Returning to Normal: Lessons from the “Spanish Flu”

Published on December 14, 1918 in The Lima Times-Democrat

With the eased CDC guidelines on mask-wearing for those vaccinated, the lifting of mandates and safety restrictions have varied significantly. Public health authorities and individuals have speculated on the timeline for a “return to normal” and what that entails: how to reopen, the adjustment to social situations, and overall experiences for this transition. Much like this moment, people in 1918-19 faced similar questions as the influenza/pneumonia crisis subsided.

From 1918 through 1919, influenza infected at least one-third of the world, causing more than fifty million deaths, with over 675,000 in the U.S. Despite its name, “Spanish Flu” likely emerged in Haskell County, Kansas in March 1918. This deadly influenza and pneumonia combination first appeared at Camp Funston and the nearby Haskell Institute – a boarding high school for indigenous students. As war raged on in Europe, domestic outbreaks of the virus continued throughout April and May, receiving very little media coverage. To most Americans, the “Spanish Flu” seemed to begin in the summer, as newspapers told of rising cases in Asia, Germany, Spain, England, and other countries. When the flu returned to U.S. soil in September, notably at Fort Devens, Massachusetts, it was perceived as the first American wave. As outbreaks spread across cities and states, its news coverage competed with and sometimes paralleled the overseas battles.

Surgeon General Rupert Blue and the U.S. Public Health Service periodically put out information and guidelines on influenza – distributed through local and national newspapers. Similar to the COVID-19 pandemic, approaches and restrictions varied geographically.With only print media, content was limited to the broad scope of the national papers or nearby outbreaks in local newspapers. In other words, people knew little about what was going on outside of their own communities.

As cases rose, most towns and cities closed theaters, pool halls, and other businesses, banned dances, concerts and gatherings, and discouraged crowding in public spaces. But even this was inconsistent. Minneapolis, Minnesota closed down. Across the river, the city of St. Paul stayed open. Responses across schools also diverged, as school boards held special meetings, debating the best way to proceed. According to Alexandra Stern, Martin Cetron, and Howard Markel, most schools closed for periods up to fifteen weeks. However, Chicago, New York, and New Haven were among the cities that remained open, using medical inspection and individual quarantine to reduce transmission. Businesses that remained open marketed their adherence to safety protocol. At the end of October in 1918, Seattle’s Bon Marché department store took out full-page ads to lay out precautions taken against influenza, which included masks on the salon employees, the removal of chairs in restrooms, and a trained nurse on staff in the infants’ department “advising mothers how to protect their families from influenza.”

An ad from Seattle’s Bon Marché department store, laying out precautions taken against influenza, which included masks on the salon employees, the removal of chairs in restrooms, and a trained nurse on staff in the infants’ department. Published on October 26, 1918 in The Seattle Star.

After the Surgeon General recommended mask-wearing in September 1918, Red Cross volunteers across the country produced identical gauze face coverings. Mask requirements were inconsistent by town. Boulder Springs, Colorado fined $100 to “any one caught not wearing a facial adornment in the form of a mask” as reported in The Anaconda Standard local newspaper. Yet in an Indiana town, children at school were exempt from mask-wearing. Private businesses also mandated masks. For example, Lima, Ohio’s Hotel Norval Domino Room advertised music and dancing in the local paper, stating, “Flu masks required.” While most hospitals required masks, Brooklyn’s Kings County Hospital banned employees from wearing them, even when cases rose among its nurses and doctors. 

Published on October 10, 1918 in the Des Moines Tribune

Concerns about transmission for mass transportation prompted epidemic rules for streetcars. Seattle staggered business hours to prevent overcrowding on streetcars required one-third of the windows to be open, enforced by police surveillance. In Portland, all streetcar windows had to be removed for additional ventilation. Children were altogether prohibited from riding on streetcars in Topeka, Kansas until the ban was lifted in February 1919. At Camp Gordon, Georgia, roads were sprayed with “a special antiseptic oil” to reduce the spread of germs through dust. Other rules addressed the sick and dying. New York City passed a law requiring landlords to provide heat of at least 68 degrees. Upstate, influenza victims had to be buried within twenty-four hours of death.

The reopening of society and lifting of restrictions was just as varied and confusing as it is now, if not more so. No effective vaccine existed to slow the spread, cases were inconsistently tracked, and the influx of soldiers from overseas complicated quarantine orders. “Returning to normal” in 1919 meant the reopening of society: schools, businesses, gathering places, taking part in dances and other activities that had been postponed, and gradual dissipation of fear. At the same time, for life to truly feel “normal,” soldiers had to return home and adjust to post-war life. It didn’t happen overnight.

While May 2021 does not directly parallel early 1919, the transition out of the influenza pandemic can provide insight and reassurance as to this moment. Reopening occurred over months. Just as most cities were beginning to close, Boston and others that had been hit earlier, started reopening as the end of October, with modified Halloween activities to acknowledge the somber post-epidemic tone. Across the United States, though, restrictions were temporarily halted on November, 11, 1918, as parades erupted to celebrate Armistice.

