kom depressionen sammen med Hoovers gentagne benægtelser af dens eksistens og derefter forsikrede, at den snart ville forsvinde. Inden længe begyndte Hoovers påstande at blive betragtet som "uforskammet, afskyeligt og overbevisende og hellip. Intet under [offentligheden] har mistro til ham nu. De har dimensioneret ham og fået hans mål. De ved af hård erfaring, at han ikke er til at stole på, og hellipthey se foran dem kun en skiftende og lurvet politiker, ryggen til væggen. "

Præsidentens undskyldere "forsøger at få det til at se ud, som om den rigtige ærede herre lider uretfærdigt af almindelige mennesker - at han får skylden for ulykker, som han ikke er mere ansvarlig for end politimanden på rytmen." Præsidenter får normalt skylden, når det går dårligt, ligesom de får for meget af æren, når det går godt. Men Hoovers manglende evne til at være gennemsigtig om den økonomiske undergang, landet står over for, betød for Mencken, at han fortjente "meget mere af den fordømmende, end nogen almindelig præsident skulle stå over for."

"Ordet princip synes ikke at have nogen betydning for ham, "skrev Mencken." Det eneste, han ser ud til at tænke på, er hans job. "Hvad der sker med sådanne ledere er uundgåeligt:" Deres væsentlige tomhed er åben for alle. Over for ægte vanskeligheder er de enstemmigt gået i stykker. "Dette var sandt, uanset om en præsident var konservativ eller liberal - Mencken var imod FDR's New Deal -politik. Det han ønskede var" en kompetent pilot, der var i stand til at vinde og kommandere besætningen. "

Vores nuværende coronavirus -problem er bekymrende, men næppe uden fortilfælde. Landet har været der før, og på en eller anden måde er det altid kommet frem i den anden ende, vores system giver ingen sikker garanti, men det er, hvad vi har. "Regeringsvidenskaben er virkelig meget enkel, ellers ville verden være gået i potten for længe siden," bemærkede Mencken engang. Vælgerne kan fastgøre, hvad der er tilbage af deres tillid til ledere, der viser ægte karakter, eller de kan fortsætte med sub-parets rang og fil. "Så for hvirvelvinden!"

Marion Elizabeth Rodgers er forfatter til Mencken: The American Iconoclast.


Forordninger og love, der kan gælde under en pandemi

Under en pandemi kan visse juridiske myndigheder Eksternt, politikker og regler gælde og tjene som grundlag for det amerikanske Department of Health and Human Services (HHS) til at reagere.

Lov om folkesundhed

Public Health Service (PHS) Act danner grundlaget for HHS & rsquo -juridiske myndigheder til at reagere på offentlige nødsituationer ved at give HHS -sekretæren tilladelse til at tage vigtige handlinger, såsom at føre al føderal folkesundhed og medicinsk reaktion, erklære en folkesundhedsnødsituation, hjælpe stater ved at imødekomme sundhedsmæssige nødsituationer, vedligeholde det strategiske nationale lager og kontrollere smitsomme sygdomme. PHS-loven blev ændret ved loven om pandemisk og alle farer (PAHPA) fra 2006 External og Pandemic and All-Hazards Reauthorization Act (PAHPRA) fra 2013 External.

Udstedelse af erklæringer

I henhold til Robert T. Stafford Disaster Relief and Emergency Assistance Act External kan præsidenten erklære en nødsituation efter anmodning fra guvernøren i en berørt stat eller en administrerende direktør for en berørt indianerstamme. Præsidenten kan også erklære en nødsituation uden en gubernatorial anmodning, hvis hovedansvaret for reaktionen ligger hos forbundsregeringen for at yde hurtig og nødvendig føderal bistand og støtte.

HHS -sekretæren kan i henhold til § 319 i PHS Act External bestemme, at en sygdom eller lidelse udgør en nødsituation for folkesundheden, eller at en nødsituation for folkesundheden, herunder betydelige udbrud af infektionssygdomme eller bioterrorangreb, ellers eksisterer. Efter en § 319 -erklæring kan sekretæren tage mange handlinger under en influenzapandemi, herunder at yde tilskud til at indgå kontrakter og foretage og støtte undersøgelser af årsagen, behandlingen eller forebyggelsen af ​​sygdommen eller lidelsen og afstå fra eller ændre visse Medicare, Medicaid , Children & rsquos Health Insurance Program (CHIP) og Health Insurance Portability Accountability Act (HIPAA) krav. Disse dispensationer eller ændringer er tilladt i henhold til § 1135 i Social Security Act External for at sikre, at der er tilstrækkelige sundhedsydelser og tjenester tilgængelige under en nødsituation i folkesundheden.

I henhold til loven om offentlig beredskab og beredskab (PREP Act) Ekstern i PHS -loven er HHS -sekretæren også bemyndiget til at udstede en PREP Act -erklæring, der giver immunitet mod ansvar (undtagen forsætlig forseelse) for krav om tab forårsaget som følge af vedrørende eller som følge af administration eller brug af modforanstaltninger til sygdomme, trusler og tilstande bestemt af sekretæren til at udgøre en nærværende eller troværdig risiko for en fremtidig nødsituation for folkesundheden for enheder og enkeltpersoner, der er involveret i udvikling, fremstilling, test, distribution , administration og brug af sådanne modforanstaltninger. En PREP Act -erklæring er forskellig fra og afhænger ikke af andre nødopgørelser.

