I often kick off the semester in my undergraduate classes at the College of Charleston with a simple question: What disease are you most afraid of?
The replies are predictable; Ebola, bubonic plague and HIV/AIDS usually top the list, though sometimes a wry public health student will mention cholera or dengue fever. I use this exercise to open up a conversation with students about an uncomfortable truth: We rarely fear the diseases most likely to make us sick or kill us. The leading causes of death in the United States today are heart disease, cancer and accidents. Students never mention accidents.
When I asked this question in January, students overwhelmingly said mumps. I didn’t actually expect the answer, but I probably should have. Since September, the campus saw 77 cases of mumps, with near-weekly “Update on Mumps Cases” emails. The outbreak has waned, but for a few months the fear of contracting mumps produced palpable anxiety on campus.
Mumps was a children’s disease, they believed, and students didn’t want to be reduced to a number — 1 in 77 — isolated by school officials, or labeled as an “anti-vaxer.” Inadvertently, the students had proved my point before I could even make it. As historian Charles Rosenberg cleverly noted several years ago, “Disease does not exist until we have agreed that it does — by perceiving, naming and responding to it.”
A few weeks later, the discourse in my class radically changed as the COVID-19 crisis dawned. Folks are worried, and with good reason. The disease has spread to about 400,000 people and more than 16,000 have died. The fatality rate was once thought to be around 2%, a tad worse than the seasonal flu. Recent estimates are more like 3%, but strikingly higher (10%-15%) for the elderly and those with weakened immune systems. As a historian of public health, the coronavirus situation deeply resonates with me.
Rumors swirl about the origin of the disease, how widespread it really is, and how best to prevent it. How will coronavirus impact the economy, or the upcoming election? Should I stockpile food and water? What will happen if I’m quarantined? Should the government even quarantine? These are our traditional responses to epidemic diseases: We name, we perceive, we respond.
Maritime quarantine was probably the single most controversial measure in the 18th and 19th centuries as yellow fever ravaged the Atlantic world. Sullivan’s Island was once a quarantine station. Quarantine, then as now, was a political tool that balanced contagious disease theory, business interests and individual rights.
When cholera first struck western Europe and North America in 1831-32, there was widespread panic of a new disease from Asia. It was even called “Asiatic Cholera” at the time. Many called for national days of prayer, fast days, and saw the epidemic as the act of a vengeful God upset by the immorality and filth of the poor. Scrub the slums, they said, ushering in the first public health revolution in the western world in the late 19th century.
In the late 1890s, an old foe, the bubonic plague, swept across the globe with devastating effect in China, India and Africa. When it arrived in the United States, in 1900, it struck San Francisco particularly hard. By then, American cities were employing health officers across the country, and they were aided by the new tools of modern epidemiology and bacteriology. But when the first case of plague came from impoverished Chinatown, the public and public health authorities panicked, quarantining the district and ushering in a new wave of anti-Chinese sentiment across the country.
In 1907, public health authorities in New York took the drastic step of quarantining an Irish-immigrant cook, Mary Mallon, as the index case for numerous cases of typhoid fever, a disease on the decline at that time. Called “the most dangerous woman in America,” Mary was a “healthy carrier” of typhoid who presented a new fear — that seemingly healthy people could be walking around and spreading the disease by touching upper-class food and doing laundry. Mary was far from the only healthy carrier at the time, but her gender and her ethnicity made her an easy target.
The influenza pandemic of 1918-19 killed between 30 million and 60 million people worldwide as World War I was ending and as the structure of public health in America and western Europe was only beginning to take shape. Schools, theaters, churches and public gatherings of all sorts closed. The mask was heralded as the savior for preventing personal infection; salvation was through rigorous hand-washing and limiting exposure to crowded spaces.
Taken together, these historical moments pose a broader question today: Why do some health and environmental problems get feared and framed as public health problems of immediate concern, while others are neglected and downplayed by policymakers and the media?
Epidemics reveal human nature, including cultural prejudices, ethnocentrism and gaps in policymaking. Epidemics are perforce political events, not simply biological ones. But epidemics also galvanize societies into public health action and drive change in medical science.
As a historian, I can’t tell my students what direction the coronavirus will take. But the history of our responses to epidemic disease can help us understand and navigate the course.
Jacob Steere-Williams is an associate professor of History at the College of Charleston.