The Covid-19 pandemic isn’t the first outbreak in history, and it won’t be the last. However, is there anything important to remember about historical quarantines and medical responses that could help us cope with our own? We spoke with Graham Mooney, an associate professor at the Institute of the History of Medicine at Johns Hopkins University, about past outbreaks.
Social distancing guidelines have been a key part of slowing the spread of the virus, but many Americans didn’t have to follow them before the COVID-19 pandemic. Are these regulations relatively new?
The kinds of policies that have been introduced during COVID-19, they have very deep historical origins. To some extent, we’ve forgotten what they are because we don’t get outbreaks like this in the United States or in the West very often.
What is important for people to remember when they compare past outbreaks with present ones, like the COVID-19 pandemic?
Every outbreak is different. One of the things you see with COVID-19, for example, is quite a lot of uncertainty at the moment about how the disease is spread. You have lots of discussion and debate about the medical science. Yet, historically people also didn’t know what the actual transmission mechanisms were, whether they were caused by airborne,was it by touch, or if the infection could be carried in bales of cotton, carts of wheat, or bedding and clothes, those sorts of things.
So, the scientific knowledge we have at the moment is always imperfect?
I think we need to recognize that. For example, in 1918, even though we didn’t know that it was a virus and nobody had seen a virus under a microscope, it was commonly assumed that it was airborne. The kinds of interventions around banning public gatherings, closing schools, self isolation and taking people to hospital, they were seen as being commonsensical methods.
What is a historical example of this?
Sometimes, for example, in the Black Death, you would have people being placed on what we would now think as “house quarantine.” You wouldn’t necessarily get taken to a pest house on the edge of the city. If this was a case of bubonic plague in your household, the whole household would be on lockdown in their own homes. And, that is kind of what we’re seeing now, particularly if there’s a case in the case of COVID within families.
Some Americans have protested lockdowns measures in multiple states. Did people in past outbreaks protest public health regulations? Were they different from protests today?
There are examples of that. If you resisted going to hospital or having your child go to hospital, or if you carried on operating your business even though your workers have scarlet fever or if you kept sending your kids to school when you knew they had whooping cough, you could be fined. If you didn’t pay the fine, you could be imprisoned. So it’s very difficult for us to say as historians that people always accepted these rules. We can’t always say that because people tend to behave differently when they are being threatened with the force of the law.
Where did these protests occur?
In Britain, France, Italy, people rioted against regulations that were put in place against cholera in the 19th century. A lot of that was the fear of poor working class people being told what to do by ruling elites and sort of working people being suspicious of the sorts of things they were being asked to do.
In the 1890s, in Nottingham, 16,000 people actually signed a petition saying that basically you’re turning our hospital into a morgue, because our kids go in, we can’t come and visit them, and they might die in the hospital and we’ll never see them again.
Today, many celebrities have been criticized because they have had access to tests whereas other people have had to face strict criteria to qualify. How did class affect outbreaks in the 19th century?
Legislation was implemented differently. The wealthy, powerful elite, didn’t have to come to the hospital. They didn’t have to change the rituals and traditions they had around funerals. Wealthy people continued to have lavish and extravagant, well attended funerals whereas poor people were told, you’re going to die in hospital and get buried.
Are there any interesting ways public health responses can help end an outbreak?
They can actually be put in place for a wrong reason, but still work. So for example, a lot of people in the early 19th century believed that cholera was the product of the degraded urban environment, that garbage, trash, or human excrement gave off gases, “miasmas” that infected people. One of the responses was, well, let’s clean up the urban environment. When you clean up the environment, you have a water supply and sewage supply constructed.
With the all of these lessons learned past outbreaks, what do you think is the best way to prevent future ones?
So the question to me is not necessarily how we prepare for a pandemic flu, but how we treat people in non-pandemic times. I think that the key is that quite often these sorts of outbreaks, is that they expose the lack of investment on the ground for particular groups, as they relate to race and class- in terms of people without insurance, with pre-existing conditions that haven’t had access to treatment and medications that help them manage hose pre-existing conditions, you’re now exposing them to the virus.
This interview has been edited and condensed for clarity.
Mooney’s most recent work Intrusive Interventions: Public Health, Domestic Space, and Infectious Disease Surveillance in England 1840-1914 focuses on the history of public health initiatives such as disease notification, institutional and domestic isolation, disinfection, and contact tracing. You can find him on twitter @histgeoghealth.