What we can learn from past pandemics

What we can learn from past pandemics
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Epidemics, plagues, and pandemics have been around since the dawn of civilization. Indeed, they are an unintended consequence of civilization. Disease certainly afflicted our prehistoric ancestors, but since the earliest humans lived in small isolated bands, they had limited opportunity to share germs beyond their own community. That situation changed dramatically when the agricultural revolution replaced a nomadic with a sedentary lifestyle 10,000 years ago. 

Once humans began to live in villages, towns, and especially cities, they had to contend with contagious diseases on a larger scale. They have been doing so ever since. COVID-19 is but the latest in a long series of pandemics. Understanding how people have dealt with them in the past may help us understand the current crisis and prepare us for future ones. 

For much of history, urban dwellers lived in crowded, unsanitary conditions. The earliest cities also had one striking characteristic in common with the market in Wuhan, China, source of the coronavirus outbreak: humans lived in closed proximity with animals.

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This living arrangement facilitated the spread of zoonotic diseases, contagions transferred from animals to humans, such as COVID-19. The earliest civilizations certainly experienced local epidemics but probably not pandemics, since they remained isolated from one another. The building of empires, however, facilitated the spread of disease, which traveled along trade and commerce routes.

One of the worst pandemics in human history struck the Byzantine Empire during the reign of Justinian in the mid-sixth century of the common era. Researchers have identified the pathogen as Yersinia Pestis, commonly known as bubonic plague, a pathogen carried by rats and transferred to humans via fleas as the intermediate host.

It began in Egypt and traveled to Constantinople (present-day Istanbul) on grain ships, from whence it spread throughout the empire. Contemporary accounts claim that at the height of the outbreak, 5,000 people a day died in the capital. By the time the plague had run its course, as many 100 million people, half the population of Europe, had perished.

The plague returned with a vengeance eight hundred years later as the most infamous pandemic in human history. In October 1347, ships docked at the port of Messina in Sicily filled with sailors stricken by a mysterious illness that produced dark swellings, or buboes, in the armpits and groin. This symptom led to the pestilence being dubbed the “Black Death.” The plague spread rapidly and within a few years had killed one-third to half the population of Europe. 

Fear followed fast on the heels of the contagion, just as it does today. In the Middle Ages, however, panic took a different form. Modern people horde N95 masks and hand sanitizer; their ancestors turned to religion. Penitent Christians paraded through the streets of Europe flagellating themselves with whips to appease God’s wrath. Lacking a scientific worldview, governments tried a variety of preventive measures. 

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The Venetians banned sailors from entering their cities for 30 days, which they later extended to 40. The Italian “quaranta giorni” (literally, “40 days”) became the English “quarantine.” In some towns, officials literally sealed infected people into their houses, a harsh precursor to current admonitions to “work from” home. While quarantines may have helped deter the spread of plague, the wholesale slaughter of cats proved counterproductive in trying to stop a disease spread by rats.

In addition to suffering intermittent pandemics, Europeans had to contend with numerous endemic diseases. Measles, Chickenpox, and especially smallpox killed millions over several centuries. Prolonged exposure to these diseases, however, gave survivors some level of immunity, which Native Americans lacked. European diseases killed an estimated 20 million people, 90-95percent of the pre-Colombian population of the Americas. Germs, not guns or steel, conquered the New World

A better understanding of transmission, improved sanitation, vaccines, and eventually antibiotics have eliminated several of history’s worst diseases, leaving what has become the endemic condition of the twentieth and twenty-first centuries: influenza, a generic category of contagious respiratory viruses transmitted by coughing and sneezing. Influenza viruses readily mutate, necessitating annual flu shots for protection against new strains. Since 2010, annual flu death rates in the United States have ranged from a low of 12,000 in 2011-12 to a high of 61,000 in 2017-18

These numbers pale in comparison to the worst pandemic in U.S. history, the 1918-19 “Spanish flu.” A particularly virulent strain of the H1N1 influenza virus spread around the world, facilitated by the return of soldiers from WWI. Unlike COVID-19, this strain proved most lethal to the young. The pandemic killed approximately 50 million worldwide, including about 675,000 Americans.

Flu pandemics occurred periodically during the twentieth century, most notably the 1957 Asian flu, the 1968 Hong Kong Flu, and the 2003 SARS outbreak, but they had little effect on the United States. However, Americans continued to die from annual.

The U.S. government badly handled the 1918 pandemic, responding to the Spanish flu much as the White House has to COVID-19. Officials downplayed the threat. That decision proved disastrous. As more deaths occurred, panic spread and people distrusted the government information. Americans witnessed scenes reminiscent of the Black Death.

In some cities, trucks and carts drove down streets calling on people to “bring out their dead,” who were then buried in mass graves. Some victims, especially children, died of neglect and even starvation, as no one would enter infected houses to care for them. During a pandemic, fear can be as much of a problem as the disease itself. 

History does not repeat itself, but it can help us understand the present and prepare for the future. The pandemics of the past offer valuable lessons. First, in all probability COVID-19 will not come close to the severity of any of the great pandemics.

We have far more knowledge and resources to prevent infection and treat this disease than did our great grandparents in 1918. Second, fear continues to be as contagious and debilitating as the disease itself. Considerable evidence suggests that COVID-19 is not particularly lethal to healthy people under 60. 

Unfortunately, this fact has not prevented the hoarding of masks and hand sanitizer. Whether current anxiety develops into a full-blown panic depends on whether the federal government has learned the final lesson of past pandemics: withholding information, distorting facts, and downplaying the threat always makes matters worse.

In a crisis, people must be able to trust their leaders. Trust can be earned and maintained only when those leaders provide clear, accurate and timely information.

Tom Mockaitis is a professor of History at DePaul University where he teaches World Civilizations. His most recent book is, "Violent Extremism: Understanding the Domestic and International Terrorist Threat."