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| A Red Cross nurse in 1918 with a medical gauze mask. Credit: Paul Thompson/FPG via Getty Images |
Contemporary and historical sources have conflicting information about the mask question. The best summary I have found is titled “Did Masks Work? — The 1918 Flu Pandemic and the Meaning of Layered Interventions” published by the Berkeley Library Update May 23 2020.
Here is the summary of that article:
Even in 1918 public health leaders were skeptical of the effectiveness of masks and thought that their use by the public was minimally effective mostly because masks were not used properly.
The recommended mask was to be made of multiple layers of medical gauze, which had a tighter weave than what most people understood as gauze. Many people did not have access to medical gauze and cheese cloth was often substituted, with poor outcomes. It was also necessary that the mask be changed and sanitized several times per day, again something that was often not done. Still others only wore a mask outside and removed it when they went indoors, in close quarters with others and with poor circulation.
Mask wearing in and of itself was not enough. “This was not simply a question of ‘mask or no mask,’ but of design, construction, supply, and use.”
A 2007 study commissioned by the Pentagon found that there was a “layered effect of protection by using multiple techniques together: school closure, bans on public gathering, isolation and quarantine of the infected, limited closure of businesses, transportation restrictions, public risk communications, hygiene education, and wearing of masks.”
During the Spanish Flu, masks were not used widely and well enough to make much of a difference, but most health workers tended to believe in their effectiveness enough to be used for front line workers.
It was the combination of interventions that worked together in 1918-1919 and which are working now.
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