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With the The Covid-19 pandemic still raging and resurging is not the first time in the United States, that public health officials are encouraging encouraged people to wear masks to limit the spread of the a deadly virus. In some parts of the United States, there has a surprising number of Americans have been hostility to angered by thissimple request. This reaction should not be unexpected. Similarly, during the 1918 so-called Spanish Flu pandemic , mask-wearing was also faced similar hostility in places to wearing maskspoliticized. Public In desperation, public health officials then turned to a variety of various tactics to get people convince Americans to wear masks then that might help encourage some to wear masks in modern epidemics.

====The 1918 During the Flu Pandemic and Masks==were people punished if they did not wear masks? ==[[File:3a049913-e8f6-4e22-927c-df23ca2fa036-Mask style article.jpg|thumb|left|Figure 2. Masks being shown as fashion items, with some ways suggested makiing the masks useless. ]]By the autumn of 1918 in the United States, it was clear the flu pandemic was becoming out of control and that surging . Surging cases across the country required public health officials to issue direct guidance for people to wear masks. For some states, masks were seen as part of policies such as a broader set of social distancing, washing hands, and general cleanliness to avoid the spread of spreading the virus. Some cities in the Western United States, including some cities towns now where we see hostility to wearing masks, passed laws that required masks to be worn at all times by the autumn of 1918. This included These laws were implemented in places all over the United States, including Phoenix, San Francisco, and even Juneau, Alaska (Figure 1). Punishments ranged from fines to imprisonment in cities. While most punishments for not wearing a mask were fines, prison sentences did occur. There was one infamous incident in San Francisco, where a special officer hired by the Board of Health to enforce mask wearing, shot a man who had earlier refused to wear a mask; two bystanders even were hit by the shooting. In another case in San Francisco, at a boxing match attended by many dignitaries from the city and government, a photographer shot a photo of that night and the well known individuals present. That photograph led to many officials being shamed for not wearing masks. People who were caught not wearing masks included a congressman, a court justice, a Navy rear-admiral, a health officer and the mayor. This led to fines for these officials and public shaming, although none of these individuals were imprisoned as others had been. Nevertheless, most people or places that had rules requiring masks generally had no major issues or incidents. Only after substantial declines in deaths and infections did most of these cities that passed mask-wearing laws gradually removed the requirement about masks.<ref>For more on laws and ways cities got people to wear masks in the 1918 flu pandemic, see: Crosby, Alfred W. <i>America’s Forgotten Pandemic: The Influenza of 1918</i>. 2nd ed. Cambridge ; New York: Cambridge University Press, 2003.</ref>

Masks Punishments ranged from fines to imprisonment in 1918, however, have been criticized cities. While most punishments for being ineffective or at least limited in preventing spread of the 1918 virus. The American Public Health Association in December 1918 concluded that not wearing a mask should be compulsory for medical staffwere fines, barbers, dentists, and other occupations that come into close contact with other individualsprison sentences did occur. HoweverOne infamous incident in San Francisco, it found masks were not always beneficial, but that mainly had to do with where a special officer hired by the materials they were made from or incorrect use Board of masks. Thus, the board recommended that only workers in close contact wear them and others who wish Health to do so should be instructed on the proper way in making and enforce mask-wearing masks. A later study in 1927 did, however, show that those shot a man who wore masks generally did help had earlier refused to limit the spread of the 1918 virus. The study also determined there wear a mask; two bystanders even were many misconceptions of what masks were for and this was part of the problem. Masks should be presented to the public as devices that help infected people from spreading their infection, whereas many people saw them differently and took them to even be a stigma. The study recognized also there is likely hostility in wearing masks in countries emphasizing individual freedom. The study made clear that masks should be presented as something that should be worn because it reflects hit during the presence of a serious disease where public and community health is more important than individual rights at a given time.<ref>For more on this study looking at the effectiveness of masks in 1918, see: Jordan, Edwin. <i>Epidemic Influenza: A Survey</i>. Chicago: University of Chicago, 1927shooting. </ref>

====Other Efforts Related to Masks==Did medical professionals support wearing masks?==Not all cities passed such laws requiring masks in 1918Nevertheless, but there were still efforts to get most people to wear or places that had rules requiring masksgenerally had no major issues or incidents. One effort attempted to get people to wear masks by stating that the effort was patriotic since it helped prevent the spread of the virus to US soldiers, who were severely impacted by the pandemic both Only after substantial declines in the US deaths and in Europe while serving. This seems to have worked as it appealed to people's patriotism and feeling infections did most of supporting these cities gradually removed the war effortrequirement about masks. There were still some dissenters <ref>For more on laws and even an Anti-Mask League was formed in San Francisco. Other ways cities, such as Seattle, did try appealing to people's fashion sense as a way to get got people to wear masksin the 1918 flu pandemic, see: Crosby, Alfred W. One newspaper, <i>Seattle Daily TimesAmerica's Forgotten Pandemic: The Influenza of 1918</i>. 2nd ed. Cambridge ; New York: Cambridge University Press, even created a headlines titled2003.</ref> [[File: “Influenza Veils Set New Fashion: Seattle Women Wearing Fine Mesh With Chiffon Border to Ward Off Malady3a049913-e8f6-4e22-927c-df23ca2fa036-Mask style article." The idea of calling them veils, rather than masks, was intended to get people to feel they were more of a fashion item, perhaps similar to how some masks today are relatively decorative (jpg|thumb|left|Figure 1)2. Perhaps Masks being shown as fashion items that also potentially made the newspaper took liberty with interpreting them as a new fashionable trendmasks useless. Some ways suggested by newspapers]]Masks in 1918, however, made were criticized for both being ineffective and having a limited value in slowing the spread of the 1918 virus. The American Public Health Association in December 1918 concluded that wearing masks uselessshould be compulsory for medical staff, barbers, dentists, despite any positive intentions these newspapers had (Figure 2)and other occupations that come into close contact with other individuals. Finally, embarrassing people Even though it was another tactic usedfound that masks were not always effective, with some places having the local newspaper print the names most of people who their concerns were caught not wearing a mask.<ref>For more direct and indirect methods used to get people to wear result of masks, see: Bristow, Nancy K. <i>American Pandemic made from inappropriate materials or the Lost Worlds incorrect usage of the 1918 Influenza Epidemic</i>these masks. Oxford: Oxford University PressIn essence, they supported masks' use, 2017but only if they were used properly and created with the correct materials.</ref>

