“When people ask, ‘When will this end? “They ask about the social ending,” said Dr. Jeremy Greene, a historian of medicine at Johns Hopkins.
In other words, an end can occur, not because a disease is overcome, but because people get tired of panic and learn to live with a disease. Allan Brandt, a Harvard historian, said that something similar happened with COVID-19: “As we have seen in the debate about opening the economy, many questions about the so-called end are not determined by medical and public health data, but by sociopolitical processes. “
Endings “are very, very messy,” said Dora Vargha, a historian at the University of Exeter. Looking back, we have a weak narrative. For whom is the epidemic ending and who’s to say? “
In the path of fear
An epidemic of fear can occur even without an epidemic of illness. Dr. Susan Murray from the Royal College of Surgeons in Dublin saw it firsthand in 2014 when she was a fellow at a rural hospital in Ireland.
In previous months, more than 11,000 people in West Africa had died of ebola, a scary viral disease that was highly infectious and often fatal. The epidemic seemed to wane and there were no cases in Ireland, but public fears were palpable.
“On the streets and in the wards, people are anxious,” Murray recently recalled in an article in The New England Journal of Medicine. “Having the wrong skin tone is enough to give you the eye of your fellow passengers on the bus or train. Cough once, and you’ll find them mixed away from you. “
Workers at the Dublin hospital were warned to prepare for the worst. They were terrified and worried that they lacked protective gear. When a young man arrived in the emergency room from a land of Ebola patients, no one would go near him; nurses were hiding and doctors threatened to leave the hospital.
Murray alone dared to treat him, she wrote, but his cancer was so advanced that all she could offer was comfort care. A few days later, tests confirmed that the man did not have Ebola; I died an hour later. Three days later, the World Health Organization declared the Ebola epidemic.
Murray wrote: “If we are not prepared to fight fear and ignorance as actively and thoughtfully as we fight any other virus, it is possible that fear can harm vulnerable people, even in places that never see a single case of infection during an outbreak. And a fear epidemic can have far worse consequences when complicated by issues of race, privilege and language. “
Black death and dark memories
Bubonic plague has hit several times in the last 2,000 years, killing millions of people and changing the course of history. Each epidemic amplified fears that followed the next outbreak.
The disease is caused by a strain of bacteria, Yersinia pestis, that lives on fleas that feed on rats. But bubonic plague, known as Black Death, can also be transmitted from infected person to infected person through respiratory drops, so it cannot be eradicated simply by killing rats.
Historians describe three major waves of plague, said Mary Fissell, a historian at Johns Hopkins: The Plague of Justinian in the Sixth Century; the 14th-century medieval epidemic; and a pandemic that struck in the late 19th and early 20th centuries.
The medieval pandemic began in 1331 in China. The disease, along with a civil war raging at the time, killed half of China’s population. From there, the plague moved via trade routes to Europe, North Africa and the Middle East. In the years between 1347 and 1351, it killed at least a third of the European population. Half the population of Siena, Italy, died.
“It is impossible for the human tongue to tell the terrible truth,” wrote the 14th-century chronicler Agnolo di Tura. “In fact, one who did not see such an awfulness can be called blessed.” The infected ones, I wrote, “swell under their armpits and in their groin trays and fall down as they speak.” The dead were buried in coarse, in piles.
In Florence, Italy, Giovanni Boccaccio wrote, “No more dead people were assigned than dead goats today.” Some hid in their homes. Others refused to accept the threat. Their way of coping, Boccaccio wrote, was to “drink vigorously, enjoy life to the fullest, walk around singing and rejoicing and rejoicing in all one’s desires when the opportunity arose, and pulling it all off as a huge joke.”
That pandemic ended, but the plague came back. One of the worst outbreaks began in China in 1855, spreading throughout the world, killing more than 12 million in India alone. Health authorities in Mumbai, India, burned entire neighborhoods trying to free them from the plague. “Nobody knew if it made a difference,” said Yale historian Frank Snowden.
It is not clear what caused the bubonic plague to die. Some scientists have claimed that cold weather killed the disease-causing fleas, but it would not have interrupted the spread by the airways, Snowden noted.
Or maybe it was a change in the rats. In the 19th century, the plague was not borne by black rats, but by brown rats, which are stronger, more evil, and more likely to live apart from humans.
“You definitely don’t want one for a pet,” Snowden said.
