Past pandemics: What can we learn from them?

The Flu, 1918. Writing for The Washington Post's "Made by History" blog, two historians of medicine write that a crucial lesson of 1918 is to not relax social distancing too soon, despite public and economic pressures.

"Thinking that the proverbial coast was clear, many communities lifted social distancing measures before the battle was truly over... The result? Cases and deaths resurged... In some cities, this second peak was even deadlier than the first," they write .

The influenza pandemic of 1918-1919 caused approximately 50 million deaths and devastated communities worldwide. The Influenza Encyclopedia produced by the University of Michigan holds more than 16,000 documents and photographs depicting the catastrophic effects of the flu in dozens of cities across the United States.

Lessons? Philadelphia was one of the worst-hit cities in the nation during the 1918 pandemic; in subsequent years, it became a model of what not to do during a public health emergency (including not to hold a parade during the peak of an outbreak). One of the cities that fared the best? Columbus, Ohio.

But it's not solely 1918...

While the 1918 pandemic has drawn many parallels with today, other influenza pandemics effected the course of events in the 20th century. In 1957, the H2N2 flu killed 1.1 million people worldwide, 116,000 in the U.S. That pandemic contributed to Surgeon General recommendations that certain populations receive an annual flu vaccine. In 1968, a new H3N2 influenza virus killed more than 100,000 people in the U.S. The strains of H3N2 circulating today are descendants of that virus from more than 50 years ago.

Cold War politics. Inoculation against disease was an important element of 1960s Cold War politics. Historian Erez Manela has argued that to some 1960s U.S. officials, "the best breeding place for Communism" was "disease and poverty. If we are going to lead the free world in its fight against the bondage of Communism," it was argued, "we have to do something about the health of these poor people." Cooperation between the U.S. and the U.S.S.R. to eradicate smallpox was deeply embedded in Cold War politics. Vaccination was a tool for expanding American power and influence.

Broader culture wars. Debates surrounding disease and treatment are never divorced from their political contexts. In a report produced by the Luskin Center for History and Policy at UCLA, three historians write that during the HIV/AIDS epidemic of the 1980s, debates over whether to close bathhouses in order to stem the rate of infection were embedded within larger cultural battles over homosexuality, civil liberties, and discrimination. In California, San Francisco shuttered its bathhouses despite a lack of scientific consensus that such a restriction would have positive public health outcomes. Los Angeles declined such closures.

Vaccinations and treatments

Where did vaccination originate ? This short video explains how the procedure known as "insufflation" originated in China. Scabs from infected persons would be ground into a powder, wrapped in cotton and blown into people's noses. A British scientist devised a modern-day inoculation for smallpox by observing that cows and milkmaids who contracted cowpox usually survived. The scientist injected his friends and neighbors with small amounts of cowpox and found they were immune to smallpox.

Smallpox devastated populations for centuries. The disease even played an important role in the American Revolution. In her book Pox Americana, historian Elizabeth A. Fenn documents the horrific seven-year smallpox epidemic from 1775-1782 that infected American and British troops, ravaged the populations of enslaved persons in Virginia, and devastated Creek and Cherokee populations in Georgia.

Yellow Fever was another disease that repeatedly decimated populations. Yellow fever outbreaks occurred in Boston in 1693, Philadelphia in 1793 and Virginia in 1855. The worst outbreak occurred in 1878 in the Mississippi River Valley. As many as 20,000 people died from the disease.

Misinformation and xenophobia

Misinformation and xenophobia contributed to the Yellow Fever outbreak in Philadelphia in 1793, including by Alexander Hamilton. As documented by the National Library of Medicine, Hamilton believed that refugees from Haiti were the source of the outbreak and sought to ban them from entering the country. Everyone from politicians to ordinary citizens had opinions on what caused the illness, much of it erroneous and rooted in racial stereotypes. African Americans were thought be immune from the disease and were conscripted to work on the front lines of medical care and as manual laborers. It would not be until 1900 that it was discovered the disease was spread by mosquitoes.

Home reading

Quarantine is an opportune time to read additional books related to pandemics and healthcare:

Villanova voices

Scholars at Villanova have contributed to our understanding of the current pandemic on topics ranging from public health and misinformation to the effects on churches and organized religion. A summation of those ideas is on this webpage.

Father Joe Ryan teaches a course at Villanova on history of disease. An article from The New York Times echoes some of the themes from his course.

"Sacrifice is a wasting asset." Villanova historian Marc Gallicchio is a historian of U.S. foreign policy who has examined Presidential leadership in times of war and crisis. He observes:

" Those at the top are always aware that the public’s willingness to sacrifice is a wasting asset. Even in the midst of crisis it is difficult to get people to take orders. That becomes even more difficult as the sense of crisis fades even while the challenges remain. That was the case in WWII. It is likely going to be an even taller order today."

(These themes are addressed in his recent book on WWII, Implacable Foes.)

COVID-19 as a product of global capitalism? Villanova historian Andy Liu writes in The Guardian and n+1 that while the coronavirus originated in China, it has spread around the world due to highly-interconnected markets of capital and tourism that have grown insatiably over recent decades. These markets are now ill-equipped to handle such a crisis, Liu argues.

More perspectives

Disease maps. The University of Washington is one of many that maintains an active website that tracks coronavirus cases in real-time. As scholar Sarah Schuetze has written, "disease maps have become a staple figure in the visual rhetoric of a disease outbreak." Examining maps of a cholera outbreak in 1832 on the website Commonplace, she writes how these seemingly objective sources were designed to reflect the terror associated with the disease. Fear was drawn into the maps themselves in 1832, especially as the disease spread from Africa and Latin America to Europe and the United States. Do today's digital disease maps also reflect our fears?

What we get wrong about fighting pandemics. Historian Jim Downs in The Atlantic on how government inaction or delay has shaped past epidemic responses.

How is COVID-19 affecting life in Iran? Here is one perspective from the website Jadaliyya.

How should we understand histories of nursing? Two books from Rutgers University Press , Nursing the Nation and False Dawn illuminate the successes and failures of the nursing in the U.S.

Free videos

From our partners at C-SPAN's American History TV.

Finally, t he documentary series Philadelphia: The Great Experiment is available for free on Youtube.

Virtual "Lunch @ Lepage" continues

Join us for virtual "Lunch @ Lepage", Wednesdays at 12:30 p.m. The Lepage Center is continuing its weekly "Lunch @ Lepage" discussions for Villanova students, faculty and staff, virtually via Zoom. We discuss the coronavirus pandemic in historical perspective; email us at lepage@villanova.edu to receive the invitations.

Update on in-person events: At present, no in-person events are being scheduled at Villanova University. Please continue to check the Villanova University website for updates.

A special message from the Dean

Dear Friends of the Lepage Center,

Spring had just arrived on Villanova’s beautiful campus when the coronavirus forced us to close it on March 13. But the Lepage Center remains open and working – as hard as ever. I expect you will agree with me that the Center’s mission to connect the past with the present is even more relevant and useful now.

Supported by a generous new gift from Albert Lepage, we are planning ways to apply historical insight to the current public health crisis and its political, social and economic reverberations. Do you have questions or ideas? Please send them to us at lepage@villanova.edu .

Thank you for your continued interest in the work of the Lepage Center, and please accept my good wishes for the health of you and your family.

Adele Lindenmeyr, PhD

Dean, College of Liberal Arts and Sciences

Professor of History

Please stay well and stay healthy