Miniature by Pierart dou Tielt illustrating the Tractatus quartus bu Gilles li Muisit (Tournai, c. 1353). The people of Tournai bury victims of the Black Death.
( Pierart dou Tielt (fl. 1340-1360)
Bob Garfield: Nearly a year into the Coronavirus’ draught through humanity, the cyclical nature of this pandemic, particularly in the United States, is clear. We bend the curve, loosen our grips, the curves springs back all because we struggled to learn lessons from earlier waves, and even from earlier plagues. There is much to glean from that history about old maladies, and about the values, temperament, infrastructures and moral structures of the societies they attack. Frank Snowden is a professor emeritus of the history of medicine, and author of Epidemics and Society: From the Black Death to the Present. When we spoke to him in March, he told us that an epidemic "holds a mirror to the civilization."
Frank Snowden: The bubonic plague in the 14th century shows what are our relationships to our fellow human beings. You read in Boccaccio about the terrible flight of people and terror from the plague. Husband left wife and vice versa. Parents fled their children. One can see the scapegoating, the search for a demonic influence. This is not something that we ourselves did, of course, it's always some other group or person that we want to blame. That seems, to me, one of the constants. We can see it in homophobia, in the American epidemic of HIV/AIDS. Today, in the assault on Asian people. It's something that seems alas to be with us since the very beginning. The hunt for witches, pogroms against Jews, Xenophobia unleashed, societies coming to a halt.
Bob: I want to move on to a more modern infection that certainly changed the face of the Western world, bedeviling Napoleon. Let's start with his invasion of Russia in 1812. Where his superior armies were overrun, not by the czars’ troops, so much as what?
Frank: Oh, dysentery and typhus. His military tactics were predicated on lightning strikes and sudden rapid movement. He wanted his army not to be ladened down with supplies and with food, but to live off the land, and so he marched an army that was half a million men. Imagine the whole city of Paris going into Russia and Napoleon having decided not to take medical supplies, bandages, or sanitary precautions of any kind at the time. They went into Russia, marching for this vast distance in what was the immediate creation of what we might call a terrible urban slum. Living in the dung of the animals and that they themselves made, drinking water that was polluted in the rivers. Very soon, they were immersed in a tremendous outbreak of dysentery that was killing something like 3,000 men a day.
Then, after Moscow, Napoleon finally decides that they can't survive a winter in Moscow, he has to return to France. Napoleon himself took off in a sled with a body guard and abandoned his troops. Only about 10,000 to 15,000 returned to France, and almost all of those 480,000 or so died of, first, the dysentery and then the typhus. There was regime change in France, and disease had a major role in that.
Bob: Pathogens 2, sociopath 0. As long as we're talking about the French, in the midst of Coronavirus, you're thinking of Napoleon and feeling a bit of déjà vu.
Frank: I think about Napoleon a lot, because it seems that he's a model of how not to react to the threat of disease that was about to overwhelm the 500,000 men he was commanding, and the larger society and empire for which he was responsible. He reacted by doing something that sounds very similar to the present day, by saying it was false facts. "We don't need to think about these diseases. We're going to match on ever forward." Napoleon seems to be someone who had contempt for the impact of the environment, nature, disease, and the threat that it posed. Not willing to think of this in terms of planning and mobilizing resources and deploying them in the way that people with knowledge and science and the lessons of history all urge should be done.
Bob: To your earlier point, he seems to take as a personal political assault, the behavior of microbes.
Frank: Napoleon took great umbrage that a disease could harm the almighty emperor of the French.
Bob: On the subject of politicization of pathogens, halfway between the Napoleonic invasion of Russia and the Coronavirus today, came the Spanish influenza pandemic of 1918 and 1919 that killed more than 50 million people around the world. In this country, officials for various political and economic reasons, soft pedal the threat. Evan Osnos in TheNew Yorker talked about a political appointee named Wilmer Krusen, city public health director, who called the killer flu "old-fashioned influenza or grip," and the news organizations played along. One headline in the Philadelphia Inquirer was "Scientific Nursing Halting Epidemic" when, in fact, the truth on the ground was horrifyingly different.