Besøg webstedet HHS -kontoret for den assisterende sekretær for beredskab og reaktion (ASPR) for at få en omfattende oversigt over HHS -juridiske myndigheder, politikker og eksterne udvalg til at reagere på nødsituationer i folkesundheden. Læs & ldquoPublic Health Emergency Declarations Q & ampA External & rdquo og & ldquoPREP Act Frequently Asked Questions & rdquo External for mere information om de juridiske myndigheder for HHS -sekretæren.

Federal Food, Drug and Cosmetic Act

Federal Food, Drug and Cosmetic (FD & ampC) Act er grundlaget for Food and Drug Administration & rsquos (FDA & rsquos) myndighed og ansvar for at beskytte og fremme folkesundheden ved blandt andet at sikre menneskers og veterinærlægemidlers sikkerhed og effektivitet, biologiske produkter og medicinsk udstyr og sikring af vores lands sikkerhed og fødevarer. Afsnit 564 i FD & ampC Act bemyndiger HHS -sekretæren til at erklære en nødsituation, der begrunder nødhjælpstilladelsen (EUA) Ekstern af medicinske modforanstaltninger (MCM'er) under nødsituationer i folkesundheden. Når en EUA erklæres, kan FDA -kommissæren tillade enten (a) brug af et ikke -godkendt medicinsk produkt (f.eks. Lægemiddel, vaccine eller diagnostisk udstyr) eller (b) ikke -godkendt brug af et godkendt medicinsk produkt under en nødsituation til at diagnosticere , behandle eller forebygge en alvorlig eller livstruende sygdom eller tilstand forårsaget af et kemisk, biologisk, radiologisk eller nukleart middel (CBRN). F.eks. Under H1N1 -influenzapandemien i 2009 godkendte FDA akut brug af antivirale midler til visse patienter og eksterne sundhedsindstillinger.

En EUA -erklæring kan kun afgives, når visse juridiske kriterier er opfyldt, og når der findes videnskabelig dokumentation for at understøtte brugen under en nødsituation. For mere information, besøg følgende Food and Drug Administration websider.

Isolation og karantæne

I henhold til § 361 i PHS -loven er HHS -sekretæren bemyndiget til at træffe foranstaltninger til at forhindre indtrængning og spredning af smitsomme sygdomme fra udlandet til USA og mellem stater. Myndigheden til at udføre disse funktioner på daglig basis er delegeret til Centers for Disease Control and Prevention (CDC), Division of Global Migration and Quarantine. Flere oplysninger om juridiske myndigheder til isolation og karantæne er tilgængelige på CDC's karantæne og isolationswebside.


Dødelig influenza fra 1918 Spuret benægtelse, derefter drastisk handling

Den seneste influenzaepidemi har dræbt 14 San Diegans. I 1918 rejste epidemien med soldater, der gik og vendte tilbage fra krig.

Nær lukning af hele byen, obligatoriske ansigtsmasker og hundredvis af dødsfald var kun uger frem, sammen med en episk kamp om handel kontra folkesundhed.

Men ingen i kystbyen ved grænsen var for bekymrede over en dødelig influenza, der hærgede verden over i september 1918. “San Diego er fuld af forkølelse lige nu, bemærkede en lokal avis, men det var ikke engang i en historie. Det var bare en reklame for noget, der hedder Dover ’s Powders.

Tingene ændrede sig næsten øjeblikkeligt. Inden for få dage blev lejre med soldater fra første verdenskrig i karantæne, den lokale sundhedsstyrelsespræsident advarede om en sygdom “ mere morderisk end nogen epidemi, nationen endnu har oplevet ”, og embedsmænd lukkede skoler, teatre, kirker og mere.

Den dødeligste epidemi, der nogensinde ramte nationen, var kommet til San Diego, hvor det ville tage livet af 368 mennesker, eller omkring en ud af hver 200 indbyggere. Mange af de ramte var unge og stærke, i modsætning til ofrene for dette års influenzasæson i amtet. (Indtil nu er 14 mennesker døde, deres alder varierede fra 46 til 92 år, og alle på nær én var allerede svækket af eksisterende sygdomme.)

Fra Kansas til verden

Epidemien af ​​den spanske influenza startede ikke i Spanien. De første rapporter i verden kom fra en militærlejr i Kansas, hvor snesevis af mænd døde efter at have kæmpet for at trække vejret midt i feber, hovedpine, kulderystelser og væskefyldte lunger.

Andre soldater overlevede for at blive sendt ud til Europa for at kæmpe i første verdenskrig i Europa. De spredte næsten helt sikkert sygdommen til det kontinent, hvor hundredtusinder blev syge og døde.

Da september 1918 blev til oktober, ville hundredvis dø på enkelte dage i Philadelphia og Boston, og de første rapporterede tilfælde af den dødelige influenza dukkede op i San Diego på Army ’s Camp Kearny.