“Impromptu Allentown Armistice Day Parade,” November 11, 1918
Allentown Morning Call Newspapers, Public domain, via Wikimedia Commons

Many towns then resumed restrictions, relaxing them toward the end of December or in early January, taking different approaches. News coverage on the pandemic turned optimistic before the crisis subsided. On New Year’s Day, a writer for the Lexington Herald-Leader observed, “Life is getting back into normal again, the influenza ban is about to be entirely lifted and school work to be resumed.” There’s never been uniform agreement about what to do during a pandemic or how to reopen. Public health authorities and regular people disagreed in the past and continue to do so now, with questions that resonate now: Are masks still necessary? When can sporting events resume? Will spectators be permitted? Are children safe at school? Town leaders took different approaches to relaxing quarantine and mask rules – some opening everything at once, with others easing up gradually.

In the first months of 1919, stories of enjoying the first dance after restrictions were lifted appeared next to announcements of illness and deaths. Likewise, news and social media in 2021 have juxtaposed vaccinated reunions with COVID tragedies, especially for countries that have struggled with the vaccine rollout. As society reopens, there needs to be public physical and digital spaces for remembering and mourning, and preparation for the inevitable outbreaks that will continue. Months after Seattle lifted its restrictions, the 1919 Stanley Cup Final had to be canceled on April 1st after multiple players and a team manager developed influenza, ending the series in a 2-2 tie. Assuming the Tokyo Olympics go forward, similar disruptions are likely for unvaccinated athletes and teams. Until global vaccination rates consistently high and cases decrease significantly, we too will continue to experience outbreaksand deaths.

The biggest takeaway from the “Spanish Flu” is the light at the end of the tunnel. While we need to grieve lives lost, the world has pushed through before and will do so again. Disease outbreaks have and can produce some positive changes, from improved waterways and sanitation to emergency preparedness plans. Remote learning and working, access to technology, and innovation in education are among the significant improvements that will hopefully continue forward. Lastly, the last fifteen months have sparked new interest in the history of epidemics and pandemics. The experiences and moments of COVID need to be preserved and disseminated for future generations to remember this crisis.

The Doable Thesis

Leisurely streaming a show or coming up with a thesis idea?

How do you figure out the topic for your thesis, dissertation, or creative project? Obviously, you want to be passionate about your area of study. At the same time, you need to choose something you can realistically tackle. Here’s the deal: your thesis or dissertation will not be the groundbreaking discovery of the century. That’s okay. Don’t perceive it as such. You want to produce quality work that you can complete not a 5-10 year research agenda that goes unfinished because it was too hard and too big from the beginning.

Factors shaping area of focus, leading to pinpointing your topic:

  • What is your program? Our grad program is Media Communication. All theses/projects therefore must be connected to some form of media.
  • What has your coursework prepared you to study? I would not recommend introducing an entirely new area/theory/method at the thesis stage.
  • Who is your advisor? What input has this person given you?
  • What piques your interest? You need to have passion for your topic, especially at the beginning. Don’t pick something just because it’s trendy, your advisor’s interest, etc.
  • What is your timeline? Your method and sample need to reflect how much time you have before you want to graduate.

Let’s start out discussing what’s not going to work. For a master’s thesis (at least in our program), you do not have time to do an ethnography or to travel for your research. You probably don’t have time to conduct an experiment or series of focus groups. (I can think of a few exceptions, but in general, not the most feasible approaches). In other words, samples that require IRB approval and then recruitment require additional months.

For the traditional thesis, studies of existing data sets or media content are much more doable. Narrowing it down further, choose samples that you can easily and cheaply access. For textual research, identify the parameters of the study, making sure that (once again) the sample is something you can realistically analyze.

3 approaches to Picking Your Topic
Once you have your broad area of focus and an idea of the method, you can take the next steps to narrow it down.

  1. Approach 1: Lightning Strikes
    An “AHA!” moment may spark the overarching concept of the thesis. During my first year of grad school, I saw the movie Daredevil and found the depiction of Journalist Ben Urich fascinating. This interest prompted my thesis on representations of journalists and the press in comic book films, which I revised and published 14 years later as this article. [Note: I am linking my thesis as an example of idea–>concept–>operationalization–>done thesis, NOT BECAUSE I THINK IT’S A GREAT THESIS. To my students reading this, I can provide better examples of a completed thesis].

2. The Question Path
If you don’t have the idea spark, no worries. You can also start broad and then narrow down the topic by asking yourself a series of questions (or your advisor/professor may ask you), such as. . .

