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The origin of the virus will never be known for certain, and the first person in the United States to contract the disease is likely also lost to history. In the United States, cases first appeared in the Pacific Northwest, and the speed of the outbreak during March and April quickly outpaced early efforts to protect against the virus. George Parrish, the health officer for Portland, Oregon, began a campaign to educate the public as to how the virus was transmitted, emphasizing the need to control coughing and sneezing, especially in crowded public places. He reached out to local religious leaders to help deliver the message from the pulpit to their congregations. A week after the first confirmed case in the city, the Oregon State Board of Health ordered the shutdown of all public gathering places; no restaurants, no theaters, and no school for tens of thousands of students. Officials reminded the public of the importance of hand washing and began a campaign to encourage social distancing. Two hundred miles to the north, Seattle had already seen a dozen deaths from the disease. The mayor asked that people avoid gathering in churches, and some public gatherings were banned entirely. On the opposite coast, the situation was no better as the White House, Congress, and the Supreme Court were closed to the public. When masks were found to reduce the risk of viral transmission, government agencies publicized their usefulness. The San Francisco Chronicle printed a public service announcement calling those who refused to wear masks “dangerous slackers” and emphasizing that beyond keeping oneself healthy, wearing a mask protected others who were more likely to suffer serious consequences. Shortly thereafter, the city of San social distancing recommendations. Across the country, politics intruded as people began to choose sides. In Portland, a city council debate became chaotic when one member decried a masking order as “autocratic and unconstitutional,” adding that “under no circumstances will I be muzzled like a [rabid] dog.” In San Francisco, 2,000 people gathered indoors to join an anti-mask rally, which included physicians, as well as one member of the Board of Supervisors. Public outcry grew louder when several city officials, including the mayor, were photographed attending a boxing match without masks. The situation in San Francisco came to a head when a special officer for the Board of Health shot a man in a dispute over mask-wearing (he survived but was arrested for not following the officer’s orders). Because most public health decisions were made at the local level, the success of mitigation strategies varied wildly. Health officials in Philadelphia advised the mayor to cancel several large public gatherings, including a parade, to prevent the spread of the virus. The mayor refused, and a surge in cases followed. Meanwhile, in St. Louis, similar gatherings were quickly shut down, robbing the virus of an opportunity to spread. In the end, St. Louis had one-eighth as many deaths as did Philadelphia. While most medical experts recommended quarantines and face masks, health officials in many cities, according to the New York Times, “opposed both these measures and placed great reliance on [the development of a] vaccine.”