By Randolph Fillmore
“Bubonic plague is the inescapable reference point in any discussion of infectious diseases and their impact on society,” wrote Frank M. Snowden in a recently published book looking at the history of epidemics and their impact on societies.
One inescapable reason for looking back to 14th century Europe is that “social distancing” was the only hope for curtailing spread of the Black Death, a disease that killed many, many millions. Nearly 700 years later, in an age of science, we are practicing Medieval methods to try to contain COVID-19 disease. How did that strategy work then, and will it work now?
Give us some Slack
Back in 1988, at the height of the HIV/AIDS epidemic, Paul Slack, British historian and Oxford University professor, published a paper in Social Research (Vol 55, No. 3) on responses to Black Death and their implications for public health. According to Slack, these are some of the “social distancing” strategies Europeans used to try to curtail the spread of disease, even when the causal role of rats and fleas and the concept of contagion were not known:
- Early reactions by civic governments to outbreaks was a denial of their existence for as long as possible as they were a threat to commerce
- Plague victims were isolated, and their contacts traced and incarcerated
- There were restrictions placed on movement and quarantine regulations on travelers and shipping
- Games and festivals were banned
- Children were prevented from playing in the streets
- The infected were isolated in their houses
Slack’s research showed that people who suffered the most from the plague were most often those who opposed the efforts of authorities to gain control; there was popular resistance to quarantines. The result was the initiation of “medical police.” Because there were no scientific explanations, the Christian view of the plague included its supernatural origins. There was also “scapegoating,” as many believed the plague was caused by Jews poisoning the water supplies.
How rigid was isolation? asked Slack. His research showed that in England the practice was total household incarceration. In the Netherlands, a more human practice allowed visits from clergymen or especially appointed “comforters.” Overall, there was consensus that sacrifices need to be made for the public good, regardless of personal liberties. Slack reported that Edmund Gibson, bishop of London, said that “Where disease is desperate, the remedy must be so too.”
British writer Daniel Defoe (author of Robinson Crusoe, starring a character who was no stranger to social distancing) wrote in his Journal of the Plague Year (1665), that he (Defoe) sympathized with both sides, meaning those who resisted quarantine and those authorities imposing it, saying, “There was no remedy.”
Slack concluded his paper opining that “reactions to threats to public health are never purely scientific…they always involve restrictions on civil liberties of a more or less severe kind.” He adds, however, that “screenings of certain groups in the population must have a clearly identified purpose.”
Writing in the era of AIDS, Slack also warned that prejudice and stigma are in danger of operating… and should be kept as small as possible.
Laurie Garrett, a 21st century street corner Cassandra?
In Greek mythology, Cassandra was a daughter of Priam, the King of Troy. Struck by her beauty, Apollo provided her with the gift of prophecy. But when Cassandra refused Apollo's romantic advances, he placed a curse on her ensuring that nobody would believe her warnings. Cassandra was left with the knowledge of future events, but she could neither alter these events nor could she convince others of the validity of her predictions. (Thanks Wikipedia).
Fast forward to March 2020, 32 years beyond 1988 and almost 700 years beyond the Black Death. Laurie Garrett, Pulitzer Prize-winning public health expert and author of many books, including the best-selling 1994 “The Coming Plague: Newly Emerging Diseases in a World Out of Balance,” guested on WBUR (Boston University National Public Radio) radio on March 17. Like a 21st century Edmund Gibson, she emphasized the need for social distancing in the face of spreading COVID-19 disease. And, like a 21stcentury Cassandra, she had a prediction.
What should we be doing? she was asked.
“We don’t have time for the whole list,” Garrett told her interviewer. “But the bottom line is that there’s a role for the federal government. There’s a role for the states. There’s a role for local. We have this strange hodgepodge system of public health in America that is unlike any other country. And, as a result, the real burden at the federal level is a combination of setting guidances, providing sort of wise strategic policy analysis, corralling resources in a timely fashion, pushing connections between public and private sector. All should be coming together with science-based leadership from the top. And we don’t have that on any single factor.”
And, on social distancing? “My goodness. If people still don’t understand that they need to have social distancing, then I don’t think we have any hope at all. I think we’re all going to drop dead,” she predicted.
Her calls for attention and action in 1994 were largely unheeded.