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History in a Crisis — Lessons for Covid-19


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History in a Crisis — Lessons for Covid-19

Writing in the heady days of new antibiotics and immunizations, esteemed microbiologists Macfarlane Burnet and David White predicted in 1972 that “the most likely forecast about the future of infectious diseases is that it will be very dull.”1 They acknowledged that there was always a risk of “some wholly unexpected emergence of a new and dangerous infectious disease, but nothing of the sort has marked the last fifty years.” Epidemics, it seemed, were of interest only to historians.

Times have changed. From herpes and legionnaires’ disease in the 1970s, to AIDS, Ebola, the severe acute respiratory syndrome (SARS), and now Covid-19, contagious diseases continue to threaten and disrupt human populations. Historians, who never lost interest in epidemics, have much to offer.

When asked to explain past events, historians are quick to assert the importance of context. If you want to understand how or why something happened, you must attend to local circumstances. But there is something about epidemics that has elicited an opposite reaction from historians: a desire to identify universal truths about how societies respond to contagious disease.

Charles Rosenberg, for instance, found inspiration in Albert Camus’s La Peste and crafted an account of the archetypal structure of an outbreak.2 Epidemics unfold as social dramas in three acts, according to Rosenberg. The earliest signs are subtle. Whether influenced by a desire for self-reassurance or a need to protect economic interests, citizens ignore clues that something is awry until the acceleration of illness and deaths forces reluctant acknowledgment.

Recognition launches the second act, in which people demand and offer explanations, both mechanistic and moral. Explanations, in turn, generate public responses. These can make the third act as dramatic and disruptive as the disease itself.

Epidemics eventually resolve, whether succumbing to societal action or having exhausted the supply of susceptible victims. As Rosenberg put it, “Epidemics start at a moment in time, proceed on a stage limited in space and duration, follow a plot line of increasing revelatory tension, move to a crisis of individual and collective character, then drift toward closure.” This drama is now playing out with Covid-19, first in China and then in many countries worldwide.


History suggests that we are actually at much greater risk of exaggerated fears and misplaced priorities. There are many historical examples of panic about epidemics that never materialized (e.g., H1N1 influenza in 1976, 2006, and 2009). There are countless other examples of societies worrying about a small threat (e.g., the risk of Ebola spreading in the United States in 2014) while ignoring much larger ones hidden in plain sight. SARS-CoV-2 had killed roughly 5000 people by March 12. That is a fraction of influenza’s annual toll. While the Covid-19 epidemic has unfolded, China has probably lost 5000 people each day to ischemic heart disease. So why do so many Americans refuse influenza vaccines? Why did China shut down its economy to contain Covid-19 while doing little to curb cigarette use? Societies and their citizens misunderstand the relative importance of the health risks they face. The future course of Covid-19 remains unclear (and I may rue these words by year’s end). Nonetheless, citizens and their leaders need to think carefully, weigh risks in context, and pursue policies commensurate with the magnitude of the threat.

Which raises one last question of history and political leadership. A “swine flu” scare struck the United States in 1976 in the midst of a presidential campaign. Gerald Ford reacted aggressively and endorsed mass immunization. When people fell ill or died after receiving the vaccine, and when the feared pandemic never materialized, Ford’s plan backfired and may have contributed to his defeat that November. When AIDS struck in 1981, Ronald Reagan ignored the epidemic throughout his entire first term. Yet he won reelection in a landslide. The current administration, thankfully, has not followed Reagan’s lead. Will it succeed where Ford went awry? Initial assessments of the U.S. government’s response have been mixed. The history of epidemics offers considerable advice, but only if people know the history and respond with wisdom.

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