Saturday, July 25, 2020

Life with Chronic Disease: Epidemics/Pandemics-It’s all happened before


Recently I gave a talk for the Cavendish Historical Society on Epidemics/Pandemics and their impact on history. It was a fascinating topic to research.

Knowing there is nothing really new in how people respond in situations like Covid-19 has given me a better outlook, helped me to not be so judgmental, not to overly stress about headlines as well as comments made to me, and over all gave me hope. Most of all it’s the reminder that this has happened before, will happen again and we’ll get through it.

In the mean, we can only control what we have control over, and be responsible for how we respond to the current crisis.

The pandemic began in the East, sweeping through cities and towns, disrupting daily life and sowing fear and uncertainty throughout much of the known world. 

Sound familiar? However, it is a description of the Antonine Plague, which lasted for 15 years during the 2nd century.

Whether it was small pox, measles or a combination of the two is unknown, but the reaction of people then, during the Black Death (Plague), the small pox epidemic that killed almost 90% of the indigenous Americans, the flu pandemic of 1918 and even Covid, are surprisingly similar. After all, they have the same common denominator, humans.

While Covid hasn’t caused anywhere near the deaths of plague (the number one pandemic killer) and other epidemics, it’s impact on society and culture will be just as significant.  

Below is a list of 10 characteristics these type of events share.

1. Panic & fear result in fight, flight, blame, despair, and cruelty. As much as possible, people flee where the outbreak is happening to a place perceived to be safer. Unfortunately, this helps to spread disease. 

Jews being killed
They also will “fight” in an effort to have some sense of control over a situation that is very much out of their control. This can have disastrous consequences, such as the burning down of the Jewish ghettos during the Black Death. During the Antonine Plague in Rome, people smeared thin needles with infected fluids and tried to stab their victims unnoticed. When they contracted the disease, it was hoped nobody would suspect foul play. The plague literally allowed unscrupulous people to get away with murder.

During the small pox pandemic, Native Americans, like the ancient Romans, looked at it through the lens of their gods and cosmologies. The belief that their gods had forsaken them caused some to commit suicide.

The outbreaks of plague in Renaissance Europe sparked rumors of malicious plague spreaders, thus focusing on a wide variety of insiders and outsiders from high-ranking officers and doctors to the lowest levels of health workers – plague cleaners, cartmen and gravediggers– were singled out, accused of perpetuating the disease for a variety of reasons including self-interested gain.

As recently as the HIV/AIDS epidemic, hate and fear were engendered against the five H’s-homosexuals, heroin addicts, Haitians, hemophiliacs and hookers.

These type of events can cause societies to break apart, scapegoating immigrants, minorities and others who are thought to be suspicious. The poor will often revolt and cruelty abounds.

However, certain factor can mitigate these reactions. The 1918 Flu pandemic and the flu of 1831 that swept through Paris did not lead to any recorded social violence, blaming or hatred. In both cases, there were other major factors at play-WWI in 1918 and the July Revolt in 1831.

While the extremes seen in past epidemics/pandemics are not as pronounced during Covid, they are none the less at play and concerning to many. Without normal routines and jobs, dwindling finances, the mandates to “stay at home” and reduce travel,  combined with fear and anxiety, people can act in ways they normally wouldn’t. The recent influx of calls to suicide hotlines, protests, riots as well as a fierce “cancel culture,” are very much in line with how people respond during pandemics.

Christians aiding the sick 2nd century
This does not mean that good does not occur during these events. The Christians during Antonine Plague converted many to their beliefs as they saw how they cared for the sick. Today, many individuals and communities have done an incredible job making sure people are safe and have access to food and care.

It’s not surprising that people are more concerned about the damaging effects of the pandemic rather than the incredible contributions many are making. Our brains are wired for a negative bias, as remembering threats to safety and well-being were key to early human’s survival. 

2. People act in their own interests. In the most extreme situations, such as the Plague, surrounded by death and suffering, inevitably people begin to question the rules of law and morality. During the 1918s, there were "anti-mask" meetings. When there was a polio outbreak in Vermont in 1917, and quarantine was ordered, a civil suit was filed  by Community Chautauquas. Today there are groups who believe mask wearing is a civil liberties issue with little regard to public health.

3. Scammers abound. The more risky the situation the more snake oil salesmen surface. With the Internet, they're having a field day at the moment.

Statue of Glycon
Alexander of Abonutichus started the cult of Glycon in the 2nd century. A mystic, magician and charlatan, he literally was pedaling snake oil. He created Glycon, a snake god, that was basically a glove puppet. Among his sales items was a charm that could be hung over the door to your house to protect you from plague. Turns out those who had the plaque over their threshold were more likely to die from the plague, probably because they went about business as usual thinking they were protected.

4. Misinformation abounds. Causes, treatments, cures are all over the map. Many do not take the time to separate fact from fiction and untold damage is done by misinformation and the spreading of it.

 As seen in 1-4, the humans can treat each other terribly. As Marcus Aurelius, Roman emperor,  noted in the 2nd century, however bad the physical disease surely was, one thing was even worse-the mental plague of corruption, vice and moral decay.

5. The health impacts won’t be known for decades. “Look back” studies show that those that had the flu of 1918 as children had considerably more health issues as adults then non infected counterparts . Interestingly, flu survivors were less likely to get cancer. You can't get shingles unless you had chicken pox at some point. On the plus side, descendants of plague survivors seem to carry a gene that made them more likely to be “non progressors”-don’t develop full blown disease- when they contracted HIV, the virus that causes AIDS.

6. Most at risk are those living on the margins: The reasons are varied but can include: inability to escape from where the pandemic is occurring; poor living conditions, including overcrowding and dense pack; more likely to have other health issues; malnutrition; no access to information due to language and literacy barriers; inadequate finances; and discrimination.

Depending on the epidemic certain groups will be more at risk than others. In the 1918 flu, the most at risk group were young adults, particularly those in their twenties and thirties. Pregnant women were at particularly high risk.

7. Every storm runs out of rain (Maya Angelou) Pandemics/epidemics don't last forever

8. Change follows. The Antonine plague was the beginning of the fall of the Roman Empire while at the same time ushering in Christianity. The black death of the middle ages made the Renaissance possible. It also paved the way for
- literacy (all the clothes that were left could be turned into paper)
- a middle class (they needed a work force and the serfs demanded a living wage)’
- the beginning of the shift from the “old scholars” approach to medicine to empirical based evidence.  

The flu of 1918 made major changes in health care in the US and historically, because of the damage it did to Wilson, the treaty of Versailles laid the foundation for WWII.

AIDS activist protesting
The AIDS epidemic revolutionized health care, from new means of treatments for cancer and other diseases, to how the FDA fast tracks drugs and allowing compassionate use. It also ushered in the age of HIPAA and confidentiality.

We’re only at the beginning of how this pandemic will change our culture and society, but already we are seeing a lot more people telecommuting. Businesses are learning that it's cheaper for them to have their employees telecommute so office buildings are being closed. There are those that prefer remote learning and so a hybrid approach to education is potentially here to stay. Thanks to forecasting and remote learning-snow days may be a thing of the past. Masking will become part of flu season etc.

9. All of this has happened before. And will happen again As noted by Marcus Aurelius,—the same plot from beginning to end, the identical staging.
Marcus Aurelius

10. No matter the situation-war, extreme loss, devastation, crisis-the number one response of the humans is resiliency. This is true across the board for all cultures. It's wired into the human DNA. It would have to be because of reactions 1-4.


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