From an initial slow response to the eventual decline of an outbreak, throughout history, intermittent outbreaks of infectious diseases have upended society. Technological progress and advances in medicine over the last century have greatly improved our ability to tackle disease. However, the societal response to COVID-19 draws significant parallels to past pandemics.
Historian Charles Rosenberg (1992) identified four distinct acts in which disease outbreaks have unfolded throughout history.
Act I is Progressive Revelation, referencing the slow response of society as an infectious disease spreads. Given the economic and social upheaval required to suppress disease outbreaks, early warnings of pandemics are often ignored. Similarly with COVID-19, many countries downplayed the threat of the virus, losing valuable time while community transmission went undetected.
Act II is Managing Randomness – the search for a cause. Historically, there is a tendency for society to blame already discriminated groups for disease outbreaks. During the 1892 Cholera outbreak, Jewish immigrants from Europe were blamed for the spread of the disease in the US (Markel and Stern 2002). During the COVID-19 pandemic, anti-China sentiment has risen, with attacks against individuals of Asian descent increasing (Human Rights Watch 2020). COVID-19 has escalated xenophobia and stigma toward migrants and other vulnerable groups wrongfully held responsible for spreading the virus (IOM 2020).
The non-pharmaceutical interventions enforced to suppress the COVID-19 pandemic echo those of past pandemics, including the Spanish Flu (1918-1919).
Act III is Negotiating the Public Response in which collective action is taken to contain the outbreak. The non-pharmaceutical interventions enforced to suppress the COVID-19 pandemic echo those of past pandemics, including the Spanish Flu (1918-1919). The earliest record of using isolation measures to reduce disease is in the Old Testament to prevent the spread of leprosy (Gavi 2020). While restrictions to normal life inevitably cause a backlash, protests against government-ordered lockdowns and mandatory wearing of masks have been extensive during the current outbreak. To add, the spread of misinformation through the internet has exacerbated opposition to these public health measures.
Finally, Act IV – Subsidence and Retrospection – describes the eventual decline in cases of the disease. Smallpox pandemics throughout history were halted by the widespread delivery of a vaccine that eradicated the disease in 1979 (WHO 2020), whereas other pandemics subsided via naturally acquired herd immunity or the discovery of an effective treatment. While some treatments – including dexamethasone – have been found to reduce deaths in severe COVID-19 cases, a safe and effective vaccine provides the best hopes of ending the pandemic entirely (Gavi 2020).
With the global population estimated to reach 9.7 billion by 2050 (UN 2020), growing population density and globalisation will increase the likelihood of infectious diseases spreading rapidly. In addition, as urban settlements encroach on animal habitats, there will be a higher risk of pathogens jumping the species barrier to infect humans, as COVID-19 did (Gavi 2020).
As urban settlements encroach on animal habitats, there will be a higher risk of pathogens jumping the species barrier to infect humans, as COVID-19 did
Rosenberg’s first three acts have manifested themselves in the present pandemic. However, the events since the declaration of the pandemic indicate that we have not applied our learnings from previous pandemics and may not respond to future pandemics effectively.
Society and government must be better prepared, communicate effectively, address ineffective responses, and combat misinformation.
A contributor and member of the Public Health Pathways team
22 September 2020