In this series, AMS Healthcare addresses the challenges facing healthcare today – particularly in light of the COVID-19 pandemic. The AMS Community promotes compassionate care, development of the leadership needed to realize the promise of technology and the understanding of how our medical history influences the future of our healthcare. A new piece will be posted every Friday on Healthy Debate.
“We’re not even counting the dead anymore.”
As a historian of medicine and disease, I encounter this stark image of past pandemics with sad repetition: from centuries of recurrent plague outbreaks to waves of cholera epidemics to the Spanish Flu. Images of devastated African villages during the Ebola outbreak of 2014 echo past stories as do pictures from Madagascar’s deadly plague epidemic of 2017. In the latter cases, we could view the collapse in burial practices online at a safe distance, smugly persuaded that we could arrest a similar outbreak long before bodies piled up here.
We would be wrong, of course. The opening quote here comes not from some apocalyptic scene set well in the past or in a distant country. Instead, it comes from a March 19 CBC story about northern Italy, where people were struggling under the weight of thousands of deaths and tens of thousands of COVID-19-infected people. Bergamo’s cemetery was so “overwhelmed with coffins” that military trucks had to take them to neighbouring provinces for burial. By April, bodies were being left in the streets in Ecuador; in New York, they have been piled into mass graves. Crematoriums can no longer cope with the workload. This is the first time in our living memory that we are collectively experiencing a truly global pandemic.
From a historical perspective, little is unique about the still-unfolding COVID-19 pandemic. The circumstances of its emergence are certainly familiar. Like many of the pandemics or widespread epidemics that the world has seen before – plague, HIV, Ebola, SARS, avian flu (H5N1), swine flu (H1N1), Zika, and many others – COVID-19 originated in animal species (that is, it is zoonotic) and “jumped” into humans when natural environments and animal habitats were disrupted. Rapid disease spread was, and has been, directly facilitated by human behaviour.
Plague Doctor. Photo by Kuma Kum on Unsplash.
Also like most past pandemics, COVID-19 is proving to be especially deadly to the old and the vulnerable in our communities, is testing the boundaries of our medical and scientific knowledge and is raising the spectre of scapegoating. Visibly foreign “others” have taken the brunt of this scapegoating, much as they did in the 14th, 19th, and late 20th centuries.
Individual and community reactions to COVID-19 likewise have their echoes in the past: Giovanni Boccaccio and Daniel Defoe’s fictional narratives of the Black Death and the 1665 Plague of London, respectively, both tell of city streets deserted through self-isolation, of social distancing heartily practiced and harshly enforced, of hoarding, of the spread of fake news and fake cures and few survivors to bury the dead. They also tell of people compassionately caring for the sick or, alternatively, revelling and refusing to take the threat of infection seriously (and still others taking it so seriously that they prepared for inevitable death by partying).
What is different today has been our ability to track COVID-19’s spread in real time. This has allowed us to be better prepared, at least in theory, when it arrived in our cities. At the same time, it expands the time for fears to build and multiply because global news and misinformation move even faster than this stunningly efficient virus. Whether all the measures that have been put in place will be enough, were enacted soon enough, and were sensibly followed by enough people – and whether our healthcare and economic institutions are robust enough to weather the storm – remains to be seen. As was true in the past, we can only measure the effectiveness of our actions with hindsight. Biomedicine may provide some answers that past societies lacked but the historically tried and tested methods of social distancing are, for now, still our best options.
We can take comfort in knowing that despite sometimes horrific losses, survivors of past pandemics embraced life again and rebuilt what had been destroyed. I trust that we can do the same and that when our history of COVID-19 is written, it will not just be about too many dead to count, overflowing cemeteries and crematoriums, crashing stock markets, and the ignoring of distancing protocols. Instead, I hope that it shows us having been compassionate in supporting others in need and looking out for the public good rather than just ourselves.
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