I begyndelsen af ​​oktober var fire militære faciliteter i karantæne. Træningen “Bluejackets ” på en søtræningslejr i Balboa Park måtte holde fast og ikke tage deres sædvanlige frihed tre gange om ugen. De spillede sport og spil i stedet, rapporterede San Diego Union.

Ingen spyt i Balboa Park

“Bestillingen er gået bort fra, at der ikke må være nogen ekspektorat på parkens gader, ” rapporterede avisen. “The punishment is that the lad spitting on the street or the plaza must wear a cigar box swung about his neck, and this box is partially filled with sand and serves as a receptacle for the cigarette and cigar stubs of the victim’s shipmates.”

The city itself, though, didn’t worry too much. Bustling with 70,000 residents and just three years past the exposition that put Balboa Park on the national map, San Diego had other things on its mind. Soldiers were flooding the city to prepare to fight in the war, and the recently elected mayor who’d run on a “More Smokestacks” platform, was pushing for more business.

As the flu worsened, city leaders took a pro-business position. They weren’t too interested in shutting anything down to prevent the flu’s spread even after the local coroner quit to protest their lack of action. What about tourism? Company balance sheets? Individual wallets? They were in danger too, and furious businessmen fought the closure of stores.

At a public meeting, a theater owner who didn’t want to shut down declared that doctors were overcharging flu patients. A doctor exploded in anger: “If this man will meet me on the street and repeat his statement, he’ll be in the hospital, or I will!”

An Angry Mayor and No ‘Pretty Faces’

Minds changed. Even the mayor tired of hearing from those who wanted to keep stores and theaters open despite the spread of infection. “There is a class of people blind and indifferent to the death and sick rate, apparently unconcerned about everything else but nickel nursing and sight-seeing,” declared the mayor, Louis Wilde. “If we cannot put life and health above dollars and pleasure for a few days, we had better abolish the Bible and the Constitution. I cannot see a particle of difference between the invasion of France by the heartless, lustful Huns and the invasion of our homes by some epidemic permitted by greed and politics.”

Ultimately, the city was almost entirely shut down for several days in December, with schools, theaters, dance halls, churches and many other public places ordered closed. Masks were mandated, and if citizens refused, they were fined and listed in the newspapers. (“We miss their pretty faces,” moaned the San Diego Union when young women wore masks.)

Decades later, in 1985, a 100-year-old woman told the San Diego Union that she wouldn’t allow her two young flu-stricken children to get out of bed until their temperatures returned to normal: “several young people died because they got out of bed too soon. It took a great deal of care to get over the flu then.”

By Christmas Eve 1918, the epidemic had dissipated enough to stop the mask requirement. It was still raging to the north, however, and health officials urged locals to avoid going to Los Angeles if possible. The Union even blamed people from L.A. for continuing to bring the flu here.

50 Million Dead

The new year, 1919, finally brought the end of the Spanish flu epidemic. San Diego had avoided the high death tolls that struck other parts of the country and the world, perhaps because it wasn’t densely populated. By one estimate, the flu killed 50 million people worldwide.

The Spanish Flu epidemic still haunts the medical world today. Why did the flu kill so many young people, whose strong and healthy bodies should have fought it off? How did it spread so easily in a world that was hardly as interconnected as it is today? And what should the government do — or not do — when an epidemic strikes in these days of skepticism about basic prevention tools like flu vaccinations?

Civil rights advocates have been raising the alarm about epidemics since states began revising their laws after Sept. 11 and the growing threat of bioterrorism.

Regulations about quarantines, in particular, have come under fire from critics who say they don’t allow for due process. The problem is that “the history of quarantine is replete with discriminatory practices,” according to a 2010 Loyola of Los Angeles Law Review article.

In California, Quarantine Law Is Strong

Each state has its own rules about medical emergencies. California’s laws are vague and only require local health officials to meet a “low standard of proof” before quarantining someone, according to the Loyola article. In Los Angeles County, for example, it’s more complicated to quarantine an animal with rabies than a person with an infectious disease.

California’s quarantine law allows law enforcement officers to destroy property to prevent the spread of an infection. State health officials even have the ability to “quarantine, isolate, inspect, and disinfect” entire cities or “localities.”

In other words, the state could declare San Diego off limits to the rest of the state, or prevent its residents from going elsewhere, all to keep a germ from spreading.

This story relies on details from “The Spanish Influenza Epidemic in San Diego, 1918-1919,” by Richard H. Peterson, in the spring 1989 issue ofSouthern California Quarterly, the National Archives and “Unforgettable: Pandemic 1918,” by Jeff Smith, in the Sept, 23, 2009, San Diego Reader, and San Diego History Center notes by historian Richard Amero.

Randy Dotinga is a freelance contributor to Voice of San Diego. This content is not available for republishing without his consent. Please contact him directly at [email protected] and follow him on Twitter: twitter.com/rdotinga.

Afsløring: Voice of San Diego members and supporters may be mentioned or have a stake in the stories we cover. For a complete list of our contributors, click here.


How DC Churches Responded When the Government Banned Public Gatherings During the Spanish Flu of 1918

As World War I was coming to a close, still another enemy was making its way toward the nation’s capitol: the Spanish Flu. Between October 1918 and February 1919, an estimated 50,000 cases were reported in the District of Columbia 3,000 D.C. residents lost their lives.[1] At the peak of the pandemic, the DC government banned all public gatherings, including churches. How Christians responded provides some lessons and principles for responding to similar dilemmas in our own day.

