H5N1

Our long night of the virus

The Tyee has published my long review of four important new books about the pandemic: Our Long Night of the Virus. Excerpt:

The pandemic and climate change, combined, have triggered what [Adam] Tooze calls a “great acceleration,” when events outrun earlier predictions and solutions. We will therefore have to improvise new solutions — or, like the populists, stick to a very old non-solution of anti-science white supremacy in the hope of returning to the “before times.” 

The imperial infection  

Rupa Marya, an American physician of Indian descent, and Raj Patel, a British academic, journalist and author, offer a solution from the before times in their book Inflamed: Deep Medicine and the Anatomy of Injustice. They argue that this pandemic, like countless disease outbreaks before it, is a consequence not just of a virus but of an imperialist world order that triggered disease and then built a medical system to serve the rulers, not the victims.  

This is not some radical Marxist spin, but established medical history. In the early 19th century, British development turned wetlands into farmlands in what is now Bangladesh, and brought a marine bacterium called Vibrio cholera into human guts. Cholera rapidly migrated on trade routes to London and beyond.  

In London, Dr. John Snow founded modern epidemiology by spotting the precise well that was infecting the neighbourhood. His medical colleagues dismissed his idea, but eventually Britain rebuilt its water supply system and greatly improved its workers’ health. Travellers from India were screened at Suez to try to stop further outbreaks from reaching Europe. But like Omicron, cholera was all over the planet by the time it was recognized.  

Meanwhile, cholera was left to ravage India itself, and we are now in the seventh cholera pandemic, which began in Indonesia in 1961 and most recently exploded in Haiti in 2010.  

Marya and Patel are by far the most radical analysts of this pandemic. They have no interest in blaming Donald Trump or the CDC; they are just the agents of a system created to serve the interests of 19th century empires, and which now protects the white heirs of those empires while ignoring the “essential” workers who serve those heirs.  

The authors have strong confirmation from others like Alex de Waal, whose recent book shows how Louis Pasteur’s germ theory defeated the German scientist-politician Rudolf Virchow, who had long argued for social and economic inequality as the root of disease outbreaks. Pasteur had blamed individual microbes, which could be isolated, fought and defeated like rebellious tribesmen in some remote colony. We still fall back on war metaphors to describe our response to the pandemic.

A new study ties lifespans to wealth gaps in Greater Vancouver

The Tyee has published my latest article: A New Study Ties Lifespans to Wealth Gaps in Greater Vancouver. Excerpt:

We like to think of Greater Vancouver as one of the best places to live in Canada, if not in the world. Yes, it is — especially for those of us living in the most affluent neighbourhoods. Those in the poorest neighbourhoods, however, are dying younger than their rich neighbours, sometimes by many years. And the gap between them was getting wider even before the opioid-overdose crisis and the COVID-19 pandemic became twin health emergencies. 

That’s an easy conclusion to draw from a recent study published in the journal Health & Place. Of course it’s more complicated than that, but it still seems paradoxical that a region as prosperous as Greater Vancouver should see some people die years younger than others living just a few kilometres away.  

The study involved UBC researchers working with the Institute for Health Metrics and Evaluation at the University of Washington and with Imperial College, London. Its ambitious goal was to track life expectancy and major causes of deaths in Greater Vancouver over a quarter-century, from 1990 to 2016. Moreover, they broke the numbers down to the census-tract-level — in effect, neighbourhood by neighbourhood. Overall, the study offers an invaluable portrait of our collective health before the pandemic.  

In some ways, it’s a very flattering portrait. Even the poorest males, in the tenth percentile, had a median life expectancy in 2016 of 77.6; that is, half died before that age and half later. For tenth-percentile females, median life expectancy was 82.5.  

But in the 95th percentile, the richest five per cent of our population, median male life expectancy was 87.1. For females in the 90th percentile, it was 90.8. The poor were paying with almost a decade of their lives for the privilege of living here. 

 The study makes a striking observation: “Between 1991 and 2016, there was a downward trend in the LE [life expectancy] gap, whereby the lowest gap was observed in 2001 (6.9 years for females and 7.9 for males), but this reversed and increased by 1.4-1.6 years between 2001 and 2016.” By a wild coincidence, 2001 was the year the BC Liberals won a huge majority over the NDP and ran the province under Gordon Campbell and then Christy Clark until 2017.  

