Issue 9 / 9 March 2020

IT’S hardly surprising the inhabitants of 14th century Europe saw an outbreak of bubonic plague as a supernatural event rather than a microbiological one.

The Black Death, as it was known, was thought to be a punishment sent by an angry deity in response to the wickedness of humanity, and the responses to it also had a large element of the supernatural about them.

Mortification of the flesh increased in popularity, based on its reputation for expunging sin, with apocalyptic cults forming around such practices. Most notable among them were the Flagellants, bands of penitents who walked the streets whipping their own bodies till they bled.

At the same time, Christian Europe saw widespread persecution of Jewish people, including waves of massacres after allegations Jews had poisoned water wells.

“History teaches us that sudden, large-scale [disease] outbreaks hold a mirror to the societies in which they emerge,” Dr Sandro Galea, dean of the Boston University School of Public Health, writes in the context of the coronavirus outbreak currently sweeping the globe.

History does indeed hold many lessons, although trying to work out precisely what they are can at times be like seeing “through a glass, darkly”, as the Bible puts it.

There have been many comparisons drawn with the devastating influenza pandemic of 1918–19 in recent weeks.

That outbreak is estimated to have killed 50–100 million people around the world, yet curiously, it largely faded from public view for 50 or more years afterwards, perhaps because it was overshadowed by the four years of warfare that preceded it.

Only in the last decades of the 20th century did historians and others start to examine in depth the impacts of the pandemic, their interest perhaps sparked by the arrival of a new communicable disease: HIV-AIDS.

Science journalist Laura Spinney, author of a 2017 book, Pale Rider, on the pandemic, sees the so-called Spanish flu as one of the key reasons for the more systematic and scientific approach to public health adopted by many governments in following decades.

On a less positive note, she also describes the way contemporary official responses to the disease were often coloured by then widespread beliefs about eugenics.

“It was common for privileged elites to look down on workers and the poor as inferior categories of human being, whose natural degeneracy predisposed them to disease and deformity,” she wrote in the Smithsonian magazine. “If [the poor] sickened and died from typhus, cholera and other killer diseases, the eugenicists argued, then it was their own fault, because they lacked the drive to achieve a better quality of life.

“In the context of an epidemic, public health generally referred to a suite of measures designed to protect those elites from the contaminating influence of the disease-ridden rabble.”

While eugenics has long lost respectability, you could draw some parallels between such attitudes and the stigmatising of gay men during the AIDS crisis of the 1980s.

But that outbreak too led to major changes in public health management, with the pragmatic harm-minimisation approach adopted by Australia arguably at the vanguard.

What will the mirror that is the coronavirus teach future historians about our crisis-ridden age with its fake news and widespread misinformation?

Only time will let that picture emerge, but Dr Galea is concerned a major lesson may be that the science of public health, so hard won across the last century, is increasingly being pushed aside by political interests.

The leader of his own country, President Donald Trump, has been making statements about coronavirus that are “not at all aligned” with those of experts, he notes.

“From climate change denial to the movement against vaccines, it has become common to hear political talking points drown out scientific voices,” Dr Galea writes. “The result is poorer health for all, both in the short and long term.”

Let’s hope future historians won’t see the last hundred years as the peak of the scientific approach to managing infectious disease, with 2020 the beginning of a slide into a less rational world.

Jane McCredie is a health and science writer, based in Sydney.



The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.


2 thoughts on “Coronavirus: holding a mirror up to our society

  1. Dr. Roger Parrish says:

    I am somewhat bewildered by the method of transmission of Covid 19. We have been told that the virus can survive on a surface which has been handled by a person who has the condition, for up to 9 days. Just how does someone touching that “infected” surface then acquire the infection? Does he/she pick their nose, suck their finger or smell the infected digit to become infected with what I gather is an URTI disease.

  2. Philip Morris says:

    In the Galea article referenced by Jane McCredie the US president is quoted as saying – He said, “I don’t think it’s inevitable. It probably will. It possibly will. It could be at a very small level or it could be at a larger level. Whatever happens, we’re totally prepared.” While the language could be more precise as Galea acknowledges – “it is not easy for a non-health expert to take rapid-fire questions from reporters, nor can it be easy for the president to balance multiple competing voices within any complex administration” the president’s comments are not significantly at odds from the comments of Dr Nancy Messonnier, head of the National Center for Immunization and Respiratory Diseases at the CDC, who said (from the same Galea article) of the disease’s spread, “It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen — and how many people in this country will have severe illness.” Subsequently, the US president and his vice president Mike Pence have brought to the fore the medical and public health experts needed to manage this challenge. All governments are struggling with their messaging – for example over the weekend the federal health minister Mr Hunt advises all people who have respiratory or other symptoms to come forward for coronavirus testing, whereas the Queensland health department is saying only individuals with concerning symptoms who have returned from overseas (anywhere, not just China) or who think they might have been exposed to others with the virus should be tested. Rather than putting a political ‘spin’ on our comments (whether we are for or against Mr Trump, or for or against Mr Morrison in Australia, for example), I think a more even-handed approach would serve the public better.

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