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Why Gauze Masks ‘Failed’ in 1918 — And What We Can Do Better

A look at the mistakes Americans made while wearing homemade cloth masks to protect against the Spanish flu, according to the secretary of the California State Board of Health in 1918

Adrien Burch, PhD
Elemental
Published in
5 min readApr 7, 2020

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An American Red Cross worker wears a gauze mask during the Spanish flu pandemic in 1918. Photo: Paul Thompson/FPG/Stringer/Getty Images

The Centers for Disease Control and Prevention has now recommended that all Americans wear masks as we live through this pandemic. And so, like our relatives who faced the influenza pandemic 102 years ago, we are now covering our noses and mouths in public with cloth masks — because that’s what’s available. Except this time, our masks will be better (we hope) and definitely more colorful.

Although there is evidence to show that surgical masks and N95 respirators offered significant protection of medical workers against contracting SARS (a closely related coronavirus), we are now moving into uncharted territory by using homemade cloth face masks to protect against Covid-19. So why not turn back the clock and learn what we can about a time when cloth masks were the gold standard?

Most of us have seen photos of nurses, workers, children, and possibly even cats wearing masks during the Spanish flu pandemic. But despite the widespread use of masks in 1918, some experts at the time concluded that masks made from gauze “failed” to help slow infections on a citywide scale in San Francisco. The main reason for this failure, they decided, was that gauze is a terrible material for filtering respiratory droplets. But they also noticed some other problems.

Now that we’re wearing cloth masks again, we should consider why the gauze mask supposedly fell short of protecting the public a century ago. Because, as we all know, history sometimes repeats itself.

To combat the Spanish flu, Americans were told to make face masks with four to six layers of fine mesh gauze — which is what was used in hospitals.

The challenges we can expect from homemade masks

Gauze masks were fairly common in hospitals by the time the great influenza pandemic arrived in the United…

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Elemental
Elemental

Published in Elemental

Elemental is a former publication from Medium for science-backed health and wellness coverage. Currently inactive and not taking submissions.

Adrien Burch, PhD
Adrien Burch, PhD

Written by Adrien Burch, PhD

Happily sifting through academic research so you don’t have to. Microbiologist, educator, entrepreneur, writer. (Yale, UC Berkeley)

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