Pandemics may be Inevitable: Ignorance is Not

"Migration of man and his maladies is the chief cause of epidemics." Alfred W. Crosby, The Columbian Exchange, 2003

(Image: Romanticized depiction of the arrival of Columbus in the New World)

Alfred Crosby's words were written in connection with the European discovery of the New World. In the wake of the discovery, Europeans began to migrate to the Americas, first a trickle, then a flood, then a tsunami. The same is true for Africans, although they did not come by choice. 

Both Europeans and Africans unknowingly brought their microbes along, unleashing an explosion of diseases in the New World. All suffered, but the indigenous inhabitants suffered most -- indeed catastrophically. It was like being attacked by several deadly pandemics at once. War and enslavement worsened things.

Native Americans were extremely vulnerable to Old World diseases. Having been isolated from the rest of the world for thousands of years, they had no experience with or immunity to a host of Old World infections. 

Smallpox, measles, influenza, pneumonia, and many other diseases killed Native Americans in huge numbers. The microbial invasion wiped out, or nearly wiped out, many Native American cultures. It was perhaps the worst demographic disaster in world history. 

The Europeans and Africans, in contrast, grew in numbers. Unlike Native Americans, they had experience and some levels of immunity to the diseases they carried from their own regions, many of which had been around for centuries or even millennia. They suffered, too, just not as much. The only major disease that the New World gave to the Old is, possibly, syphilis. The disease exchange was heavily one-sided.

Africans were vulnerable to some European diseases, especially respiratory disorders such as pneumonia and tuberculosis. Europeans were vulnerable to some African diseases, especially tropical fevers such as falciparum malaria and yellow fever. Bad as these could be, they did not prevent population growth among the new arrivals.

As Western peoples moved around the globe during the orgy of imperialism in the 19th century, the same epidemiological patterns were repeated. Remote island peoples, for example in the South Pacific, faced an onslaught of western diseases. Westerners in some regions faced disease tsunamis of their own when they moved into Sub-Sharan Africa and parts of South Asia. 

There are many other examples of disease that spread through human migration. In the 14th century, the Second Plague Pandemic  (Black Death) migrated along trade routes such as the Silk Road and pilgrimages routes. Swift Mongol horsemen also played a role in spreading plague as they conquered much of Eurasia.  

The Cholera Pandemics of the 19th century followed a similar pattern. Originating in British India, cholera crept along trade routes and reached Western Europe and the Americas by the early 1830s, sparking panic. 

The Third Plague Pandemic, which began in China in the late 19th century, spread around the world aided by steamships and railroads. It reached San Francisco and Sydney, Australia by 1900. It was especially deadly in India, killing about ten million. (Image: Plague in Sydney, Australia, 1900: rat killing)

The mass movement of millions of soldiers in World War I famously spread the Great Influenza of 1918-20. American troops aboard crowded ships brought the influenza to Europe, where it mutated. Then they brought the more virulent mutation back to the Americas. (Image: Pandemic Incubator: US troopship returning from Europe, 1918)

That is history, ancient history for many of us. Today the world is battling against another virulent disease that has spread in part through the temporary migration we call tourism. Commercial airliners can spread microbes around the globe faster rate than even steamships and railways. 

Unprecedented numbers of people are constantly on the move, fleeing from violence, oppression, and poverty. Human migration into hitherto sparsely populated regions like rain forests and increased contact with wild animals have helped to create new deadly viruses like Ebola, SARS and now Covid-19. Unlike the first two, coronavirus is highly contagious and becoming ever more so as new strains like Delta and Omicron evolve. 

One of the main means of controlling Covid, or at least slowing its spread, is to restrict human migration, a difficult and sometimes inhumane thing to do. Countries can close their borders to prevent both in migration and out migration. Many have, but often too late. 

The perceived economic cost led most countries to avoid such restrictions for too long. Governments have mastered the art of closing the barn door after the horses have left. Economies are crashing anyway. 

"No one could have predicted this" is a common but largely false claim. Epidemiologists and public health experts have been predicting something like this for decades. WHO has been warning for decades that "disease X" will come from nowhere and we must be prepared for it. Even the film industry warned us, if often in an overly sensationalized form. Contagion (2011) was the best of these.

Those who made the predictions had science on their side, and history as well. But who pays attention to science and history nowadays?

The present combination of overpopulation, mass migration, tourism, and destruction of natural habitats makes the coming of more more "disease X's" and pandemics almost inevitable. The changes necessary to reduce their likelihood may be beyond the capabilities of the global systems we  have created, with their emphasis on maximizing GDP at all cost to the planet. 

Pandemics may be inevitable. Humans have the ability to minimize their damage if we learn the lessons that history and science can teach us. Ignorance is not inevitable, but overcoming it is a huge task. It will be especially difficult as long as sections of the media, especially social media, give free reign to the spread of false information and bizarre conspiracy theories.

 

Yellow Fever and Quarantine in Charleston, South Carolina

During the Covid pandemic, countries, states, localities faced a stark choice: should they restrict human interaction by restricting commercial activity and risk harming the economy? Or should they allow businesses to continue to operate as normal, thus endangering people's lives?