THE RISING DEATH TOLL

The first active cases in the District were reported in September 1918. Between September 21–26, six people succumbed to the flu. On September 26, Health Officer Dr. W. C. Fowler warned the public to be cautious about influenza but said he did not yet expect a full-on pandemic.[2] Han tog fejl. The next day saw three more deaths and 42 new cases.[3] From that point on, cases multiplied rapidly and deaths followed shortly thereafter.

When 162 new cases were reported on October 1, city officials took action. Public schools were ordered to close indefinitely and operating hours for stores were limited to 10 AM to 6 PM.[5] More closings followed in the next few days. On October 3, private schools and beaches were ordered to be closed. On October 4, the number of cases spiked 618 new cases were reported. As a result, the city Health Officer Dr. Fowler called for additional bans on public gatherings, including church services, playgrounds, theaters, dance halls, and other places of amusement.

An article from “The Star” on Sept. 27 draws attention to the rising death toll[4]

On October 4, the headline of the DC-based Aftenstjernen read “Churches Closed While Influenza Threatens in D.C.” According to official documentation, the formal request used the following language:

Whereas the surgeon general of the United States public health service and the health officer of the District of Columbia have advised the Commissioners of the District of Columbia that indoor public assemblages constitute a public menace at this time therefore, be it ordered by the Commissioners of the District of Columbia that the clergy be requested to omit all church services until further action by the Commissioners.[6]

THE RESPONSE OF PASTORS

DC churches responded by calling an emergency meeting of the Protestant ministers on Saturday, October 5. There, they “voted unanimously to accede to the request of the District Commissioners that churches be closed in the city.”[7] As Aftenstjernen reported the next day that the “Pastors Federation of Washington” would comply with and support the safety measures called for by the city.[8] Gathering at the New York Avenue Presbyterian Church, the pastors released the following statement:

Resolved, in view of the prevailing condition of our city (the widespread prevalence of influenza, that has called forth the request from the District of Columbia Commissioners for the temporary closing of all churches) we, the Pastors’ Federation, in special assembly, do place ourselves on record as cheerfully complying with the request of the Commissioners, which, we understand applies to all churches alike. We furthermore recommend that our people shall conduct in their own homes some form of religious worship remembering in prayer especially the sick, our allied nations at war and the present canvass for the fourth liberty loan.[9]

A gathering of representatives from 131 African-American churches decided likewise to abandon services. Although responses to this order were mixed, churches demonstrated a unified response by complying with the directives of the DC government.

The Saturday, October 5 edition of Aftenstjernen listed all of the church services for the following day. Most headings simply stated: “no services.”[10] Some churches listed longer messages in their newspaper advertisements, explaining their choice to gather outdoors instead. One Presbyterian Church explained their cancellation of services in the following way:

Inasmuch as it has seemed wise to the Commissioners of the District, after careful consideration of the question, to prohibit the gathering of the people on Sunday in their accustomed places of worship, may I suggest that at the usual hour of morning service you gather in your homes and unite in common prayer to the God of Nations and of families, that He will guide us in all wisdom in this time of trial, that our physicians and public officers may be led in their performance of duty and be strengthened by divine help, that the people may be wise and courageous, each in his place. Let us never forget that “Help cometh from the lord which made heaven and earth.” Behold He that keepeth Israel shall neither slumber nor sleep.[11]

OUTDOOR PUBLIC SERVICES

One way some churches managed to technically comply with DC regulations while continuing to meet was to obtain permits to gather outdoors. Examining the “Church Notices” section of newspapers at the time shows that many churches opted to gather outdoors on October 6—some in front of their buildings, others in public parks.[12]

The Washington Times | October 5, 1918[13]

Det Washington Times reported the same on October 6: “With the closing of churches by the Commissioners the pastors of the city have arranged for outdoor services.”[14] Another paper reported the day before,

All churches will be closed tomorrow. Open air services will be substituted wherever possible. Numerous permits have been obtained to hold services in various Government parks in the city. These open air services will continue each Sunday until such, time as the District Commissioners decide the influenza epidemic is sufficiently abated to warrant resumption of meetings in church buildings.[15]

While churches were forbidden from gathering indoors, there was still the possibility of obtaining permits to gather outdoors.[16]

THE HEALTH DEPARTMENT’S RESPONSE

This move by churches to hold services outdoors was not well received by District Health Commissioner Brownlow, who on October 9 ordered the ban on public meetings to include outdoor church gatherings.[17] “This order includes all indoor and outdoor services in churches,” Commissioner Brownlow said. “No outdoor gatherings will be allowed.”[18]

OPPOSITION TO THE BAN ON CHURCH GATHERINGS

Churches responded by complying with this additional restriction on outdoor gatherings. Over the following weeks, the number of new cases and deaths from the virus kept increasing in D.C., reaching its peak on October 18 when 91 deaths were reported in a 24 hour period along with 934 new cases—including the DC Commissioner, Louis Brownlow. Then, slowly, the influenza began to decline. The number of deaths reported in a 24-hour period declined to 28 on October 28, and the number of new cases declined to 235.[19]

