HAUNTING pictures show the city of San Francisco had the Spanish flu pandemic of 1918 under control – until social distancing measures were lifted.
Images show people taking strict action to protect against the Spanish influenza, which helped flatten the curve of case numbers – and the aftermath once those restrictions were eased.
Many experts have warned as coronavirus curves flatten in the U.S. and states begin to ease lockdowns that if social distancing restrictions are lifted too soon, it could cost hundreds of thousands of lives.
The Influenza Encyclopedia – a document of the Spanish Flu pandemic of 1918-1919 created by the University of Michigan – details how the outbreak was handled with strict social distancing measures and what happened after lockdowns were lifted in San Francisco.
One haunting image shows rows of hospital beds just feet apart, spanning across a large room in a Naval Training Station, set up as a temporary hospital.
Another picture shows emergency hospital tents set up in the city, with US Navy Hospital corpsmen working outside.
Other images show nurses sewing masks, or people waiting in line to buy face masks.
"There was a lot of pressure in pretty much all of these American cities to reopen," Alex Navarro, the assistant director of the Center for the History of Medicine at the University of Michigan, told NBC News of the Spanish influenza pandemic lockdowns in a phone interview.
Outbreaks began in September 1918, and by mid-October, cases had climbed to over 2,000, according to the Influenza Encyclopedia.
When cases began to rise, officials set social distancing measures, including encouraging people to avoid crowds.
Later, stricter measures were implemented.
The city's mayor, James Rolph, issued a closure order for many non-essential businesses like theaters and dance halls, and recommended other events like church services be held in open air.
One image shows congregants praying outside the Cathedral of saint Mary of the Assumption amid the Spanish flu pandemic.
Another picture shows court being held in open air in an effort to help minimize virus spread indoors.
San Francisco was one of the first cities to make it mandatory for residents to wear masks.
At first, the city issued a recommendation in mid-October for residents to wear masks. It was later mandated that all residents wear masks, and those that did not were issued a fine of up to $5, the Influenza Encyclopedia said.
Although more than 20,000 people were infected in the city, with social distancing measures, cases began to decline.
The city had begun to get a hold on the pandemic.
People still gathered on Armistice Day, when allies of World War I and Germany signed an agreement to stop fighting on November 11, 1918.
In mid-November, the Board of Health voted to lift different lockdown measures across the city.
Eager to get out after lockdowns, residents packed into theaters, sports arenas, and other entertainment venues.
One image shows crowds of people packed in the Civic Center Auditorium around a boxing ring on November 16, just as closure orders were lifted.
Days later, on November 21, residents were no longer required to wear masks.
Within a matter of weeks, San Francisco began to see a slight increase in cases. By January 10, more than 600 new cases were reported in one day, the Influenza Encylopedia said.
Cases saw a resurgence, and over the fall and winter of 1918 and 1919, more than 45,000 San Franciscans were infected, and more than 3,000 died.
San Francisco became one of the hardest-hit cities amid the Spanish flu pandemic.
Navarro told NBC: "They were flattening that curve; they just weren't realizing it," Navarro said.
"A lot of people thought, ‘Well, what did we go through that for? It did have an impact, they just didn't know it," he added of the social distancing guidelines.
San Francisco's current Mayor, London Breed, told NBC in an earlier interview that she took other pandemics into consideration when issuing a stay-at-home order amid the coronavirus outbreak.
"Just because San Francisco is being praised for flattening the curve, we're not there yet," she told NBC. "And so we cannot let up just because for some reason we believe that we're in a better place."
On April 17 it became mandatory for city residents to wear a face covering in public places.
As cases in some states have begun to stabilize across the U.S. – and other places see cases continuing to rise – governors have begun to implement plans to lift social distancing measures, and others have already started to open.
When Georgia last week prepared to begin re-opening, President Trump said he believes it's "too soon."
Trump said when announcing a plan for states as they re-open that individual states will determine when it's safe to ease measures, and he will give them authorization.
The President said neither he nor Vice President Mike Pence gave Georgia the go-ahead to open.
Protests have continued across the U.S., as people call for the end of lockdowns and demand for businesses to be allowed to open.
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