Tom Koch is a medical geographer at the University of British Columbia and the author of Cartographies of Disease and Disease Maps: Epidemics on the Ground.
At press conferences and in media reports around the world, the current COVID-19 crisis has been cast as something extraordinary. Health officials have described it as “remarkable” and “unprecedented.” The head of the World Health Organization, who has since declared a pandemic, has even described this moment as uncharted territory.
But for a medical historian, the novel coronavirus is simply a case of going back to the future.
COVID-19′s expansion follows a pattern of infectious diseases we have seen time and time again for centuries, which makes sense: It is the newest member of a viral family beginning with influenza, which crossed over to humans around 2500 BC when poultry was first domesticated in China. Indeed, by around 400 BC, it had become sufficiently widespread that Hippocrates described it in his Epidemics.
It was the bubonic plague in the 14th century that kicked off the pattern for all future reactions to infectious diseases that were deadly enough to affect urban commerce and life. Venetians coined the term “quarantine” to describe the 40 days that ships from a plague-affected country would have to stand at sea before being allowed to enter a port. Patients in affected cities were quarantined in homes or makeshift facilities until they miraculously recovered, or died. Public meetings were discouraged.
Both China’s modern quarantine program and Italy’s “lockdown” of its people have their antecedent in a 1690 program ordered by Filippo Arrieta, then the royal auditor and military governor for Bari, which was a province of the kingdom of Naples. Felucca sailboats skimmed along the coastline to keep watch, while on land, the province was sealed off by troops. Inside the cordons, separate military barriers surrounded cities where the plague was active to keep people in, and those where it had yet to arrive to keep people out. Within each affected town, care facilities were set up. There were almost certainly other, similar programs elsewhere, but it is Arrieta’s report that remains from that time.
Then, in the 1700s, recurrent yellow fever epidemics arrived on the scene. This didn’t just threaten trade, but the very existence of the nascent United States as a country. In 1793, Philadelphia lost 5,000 people – roughly 10 per cent of its population – in a few weeks. “Why should cities be erected,” asked Noah Webster, the lexicographer seen as the father of American scholarship and education, “if they are only to be the tombs of men?” The disease threatened the still-fragile relationship between the newly independent U.S., which provided raw goods, and England, where those goods were needed in factories and mills.
Perhaps the first truly modern global pandemic emerged a few decades later, when cholera progressed from India in 1818 to Europe and then England in 1831 along overland and seaborne shipping routes. Months later it was brought to Canada and the U.S. across heavily travelled sea routes.
In England, national quarantines were proposed but quickly rejected as economically disastrous. Editors in influential medical journal The Lancet wrote that a bit of cholera was better than economic restraint. The first pandemic in England – there have been four – killed tens of thousands.
The granddaddy of all human viruses followed. Influenza remains an annual visitor to this day, but because its fatality rates are rarely high, it is usually accepted as an inconvenient fact of life. The ferocious Spanish flu pandemic of 1918-19, however, was different. It was a far more potent virus, a killer propelled by troop movements during the First World War. Again, folks were encouraged to avoid mass congregations and to practise good hygiene. Hospitals everywhere were overwhelmed and most of those who died did so at home.
Then, between 1951 and 1953, the last poliomyelitis pandemic spread around the world. There was no cure, and because its primary target was young adults, schools and playgrounds were closed in many areas. Affected homes were quarantined with notices posted on their doors. Public meetings were banned or discouraged. In some places, gymnasiums were transformed into hospital wards to treat the dangerously ill. I am told by those who remember that as late as 1957, people were even wary of weddings and other family gatherings, in case the virus might still be active.
As a response, vaccines were developed to prevent previously killer viruses such as measles and polio. And so, despite what was largely seen as the inconvenience of influenza, national health organizations spent the last few decades growing increasingly confident that, as a class, infectious diseases had been tamed by vaccines and, when present, treatable by a new generation of antibiotic drugs.
For those of us who study epidemics, and especially for those who remember polio, the current health response has a familiar ring, like the almost forgotten tune of a one-hit wonder: Quarantines have returned, along with the cancellation of public events and the closing of schools. The supply chains of commerce are interrupted. We are again warned to practise good hygiene and to avoid panic while remaining vigilant. History made it clear that this was all to be expected.
Microbes, both bacterial and viral, are stressed by programs of animal domestication, deforestation and urbanization, activities that have accelerated in recent decades. Forced from their traditional habitats by human actions, the microbes evolve so they can survive in new habitats and hosts, whether avian, insect or animal. The most vigorous among them mutate into forms that colonize human populations, beginning with those in the densest urban centres, before spreading human-to-human through trade and travel.
As ever – or at least since the mid-19th century – public concern is divided between a new microbe’s health effects and the resulting effect on a national or regional economy. Global connections have only grown tighter and more numerous since the days when yellow fever blossomed through the pas de deux of raw goods from the New World to manufacturers in Europe.
It’s a new virus, a new disease, but it’s the same old tune. We just have not heard it for a while.
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