3. US Public Health Service made recommendations, not mandates
By the late summer of 1918, officials at the national level recommended steps for communities to protect themselves from the formidable flu. Some did. Others did not. Philadelphia at first ignored the recommendations to limit social interactions. Instead, through its Director of Public Health, a political appointee the name of Wilmer Krusen, it reassured the public that the growing threat was merely seasonal flu, no more dangerous than any other. He suggested Philadelphians keep warm and dry and recommended the use of laxatives to “keep their bowels open”. Krusen was the official responsible for the city’s failure to cancel the parade, and thus the tragic aftermath which followed.
In St. Louis, an altogether different public official dictated the community’s response. When the first reports of the infection rates in Missouri army barracks arrived, Dr. Max Starkloff, the Commissioner of Health, wrote a column in the St. Louis Post-Dispatch telling citizens to avoid crowds and crowded areas. Following his recommendations, the city moved rapidly to close schools. The city banned public gatherings, closed its theaters and pool halls, and ordered many other businesses to close. Starkloff called for volunteers to treat the afflicted in their homes. The business community opposed most of his actions, but the city government backed their health commissioner.