As these numbers began to decline, churches started to argue for a lifting of the ban. On October 25, an opinion piece on the Friday edition of The Star argued that churches should be transferred from the prohibited to the regulated class of gatherings, such as war workers in factories. The author listed two reasons:

(1) Because intelligent stringent regulation can prevent absolutely the crowding of the church edifices and can eliminate or reduce to a minimum the danger of germ distribution through such assemblages and (2) Because the purposes of church assemblages are such as to entitle them to be the very last to be absolutely forbidden by the civil authorities.[20]

According to the author, church gatherings should only be prohibited when absolutely necessary because prohibiting church gatherings constitutes a threat to religious liberty:

Except in case of absolute, demonstrated unavoidable necessity public worship in the churches should not be prohibited by the civil authorities, because there is involved a certain infringement in spirit and effect of the free exercise of religious liberty. The authorities know that through national and civil loyalty their prohibitive order will be obeyed. [However] they should be reluctant to prevent men and women from doing that which their consciences and, in the belief of some of them, God’s command impel them to do.[21]

Additionally, the author argues that church gatherings actually have a positive effect of fighting the influenza:

In the influence of the churches upon the minds and souls of men, in quieting through strengthened faith in God the panic and fear in which epidemic thrives, the churches are potential anti-influenza workers, fit to co-operate helpfully with our doctors and our nurses, of whose fine record in these times that try men’s souls we are all justly proud.[22]

This author wasn’t the only one who opposed the ban on church gatherings. The very next day, October 26, another article reports that “strong pleas” were made to Health Officer Fowler and the Surgeon General by the Protestant Pastors Federation of Washington, DC. This group, which had exactly three weeks earlier voted to abide by the city’s restrictions on church gatherings, now sought unsuccessfully to obtain permission to gather for worship the following day. According to one newspaper, “The members of the delegation were told that until the health authorities feel fully assured that all danger of the spread of infection through large public gatherings has disappeared the ban would not be lifted.”[23] The Commissioners released a statement in response explaining that they did not “desire to interfere any longer than is made necessary by unusual conditions with the regular assemblage of the people in their churches.” However, they indicated no move to lift the general ban on all public gatherings, including churches, theaters, and moving picture houses until the influence of the influenza had abated.[24]

In a letter to the editor in that evening’s edition of Aftenstjernen, Rev. Randolph H. McKim, pastor of the Church of the Epiphany in Washington DC, protested the continued ban on church gatherings.[25] In the opinion piece, he argued in strong terms that “nothing has so contributed to that state of panic which has gripped this community as the fact that the normal religious life of our city has been disorganized.” He further protested that when the Federation of Pastors met with the City Commissioners to consider the matter, the Commissioners reasoned purely on “materialistic grounds.” No weight or consideration was given to the power of prayer or the comfort against anxiety that church gatherings would provide. In the authors’ words, “That prayer had any efficacy in the physical world was an idea that was given no hospitality” by the Commissioners.[26]

Letters and appeals from pastors to the Commissioners to lift the ban continued for several more days as deaths and new cases continued to decline. One Baptist minister, Pastor J. Milton Waldron, published an editorial on October 29, writing on behalf of “the eleven hundred members of Shiloh Baptist Church.” In the article, Pastor Waldron expresses his members’ concern that the city officials are carelessly “interfering with the freedom of religious worship.” In particular, his people feel that “the authorities are woefully lacking in reverence to God and wanting in a correct knowledge of the character and mission of the church when they place it in the same class with poolrooms, dance halls, moving picture places, and theaters.” As Waldron puts it, “The Christian church is not a luxury, but a necessity to the life and perpetuity of any nation.”[27]

THE BAN LIFTED

Then, finally, on October 29 the Commissioners released an order to lift the ban:

That the operation of the Commissioners’ order of October 4, 1918, requesting the clergy of Washington to omit all church services until further action by the Commissioners, be terminated on Thursday, October 31, 1918.

According to the DC health officer Dr. Fowler, conditions were such now that he felt assured by the fall in the death rate and the reduction in the number of new cases that “it was safe to open the churches this week [Thursday] and the opening of the theaters, schools, and other public gathering places Monday.”[28] A few churches placed advertisements in the Wednesday, October 30 edition of The Star announcing the resumption of services. For instance, Calvary Baptist Church announced that it would be resuming its mid-week prayer meeting on Thursday, October 31 as well as regular services on Sunday, November 3.[29]

On that first Sunday, the Reverend J. Francis Grimke preached a powerful sermon that was later published and distributed, “Some Reflections: Growing Out of the Recent Epidemic of Influenza that Afflicted Our City.”[30] In the sermon, Grimke acknowledges that there was “considerable grumbling” on the part of some regarding the closing of churches. However, he offered a defense of the ban on gatherings:

The fact that the churches were places of religious gathering, and the others not, would not affect in the least the health question involved. If avoiding crowds lessens the danger of being infected, it was wise to take the precaution and not needlessly run in danger, and expect God to protect us.[31]

In conclusion, the influenza of 1918 provides an example of how churches in Washington DC responded to a public health crisis and government orders to close churches. During one of the worst epidemics to ever hit our country, churches respected the directives of the government for a limited time out of neighborly love and in order to protect public health. Even when churches began to disagree with the Commissioners’ perspective, they continued to abide by their orders. This demonstrates a place for freedom of speech and advocacy while respecting and submitting to governing authorities.