In cities heavily reliant on commerce, epidemic diseases have long posed an agonising dilemma. Closing a city to trade through strict quarantine threatens people’s livelihoods. Leaving it open, even partially open, threatens their lives. As was the case with Covid, both options had their advocates and opponents. 

Charleston, South Carolina, provides an instructive case study of this dilemma. From its foundation in 1670, this southern port was dependent on global trade. At the time of the American War for Independence in the 1770s, South Carolina was the richest of the thirteen colonies. Its wealth derived mainly from exports of rice, indigo, and after 1800, cotton. All of these crops were grown on plantations worked by thousands of enslaved Africans. The reliance on this labour source required regular imports of human cargo. [Image: Charleston Harbor, early 19th century]

As a commercial port, Charleston received unwelcome imports of another sort: diseases from Europe, from Africa, from the Caribbean, and other North American colonies. Some of these imported diseases were highly contagious and deadly, notably smallpox. One, cholera, was transmitted mainly through contaminated water. But nasty as it was, cholera did not arrive until the 1830s and was only an occasional visitor thereafter.

Other imported diseases were transmitted by insect vectors, particularly mosquitoes. The most important were malaria and yellow fever. At least two types of malaria were imported: vivax malaria from Europe and the deadlier falciparum malaria from Africa. Malaria became endemic in South Carolina from the early days of the colony. It flared up every summer and lasted into the late autumn or early winter. Malaria was generally a greater problem in the countryside than in Charleston, especially after about 1750.

Unlike malaria, smallpox and yellow fever were epidemic diseases. They were not an annual problem, but when outbreaks occurred, they could produce widespread terror and high mortality rates. Until the early 19^th century and railroads, yellow fever was largely confined to Charleston and other coastal ports because its vector, the Aedes Aegypti mosquito is a poor flier. Smallpox, by contrast spread widely into the countryside, wherever infected humans travelled. But it came less often than yellow fever.

How to prevent or minimize the effects of epidemics was always a contentious issue for the city’s leaders. It was complicated in the case of yellow fever by difficulties of diagnosis and conflicting views of how it spread. One view was that it spread through the air, through miasmas, or bad air. Another was that it was contagious, passing from person to person. Neither view was correct. The role of mosquitoes in transmitting yellow fever was not established until 1900.

Miasmatists and contagionists differed over the best way to limit the spread of yellow fever. Miasmatists generally believed that disease-causing bad air was generated locally. Closing the port would do little to control the fever, they insisted. Contagionists viewed yellow fever as imported, mainly from Africa or the Caribbean. The best way to control it, they argued, was through quarantine measures. Ships coming from places where yellow fever was common or known to be present should be inspected by physicians. If found to be harbouring the disease, the ships should be ordered into quarantine. Crew and passengers should remain on the ships just outside the harbour or be removed to the pest house or quarantine station until they were no longer considered a danger. 

South Carolina erected the first of several pest houses on nearby Sullivan’s Island around 1707. Quarantine measures were the dominant way of controlling yellow fever, smallpox, and other epidemic diseases in the 18^th century. They were supported by most doctors.

Opposition to quarantine measures for yellow fever increased markedly after 1800. The change was undoubtedly connected to economic decline in South Carolina and Charleston’s sagging importance as a trading port. Interruptions of commerce became a more serious problem than they were in the 18^th century. Acknowledgement that yellow fever was present in a port could greatly reduce its seaborne trade and sharply curtail visitors and potential immigrants.  

Merchants, city leaders, and most doctors in Charleston became increasingly reluctant to declare the presence of yellow fever. They would first deny that a problem existed. When the problem became obvious, they denied that the disease was yellow fever but rather something less dangerous. When forced to concede that yellow fever was epidemic, they argued that quarantine measures would be ineffective, because the disease was generated locally through bad air.

The solution, these Miasmatists believed, lay in sanitary improvements. Eliminating sources of bad odours, cleaning the streets, removing organic wastes and offal, and providing clean water. These measures could have improved health in other ways, but they would have done little to stem yellow fever. 

In any case the city’s sanitary condition did not improve much before the early 20^th century, when yellow fever had already ceased to be a problem. One reason is that sanitary improvement was expensive and often collided with personal and property rights.

A miasmatic explanation of yellow fever, combined with attempts to deny the presence of the disease, had a clear economic advantage. It reduced disruptions to seaborne commerce. Imposition of quarantine measures was delayed, limited, or altogether avoided. 

The fact that most of the victims of yellow fever were “strangers” -- visitors and immigrants, mainly Irish and German – may have made that choice more palatable. It also reduced the number of immigrants, which some locals did not much mind. Charleston's reputation as a yellow fever hotspot for foreigners is one reason why it did not receive as many immigrants as New York, Boston, and Philadelphia.