Frank: That's exactly what's happening even before our very eyes, where there's the sense that this crisis that we're facing is just the common cold or no worse than seasonal influenza. There is a tendency of some people, when confronted by something new, not to admit that they don't understand, but instead to label it something different that they think that they can manage. That seems to me the story in Philadelphia and the story before us today.
Bob: If the public health officials in Philadelphia in 1918 were responding to what they thought was their short-term, political propaganda interests, did we not see exactly the same thing with the outbreak of SARS, and the Chinese government's attempt to suppress the news?
Frank: In the long arc of the history of epidemic disease, it's a theme from plague down through SARS and Ebola, and I think it's probably at work today in dealing with Coronavirus. "This is bad news which will show that we as rulers have done something wrong. That we have been negligent in some way. It will harm trade or tourism and our economic interests. It will make our political party look bad. Let's pretend it's not actually there." In China, with regard to SARS, where the regime denied that it existed. This goes back to the beginnings of epidemic disease.
In my book, I treat 1911 epidemic of Asiatic cholera that was covered up by the Italian government and has never been fully admitted. Because by 1911 cholera was thought to be an Asiatic sign of backwardness and of disgrace, and so to admit that it existed meant that you were an uncivilized nation. It meant that maybe left-wing parties would hold you accountable. It also meant that the celebrations for the 50th anniversary of the unification of Italy would have to be set aside. This is a perennial temptation, and it comes up again and again and again.
Bob: I want to turn to 1995 and the outbreak of Ebola in the Democratic Republic of Congo, and then eight years later, in rural Guinea in West Africa. The first response, at least in the West, was absolutely ignoring what was a significant, fairly localized public health crisis. Then once it came to Western shores in very small number of cases, suddenly hysteria. What does that tell us about disease and us?
Frank: The world wanted to turn its back on West Africa. It was Doctors Without Borders that got first involved and they pleaded for the intervention of outside nations, and this they said was the potential of a regional or even a pandemic outbreak. The World Health Organization sat on its hands, the American government did nothing until a physician and a nurse who were American and white working in West Africa were stricken with Ebola and brought back to the States.
Suddenly, there was this wave of horror. "Oh, no, this can affect not just Africans, but white people." It did lead at last to large scale intervention medically in West Africa, but what does it say about us that it took an infection to invade white and American bodies before people could take it as something that had to be dealt with? That seems, to me, a really depressing moment in human history.
Bob: Now, we come to coronavirus which seems to be playing out as scapegoating, xenophobia, opportunistic denial. Once again, medicine and epidemiology have advanced incalculably over the centuries. Has human behavior begun to catch up?
Frank: We can see different actors in this drama espousing different solutions. We see the denial impulse. We see the blame impulse. We see the attachment to ethnic barriers, to national barriers, but we also see Dr. Tedros of the WHO--
Bob: That's Tedros Adhanom, the Director-General of the World Health Organization.
Frank: We see lots of other people at NIH and the CDC and around the world and health ministries, who are taking a scientific and community-based approach to the disease that it's about education, about involving the populace. It's about taking care of the entire globe. That is to say your resources have to be deployed not where there's money, but where there is need.
They need masks and respirators. Ventilators need to be moved to the place where they're required, not to the place where there are people with lots of money to purchase them, whether or not they're needed. Virologists all around the world have been expecting an event of this kind, saying it was inevitable. Why is it we weren't prepared?
It was Bruce Aylward coming back from China who was asked the question, "What is it that we need to do to be more prepared?" He said, "The first thing we need to do is to change our mindsets and begin to act in an international coordinated way based on truth and science and learning the lessons of history." We're not going to be prepared. It's not just a technical question of having a magic bullet, a vaccine. This is something that lies below that. The question is are we willing and prepared to take up that challenge?
Bob: Frank, thank you so much.
Frank: Great pleasure to be with you. Thank you for having me.
Bob: Frank Snowden is a professor emeritus of the history of medicine and author of Epidemics and Society: From the Black Death to the Present. We spoke to him in March. Join us this week for the big show, where we will be taking a momentary break from contemporaneous horrible news to talk about Shakespeare. Happy Thanksgiving to you and yours from everyone at OTM. I'm Bob Garfield.
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