Another hypothesis is that the bacterium developed to be less deadly. Or maybe actions done by people, such as the burning of villages, helped dampen the epidemic.
The plague never really disappeared. In the United States, infections are endemic among prairie dogs in the Southwest and can be transmitted to humans. Snowden said one of his friends was infected after a stay at a hotel in New Mexico. The previous occupant of his room had a dog that had fleas carrying the microbe.
Such cases are rare and can now be treated with antibiotics, but any account of a case of plague raises fears.
An illness that actually ended
Among diseases that have reached a medical end are smallpox. But it is unusual for several reasons: There is an effective vaccine that provides lifelong protection; the virus, Variola minor, has no animal, so elimination of the disease in humans meant total elimination; and the symptoms are so uncommon that the infection is obvious, enabling effective quarantines and contact tracking.
But while it was still raging, the cups were terrible. The post-epidemic swept the world for at least 3,000 years. People infected with the virus developed a fever, then a rash that became filled with spots that were encapsulated and fell off, leaving scars. The disease killed 3 out of 10 of its victims, often after enormous suffering.
In 1633, an epidemic among Native Americans disturbed “all the indigenous communities of the Northeast and certainly facilitated the English settlement in Massachusetts,” said Harvard historian David Jones. William Bradford, head of the Plymouth Colony, wrote a report on the disease of Native Americans, saying the broken pustules would effectively glue a patient’s skin to the mat he was wearing, only to be torn off. Bradford wrote, “When they turn around, an entire page will settle in immediately, as it were, and they will all be a giant blood, most afraid to see.”
The last person to contract smallpox naturally was Ali Maow Maalin, a hospital cook in Somalia, in 1977. I recovered, only to die from malaria in 2013.
Influenza from 1918 is today maintained as the example of the pandemic ravages and the value of quarantines and social distance. Before it ended, the flu killed 50 million to 100 million people worldwide. It swapped young to middle-aged adults – orphans, deprived families of parents, killed troops in the middle of World War I.
In the fall of 1918, William Vaughan, a prominent physician, was sent to Camp Devens near Boston to report on a flu raging there. He saw “hundreds of indispensable young men in their country’s uniform, enter the wards of the hospital in groups of 10 or more,” he wrote. “They are placed on cots until each bed is full, yet other quantities enter. Their faces soon have a bluish cast; a disturbing cough brings up blood-stained sputum. In the morning, the dead bodies are stacked in the stretcher as barbed wire. “
The virus, I wrote, “demonstrated the inferiority of human inventions in the destruction of human life.”
After sweeping through the world, the flu disappeared and developed into a variant of the more benign flu that comes every year.
“It was like a fire that after burning down the available and easily accessible tree, it burned down,” Snowden said.
It also ended socially. World War I was over; people were ready for a new start, a new era and eager to put nightmares about illness and war behind them. Until recently, the 1918 flu was largely forgotten.
Other flu pandemics followed – none so bad, but all the same, nevertheless. In the Hong Kong influenza of 1968, 1 million people worldwide, including 100,000 in the United States, died mostly people over the age of 65. This virus still circulates as a seasonal flu, and its original path to destruction – and the fear that followed – is rarely remembered.
How does COVID-19 end?
Will this happen with COVID-19?
One of the options, historians say, is that the coronavirus pandemic could end socially before it ends medically. People may become so tired of the restrictions that they declare the pandemic even as the virus continues to wreak havoc in the population and before a vaccine or effective treatment is available.
“I think there are these kinds of social-psychological issues about exhaustion and frustration,” said Yale historian Naomi Rogers. “We might be in a moment where people just say, ‘That’s enough. I deserve to be able to return to my ordinary life. ‘ “
It’s already happening; in some states, governors have lifted the restrictions, leaving hairdressers, nail salons and gyms open again, contrary to warnings from public health officials that such steps are premature. As the financial disaster created by lockdowns grows, more and more people may be ready to say “enough.”
“There are these kinds of conflicts now,” Rogers said. Public health officials have a medical end in sight, but some members of the public see a social end.
“Who’s claiming the end?” Rogers said. “If you push back towards the notion of its ending, what are you pushing back against? What do you claim when you say ‘No, it doesn’t end.’ “
The challenge, Brandt said, is that there will be no sudden victory. Trying to define the end of the pandemic “will be a long and difficult process.”