How hospitals will decide who lives and who dies in the COVID-19 crisis
How politics infected America's first epidemic and cost lives
Politics has infected discussion of the novel coronavirus, especially on social media. When Democratic Denver City Councilwoman Candi CdeBaca expressed solidarity with this tweet: "For the record, if I do get the coronavirus I'm attending every MAGA rally I can," she received a swift rebuke. "The depths to which Democrats are sinking to politicize coronavirus is disgusting," Republican National Committee Rapid Response Director Steve Guest responded. CdeBaca clarified her comment as sarcasm.
Given today's polarized political climate and lack of impulse control on social media, it's easy to assume that this is the first time politics has tainted a public health crisis. In fact, politics infected America's first epidemic and cost lives.
"The yellow fever increases. The week before last about three a day died. This last week about 11 a day have died; consequently, from known data about 33 a day are taken, and there are about 330 patients under it," Secretary of State Thomas Jefferson wrote to Congressman James Madison on Sept. 8, 1793, about the yellow fever epidemic infecting America's capital city of Philadelphia. "They are much scattered through the town, and it is the opinion of the physicians that there is no possibility of stopping it, They agree it is a non-descript disease."
Jefferson's political rival and fellow cabinet member, Treasury Secretary Alexander Hamilton, had come down with it.
"With extreme concern I receive the expression of your apprehensions that you are in the first stages of the prevailing fever," President George Washington had worriedly written Hamilton, who faced yellow fever's symptoms of yellowing of the skin, high fever, and stomach bleeding that led to black vomit.
Politics affected which treatment people chose, Hamilton's doctor's method or Jefferson's doctor's method.
Worried about the "undue panic which is fast depopulating the city, and suspending business both public and private," Hamilton wrote a letter on Sept. 11, 1793, to Philadelphia's College of Physicians that was published in the "Federal Gazette" and other newspapers.
"I have myself been attacked with the reigning putrid fever, and with violence-but I trust that I am now completely out of danger. This I am to attribute, under God, to the skill and care of my friend Doctor Stevens, a gentleman lately from the island of St. Croix," Hamilton wrote. He'd known Stevens from childhood when he lived in the Caribbean, where yellow fever was common.
"His mode of treating the disorder varies essentially from that which has been generally practiced - And I am persuaded, where pursued, reduces it to one of little more than ordinary hazard," Hamilton wrote, recommending Steven's method.
"I know him so well ... and being in my own person a witness to the efficacy of his plan, I venture to believe, that if adopted, and if the courage of the citizens can be roused, many lives will be saved, and much ill prevented," he concluded, explaining that his wife had also caught the disease but was recovering by following Stevens' method, which involved hydration, wine, baths, and herbs.
Hamilton's recommendation was instantly political. How could a medical remedy become political and controversial? Stevens opposed the blood-purging method of Benjamin Rush, the city's most prominent physician. Rush was a Republican proponent and friend of Jefferson's.
Stevens's method became the Federalist method for treating yellow fever and Rush's became the Republican method. If you favored Hamilton's Federalist politics you trust Stevens and chose staying clean, hydrated, and inhaling herbs. If you favored Jefferson, you chose Rush's method and allowed leeches to suck the blood out of your body to supposedly purge the poison from your blood. Given what we now know about medicine, Stevens's hygienic, homeopathic method was more effective. Rush was a failure.
Jefferson's disdain of Hamilton also prevented him from expressing empathy for his rival. Instead, Jefferson spoke ill of the ill Hamilton in his letter to Madison.
"His family think him (Hamilton) in danger and he puts himself so by his excessive alarm. He had been miserable several days before from a firm persuasion he should catch it," Jefferson wrote before insulting him and his military service. "A man as timid as he (Hamilton) is on the water, as timid on horseback, as timid in sickness, would be a phenomenon if the courage of which he has the reputation in military occasions were genuine." He also questioned whether Hamilton truly had yellow fever. "His friends, who have not seen him, suspect it is only an autumnal fever he has."
The first cases appeared in Philadelphia in early August 1793 not long after a ship arrived from Santo Domingo, where an earlier outbreak had occurred. It would take a hundred years before scientists discovered that mosquitoes transmitted yellow fever.
What stopped the 1793 epidemic? The change of seasons through the arrival of winter ended the epidemic. November's cooler temperatures killed the mosquitoes that spread the disease.
Yellow fever took more than five thousand lives in 1793 in a city with more than fifty thousand people. Among them were John Todd and one of his two young sons, an infant named William. Todd's wife, Dolley married Congressman Madison nearly a year later.
Choosing a medical treatment based on the politics of the doctor and his political friends seems ridiculous today. But let it be a cautionary tale of the importance of keeping politics out of an epidemic. Let the evidence, facts, and physicians lead the way.
Jane Hampton Cook is the author of "America's Star-Spangled Story" and "The Burning of the White House: James and Dolley Madison and the War of 1812." She is a former White House webmaster for President George W. Bush.