[3] Evening star. [volume] (Washington, D.C.), 27 Sept. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-09-27/ed-1/seq-1/

[4] Evening star. [volume] (Washington, D.C.), 27 Sept. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-09-27/ed-1/seq-1/

[5] Evening star. [volume] (Washington, D.C.), 02 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. <https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-02/ed-1/seq-1/>

[7]The Washington times. [volume] (Washington [D.C.]), 05 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn84026749/1918-10-05/ed-1/seq-2/. Accessed on March 10, 2020.

[8] Evening star. [volume] (Washington, D.C.), 06 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-06/ed-1/seq-7/

[10] Evening star. [volume] (Washington, D.C.), 05 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-05/ed-1/seq-10/. March 10, 2020.

[11] Evening star. [volume] (Washington, D.C.), 05 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-05/ed-1/seq-10/. March 10, 2020.

[12]The Washington times. [volume] (Washington [D.C.]), 05 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn84026749/1918-10-05/ed-1/seq-2/. Accessed on March 10, 2020.

[13]The Washington times. [volume] (Washington [D.C.]), 05 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn84026749/1918-10-05/ed-1/seq-2/. Accessed on March 10, 2020.

[14] “The Washington Times,” October 06, 1918, NATIONAL EDITION, Page 19. https://chroniclingamerica.loc.gov/lccn/sn84026749/1918-10-06/ed-1/seq-19/. Accessed on March 10, 2020.

[15] The Washington times. [volume] (Washington [D.C.]), 05 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn84026749/1918-10-05/ed-1/seq-2/. Accessed on March 10, 2020.

[17] The Washington Times, October 9, 1918, p. 3.

[19] Evening star. [volume] (Washington, D.C.), 28 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-28/ed-1/seq-2/

[20] Evening star. [volume] (Washington, D.C.), 25 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-25/ed-1/seq-6/. P. 6.

[22] Evening star. [volume] (Washington, D.C.), 25 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-25/ed-1/seq-6/. P. 6.

[23] Evening star. [volume] (Washington, D.C.), 26 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-26/ed-1/seq-1/

[24] Evening star. [volume] (Washington, D.C.), 26 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-26/ed-1/seq-1/

[25] Evening star. [volume] (Washington, D.C.) 1854-1972, October 26, 1918,

[27] Evening star. [volume] (Washington, D.C.), 29 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-29/ed-1/seq-24/

[28]Evening star. [volume] (Washington, D.C.), 29 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-29/ed-1/seq-1/

[29] Evening star. [volume] (Washington, D.C.), 30 Oct. 1918. Chronicling America: Historic American Newspapers. Lib. of Congress. https://chroniclingamerica.loc.gov/lccn/sn83045462/1918-10-30/ed-1/seq-3/

[30]Grimké, F. J. (Francis James)., Butcher, C. Simpson. (1918). Some reflections, growing out of the recent epidemic of influenza that afflicted our city: a discourse delivered in the Fifteenth Street Presbyterian Church, Washington, D.C., Sunday, November 3, 1918. [Washington, D.C.?]: https://babel.hathitrust.org/cgi/pt?id=emu.010002585873&view=1up&seq=3

A graduate of Georgetown University and The Southern Baptist Theological Seminary, Caleb Morell is a pastoral assistant at Capitol Hill Baptist Church. You can follow him on Twitter at @calebmorell.


These surprisingly relevant vintage ads show how officials tried to convince people to wear masks after many refused during the 1918 flu pandemic

As the Spanish flu swept through the US in 1918 and 1919, face masks became ubiquitous to help in preventing the spread of the disease, much as they have today during the coronavirus pandemic.

However, many refused to wear them in 1918, saying that government-mandated mask enforcement violated their civil liberties. An "Anti-Mask League" was even formed in San Francisco to protest the legislation.

But men, it turns out, needed more convincing than did women to heed the advice of public health officials.

Some men associated masks with femininity, and behaviors like spitting, careless coughing, and otherwise dismissal of hygiene made men the "weak links in hygienic discipline" during the 1918 pandemic, according to a 2010 report published in the US National Library of Medicine. So public health leaders rebranded personal care as a display of patriotism and duty to incentivize men to wear masks.

"The influenza pandemic offered a teaching moment in which masculine resistance to hygiene rules associated with mothers, schoolmarms, and Sunday school teachers could be replaced with a more modern, manly form of public health, steeped in discipline, patriotism, and personal responsibility," reads the report.

It's yet another instance of history rhyming. Fast forward to the present-day coronavirus pandemic and anti-lockdown protests dot the US, with many refusing to wear masks and citing their civil liberties as a reason for defying public health orders. A recent survey of 2,459 people found that men specifically see masks as "a sign of weakness" and "not cool" and are less likely to wear face masks outside.

Many of the adverts and public health messaging during the 1918 pandemic encouraging the public to practice good hygiene depicted men and young boys. Here's what some of them looked like.


