Nurses tend to the sick at a temporary hospital at the Oakland (Calif.) Municipal Auditorium in 1918 during the Spanish flu outbreak. Epidemiology professor Dr. George Rutherford says that pandemic offers lessons that can be used to fight COVID-19. (Getty Images)

Venues from nightclubs to stadiums closed their doors en masse in mid-March as the coronavirus arrived in the U.S. and forced government officials to restrict large gatherings and performers and sports teams to postpone or cancel events for the next several weeks.

The unprecedented measures, which began in earnest with the cancellation of Miami’s major electronic music festival Ultra on March 4, and continued the following week with the halt of the NBA and NHL seasons, may have initially seemed premature to industry observers and fans alike, given that American cases of the virus had yet to spike.

But Dr. George Rutherford, a professor of epidemiology specializing in infectious diseases at University of California, San Francisco, emphasized that the decisions were prudent, grounded in history, and likely to save lives.

“The basic lesson is that if you’re going to do this, and move to these so-called non-pharmaceutical options” — event cancellations and quarantines — “you gotta do it early and you gotta nip it in the bud, before there’s a lot of transmission,” Rutherford told VenuesNow.

While COVID-19, which is caused by the novel coronavirus, has an estimated death rate around 2% — far less than previous epidemics like SARS and Ebola, which hovered around 11% and 50%, respectively, according to World Health Organization data — it’s still far more deadly than the seasonal flu, which typically has a death rate of 0.1%. And because those infected with coronavirus can “shed virus” (industry parlance for spreading the disease) before developing symptoms, or remain asymptomatic or mildly symptomatic entirely, it’s particularly pernicious.

“Imagine a scenario where somebody walks into South by Southwest and is in this active shedding phase,” Rutherford said. “Even a couple days before they develop symptoms, they still start to shed virus and become infectious. Maybe not at really high levels. But then they get sick and there’s some 24-year-old stud that toughs it out. He hacks and coughs and, all of a sudden, you have 500 people infected. That’s exactly what you don’t want to have. And if you have two or three people coming in …”

Coronavirus is spread by the droplets that fly through the air when someone coughs or sneezes and can also be transmitted if someone comes into physical contact with a surface that one of these droplets recently landed on. The coronavirus particles don’t hang in the air in the same way that something like measles does, Rutherford said, but transmission is still highly risky for someone in proximity. Safe social distancing estimates vary, but WHO advises 3 feet and the Centers for Disease Control and Prevention cautions a more conservative 6 feet.

Either measure disqualifies sporting events and concerts of most sizes.

“You want to get distance between people,” Rutherford said. “At big festivals, where everybody’s sitting around out on the green or dancing or whatever, and somebody starts coughing and hacking, you can get a lot of people exposed pretty quickly.”

Coronavirus arrived in countries across the globe before the U.S., and even as the threat to Americans appeared distant, countries from China, where the outbreak originated, to South Korea and Italy tightened restrictions on public gatherings. One of the best precedents for how our society should respond to coronavirus, according to Rutherford, actually took place more than a century ago, when the Spanish flu pandemic swept across America.

That pandemic “is one of the big things we have to go on,” Rutherford said, because it demonstrates how quarantining can halt the spread of a contagious, possibly lethal disease — and how refusing to do so can contribute to its spread.

By studying the Spanish flu’s spread in major American cities early in the 20th century and cross-referencing those with containment and social distancing measures, infectious disease experts today have definitively linked aggressive restrictions on public gatherings to reduced rates of transmission and infection.

For instance, Philadelphia notoriously proceeded with a patriotic Liberty Loan Parade on Sept. 28, 1918, although flu cases had arrived in the city just over a week prior. Two hundred thousand attended the gathering, and cases spiked.

“If you’re going to contain it and not have all the excess mortality that happened in 1918, 1919, you had to start it early and you had to not let up,” Rutherford said. “One of the most successful cities was St. Louis. They started [containment] around early September, and they stopped prematurely — what turned out prematurely — in early November, December, and then had a big rebound and had to put everything back into place. You gotta hold the line longer than you think.”

Rutherford said that as major cities lift containment measures today, it’ll demonstrate in real time whether containment periods were sufficient.

Live events, specifically, present plenty of opportunities for transmission that other social gatherings might not.

“There’s the question of mixing, getting people in and out through funnel points,” Rutherford said. Even at, say, an amphitheater show, “It’s not like they’re sitting out, all 6 feet from each other on picnic blankets or anything, because they have to go through these chokepoints as they go in and out” of the venue.

Ventilation systems can also exacerbate transmission, Rutherford said. Smaller clubs, especially older ones, often have “crappy ventilation and you can spread stuff around pretty quickly.”

For indoor venues from clubs to arenas, ventilation could be improved to combat virus transmission, but the measures would likely be costly and time-consuming to implement.

“There are things you can do with ventilation systems that you would do in hospitals, like putting ultraviolet lights in it to fry all the bacteria and viruses that go by, before they get recirculated,” Rutherford said.

Rutherford also suggested that venues could reduce transmission by implementing thermal-imaging devices to screen out people with fevers.

“Temperature is a good indicator, although you probably don’t develop fever until day two, say, of the period you’re infectious,” he said. “So, you’re going to miss a few.”

Complicated, costly measures like these would make live events safer, but would also be huge investments that wouldn’t mitigate the risk of transmission completely.

And ideas like what the Stanford women’s basketball team implemented in the coronavirus crisis’ early days – filling the venue partially so that patrons could distance themselves from others – remain imperfect from a public health perspective, while also substantially cutting into a facility’s bottom line.

With both vaccines and anti-viral treatments months away from public distribution, the near-total shutdown of the live industry seems likely to continue, saving lives but frustrating fans, talent, venue operators, concession and security workers, and everyone else with a stake in the business.

But, Rutherford wryly joked, it could be worse: “Imagine if you were managing the Tokyo Olympics. You think you’ve got problems?”