British researchers noticed a very similar effect during Margaret Thatcher’s years in power: Around 1980, British and Japanese life expectancy were about the same, but then, as the U.K. income gap widened, British lives grew shorter. In Japan, with a much narrower income gap, life expectancy rose to among the highest on the planet.  

What we’re dying of  

And what have Greater Vancouver residents been dying of? Between 1990 and 2016, deaths from cardiovascular diseases, neoplasms (cancers) and unintentional injuries dropped sharply. Clearly, we’ve been exercising more, smoking less, and taking care of ourselves, at least up to a point.  

But we’ve also seen a 10 per cent increase in neurological disorders, a catch-all term that can include everything from Alzheimer’s to eating disorders to meningitis. Other noncommunicable diseases like diabetes mellitus and kidney disease rose by almost four per cent.  

And while the richest of us had little to fear from infectious diseases in 1991, the poorest were already contending with (and dying from) HIV-AIDS and sexually transmitted infections at 12 times the rate as the richest. The poorest faced seven times the rate of maternal and neonatal disorders. They died of neoplasms at over four times the rate of the richest.

Reading about COVID-19

Early next year, I'll be teaching "Perspectives on Pandemics," a course for Eldercollege here on the North Shore—going back to the Athenian and Justinianic plagues and the Black Death, but focusing on COVID-19. I'm pulling together a suggested reading list for my students, and it occurred to me that others might want to explore some of these titles as well. So here they are. Some include links to my Tyee reviews; others will be mentioned in a long article I'm working on. I'll update this list from time to time.

Peter Baldwin, Fighting the First Wave: Why the Coronavirus Was Tackled So Differently Across the Globe. Cambridge University Press, 2021. My review: https://thetyee.ca/Analysis/2021/03/30/Best-Book-Written-About-COVID-Pandemic/

Alex De Waal, New Pandemics, Old Politics: Two Hundred Years of War on Disease and Its Alternatives. Polity Press, 2021. My review: https://thetyee.ca/Culture/2021/07/09/All-Plagues-Are-Political/

Elaine Dewar, On the Origin of the Deadliest Pandemic in 100 Years: An Investigation. Biblioasis, 2021.

Fang Fang, Wuhan Diary: Dispatches from a Quarantined City, translated by Michael Berry. HarperCollins, 2020. My review: https://thetyee.ca/Culture/2020/05/27/Wuhan-Diary-Book/

Richard Horton, The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again. Polity Press, 2020. My review: https://thetyee.ca/Culture/2020/06/22/Only-Newly-Vigilant-Society-Can-Stop-Next-Pandemic/

Colin Kahl & Thomas Wright, Aftershocks: Pandemic Politics and the End of the Old International Order. St. Martin’s Press, 2021.

Michael Lewis, The Premonition. W.W. Norton, 2021. My review: https://thetyee.ca/Culture/2021/05/18/Hot-Pandemic-Book-Poses-Danger/

Rupa Marya & Raj Patel, Inflamed: Deep Medicine and the Anatomy of Injustice. Farrar, Straus & Giroux, 2021.

Jon Sternfeld, Unprepared: America in the Time of Coronavirus. Bloomsbury, 2021. My review: https://thetyee.ca/Culture/2020/12/22/Unprepared-America-Time-Coronavirus-Book/

Steven Taylor: The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. Cambridge Scholars Publishing, 2019. My review: https://thetyee.ca/Culture/2020/07/10/Mental-Toll-Covid-Doctors-Saw-Coming/

Adam Tooze, Shutdown: How Covid Shook the World’s Economy. Viking 2021.

Lawrence Wright, The Plague Year: America in the Time of COVID. Alfred A. Knopf, 2021.

The EU will create an agency to guide its response to future pandemics

Via The New York Times: The E.U. will create an agency to guide its response to future pandemics.

The European Union announced on Wednesday the creation of a new biomedical authority designed to better respond to future pandemics, as it seeks to avoid repeating the mistakes that plagued its early response to the coronavirus. 

Ursula von der Leyen, the president of the European Commission, the bloc’s executive arm, also pledged to donate 200 million extra coronavirus vaccine doses to middle- and low-income countries by mid-2022, in addition to 250 million already promised by the end of the year.  

In her annual speech on the state of the union, Ms. von der Leyen described vaccination discrepancies as one of the greatest geopolitical issues facing nations.  

