A Time to Choose

This COVID dominated period our global human society is going through gives me a partial sense of what it must have been like during one of the six great prior plagues humanity has endured and survived. The “good news” is that we have the opportunity to choose to put this terrible human tragedy behind us. Before looking at that choice, let’s look at the pandemics that preceded for comparison. 

The first recorded “great plague” was the Plague of Justinian in 541 CE, which arrived in Constantinople when rats harboring bubonic infested fleas stowed away aboard a grain shipment from Egypt to Constantinople. From that capital city varying estimates put the number of dead between 30-50 million people, likely about half the world’s population at that time. The plague appeared to end because it killed everyone that couldn’t develop immunity. Unfortunately, the rats and fleas never really left, so the “Black Death,” as it was called, slammed into Europe in 1347 killing 220 million Europeans in just four years. 

Here’s a great data point for modern times: some far sighted port official in the Venetian controlled city of Ragusa found that by requiring ships entering from distant ports to hold at anchor for 40 days, creating the precursor concept of our modern quarantine (quaranta is the Italian word for forty), infections of plague declined. As primitive as that gesture was, it actually worked! Proximity to new sources of infection actually reduced total infections. That fleas on the rats were the vector of the Black Plague was yet unknown, so they hadn’t yet realized the need to block ships’ lines to the docks. Still, just keeping the quarantine for sailors was a major improvement. Social distancing, folks!

The Great Plague of London was actually a series of approximately 40 separate outbreaks (roughly every ten years) between 1348 and 1665, killing approximately 20 percent of every man, woman, and child in the British Capital. The flies were at least geographically contained to the capital, but the populace still didn’t know what caused the plague and were thus powerless to prevent it from returning about every ten years for almost 300 years! So much for Dr. Scott Atlas’s flawed theory that “herd immunity” would solve the current pandemic. It’s been tried and has failed. 

Smallpox was a long-lasting plague in Europe, Asia, and the Arabian Peninsula. For centuries it killed three out of ten who became infected and scarred survivors with “pock marks” (derived from “pox”). When arrived in the New World, it proved to be far deadlier to indigenous populations with absolutely no immunity from it whatsoever. Nothing has devastated any population like the native populations in Mexico and North America in the 16th-18th centuries. According to Thomas Mockaitis, a history professor at DePaul University, Mexico’s pre-conquest population went from 11 million to 1 million! That “plague” was the first to end with the invention of a vaccine in 1796 by Dr. Edward Jenner. He correctly observed in 1801 that the scourge of smallpox could be eliminated from the earth with a vigorous vaccination program. He proved to be correct in 1980 when the World Health Organization (“WHO”) declared that smallpox had in fact been eradicated globally.

Although only tens of thousands of people were killed in the mid-19th century British Cholera Epidemic, I’m mentioning it as it ended due to clever research, rather than vaccination. The breakthrough came through careful scientific investigations by Dr. John Snow, who had a single pump handle removed from a popular drinking well and conclusively proved that cholera was waterborne. In other words, he demonstrated that simple prudent steps like wearing a mask today, or in those days drinking from a different well, could prevent disease and even end an epidemic.

And, although cholera continues to plague developing countries, particularly those overwhelmed by storms and/or violence that interrupts normal water flows, it is clear that we can test for it, contain it, and eliminate it if we use prudence and follow scientific guidance. It’s just like trying to get everyone to realize that wearing masks, social distancing, and maintaining good hygiene will reduce this epidemic in background infection rates until the upcoming vaccines can completely knock it out.

This historical review would not be complete, of course, without reference to the Spanish Flu of 1918. An avian-borne flu that killed between 50-100 million people worldwide, including at least 675,000 Americans. How did this one end? Well, people started wearing masks, trying to stay away from obvious points of infection, and cities banned large public gatherings to avoid spreading the disease. 

Sound familiar? Philadelphia decided there was no real problem (just like the now disgraced Dr. Atlas) and held what today we would call a “super spreader” event, the “Liberty Loan” parade of September 1918 which went on to kill 1,000 and sicken 200,000 more within 10-20 days of the event. The event was one of the reasons that October 1918 was the deadliest pandemic month on record at that time. The economic damage was just like we’re seeing today to the domestic economy.

So, we get to choose. Do we want to learn from the past and alter our behavior? It worked in the Spanish Flu and cholera pandemic. Shall we cooperate with President-Elect Joe Biden’s plea to wear our masks for just 100 days after his inauguration? Do we want to seek out vaccination when it becomes widely available in just a few of months as was used to defeat smallpox? And, are we willing to band together with the WHO to prevent all the pandemics above, not to mention HIV and SARS, handled by pharmacology and measures common to good public health administration going forward? 

We have to choose. How much pain do we want to incur before following public health guidelines until the vaccine arrives, and when it does be willing to take it? We have to choose, and we have to do it now as the death toll in the U.S. approaches the 300,000 mark this week. We must choose wisely. For, as George Santayana famously quipped, “Those who do not remember the past are condemned to repeat it.”