A Historical Perspective on the COVID-19 Pandemic: Public Health Watch

This is not the first infectious challenge society has faced, and nor will it be the last.

Right now, we are likely all too focused on the present to think about the history.

However, all the clichés about the lessons we can learn from the past are well-worn for a reason. There’s a least some truth to them.

Which, at its essence, is the underlying theme of the thought-provoking commentary, published March 12th by the New England Journal of Medicine and authored by David S. Jones, MD, PhD, A. Bernard Ackerman Professor of the Culture of Medicine in the Department of the History of Science at Harvard University. Needless to say, his colleagues in infectious diseases and public health—among other specialties—have been busy as of late, attempting to tackle the ongoing new coronavirus pandemic.

“The response to COVID-19 requires input from anyone who has value to offer, and historians and other social scientists have much to say that is valuable about epidemics,” Jones told Contagion®. “Human societies have been coping with epidemics for as long as we have lived in cities. We have learned much about how best to respond from careful analysis of historical epidemics—for example, the current enthusiasm for social distancing arises from historical analysis of influenza in 1918. We have also learned, with regret, that there are many unhelpful aspects of human responses, especially blame, stigmatization, and related behaviors that exploit preexisting tensions within society instead of bringing everyone together to mount a collective response. This is especially important since it is usually the most marginalized people in society—whether by class, race, ethnicity, gender identity, or anything else—who are most vulnerable to an epidemic.”

Jones starts out the piece with what is (likely intentionally) an almost absurd position, taken by renowned microbiologists Macfarlane Burnet and David White in 1972. With novel antibiotics and vaccines seemingly coming online at a breakneck pace at the time, they wrote, in their seminal text Natural History of Infectious Disease, that “the most likely forecast about the future of infectious diseases is that it will be very dull.”

It has, of course, been anything but. However, to be fair to Burnet and White, who could have predicted the overuse of some of those important drugs? And, the resultant development of resistant pathogens?

Who too would have understood the full ramifications of climate change, and the seemingly endless discovery of new tropical infectious diseases in the decades since?

Indeed, as Jones writes, historians often highlight the “importance of context” when asked to explain past events. As he puts it, “If you want to understand how or why something happened, you must attend to local circumstances. But there is something about epidemics that has elicited an opposite reaction from historians: a desire to identify universal truths about how societies respond to contagious disease.” As an example, Jones cites the work of Charles Rosenberg on the HIV/AIDS epidemic, which was inspired, at least in part, by Albert Camus’s La Peste.

“In Camus’s classic account of plague, and Rosenberg’s riff on that, you see 1 classic problem: societies often fail to notice early signs of the epidemic, even as the evidence becomes irresistible, and this then compromises the success of our responses,” Jones explained. “China downplayed what was going on early on. By early January, it was clear that there was an epidemic in China. But somehow the rest of us failed to recognize the threat to us—we spent 2 months dithering and minimizing. Had the government said in mid-January: ‘Let’s mobilize,’ I think we would be in a better and different place... Of course, it’s easy to be a Monday-morning quarterback.”

As Jones describes it, history shows us that recognition of the epidemic engages the scientific community to “demand and offer explanations.” The resulting explanations generate public response, like the panic that has ensued in the US and elsewhere in recent weeks, which can be “as dramatic and disruptive as the disease itself,” Jones writes.

For him, this last step in the historical cycle of the COVID-19 outbreak has brought with it unexpected notoriety. After speaking on the topic as part of a panel discussion in February, his comments went, ahem, viral, even reaching China.

“The piece I wrote is not at all innovative,” he said. “It glosses the most basic aspects of how any historian of medicine would think about epidemics. I’m gratified that some people have found even this modest intervention to be useful.”

Useful indeed.