In 1840, Dr Benjamin Strobel of Charleston wrote a highly controversial essay on yellow fever. He accused commercial interests, boards of health, and the medical establishment, of endangering human lives. Worse, he charged them with "exploiting public ignorance" to rouse opposition to quarantine. The very people who would benefit from a strict quarantine were among its most vociferous opponents. [Image: Benjamin Strobel, 1803-1849]

Strobel demonstrated that yellow fever usually broke out and was heavily concentrated in areas of Charleston closest to the wharves and where sailors and immigrants lodged on arrival. He avoided the thorny issue of contagion. Instead, he argued that yellow fever was somehow transmissible. And he was sure it had been transmitted to the city from ships. He was ostracized for his efforts and left town.

In the 1850s, several lethal epidemics coincided with the opening of a steamship link with Havana, Cuba, a port notorious for endemic yellow fever. In the wake of these outbreaks, support for quarantine measures grew, with a Citadel science professor, William Hume, leading the charge. Hume had been an advocate of miasma theory, but his research convinced him that yellow fever was imported, mainly from the Caribbean. His ideas did not receive a warm welcome either. 

Yellow fever was absent from Charleston during the Civil War. Probably not coincidentally, thanks to the Union blockade, so was most seaborne trade. The last documented epidemic in the city occurred in 1877. How much the retreat of yellow fever owed to stricter quarantine is difficult to say. The decline of the port’s seaborne trade after the war may have been more important. Yellow fever continued to strike busier southern ports hard, notably New Orleans, which suffered the last epidemic in North America in 1905, and the region around Memphis, scene of the worst epidemic in the USA, in 1877. 

Yellow fever in the 19^th century South, as Margaret Humphreys has stated, “was above all, a commercial problem.” And sometimes, local authorities chose the health of commerce, as they saw it, over the health of the people. 

Further reading:

Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (New York: Cambridge University Press, 2011)

Margaret Humphreys, Yellow Fever and the South (Baltimore and London: Johns Hopkins University Press, 1992)







  

Trump Virus or Kung Flu? Naming Pandemics in History

Last year, Chinese officials and many others accused Donald Trump of racism because he referred to Covid-19, or coronavirus, the "Chinese virus." At his Tulsa rally, he called it "Kung Flu."  "Trump Virus" may be the most accurate name, because he has done more than anyone on the planet to spread it. His rhetoric has also contributed to an upsurge on attacks on Asian Americans. 

Racist or not, and it often is, naming pandemic diseases after their alleged place of origin is an old practice. In 1957 and 1968, two deadly flu pandemics were named the "Asian Flu" and the "Hong Kong Flu." A pandemic flu first reported in St. Petersburg in 1889 was denoted the "Russian Flu." It was later called "Asiatic Flu," although St. Petersburg is a long way from Asia.

When pandemic cholera first made its way from India to the UK in the early 19th century, people called it the "Indian Cholera," as in the broadsheet below from 1831. One reason for adding the adjective "Indian" was to distinguish this new, mysterious disease from an old, familiar one: "cholera infantum," a type of childhood diarrhea. but the name led to Indians being blamed for the disease.

In the cartoon below, also from 1832, the cholera is dressed in Indian garb, trying to enter England, but caught by stout John Bull. The reality was far different for England and the world. A series of cholera pandemics during the 19th and early 20th century killed millions in Asia, Africa, Europe and North America, more than 30 million in India alone.

Later in the 19th century, cholera was often referred to as "Asiatic Cholera."

In 1918-1919, a virulent form of influenza became pandemic, and ultimately killed 50-100 million people worldwide. It quickly became known as the "Spanish Flu," although it probably originated in the USA. But the USA was engaged in World War I and sending thousands of troops to Europe. The press was instructed not to report about the epidemic, lest it lead to demands to stop troop shipments -- the overcrowded ships were excellent incubators for such a disease. 

Most European countries involved in the war similarly kept quiet at first, to avoid hurting morale. Spain, however, was neutral, and its press reported on the outbreak. Spain's reward was to have one of the worst pandemics in history named after it. 

It was also called "Flanders Grippe" in Britain, "Bolshevik Disease" in Poland, "Too much inside sickness" in Hong Kong.

Today, it is usually called the "Great Influenza." Perhaps it should be called the "American Flu."

Interestingly, the greatest and most famous pandemic in world history was not named for a place or nation. That was the pandemic of plague that ravaged Eurasia during the 1340s, killing between 75 and 200 million, It wiped out perhaps as much as 60 percent of the European population. It probably originated in Central or East Asia and traveled west along the Silk Road to the Middle East, Europe, and North Africa. 

The 14th century pandemic is best known today as the Black Death, but that name was not applied to it at the time. Other names for it include, Plague, Great Plague, Black Plague, and Pestilence (La Peste). Before the pandemic, plague and pestilence simply meant a deadly epidemic disease. (Below: The Dance of Death, or Danse Macabre, late medieval, Nuremberg Chronicles).

Syphilis, which struck Europe in pandemic form after 1500, was generally named after other, often disliked, countries. The English called it the French Disease. The French called it the Italian Disease. The Italians returned the compliment. The Dutch called it the Spanish Disease. Russians called it the Polish Disease. Turks called it the Christian Disease. The Japanese called it the Portuguese Disease because Portuguese traders brought it from Europe.