7 Lessons Learned Epidemics and Society: From the Black Death to the Present
How the Past Can Help us Understand Our Post Covid-19 Future
I originally purchased Epidemics and Society thinking it would provide perspective on what we faced from the Covid-19 outbreak. Along with these insights, the book provides lessons for understanding the lasting impact of infectious disease on human affairs. Long after health risks have subsided.
Original Notes these lessons came from.
Lesson 1 – Optimism for Cures Eradicating Diseases is often Premature
In 1969 the US Surgeon General experienced a premature surge of optimism in the power of science and public health to combat microbes, declaring the end of the era of infectious diseases. During the same era of exuberant hubris, international public health authorities announced that it would be possible by the end of the twentieth century to eradicate one microbial threat after another, beginning with malaria and smallpox. In this triumphant climate, schools of medicine such as Yale and Harvard closed their departments of infectious diseases.
Well into the twenty-first century smallpox remains the only disease to have been successfully eradicated. Worldwide, infectious diseases remain leading causes of death and serious impediments to economic growth and political stability. Newly emerging diseases such as Ebola, Lassa fever, West Nile virus, avian flu, Zika, and dengue present new challenges, while familiar afflictions such as tuberculosis and malaria have reemerged, often in menacing drug-resistant forms. Public health authorities have particularly targeted the persisting threat of a devastating new pandemic of influenza such as the “Spanish lady” that swept the world with such ferocity in 1918 and 1919.
Lesson Learned
Initial enthusiasm for quickly eradicating a disease using science and technology can quickly wane. As unseen barriers to cures reveal themselves over time.
Lesson 2 – Our Defenses Are Porous
Indeed, many of the central features of a global modern society continue to render the world acutely vulnerable to the challenge of pandemic disease. The experiences of SARS and Ebola—the two major “dress rehearsals” of the new century—serve as sobering reminders that our public health and biomedicine defenses are porous. Prominent features of modernity—population growth, climate change, rapid means of transportation, the proliferation of megacities with inadequate urban infrastructures, warfare, persistent poverty, and widening social inequalities—maintain the risk. Unfortunately, not one of these factors seems likely to abate in the near future.
Lesson Learned
Resurgence of cases when economic activity resumed was unavoidable. The design of the modern world naturally spreads disease. Disruption from measures put in place to combat it are inevitable.
Lesson 3 – Societies Valuing Liberty Have a Harder Time Suppressing Outbreaks
…epidemic diseases are not random events that afflict societies capriciously and without warning. On the contrary, every society produces its own specific vulnerabilities. To study them is to understand that society’s structure, its standard of living, and its political priorities. Epidemic diseases, in that sense, have always been signifiers, and the challenge of medical history is to decipher the meanings embedded in them.
Lesson Learned
Covid-19 revealed cultures more resistant to infringements of personal liberty have a harder time stopping the spread of disease during epidemics.
Ancillary Lesson
Countries with top down governance have public health authorities better able to enforce unpopular rules that often help reduce the spread of disease.
Lesson 4 – Difference Between an Outbreak and an Epidemic
Infectious diseases are normally placed along a continuum according to their severity in terms of the numbers of sufferers and the extent of their geographical reach. An “outbreak” is a local spike in infection, but with a limited number of sufferers. An “epidemic,” by contrast, normally describes a contagious disease that affects a substantial area and a large number of victims. Finally, a “pandemic” is a transnational epidemic that affects entire continents and kills massive numbers of people. All three terms, however, are loose approximations, and the boundaries separating one from another are imprecise and sometimes subjective. Indeed, a contagious disease confined to a single locality is occasionally termed a pandemic if it is sufficiently virulent to afflict nearly everyone in the area.
Lesson Learned
This explains why public authorities initially referred to Covid-19 as an outbreak when it emerged in China. Now referring to it as a pandemic since its spread worldwide.
Lesson 5 – Some Diseases Prefer Warm Weather
In accordance with this terminology, humanity has experienced three pandemics of bubonic plague. Each consisted of a cycle of recurring epidemic waves or visitations, and the cycle lasted for generations or even centuries.
The cyclical pattern of plague was marked also by a pronounced seasonality. Plague epidemics usually began in the spring or summer months and faded away with the coming of colder weather. Especially favorable were unusually warm springs followed by wet, hot summers. The modern explanations for these propensities are the need of fleas, which carried the disease, for warmth and humidity to enable their eggs to mature, and the inactivity of fleas in cold and dry conditions. Although this pattern predominated, the disease has also been known to erupt mysteriously in Moscow, Iceland, and Scandinavia in the depth of winter. These atypical eruptions of the disease posed serious epidemiological puzzles.
Lesson Learned
While different diseases manifest in different ways. Epidemic diseases have the ability to suddenly manifest in unexpected ways. You cannot let your guard down with preventative measures.
Lesson 6 – Epidemics Stress the Foundations of Societies
Thus a city besieged by a major plague epidemic became a perfect dystopia. Bonds of community and family ties were severed. Religious congregations found their churches bolted, sacraments unavailable, and bells silent. Meanwhile, economic activity halted, shops closed, and employment ceased, increasing the threat of hunger and economic ruin. The political and administrative practices of normal life did not survive as authorities fell seriously ill, died, or fled. Worst of all, above every other concern towered the menace of sudden and painful death made vivid by the stench in the streets and the dying sufferers who often lived out their final anguish in public.
Lesson Learned
The after effects of Pandemics are felt far into the future. Casting a shadow over how communities operate long after they are gone..
Lesson 7 – Regulatory Risk
Plague regulations also cast a long shadow over political history. They marked a vast extension of state power into spheres of human life that had never before been subject to political authority. One reason for the temptation in later periods to resort to plague regulations was precisely that they provided justification for the extension of power, whether invoked against plague or, later, against cholera and other diseases. They justified control over the economy and the movement of people; they authorized surveillance and forcible detention; and they sanctioned the invasion of homes and the extinction of civil liberties. With the unanswerable argument of a public health emergency, this extension of power was welcomed by the church and by powerful political and medical voices. The campaign against plague marked a moment in the emergence of absolutism, and more generally, it promoted an accretion of the power and legitimation of the modern state.
Lesson Learned
Powers granted to authorities to combat the proliferation of infectious diseases are often abused and not easily taken back once bestowed.
Thank You for Reading
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He's published three books. Most recently The World After Covid 19: Coexisting with the Novel Coronavirus.
His musings can be found at stevenlmiller.me. Subscribe to The Pompatus Times for updates.
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