COUNCIL PLANS VOTE TODAY ON QUARANTINE REGULATIONS

One of the most drastic influenza quarantines in any American city since the outbreak of that malady will go into effect at midnight tonight in San Diego, provided the city council, at 10, o’clock this morning, passes an ordinance which it late yesterday ordered the city attorney to prepare. This ordinance, if adopted, and members of the council say they will vote for it, will close all places in the city except those necessary for the distribution of necessities of life, until Wednesday afternoon, Dec. 11, a period of six days.

The resolution passed by the council, after a stormy session, in which members of the board of health, business men and theatrical managers took part, is as follows:

“That the city attorney be and he is hereby authorized and directed to prepare and present to this common council the necessary papers to enable them to establish and enforce an absolute quarantine upon all places within the city of San Diego, such quarantine to continue up to the hour of 2 o’clock p.m. of Wednesday, Dec. 11, A.D. 1918, and which time said order and quarantine shall expire.

“The order of quarantine to contain such provisions as will authorize the distribution of the necessities of life, and to also contain an emergency clause and a provision for the punishment of a violation of such order.”

City Attorney Cosgrove and his deputies were at work last night on an ordinance covering the entire situation. The city attorney said that he expects to have the ordinance in the hands of the council promptly at 10 o’clock this morning. He was not prepared last night to say just what will be specified in the ordinance as “necessities of life.”

A resolution presented by the board of health to the council yesterday afternoon will be embodied in the ordinance, but greatly enlarged upon. The health board resolution, which did not provide for the closing of stores, and which was not adopted by the council for that reason, was as follows:

“Resolved, That all schools, public and private, churches, lodges, waiting rooms, saloons, poolrooms, clubs, theatres and moving picture shows, public swimming pools, dance halls, rest rooms in stores and other places be closed: that all public or private gatherings of any kind or character, women’s meetings, dinner parties, and all other gatherings or meetings of citizens in any hotel room or building within the city, in parks, or any public place within doors or out of doors, be, and the same are hereby prohibited that all employes in the city, who in the course of business come in contact with the public are hereby required to wear masks while waiting upon or serving the public that all crowding in street cars be prohibited that street cars are hereby required, while being operated, to keep windows and doors open, and during the continuance of the influenza epidemic no street car shall be permitted to carry more passengers at any one time than can be seated therein that no person be permitted to enter a store or place where merchandise is sold or offered for sale without wearing a gauze mask that all elevators in the city shall be prohibited from carrying a number of passengers in excess of the number designated by the inspector of the health department that all cases of influenza be subject to a strict quarantine, including all members of the household, for a period to be determined by the physician in attendance.

“And be it further resolved, That we respectfully request the common council to pass an ordinance informing the provisions of this resolution and providing a proper penalty for violation thereof.”

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Face-Covering Requirements and the Constitution

To slow the spread of COVID-19, the federal Centers for Disease Control and Prevention (CDC) currently recommends the use of cloth face coverings in public settings such as grocery stores where other social distancing measures are difficult to maintain. Medical experts say that “Apart from avoiding crowded indoor spaces, the most effective thing people can do is wear masks.” Some state and local governments mandate the use of face masks or coverings in specific settings, typically in retail establishments and on public transportation. As face-covering requirements multiply around the country, lawsuits challenging them follow.

In a public health emergency, can state or local governments require the general public to wear face coverings? More than a century has passed since face mask ordinances proliferated in U.S. towns and cities during the 1918-1919 pandemic flu. Face mask ordinances, where they existed, could be enforced with citations and fines, with municipal judges holding what journalists referred to as “ influenza court ” in which a citizen could contest the citation and hope to avoid paying a fine. Few reported court decisions (and none from federal courts) emerged from that era. But as a general rule, judges deferred to state and local elected officials on face-mask ordinances, as well as the decision to close businesses and schools and prevent public gatherings.

In the face of that devastating pandemic, the judicial branch seemed to adopt a non-justiciable, political question-type approach to local health measures in an emergency. Typical is the Supreme Court of Arizona’s pronouncement, “Necessity is the law of time and place, and the emergency calls into life the necessity … to exercise the power to protect the public health.” In 1905, the U.S. Supreme Court had called for just such deference in Jacobson v. Massachusetts . In the midst of a small-pox outbreak, local authorities could mandate vaccination on penalty of a fine for refusal: “Upon the principle of self-defense, of paramount necessity, a community has the right to protect itself against an epidemic of disease which threatens the safety of its members.”

Constitutional doctrine changed profoundly over the ensuing century, not only with respect to due process and equal protection but also individual and associational rights under the First Amendment. Endnu Jacobson has continued to be the seminal decision on public health authority in an emergency, against which modern civil rights and liberties are balanced.

This is why Chief Justice John Roberts’s invocation of Jacobson in a recent religious liberty case is a significant signal. I South Bay United Pentecostal Church v. Newsom , the Chief Justice affirmed the central position of Jacobson v. Massachusetts :

Our Constitution principally entrusts “[t]he safety and the health of the people” to the politically accountable officials of the States “to guard and protect.” Jacobson v. Massachusetts, 197 U. S. 11, 38 (1905). When those officials “undertake to act in areas fraught with medical and scientific uncertainties,” their latitude “must be especially broad.” Marshall v. United States , 414 U. S. 417, 427 (1974). Where those broad limits are not exceeded, they should not be subject to second-guessing by an “unelected federal judiciary,” which lacks the background, competence, and expertise to assess public health and is not accountable to the people.