“The scale of injustice and the level of urgency are obvious,” Ms. von der Leyen said in front of lawmakers at the European Parliament in Strasbourg, in eastern France. E.U. member countries had only donated 18 million doses as of early September, a fraction of the 200 million promised.  

While most developing countries have yet to administer a single dose of a coronavirus vaccine, including in the European Union’s immediate neighborhood, more than 70 percent of adults across the bloc have been fully vaccinated. Ms. von der Leyen said that puts the bloc among the world’s leaders in vaccinations.  

“We delivered,” she said, although she conceded that the bloc faced wide discrepancies domestically, as several Eastern European countries have been lagging behind.  

Ms. von der Leyen’s confident tone on Wednesday came in great contrast with her speech last year, when new Covid-19 cases were picking up across the bloc and coronavirus vaccines were months away.  

“When I stood here in front of you a year ago, I didn’t know when and if we could have a safe and effective vaccine against the pandemic,” she said.  

The European Commission, which negotiated for vaccines on behalf of member countries, was heavily criticized for the sluggish beginning of its vaccination program. The commission signed its first deal on behalf of member nations months after the United States, hampering vaccine deliveries and, later, inoculation campaigns.  

Yet the rollout gained speed in recent months, and many E.U. countries have now overtaken other rich nations like the Britain, Israel and the United States, and have started administering booster shots to millions of older and vulnerable residents.  

On Wednesday, Ms. von der Leyen said the new agency, known as the Health Emergency Preparedness and Response Authority, or HERA, would aim to “make sure that no virus will ever turn a local epidemic again into a global pandemic.”  

The new authority is set to become the European equivalent of the United States’ Biomedical Advanced Research and Development Authority, or BARDA, the federal health agency that focuses on vaccine development and pandemic preparedness.  

It is set to receive 50 billion euros (about $59 billion) in funding by 2027 and will function alongside the E.U.’s existing health agencies, the European Center for Disease Control and the European Medicines Agency.

WHO opens pandemic intelligence hub to look out for future crises

You always need surveillance long before you think you need surveillance. Via The Guardian: WHO opens pandemic intelligence hub to look out for future crises.

A World Health Organization “pandemic intelligence hub” launched by the UN agency’s director general, Tedros Adhanom Ghebreyesus, and Germany’s Angela Merkel in Berlin on Wednesday will try to help governments identify future pandemics at an earlier stage and improve monitoring of new variant strains of Covid-19. 

The hub, which will host scientists and policymakers from around the globe on a project-by-project basis, is designed to make it easier for governments to compare notes on emerging infectious diseases and pull in additional relevant information on travel patterns, trade routes or human-animal interactions in agriculture. 

The WHO, which connects the UN’s 194 member states on health policy, sounded its highest level of alarm about the Covid-19 pandemic on 30 January 2020, but studies have since suggested the coronavirus may have circulated globally at least a month beforehand.

"Covid-19 has highlighted a problem,” said Oliver Morgan, the director of the WHO’s health emergency information and risk assessment department. “There is a lot of data and public information out there at the moment that we are struggling to make sense of.” 

Every month the WHO processes on average 9m pieces of information relating to pandemic or epidemic developments, and investigates about 300 events in more detail. 

The WHO says part of the problem is that while governments and NGOs are collecting more and more information relevant to public health, databases are rarely streamlined to allow easy international comparisons. 

Analytical tools are often developed in isolation or on an ad hoc basis, and analyses are hampered by data formatting issues. Morgan said the problem was becoming particularly apparent in the monitoring of new variants of Covid-19. 

“One problem we have is that clinical samples are currently often de-linked from epidemiological information such as incidence rates or hospitalisations. So even if we do identify a variant, we don’t know if it will be a gamechanger,” he said. 

Epidemic surveillance through genome sequencing – which involves deciphering the order of the nucleotide molecules that spell out a particular virus’s genetic code – has proved valuable in monitoring polio and strains of influenza. 

But while countries such as the UK and South Africa have scaled up their genomic sequencing capacities over the last decade, the worldwide coverage remains patchy. “We currently don’t have a consistent view of how Covid-19 variants are developing across the globe, and no single database that allows us to easily share information,” Morgan said. “We only really have small windows into the overall picture via some countries with advanced labs.” 