====Complaints and Concerns====The standard complaints people did give in 1918 on why they did not wear masks did varyThus, besides the main reason being board recommended that some saw only workers in close contact wear them as impinging on their personal freedom. One of the most common complaints was they were hot , and stuffy. Some businesses worried masks would limit sales, as people would not want others who wish to wear them do so they would not go outside should be instructed on the proper way of making and shop. Others pointed out that mask were ineffective. Many of these complaints had merit, although they could have been remedied or at least minimized, such as wearing masks properly to make them more comfortable and effective as well as providing information as to why they were being used for public health. For instanceHowever, people were caught making holes a later study in their 1927 showed that those who wore masks so they could smoke, negating generally did help limit the utility spread of a maskthe 1918 virus. Protests did spring up, including those organized by anti-mask groups such as the Anti-Mask League, but generally people complied with either laws requiring masks to be worn or followed due to public pressure and sense The study also determined many misconceptions of duty.<ref>For more on complaints and concerns about what masks in 1918/1919were for, see: Phillips. H, and David Killingray, eds. <i>The Spanish Influenza Pandemic which was part of 1918-19: New Perspectives</i>. Routledge Studies in the Social History of Medicine 12. London ; New York: Routledge, 2003problem.</ref>

Masks should be presented to the public as devices that help infected people spread their infection, whereas many people saw them differently and took them even to be a stigma. The study also recognized there is likely hostility in wearing masks in countries emphasizing individual freedom. The study made clear that masks should be presented as something that should be worn because it reflects the presence of a serious disease where public and community health is more important than individual rights at a given time.<ref>For more on this study looking at the effectiveness of masks in 1918, see: Jordan, Edwin. <i>Epidemic Influenza: A Survey</i>. Chicago: University of Chicago, 1927. </ref> ==Other Efforts Related to Masks==SummaryNot all cities passed such laws requiring masks in 1918, but there were still efforts to get people to wear masks. One action attempted to get people to wear masks by stating that the effort was patriotic since it helped prevent the spread of the virus to US soldiers. The pandemic severely impacted the United States troops both in the US and Europe. This effort worked because it appealed to people's patriotism and gave them a tangible way to support the war effort.  There were still some dissenters, and even an Anti-Mask League was formed in San Francisco. Other cities, such as Seattle, tried appealing to people's fashion sense to get people to wear masks. One newspaper, <i>Seattle Daily Times</i>, even created headlines titled: "Influenza Veils Set New Fashion: Seattle Women Wearing Fine Mesh With Chiffon Border to Ward Off Malady."  The idea of calling them veils, rather than masks, was intended to get people to feel they were more of a fashion item, perhaps similar to how some masks today are relatively decorative (Figure 1). Perhaps also the newspaper took liberty with interpreting them as a new fashionable trend. However, some ways suggested by newspapers made masks useless, despite any positive intentions these newspapers had (Figure 2). Finally, embarrassing people were also tried by the authorities. In some places, the local newspaper printed the names of people who were caught not wearing masks. <ref>For more direct and indirect methods used to get people to wear masks, see: Bristow, Nancy K. <i>American Pandemic the Lost Worlds of the 1918 Influenza Epidemic</i>. Oxford: Oxford University Press, 2017.</ref> ==Why did people refuse to wear masks? ==The standard complaints people did give in 1918 on why they did not wear masks did vary, besides the main reason being that some saw them as impinging on their personal freedom. One of the most common complaints was they were hot and stuffy. Some businesses worried masks would limit sales, as people would not want to wear them, so they would not go outside and shop. Others pointed out that masks were ineffective. Many of these complaints had some merit, although they could have been remedied or at least minimized, such as wearing masks properly to make them more comfortable and effective and providing information as to why they were being used for public health.  For instance, people were caught making holes in their masks to smoke, negating the utility of a mask. Protests did spring up, including those organized by anti-mask groups such as the Anti-Mask League. Still, generally, people complied with the laws requiring masks to be worn or followed due to public pressure and a sense of duty.<ref>For more on complaints and concerns about masks in 1918/1919, see: Phillips. H, and David Killingray, eds. <i>The Spanish Influenza Pandemic of 1918-19: New Perspectives</i>. Routledge Studies in the Social History of Medicine 12. London ; New York: Routledge, 2003.</ref> ==Summary==The 1918 -1920 flu pandemic offers us valuable insights into efforts to get getting people to wear masks as well as and common complaints against them. Similar to today, American society debated their its utility and looked at issues of personal freedom and comfort. While many concerns and issues faced are familiar to us, people were also were creative in attempting to get people to follow community health practices. This ranged from These efforts included punishment, to embarrassment, appealing to patriotism, or making wearing creating more fashionable masks a more positive experience such as fashion sense. While these tactics were not always effective, they did also generally get convinced people to mostly wear masks at least in parts of the United States such as in the West.