What Can and Can’t Be Learned From a Doctor in China Who Pioneered Masks

"In late 1910, a deadly plague started spreading in the northeast reaches of China, reaching the large city of Harbin. Tens of thousands of people coughed up blood; their skin pruned and turned purple. They all died.

This outbreak sent the Qing government into a tailspin: They didn’t know what illness was causing these deaths, let alone how to control it. So they brought in one of the best trained doctors in Asia at the time, Dr. Wu Lien-Teh. After performing autopsies, Dr. Wu found Yersinia pestis, a bacterium similar to the one that had caused bubonic plague in the West. He recognized Manchuria’s plague as a respiratory disease and urged everyone, especially health care professionals and law enforcement, to wear masks.

Chinese authorities, heeding his call, coupled masking with stringent lockdowns enforced by the police. Four months after the doctor was summoned, the plague ended. Although often overlooked in Western countries, Dr. Wu is recognized in world history as a pioneer of public health, helping to change the course of a respiratory disease spread by droplets that could have devastated China in the early 20th century, and perhaps spread far beyond its borders.

In addition to masks, officials enforced a strict cordon sanitaire, another method that dates back at least to the 1800s when French officials sought to contain the spread of Yellow Fever. Travel was restricted, government officers were instructed to shoot anyone trying to escape, and police officers went door to door, looking for anyone who had died from plague. In an echo of some of these techniques last year during the fight against Covid, China strictly curtailed transportation around Wuhan, and people needed permission from authorities to leave their homes.

While the Chinese of that era complied with these strategies, public health professionals in the United States and other Western countries have struggled to get people to listen to them during the Covid-19 pandemic. China, too, ran into challenges early on, but the country’s institutional memory from previous viral outbreaks helped turn the tide. And as many Americans abandon masking, push to restore normality in places where risks of infection remain high and hesitate to get vaccinated, some public health experts have looked to Dr. Wu’s success, seeking lessons on handling not only Covid, but also future epidemics.

A factor that likely helped Dr. Wu, medical historians say, is that he made masks affordable and accessible. A similar approach was used during the coronavirus pandemic in Hong Kong, which offered every resident a free, reusable mask and put kiosks in public to distribute them.

Countries that have provided significant support to their citizens to comply with public health mandates during this pandemic have generally fared better than places that left the same measures up to individuals, Dr. White of Johns Hopkins said.

And the more affordable and accessible public health measures are to adopt, the more likely they are to be adopted, said Kyle Legleiter, the senior director of policy advocacy at The Colorado Health Foundation."