As officials scramble to safely conduct primary contests amid the coronavirus pandemic, worries mount about how the country can safely conduct a presidential election this November.

How officials handled voting during the Spanish flu pandemic offers crucial lessons on balancing public health with democracy.

"Voter turnout was lower than it had been previously, by about 10 percentage points," he said, noting that while "the pandemic almost certainly had an impact ...

But not wanting to cancel the election, officials scrambled to make it work: They ordered inspectors to guard polling sites against overcrowding and placed some voting booths outdoors.

Currently, dozens of states have postponed their primaries or moved to mail-in or drive-by voting as the pandemic has upended the 2020 election cycle.

A second wave of the 1918 flu swept across America later in the winter, though Navarro said it’s hard to trace the spikes in major cities to Election Day specifically since the virus was spreading so rapidly and easily there anyway.

In rural cities around the country, the Spanish flu hit communities hard after voting in-person, said Kristin Watkins, an expert infectious disease and public health who studied the 1918 pandemic in rural Nebraska.

But they paid a price for it: In the week following Election Day, Watkins said, 110 people died — roughly 6.5% of the population.

She said it was a forewarning to election officials about voting safely.

Many states are expanding vote-by-mail options this year as a way to make Election Day safer, even as President Donald Trump falsely claims that voting by mail is rife with fraud.

"Despite what we’re seeing from politicians and the White House and elsewhere who are mostly concerned about who’s going to win an election," Becker said, "election officials in the state are doing what they need to do to protect voters."