Public/Global Health

How coronavirus might reshape society

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As public health officials wrestle with the short-term challenge of bringing the deadly coronavirus under control, some are beginning to consider what society might look like once that happens.

Will the commercial real estate market collapse as more people work from home? Will elbow bumps replace handshakes and hugs? Or, more darkly, will there be rampant discrimination against people wrongly thought to be carriers of the pathogen?

Medical historians and experts say humanity’s past experiences with diseases have shaped the world we know today, from the way our cities are constructed to modern privacy laws and even the way people think about sex.

“Right now, our lives have changed 180 degrees. Today, I’d be in my office or teaching or doing something at the hospital,” said Howard Markel, a physician and director of the Center for the History of Medicine at the University of Michigan. “This has been absolutely life changing, and the fact that we don’t know how long we have to do it is also very problematic.”

The coronavirus pandemic raging across the world has put billions of people on lockdown, sent millions of Americans to work from home, cost millions of people their jobs, shuttered bars and restaurants and parks, and canceled public events and school classes.

“These pandemics are not just interchangeable causes of death, but each one is experienced by society in a very different way,” Frank Snowden, a historian at Yale and author of the 2019 book “Epidemics and Society: From the Black Death to the Present,” said recently in a live chat with the editor of the Journal of the American Medical Association.

Some of those changes stem from new discoveries about how disease works.

A few years after the pioneering physician John Snow discovered contaminated water was at the root of cholera outbreaks that killed tens of thousands of Londoners during the middle part of the 19th century, a so-called Great Stink emanating from the River Thames inspired construction of one of the world’s first massive sewer systems that still serves the city today.

Thirty years later, Robert Koch isolated the bacterium that causes cholera, launching the beginning of modern germ theory.

Across the Atlantic, an outbreak of Yellow Fever along the Mississippi River in 1878 forced Memphis, Tenn., and New Orleans to abandon old practices of water storage in favor of more sanitary piped water system.

“City design and sanitation changed drastically in the 1800s after diseases like cholera and yellow fever,” said Joshua Loomis, a biologist at East Stroudsburg University and author of “Epidemics: The Impact of Germs and Their Power Over Humanity.”

“People were still dumping their sewage into the same water that they drank from,” he said.

Koch also helped discover the root cause of tuberculosis, developing a test to identify its presence in a human. A broader societal understanding of the ways tuberculosis spread led to the death of the common cup, a communal water vessel regularly seen on trains and in public places at the time, and gave rise to the disposable paper cup and the earliest water fountains, said Mitchell Hammond, a medical historian at the University of Victoria and author of “Epidemics and the Modern World.”

There were other welcome changes, he said.

“People started to be discouraged from spitting,” Hammond said.

In 1911, the invention of the camera helped bring terrifying photographs of an outbreak of plague in Manchuria to people around the world. The photographs captured something novel at the time — people wearing face masks to protect themselves, something that Americans tried for the first time en masse during the 1918 Spanish flu.

A growing battle against polio in the middle of the 20th century created a host of innovative techniques that are now core elements of modern medicine.

Fragile children suffering from polio were put into early versions of intensive care units. While some people treated polio patients by making them lie still in bed, an Australian nurse decided to get her patients moving, the first form of physical therapy.

Polio also spawned the beginnings of the modern disability rights movement, advocates who eventually won passage of the Americans with Disabilities Act in 1990.

Many of the top experts working to combat the coronavirus today — including Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases; Deborah Birx, the lead coordinator of the coronavirus task force; and Robert Redfield, director of the Centers for Disease Control and Prevention — cut their teeth on the most substantial outbreak of the later part of the 20th century, an unknown virus that seemed to disproportionately strike men who have sex with other men.

That virus, HIV, carried its own set of societal innovations. After decades of increasingly liberal attitudes toward sex, safety started entering public health conversations that had once been taboo.

“Before HIV, maybe the worst you could get was herpes or gonorrhea where you could take some antibiotics,” Loomis said. “The whole idea of safe sex, they were still in the free love world in the 1970s. People point to HIV in 1980, 1981 as the moment that ended.”

HIV and AIDS also led a revolution in medical privacy, after some gay men were outed by their doctors after testing positive for the virus. The backlash eventually led to the Health Insurance Portability and Accountability Act of 1996, or HIPAA, the law that dictates how personal medical information should be handled and kept private.

Disease can also inspire the worst in society, especially when some try to blame specific ethnic groups for the presence of a pathogen. Thousands of Jews were murdered in Strasbourg in 1349 after rumors circulated that they were responsible for the plague sweeping across Europe.

There is a disturbing parallel today, in which people of Asian descent are being blamed for a virus that likely emerged from a wet market in Wuhan, China. An Ipsos poll conducted for the Center for Public Integrity found nearly a third of Americans said they had witnessed someone blaming an Asian person for the pandemic.

Americans have a long history of discrimination against those of Asian heritage, from the Chinese Exclusion Act that kept Chinese immigrants out of the country to the Japanese internment camps that confined American citizens during World War II because of their ethnic heritage.

“We see once again this stigma against Asian people as if there was something in an Asian person’s DNA that makes them terribly dangerous,” Snowden, the Yale historian, said during the interview. “You’d think that we would be in a sense inoculated against that particular form of ethnic prejudice, but we don’t seem to be.”

How and whether society makes substantial long-term changes after the coronavirus outbreak is wrangled under control is not yet known. But many have warned that, until a vaccine or a reliable treatment exists, the normal that we so desperately hope to return to is not going to be the normal that existed before.

It is likely that more people will work from home, even after life does return to some semblance of normality, though a mass exodus from the modern office seems unlikely. Some health systems have already experienced a tremendous growth in the use of telemedicine — medical care by video conference that has existed for years but had been slow to take off.

The coronavirus “is going to afford a rapid ascent of telehealth and other things that have been sort of waiting for a reason to gain momentum,” said Kevin Carney, who oversees emergency medicine and urgent care units at Children’s Hospital Colorado.

And just like people in the late 19th and early 20th century had to get used to the idea of germs that caused illness, today people are becoming accustomed to seeing charts and graphs, previously the domain of epidemiologists and statisticians, as a way to understand what is happening around them. Phrases like “flatten the curve” have entered the modern lexicon.

“I think people today are being acclimated to the use of statistics,” Hammond said. “People are growing accustomed to seeing curves and relying on them and even using them to forecast what might happen and using them for decisionmaking.”

Fauci has already said he would like to see one particular outcome from the coronavirus pandemic.

“I don’t think we should ever shake hands ever again, to be honest with you,” Fauci told a Wall Street Journal podcast this month. “Not only would it be good to prevent coronavirus disease, it probably would decrease instances of influenza dramatically in this country.”

But the balance between making drastic changes in the name of public health and preserving less harmful traditions can be delicate.

“There are some changes that are good ideas. Not shaking hands is probably a good idea. People who may wash their hands a lot more than they used to is always a good idea,” Markel said. “I hope we don’t throw the baby out with the bathwater, that we do adopt safer health practices related to not catching respiratory viruses, but that we don’t let our fear or our panic control how we live our lives.”

But, he added, on the handshake front: “It is disgusting when you think about it on a microbiological level. You don’t know where those hands have been.”

Tags AIDS Anthony Fauci China Cholera Coronavirus COVID-19 England HIV London Pandemic Polio Wuhan
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