The 5-4 decision generated a dissent by Justice Kavanaugh, joined by Justices Thomas and Gorsuch. Still, as the U.S. Supreme Court’s first foray into COVID-19 control efforts by state and local governments, Chief Justice Roberts clearly intended to provide broad guidance to lower courts. Jacobson v. Massachusetts counsels judges to afford wide latitude to the judgment of health experts, so long as such measures are neutral, generally applicable, and have a medical necessity a government can justify. Thus while courts must be deferential to the need to protect public health, courts must also be vigilant against abuses of public health powers. To do that they must ask what is reasonable, look at the public health evidence, and be attuned to the pre-textual or abuse of power.

A number of courts to date have affirmed the authority of state or local governments to impose social distancing measures such as temporary business closures , although religious freedom claims have a mixed reception. Are face-covering requirements different, though? At one level, the answer is clear: In the face of a virus spread through respiration where a significant percentage of contagious people have no symptoms, abundant medical justification exists for a state or local government to consider this a necessary public health measure. “Neutral” and “generally applicable” will be key in evaluating state-imposed face-mask requirements under both federal and state constitutions, as is the case for other public health emergency measures such as restrictions on gatherings and temporary business closures.

Face mask requirements also should allow exceptions for medical need, such as persons with breathing problems. I KOA v. Hogan , the face-covering requirement included an exception based on guidance from the Maryland Department of Health : “People with disabilities who are unable to wear a mask are provided reasonable accommodations per the Americans with Disabilities Act.” I Pennsylvania , seven individuals have sued a grocery chain for failing to provide reasonable ADA accommodations when they tried to enter the store without a face covering. For state or local face-covering mandates, courts would likely require an exception for those whose medical condition prevent safely covering airways, as the court in Koa v. Hogan indicated.

But face-covering requirements are different from other social-distancing measures in this respect: Is a face-covering requirement “forced speech,” or does it violate a right to freedom of expression, to identify with a political position, for example? At least one federal court has rejected this claim. I Koa v. Hogan , a group of military veterans alleged harm from association with capture on the battlefield and “subservience to the captor,” a meaning the court held not to be “overwhelmingly apparent.” More to the point, the court stated, “Requiring necessary protective equipment be worn to engage in certain public activities is simply not the equivalent of mandating expressive conduct.” Face-covering requirements regulate conduct, not speech. The State of Maryland had established a rational basis between the bestille to cover faces in public areas and the legitimate public interest in protecting citizens against COVID-19.

Industry-specific regulation of employers present fewer constitutional hurdles. A 2016 New York case, Spence v. Shah , held that a healthcare employer could require a nurse to wear a protective mask if she refused to get a flu vaccine. New York courts have since upheld similar requirements. I Michigan, New York, and Rhode Island, Governors have ordered that all employers provide face masks and require employees to wear them if the employees will be in close contact with others. Det EEOC reminds employers to provide reasonable accommodations for religion and disability if they do provide facemasks. Whole Foods has required that third party workers (e.g. Instacart shoppers) wear their own masks to shop. Some consumer retail establishments require customers to wear face coverings in the absence of a state or local mandate that they do so, such as Empire State South in Atlanta.

No-smoking ordinances for restaurants and other retail establishments provide a useful comparison. Even in the absence of a public health emergency, state and local governments have ample authority to protect the health of the general public in indoor spaces. Smoking bans, for example, are designed to protect the health of employees and patrons, not the smoker, and such ordinances have been routinely upheld as within the police power of the state. Cumulative evidence of harm to health from second-hand smoke readily supplies a rational basis for state action.

Similarly, the CDC estimates that up to 35% of people infected with the coronavirus have no symptoms, yet they may unknowingly infect others when in close contact in enclosed spaces. Masks reduce the chance of infected people transmitting the respiratory droplets that contain the virus. State or local face-covering requirements rely on the current medical consensus that not wearing a face covering or mask may endanger others. Jacobson recognized that a state’s duty to “guard and protect…the safety and health of the people” includes the duty not to endanger others: “Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect to his person or his property, regardless of the injury that may be done to others.”

I South Bay , Chief Justice Roberts himself recognized the extraordinary situation we find ourselves in:

The Governor of California’s Executive Order aims to limit the spread of COVID–19, a novel severe acute respiratory illness that has killed thousands of people in California and more than 100,000 nationwide. At this time, there is no known cure, no effective treatment, and no vaccine. Because people may be infected but asymptomatic, they may unwittingly infect others.

Som bemærket i KOA v. Hogan , when leaders exercise “the powers given to [them] by the legislature in the face of the COVID-19 Crisis, [and] have made reasonable choices informed, if not dictated, by such data science and advice,” courts will generally uphold those orders. Neutral and generally applicable face-covering requirements are rational countermeasures adapted to rapidly changing data about a viral pandemic. (For that matter, face-mask requirements are also substantially related to an important government objective, should some form of heightened scrutiny apply to interests in bodily integrity.) The Supreme Court has—and lower courts should—entrust the politically accountable branches with protecting public health and safety.


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