Coordinating the fight against epidemics

epidemics Inside
Some lessons about past epidemics are more difficult than others to learn.

What does corona virus mean for the economy, your pension, your holiday, St Patrick’s Day, theatre performances, the Olympics, or even toilet paper supplies? If you’re currently at the Cheltenham Festival, then it probably means very little to you. But the impact of COVID-19 has so far been huge, whichever way you look at it. And the nature of the threat has led many research funders and medical agencies to call up a fully coordinated and unprecedented global response to disease.

While this coordinated response includes the usual suspects, not least GPs, hospital consultants, pathologists, microbiologists, ethicists and statisticians, many people are also looking to historians, largely because the epidemic seems unprecedented, unless you look back further in history.

The history of epidemics and pandemics has indeed been a staple of medical history for decades, with book-length studies of plague, cholera, TB, not to mention influenza and AIDS filling the shelves of libraries, not to mention the reading lists of history of medicine courses.

Whether studying plague or cholera, two diseases that visited the UK, albeit centuries apart, epidemics have always generated social and economic responses, and not purely medical ones, let alone rational ones. Both of these epidemics also ravaged communities before the emergence and acceptance of germ theory. Although scientists appear to be speaking the same language today, responses by nations, companies and individuals continue to vary. If anything, epidemics reveal the different values of people and populations, especially when the public is looking for scapegoats. For example, continental countries in the past employed cordon sanitaires and quarantine far more regularly than countries like Britain and the US, where free markets made people sceptical of visible hands. The market is clearly at the centre of this outbreak and the real question on this occasion is whether the UK will defy its past and introduce new and more restrictive methods to stop the spread of COVID-19. The PM currently appears to be embracing the old ways by suggesting we just take it on the chin, but other reports seem to suggest that extreme measures may be called for, not least because the global economy has become more connected than ever before. That said, China and Italy’s early responses may have set an important precedent on this occasion. We are always told first movers have an advantage in business, but in epidemics, first-mover advantages are rarely recognised.

Another lesson we can learn from past epidemics is that naming outbreaks often carries stigma. Syphilis was variously called the Italian disease or the French disease, depending on which side of the border one lived in the eighteenth century. Spanish flu similarly associated a global pandemic in 1918-19 with particular foreign nationals and implied a causal relationship between a country and an outbreak. This of course promoted irrational fears and stigma, and is a reason COVID-19 has been given a name free from a geographical association. The media might be equally cautious about the way it discusses the search for patient zero, for this might stigmatise groups, while obscuring important structural aspects crucial to the spread of disease.

In any case, the pandemic will eventually dissipate, perhaps in a few weeks, or months, hopefully causing less of an impact as a result of the measures introduced by governments and communities. If deaths and disruption are less than predicted, hopefully few will suggest that authorities over-reacted. Often the anti-climactic ways in which past epidemics ended has also been an important and overlooked aspect of these events. If it isn’t as bad as many expected, perhaps we should simply thank public health experts, among other authorities, for their clear advice and decisive action. More than likely, however, many will be suggesting, as on previous occasions, that it was all ‘much ado about nothing’. Some lessons about past epidemics are more difficult than others to learn.  

Professor Jonathan Reinarz - Director, The History of Medicine Unit.