A focus on improving the global tracking of Covid-19 variants via genome sequencing was likely to be the new hub’s initial priority, he said. 

The hub will be part-funded by the German government with $100m for the first three years, and will initially operate from a space on Luisenstrasse in central Berlin, leased from the Charité university hospital. 

It will later move to a permanent campus on Moritzplatz in Kreuzberg district. The hub will have space for up to 120 people, most of whom will not be WHO staff but visiting scientists or policymakers.

The most important book yet on pandemics and their causes

The Tyee has published my article All Plagues Are Political. It's a long review of a new book that offers a critical perspective on pandemics and their origins. Excerpt:

New Pandemics, Old Politics: Two Hundred Years of War on Disease and its Alternatives By Alex de Waal. Polity Books (2021) 

“Anagnorisis” is Greek for “learning upward” — the sudden shock when we finally see and understand what’s really going on. I had such shocks on almost every page of this very important new book. This is a long review because the book raises very many issues rarely mentioned in medical or political history. It calls into question not only our global health system, but the economic and political systems that pretend to support it. 

Alex de Waal is the executive director of the World Peace Foundation at The Fletcher School of Law and Diplomacy and professorial fellow at the London School of Economics. He is an expert on the politics of Sudan and the Horn of Africa, and the author of seven previous books on Africa, AIDS and famine. He is also writing sharp analysis of the war in Tigray that attracts a lot of critics on Twitter. 

I may believe his critics when they document their charges as well as de Waal documents his case in this book. And that case is that the world system we have built over two centuries of imperial conquest and rule is itself the generator of pandemics; the pandemics emerge from our politics and economics, and we respond to them politically — not medically.

Expert independent panel calls for urgent reform of pandemic prevention and response systems

A news release from the Independent Panel for Pandemic Preparedness and Response: Expert independent panel calls for urgent reform of pandemic prevention and response systems. Excerpt:

As the COVID-19 pandemic continues to devastate communities across the world, the Independent Panel is making a series of immediate recommendations to halt its spread. It recommends that:  

• High income countries with a vaccine pipeline for adequate coverage should, alongside their scale up, commit to provide to the 92 low and middle-income countries in the COVAX Gavi Advance Market Commitment with at least one billion vaccine doses by September 2021. 

• Major vaccine-producing countries and manufacturers should convene, under the joint auspices of the WHO and the World Trade Organization (WTO) to agree to voluntary licensing and technology transfer. If actions on this don’t occur within three months, a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights should come into force immediately. 

• The G7 should immediately commit to provide 60% of the US$19 billion required for the Access to COVID-19 Tools Accelerator (ACT-A) in 2021 for vaccines, diagnostics, therapeutics, and strengthening of health systems, and a burden-sharing formula should be adopted to fund such global public goods on an ongoing basis. Every country should apply proven public health measures at the scale required to curb the pandemic. Leadership from heads of state and government to achieve this is crucial. 

The world must also urgently prepare to prevent a future outbreak from becoming a pandemic. To this end, the Independent Panel calls for the engagement of heads of state and government to lead on efforts to transform the existing system. The Panel calls for a series of bold and forward-looking reforms, including:   

• Establishing a Global Health Threats Council that will maintain political commitment to pandemic preparedness and response and hold actors accountable, including through peer recognition and scrutiny. Countries should also adopt a Pandemic Framework Convention within the next six months. 

• Establish a new global system for surveillance based on full transparency. This system would provide the WHO with the authority to publish information about outbreaks with pandemic potential on an immediate basis without needing to seek approval and to dispatch experts to investigate at the shortest possible notice.   

• Invest in national preparedness now as it will be too late when the next crisis hits. All governments should review their preparedness plans and allocate the necessary funds and people required to be prepared for another health crisis.   

• Transform the current ACT-A into a truly global platform aimed at delivering global public goods including vaccines, diagnostics, therapeutics, and supplies that can be distributed swiftly and equitably worldwide—shifting from a market model to one aimed at delivering global public goods. 

• Focus and strengthen the authority and financing of the WHO, including by developing a new funding model to end earmarked funds and to increase Member State fees.   

• Create an International Pandemic Financing Facility, which would have the capacity to mobilize long term (10-15 year) contributions of approximately US$5-10B per year to finance ongoing readiness. It would also be ready to disburse from US$50-100B at short notice by front-loading future commitments in the event of a pandemic declaration. The Global Health Threats Council would allocate and monitor the funding to institutions which have the capacity to support the development of preparedness and response capacities. 

