Covid-19. What does the History of Epidemics Teach Us?
The introduction of quarantine and anxiety due to the Covid-19 coronavirus is gaining momentum, along with memes on the subject. People are actively buying buckwheat, toilet paper, and antiseptic agents, leaving behind empty store shelves. But is there reason to panic?
Here is a brief retelling of a recent article (dated March 12) by candidate and doctor of medical sciences David S. Jones, in which he describes how humanity has experienced various epidemics throughout history, how it has been fought, and what can teach us. And really there is something to learn.
The boring future of infectious diseases
In the intoxicating times of the advent of new antibiotics and immunization, respected microbiologists McFarlane Burnet and David White predicted (in 1972) that “the most likely prognosis of the future of infectious diseases is that it will be very boring.”
They admitted that there was always a risk of “some completely unexpected new and dangerous infection, but nothing like that had happened for the past fifty years.” It seemed that epidemics would now be of interest only to historians.
Times have changed. From cold sores and legionnaire diseases in the 1970s (a form of SARS caused by any type of Legionella bacteria) to AIDS, Ebola, severe acute respiratory syndrome (SARS), and now Covid-19 coronavirus, infectious diseases continue to threaten humanity. Historians who have not lost interest in epidemics have something to answer for this.
The dramatic reaction of society
Before explaining past events, historians always state the importance of context. If you want to understand how or why something happened, you must know and consider the circumstances. But historians also have a desire to determine the universal principles of how different societies respond to infectious diseases.
Charles Rosenberg, for example, was inspired by the Plague novel by Albert Camus and created a report on the archetypal structure of an outbreak. According to Rosenberg, epidemics unfold like social dramas in three acts.
The earliest signs are elusive. At first, people do not believe and ignore hints that something is wrong until the increase in morbidity and mortality forces one to be reluctant to acknowledge the problem. Recognition launches a second act in which citizens demand and offer explanations. The explanations, in turn, generate public responses. This can make the third act as dramatic and destructive as the disease itself.
Epidemics are ultimately resolved, whether they succumbed to social action or ran out of susceptible victims.
As Rosenberg said: “Epidemics begin at a point in time, go on to a stage limited in space and duration, follow the storyline of growing tension, go on to an individual and collective crisis, and then leave.”
This drama is now unfolding with Covid-19, first in China, and then in many countries of the world.
Additionally: you can see what the top 5 coronavirus myths are.
Who’s guilty?
But historians were not limited to the description. Rosenberg argues that epidemics put pressure on the societies they hit. The disease makes visible, hidden structures that otherwise would not be obvious. It shows what is really important for the population and who is really appreciated.
One of the dramatic moments of responding to epidemics is the desire to share responsibility. From Jews in medieval Europe to meat traders in Chinese markets, they always blame someone. This guilt discourse takes advantage of existing social divisions: religions, races, ethnic groups, classes, or gender identities. In response, governments respond, for example, through quarantine or compulsory vaccination. This step usually involves people with power and privileges who impose measures on ordinary people, which is the driving force behind social conflict.
Another recurring theme in the historical analysis of epidemics is that medical interventions and public health measures often fail to deliver on their promises. The technology needed to eradicate smallpox – vaccination – was described in 1798, but it took almost 180 years to succeed.
In 1900, health workers in San Francisco pulled a rope around Chinatown in an attempt to control the outbreak of the bubonic plague – only white people (and, presumably, rats) were allowed to enter or leave the area. This measure did not produce the desired effect.
Syphilis, one of the greatest disasters of the early 20th century, could theoretically be defeated if everyone adhered to a strict regime of abstinence or monogamy. But, as one US Army officer complained in 1943, “sexual intercourse cannot be made unpopular.” When penicillin became available, syphilis could be eliminated more easily, but some doctors cautioned against its use, fearing that it would remove the sentence from licentiousness.
The human immunodeficiency virus (HIV), theoretically, could have remained in the 1980s, but this did not happen. Although the advent of effective antiretroviral therapy in 1996 dramatically reduced AIDS deaths, it did not put an end to it. There is still a striking difference in AIDS rates for the familiar attributes of race, class, and gender.
