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Mindblowing Tales From San Francisco's (Long) History With Epidemics

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 (Engin Akyurt/ Unsplash)

As we slowly trudge, un-showered and in sweatpants, towards the end of the first month of lockdown, mood swings are almost inevitable. Oscillating wildly between resignation, frustration and good old-fashioned anxiety has become the new normal.

It’s probably the perfect time, then, to point out that not only has the Bay Area been through epidemics before, it definitely handled things much, much worse the last time. And the time before that. Repeatedly. Especially in San Francisco.

The last time a health-related lockdown began in the city, it was Friday, Oct. 18, 1918, when the San Francisco Board of Health voted to close all schools and “places of public amusement” in an effort to stem the spread of the dreaded influenza. This was followed one week later by an order that required everyone in the city to don face masks in public.

Which all would have been smart and appropriate and proper if only city residents hadn’t been such stubborn jerks about cooperating with the orders. So many folks continued leaving their faces uncovered, the city had to start charging people with disturbing the peace, and punishing them with either $5-10 fines or county jail time.


Then, once restrictions on venues were lifted after a 28-day lockdown, people rushed straight out to socialize, fearlessly packing dance halls and theaters with their germs. Apparently leading by example, this included Mayor James Rolph, who attended a boxing match between Fred Fulton and Willie Meehan at the Civic Auditorium on Nov. 16, and was caught flouting his own mask rule so flagrantly that the police chief fined him $50.

Five days later, on Nov. 21 at noon, a city-wide whistle blast signaled that it was “safe” to take masks off. But people simply tossed them in the air, ignoring health officials’ pleas to save the gauze for later. The San Francisco Chronicle reported the following day that “sidewalks and runnels were strewn with the relics of a torturous month.”

Unsurprisingly, flu numbers flared up again after this premature move, and the city responded by sending out as much mixed messaging as humanly possible. Mayor Rolph told San Franciscans on Dec. 7 to put their masks back on, but an official ordinance from the Board of Supervisors didn’t come until Jan. 17, 1919.

To make matters worse, the fact that public places were still open and operating was apparently not enough to appease freewheeling San Franciscans. We know this because over 2,000 residents banded together in January to attend a rally organized by some geniuses calling themselves the Anti-Mask League. Mandatory mask use was lifted once again on Feb. 1 as the city grew tired of dealing with loudmouthed rebels flouting the law.

All told, the flu epidemic infected 45,000 San Franciscans, and killed 3,000 in the city, due to a deadly combination of mixed messaging from authorities and public resistance to restrictions.

Red Cross volunteer nurses tend to flu patients at the Oakland Municipal Auditorium in 1918. It was used as a temporary hospital during the epidemic.
Red Cross volunteer nurses tend to flu patients at the Oakland Municipal Auditorium in 1918. It was used as a temporary hospital during the epidemic. (Edward A. "Doc" Rogers/Library of Congress via AP)

San Francisco’s uneven response to health crises wasn’t limited to the 1918 flu epidemic. In 1888, a Biennial Report by the California Department of Public Health reported that the entire Bay Area was, at that time, dealing with cases of smallpox, scarlet fever, typhoid, consumption, diphtheria and cholera.

Amazingly, The Cholera Epidemic of 1873 in the United States, written by the U.S. Surgeon General’s Office in 1875, reports that cholera first landed in San Francisco as early as September 1850. This was due to the arrival of the S.S. Carolina—a steamer ship that had lost 13 passengers to the disease before it even docked—and exacerbated by an attitude to sanitation that can most kindly be described as laissez faire.

The following description is from 1854’s Annals of San Francisco:

The streets were thickly covered with black rotten mud. These were the proper dunghills of the town and were made a general depot for all kinds of rubbish and household sweepings, offal and filth. Sometimes the rains came and scattered the abominable stuffs, carrying part of them into the bay. Rats—huge, fat, lazy things—prowled about at pleasure… Sickening stenches invaded every quarter.

Outbreaks of cholera in San Jose, Carson Valley and Sacramento quickly followed—said to be made worse by the spread of the illness via “overland emigrants.” By the end of the 1850 cholera outbreak, over 1,000 residents had died in Sacramento alone, out of a population of 8,000.

It’s true that infrastructure, including plumbing, had a hard time catching up to the population boom born of the Gold Rush, but it’s also true that San Francisco, for the longest time, cared not what was docking in its Bay. Having failed to learn its lesson after the 1850 cholera outbreak, another infested ship (the S.S. Sam this time) was permitted to enter the city just five years later which—you guessed it—caused another deadly cholera outbreak.

This time, the disease’s spread was assisted by both crappy sanitation and makeshift living quarters. The San Francisco Historical Museum has since described the city of the period thusly:

What a strange town was that, the San Francisco of 1856, its 30,000 people in speedy transition from a city of tents and shacks to one of brick and stone buildings, architecturally on a par with those of Atlantic seaboard cities, and its flimsy wooden and more pretentious sheet iron buildings filling in the spaces in between.

Remarkably, an 1883 copy of the San Francisco Western Lancet medical journal suggests that, despite these outbreaks and dangerous habitations, sanitation in San Francisco remained in an abysmal state, even three decades later.

The sewer on Fifth Street, having no bottom, continually filling with shifting sand, causes the sewage to collect and foul gasses to generate. One man recently met his death there because of the foul condition of the sewer… Just consider for a moment the condition of a municipal government which will allow a cesspool five miles long to exist in the heart of its jurisdiction. It is a criminal neglect of duty.

No surprise, then, that San Francisco was treated to an outbreak of plague (actual Bubonic Plague!) as late as 1900. The neighborhood affected most was Chinatown, but California’s Governor at the time, Henry Gage, denied the outbreak was happening for two full years. By the time George Pardee replaced Gage in 1902 and started prioritizing people over commerce, the disease had such a foothold that it took another two years to quash.

Compared to these moments in the city’s history, we’re blessed in 2020 to have leadership willing to make decisive calls for the sake of public safety. Let’s not forget that San Francisco was the first American city to issue a stay-at-home order in this coronavirus crisis, and had zero qualms about extending its stay-at-home order until at least May 3.


One 2007 analysis of the 1918 flu epidemic claimed that if lockdown measures had stayed in place in San Francisco until Spring 1919, 90% of deaths in the region could have been prevented. The lessons from history are clear: Stay inside, be grateful for good plumbing and, most importantly of all, don’t be a rebellious jerk.

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