• Heads of state and government should at a global summit adopt a political declaration under the auspices of the UN General Assembly to commit to these transformative reforms. 

The Panel’s report also shared recommendations for individual countries, including that heads of state and government should appoint national pandemic coordinators who are accountable to them, and who have a mandate to drive whole-of-government coordination for pandemic preparedness and response.  

In the presentation of the report and its findings, Panel Co-Chair and former President Ellen Johnson Sirleaf stressed the need for bold reform: 

“Our message is simple and clear: the current system failed to protect us from the COVID-19 pandemic. And if we do not act to change it now, it will not protect us from the next pandemic threat, which could happen at any time.”

Canada: Top scientists propose moving pandemic warning system outside government

Via The Globe and Mail, a proposal that's hard to argue with: Top scientists propose moving pandemic warning system outside government. Excerpt:

A group of top scientists concerned about the decline of the federal pandemic early warning system in the years before COVID-19 emerged have proposed relocating the operation to a university where it can work independently of government. 

The proposal is aimed at restoring the Global Public Health Intelligence Network to its former status as an internationally respected pandemic surveillance system. Documents outlining the plan were submitted to an independent panel in Ottawa that is reviewing the system’s future. 

 According to the documents, GPHIN would work with the World Health Organization and be based at the University of Ottawa’s Bruyère Research Institute. The university and the WHO back the idea, says the proposal, which was reviewed by The Globe and Mail. 

“We propose the creation of a Canadian-based WHO collaborating centre for global health intelligence,” the proposal states. Such a move “would provide a new, stable and cost-effective environment for the future management of GPHIN. 

“GPHIN must be guaranteed freedom from government influence or interference. To achieve independence of any future government influence, bias or interference, GPHIN must be situated outside of government.” 

A Globe and Mail investigation last year found that GPHIN’s capabilities had been allowed to erode Loading... over the past decade as priorities within the government changed, and senior officials in the Public Health Agency of Canada (PHAC) sought to deploy its resources elsewhere. 

Some of the core functions of the system, which provided crucial intelligence before and during the 2003 SARS crisis and 2009 H1N1 outbreak, were silenced in 2018 and 2019. With no pandemic threats apparent, management in the department sought to shift resources to areas that didn’t involve outbreak surveillance. 

The proposal to partner with the WHO is being led by Ron St. John, a former top federal epidemiologist who helped create GPHIN in the 1990s, and other current and former top federal scientists. If it succeeds, the operation would run as a non-profit, funded in part by the federal government, and also able to seek science and technology grants from other sources, which it currently cannot do.

COVID-19: Thoughts at the end of Year 1

Precisely one year ago today, to the hour, I was sitting here at the kitchen table doing my usual morning scan of Google alerts, email, and new posts from other bloggers. After a few minutes, at 7:48 a.m. I made my first post about what became known as COVID-19:

Hong Kong: CHP closely monitors cluster of pneumonia cases on Mainland

Thanks to Mike Coston, Giuseppe Michieli, and Ian Mackay for alerting me to this report by the Centre for Health Protection: CHP closely monitors cluster of pneumonia cases on Mainland. Excerpt: 

The Centre for Health Protection (CHP) of the Department of Health is today (December 31) closely monitoring a cluster of pneumonia cases in Wuhan, Hubei Province, and has contacted the National Health Commission for further information.

According to an announcement from the Health Commission of Hubei Province, a number of pneumonia cases related to a local seafood market was recently reported in Wuhan. The Wuhan Municipal Health Commission has commenced investigation and so far identified 27 cases. Among them, seven cases were serious and the remaining were stable. Symptoms were mainly fever while a few had presented with shortness of breath. All patients are isolated and receiving treatment. Contact tracing of close contacts and medical surveillance are ongoing.

The Wuhan Municipal Health Commission announced that assessment by relevant experts revealed that the cases were compatible with viral pneumonia. For the time being, no obvious human-to-human transmission has been observed and no healthcare workers have been infected. The causative pathogen and cause of infection are still under investigation.

