The nation’s expectations about what the federal government could do to help were very different in 1918 than they are today. On September 28 of that year, Surgeon General Rupert Blue, in the crisp blue military uniform of the U.S. Public Health Service, testified before the Senate Appropriations Committee that the nation needed federal help: “Until we get a vaccine we have to rely upon careful treatment of the sick, keep away from crowds, and cover up the mouth and nose so that they will not spread the disease.” Even with the $1 million Congress agreed to that fall, Blue could do little more than try to coordinate the distribution of doctors, nurses, and supplies from richer states to poorer ones. He also provided advice and information to local health authorities, including urging bans on public gatherings anywhere the flu was present. Eventually, the Public Health Service published 6 million bulletins, posters, and newspaper articles and distributed them throughout the country.

Meanwhile, city and county officials made their own decisions about when to close schools, stop travel, and prevent public gatherings. Examples abound of the variation in decision-making abilities among local leaders. The City of St. Louis took the surgeon general’s advice to close schools, churches, and places of entertainment, and to cancel public events. Philadelphia did not. The result, as The New York Times recently reported, was a dramatic difference in death rates between the two cities. In Philadelphia, health officials suggested to the mayor that a parade in support of the sale of war bonds should be canceled in light of the epidemic, but the mayor refused. Huge crowds showed up, and flu cases spiked afterward. By contrast, St. Louis more quickly and promptly shut down public gatherings and had one-eighth as many flu-related fatalities at the end.

The influenza pandemic hit the country unevenly in three waves over the course of two years. The greatest hardship for families and individuals was economic: restaurants, bars, and other businesses were ordered to close. Such measures took away livelihoods and caused widespread unemployment with no social-safety net to fall back on—this was, of course, before the advent of the country’s major welfare programs during the New Deal. Local welfare barely existed, and private charities, often the only option, were overwhelmed just like everybody else. Prohibitions on church services and funerals pained people emotionally and spiritually.

A resigned and terrified population mostly complied with the orders of mayors, town councils, health officers, and school boards. (Those ordered into complete isolation were too sick to be out anyway.) But residents sometimes turned to the courts to challenge these measures—not surprising, perhaps, given American legal traditions and strong notions of individual liberties in the U.S.