  • In your coursework, what papers related to your broad topic have you written? What did you enjoy about those topics? What didn’t you enjoy? Is there a project that you’d like to expand for your thesis?
  • Do you want to do a historical study or examine a current issue? If current, do you want it to be related to the pandemic?
  • Within your area of focus, what interests you more specifically?
  • What methodological approach would you like to take (qualitative, quantitative, mixed)?
  • Do you want to study content, effects, or both? (Specific to media)
  • What type of sample interests you?
  • Have you checked out existing literature (see #3)?

3. Going to the Literature Approach
If you don’t have the idea spark, no worries. Take your area of interest to Google Scholar and do a little reading. What’s been done before on your topic? With what sample? What timeframe? Using what theories and approaches? Identify the gaps in the literature and figure out what interests you.

The next step is to meet with your advisor/potential advisor. This person can help you figure out what is doable and what is not. Seasoned instructors can also help, but it is very important that your advisor is on board from the beginning.

Do ThisNot That
Analysis of 8 films on a topicInterview 20 film producers
Secondary data set on voter beliefsSurvey of 20,000 voters
Twitter scrape to assess vaccine misinformationEthnographic study at medical offices
Narrative analysis of children’s cartoonsFocus groups with children
Content analysis of Olympic coverage in mainstream newsParticipant-observation at the 2021 Olympics
Realistic plans (at least for a Master’s Thesis)

Do you see a common theme here? DOABLE. Set yourself up for success from the beginning of the writing process. If your topic isn’t working, talk to your advisor immediately about shifting the plan or making a new one. Remember, the goal isn’t to become a star from your magnificent piece of research, but to move from student to graduate.

Free Beer or Campus Mandate: Addressing the Reluctant

Others’ vaccination status affects all of us.
Me after my first dose.

As of April 27, 2021, 141 million Americans have received at least one dose of a COVID vaccine and 95.9 million are fully vaccinated, according to The Washington Post. These rates differ greatly by state and demographic.

We are witnessing a growing number of people who fit in a gray space of immunization, in which they aren’t against getting vaccinated for COVID-19 and yet, they haven’t received their first shots. Clumped into this group are also those who did get the first dose, but have lagged for the second.

The largest two clusters of unvaccinated people: conservative, rural white people that believe that any COVID precautions (including the vaccine) infringe on their freedom and people of color, whose hesitancy stems from a history of medical betrayal. While these groups (especially the latter) certainly warrant attention, I’d like to focus on a different population: those who are not opposed, but aren’t very motivated to get vaccinated. College students, twentysomethings, and additional folks that fit this description feel that they don’t have enough of a reason to make a vaccine appointment and then take time from work/school/life to go to an immunization site and get the shot. I say “shot” and not “shots” because these people need the one-dose. If it’s hard to prompt someone to get a first dose, the second dose is unlikely (helping to explain the drop-off of 2nd-dose recipients).

With the current widespread availability of vaccines in the U.S. for ages 16 and over, most people who were eager and willing have already been immunized. The vaccine-reluctant, then, need to be targeted, with their carrots identified. History is repeating itself on this one. In the late 1950s, this same age group held out on getting the polio vaccine, believing they weren’t susceptible enough to the virus to make it worth the shots. As I wrote about in my article for The Washington Post, the Ad Council initiated a mass public health campaign addressing this hole in the herd immunity.

How do we motivate the vaccine-reluctant during our current pandemic? We need a combination of targeted campaigns with messages that appeal to this age group, combined with incentives. Creative motivators have already sprung up: free donuts from Krispy Kreme, beer from Sam Adams and a number of breweries in New Jersey, on-campus vaccine site raffles, and employer-specific bonuses of vacation time or cash, to name a few. West Virginia Governor Jim Justice has promised savings bonds of $100 for those 18-35 who get the vaccine. In D.C., the organization Marijuana Justice gave out free joints at vaccination centers on April 20th, much like the Michigan-based “Pots for Shots” campaign. Such incentives have and will help close the gap of the vaccine-reluctant.

However, it’s not enough. What we need are vaccine requirements for various activities and places. To be pandemic-responsible, concerts, music festivals, and other large-gathering attendees should have to provide proof of vaccination — a notion that is being considered for Burning Man and other events scheduled for later this year. Additionally, college campuses need to mandate COVID vaccines for students, faculty, and staff. According to The Chronicle of Higher Education, 209 colleges will mandate vaccines. Most of these institutions are private and located in blue states. Mandatory COVID vaccination fits with existing immunization requirements (MMR, varicella, meningitis) and still allows for religious exemptions. Widespread college and university COVID vaccine mandates will (obviously) incentivize the difficult-to-reach population, normalizing this immunization for young adults. This approach also reinforces the necessity of mass vaccination as vital to public health — not as a person choice.

We need drastic action to even begin to dream of herd immunity, if that is a possibility. Motivating the super-spreader group to get vaccinated should be a top priority. Since emotional appeals may not reach the vaccine-reluctant, it’s time to create incentives and requirements that push them to get vaccinated. A free beer and the return to campus life?