Locally, while surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

The CHP's Port Health Division conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases with serious infectious diseases identified will be immediately referred to public hospitals for isolation, treatment and follow-up. The CHP has also informed the Hospital Authority about the cluster of pneumonia cases in Wuhan.

Travellers are reminded to wear surgical masks and seek medical attention if they present with respiratory symptoms, and reveal their travel history to doctors. The CHP will continue to closely monitor the latest situation of the cluster of pneumonia cases in Wuhan and update the surveillance criteria and testing strategies accordingly. 

Mike Coston has three posts on the outbreak and the response in Hong Kong and Taiwan. A quick check of Wuhan media didn't turn up anything, but I'll keep looking around.

I posted several items that morning. Far more knowledgeable people than I were clearly worried, and this "unxplained pneumonia" stirred echoes of SARS—the outbreak that first got me interested in emerging diseases and blogging. If this was like H5N1, H1N1, H7N9, cholera, MERS, and Ebola, the Wuhan outbreak would tell us a lot about the society dealing with it. China had tried to suppress news of SARS, and suffered for it. Its response to H7N9 avian flu had been far more open, and earned China new respect as a country with a vastly better public health system. 

Well, we learned China will still suppress news when it wants to, and will respond with breathtaking decisiveness when it wants to. And we've also learned that a real pandemic tells us a lot about every society it affects—including our own. These have been unpleasant insights, especially into those countries that fancy themselves "advanced." 

Now we begin Year 2 of COVID-19, and I do not expect a sudden news story to announce its end. It will go on for a long time, driven into corners and then resurging again and again—not because it's so malevolent, but because we are so stupid, and we insist on paying high tuition fees for very simple lessons.

Los Angeles: Our century-old mask wars

Via The Los Angeles Times: Coronavirus Today: Our century-old mask wars. Excerpt:

Good evening. I’m Amina Khan, and it’s Tuesday, Dec. 29. Here’s what’s happening with the coronavirus in California and beyond. 

The pitched political battle over masks may feel like a quintessentially 2020 kind of conflict. But as it turns out, the anti-mask movement is more than a century old. Columnist Gustavo Arellano takes us back to 1919, when the world was facing another devastating global outbreak: the so-called Spanish flu, which is estimated to have infected a third of the world’s population and killed at least 50 million.  

Back then, more than 700 concerned citizens and doctors signed a petition asking the Los Angeles City Council to enact a mask mandate to combat the pandemic, or “the disease will come back again, and will exact a heavier toll than ever.” 

But councilmembers wouldn’t budge. One said the masks left the wearer “breathing in the foul air which they exhale.” Another snarked that he might have been more sympathetic “if the doctors would come through and agree on some one thing, or if any of them could agree at all.” A third said he would “not propose to take the advice of a lot of outsiders.”  

L.A. weathered the flu pandemic better than most major American cities, largely thanks to City Health Commissioner Dr. Luther Powers, who shut down businesses and schools early on, even when others did not. But Powers had a chance to save even more lives by implementing a mask ordinance — and he didn’t. 

If Powers had required everyone to wear masks in public, that “would’ve had an impact,” said J. Alexander Navarro, a medical historian at the University of Michigan.

Widespread mask use in L.A. seemed imminent when the Spanish flu hit California in the fall of 1918, Arellano writes. San Francisco issued an order for people to wear them outside their homes, and San Diego required them for anyone serving the public. Gov. William D. Stephens urged Californians to wear masks, saying they offered “but little discomfort and means a service rendered to our fellow-men and to our country.” 

These messages appear to have had an effect: The Times reported on Oct. 23 that masks in L.A. “were quite common in large offices ... where the general public is coming and going all day in numbers.” 

Mayor Frederick Woodman even brought a resolution to the City Council to enforce mask wearing, but Powers balked and the enforcement measure failed. Instead, the council passed a measure advising the public to wear masks, but not requiring it.  

The window of opportunity, it seemed, had closed. The council soon became hostile to a mask mandate. This paper openly called masks “muzzles” and published editorial cartoons mocking their advocates. In a Dec. 1, 1918, editorial titled “Adios ‘Flu’ Scare!” the paper’s editorial board wrote that “the real sufferers are the men and women whose incomes have been stopped, whose businesses have been all but ruined.” Sound familiar? 

Little did they know that the city was about to be overwhelmed by a second wave of influenza. In January, Powers finally wrote up a mask mandate but ultimately did not back its passage.