Given what historians have learned about past epidemics, now we are all exhausted. This particular coronavirus may be new, but we have seen it all before. Is there a new pathogen in China? This is not surprising: China has spawned many past pandemics. People in no hurry to recognize the threat? This is what Camus described so well. Did officials try to suppress early warnings? Of course. Did governments respond with authoritarian interventions? They often do so – although the scale of China’s interventions can be unprecedented. Can the quarantine not delay the pathogen? This has happened more often than ever, especially with pathogens such as the influenza virus and SARS-CoV-2, which make people contagious before the onset of symptoms.
This does not mean that interventions are useless. When the flu hit the United States in 1918, different cities reacted differently. Some could learn from the mistakes of those who were first struck. Cities with strict controls, including school closures, bans on public gatherings, and other forms of isolation or quarantine, have slowed the epidemic and reduced overall mortality. China’s aggressive reaction may have delayed the global spread of the current outbreak.
Two familiar aspects of responding to epidemics are particularly discouraging. First, stigmatization is closely associated with each pathogen. The anti-Chinese feud was a constant problem, be it the San Francisco plague in 1900, the SARS in 2003, or the Covid-19 today. Secondly, epidemics all too often take the lives of health workers. Doctors died during outbreaks of plague in medieval Europe, during the outbreak of yellow fever in Philadelphia in 1793, during the Ebola epidemic in 2014, and now in China. Although such mortality shows the heroism of healthcare providers, they can blame governments that ask clinicians to resist the disease without the “personnel, equipment, space, and system” they need to successfully and safely fulfill their duty.
History and Politics
Historians, as we have already noted, perfectly document past epidemics, but cannot predict anything accurately. How much should we worry about Covid-19? Some experts warn that half of the world’s population will be infected by the end of the year, which could lead to the death of more than 100 million people.
There are plenty of epidemics of plague, smallpox, measles, cholera, influenza, Marburg viral diseases, and respiratory syndrome in the Middle East. But the catastrophic epidemics that kill millions were extremely unusual, and only a few have occurred in the last millennium. Are we really in one of those rare moments when we encounter the pathogen only with the right (wrong?) Mixture of infectiousness and virulence, with societies that provide the necessary contact between humans and animals, urban crowding, global travel and populations under stress due to growing social inequality? Given the historical rarity of catastrophic epidemics, such an ideal storm is unlikely. But, unfortunately, this is possible.
History shows that, in fact, we are at a much greater risk of exaggerated fears and inappropriate priorities. There are many historical examples of an unjustified panic about epidemics – to take at least the H1N1 flu in 1976, 2006, and 2009. There are countless other examples of how societies worry about a small threat (for example, the risk of Ebola spreading in the United States in 2014) while ignoring much larger ones.
SARS-CoV-2 killed about 5,000 people by March 12. This is part of the annual flu loss. While the Covid-19 epidemic was unfolding, China probably lost 5,000 people every day due to coronary heart disease. So why are so many Americans abandoning flu vaccines? Why has China shut down its economy to delay Covid-19 while not taking the necessary steps to limit cigarette consumption?
Societies and their citizens misunderstand the relative importance of the health risks they face. The future course of Covid-19 remains unclear (and I can regret these words by the end of the year). However, citizens and their leaders must carefully consider, weigh risks, and take measures commensurate with the magnitude of the threat.
What raises the last question is history and political leadership. In 1976, swine flu broke out in the United States at the height of the presidential campaign. Gerald Ford reacted aggressively and endorsed mass immunization. When people fell ill or died after vaccination, and when a dangerous pandemic never happened, Ford’s plan had the opposite effect and possibly contributed to its defeat in November. When AIDS erupted in 1981, Ronald Reagan ignored the epidemic throughout his first term. Fortunately, the current administration did not follow Reagan’s example. Will they succeed where Ford is out of luck?
History of epidemics can give good advice, but only if people know the story and act wisely.
