A Great Societal Challenge Returns Accompanied by Lessons (and Questions) From the Past

An American studies instructor, who spent decades studying the ‘Spanish Flu’ outbreak, mulls how future peers will chronicle the COVID era.

Most Americans lived comfortably for decades in the false knowledge that whatever dangers we may face from firearms in schools or terrorists in cockpits, we would never have to worry about epidemics.

Until March, epidemics happened to other countries, in places physically far away and remote. Americans could ignore the shrinking of distance and time occasioned by the commercial jetliner.

When Ebola—a fluid-borne virus—made an appearance in 2014, our health leaders reacted with the sort of speed we expected and headed off an outbreak.

Spanish Flu
Interns and residents from the 1917-18 era were on the front lines in the fight against flu.

Zika fizzled.

Swine flu sickened huge numbers, but deaths remained relatively low.

SARS never crossed our frontier with Canada.

H5N1 (remember that doomsday bug?) still sickens and kills, just not in America.

With the exception of HIV, which has been mitigated by the introduction in 1996 of anti-retroviral therapies, we have to reach back to 1955 and polio to understand the fear and impotence and death that a virus can cause in our nation. (While HIV is the major exception to the rule of an epidemic-free America, the disease was often viewed—erroneously—as something that “other people” contracted.)

Spanish Flu
This chart shows mortality from the 1918 influenza pandemic in the United States and Europe.

We’ve forgotten the terror of infectious disease, the loss of burying children, the grief of hearing bells toll every day for weeks when diphtheria, scarlet fever or any one of a dozen other diseases broke out.

We have done so well that millions of Americans either refuse to vaccinate or do so only grudgingly. Gone are the days when parents lined up by the millions, waiting hours for their children to receive a shot of Jonas Salk’s miracle in their arms. (If you don’t know who Salk was, look him up and see what he meant and why he was treated as a global hero and ask yourself why you don’t recognize his name.)

As we now move into the “yellow” and even “green” phase in most of Pennsylvania and the nation, the challenges of reopening, of bringing people back together, stare us directly in the face.

Our reopening will allow for greater opportunity for the virus to come into contact with susceptible material—which is a euphemism for people not already infected and, hopefully, immune for at least a year or two—to the virus.

Our current phased reopening will give some indication, however imperfect, of what we might face in a few months, when a drop in temperature and humidity will allow for the virus to survive longer on surfaces and in the air.

Spanish Flu
A view of the Jefferson Medical College Hospital at 10th and Sansom streets.

Phased reopening will, sadly, also offer people false hope that the pandemic is finished and the coming autumn and winter will be less terrifying and disruptive than the spring of 2020.

It is far too early for any definitive assertions about how historians will narrate the COVID-19 pandemic in America, especially as the epidemic is likely to remain a vital factor in our lives for the next year or more. Sadly, this is because we may not yet have experienced the worst of its fury.

Yet, as an historian of medicine, and one who has spent 20 years intensively studying the influenza pandemic of 1918 to 1922, I believe that during the course of the coming century a number of lines of inquiry will be followed.

Perhaps a sense of history will help us decide how to fight our present invisible enemy.

They will select winners and losers, and I have a hunch that the criteria will be simple: Did you save or endanger lives?

With few exceptions, the policy, health and business leaders of 1918 faced the greatest challenge of their lives. The stakes were never higher.

Historians will look back in the coming decades and judge the decisions of local, state and national leaders upon this premise: What did you do when COVID-19 came calling?

They will select winners and losers, and I have a hunch that the criteria will be simple: Did you save or endanger lives?

The potential availability of a vaccine in late 2020 will largely shape this discourse, but beware, leaders: If a vaccine is not available and you fail to rise to the occasion, your grandchildren and great-grandchildren will read about it.

Think it doesn’t matter what people think when we’re gone? Well, the family of an important public health official in Philadelphia in 1918 have for years read hurtful, and erroneous, accounts of their relative’s failures during the pandemic until more careful, recent scholarship has begun to correct those perceptions.

Spanish Flu
An 1918 influenza epidemic poster issued by the Board of Health in Alberta, Canada.

Historians will examine rates of death among African Americans and Latinos that indicate mortality rates out of all proportion to their share of the population.

They will note that contemporary commentators of all stripes decry the reasons for these deaths rates—poverty, lack of access to medical care, food deserts in our inner cities and rural areas, employment in suddenly essential jobs that nevertheless pay poorly, exposure to environmental pollutants.

But, in the hands of historians, these facts will also help scholars describe to future generations the priorities of an early-21st century America that was too often content to be largely laissez-faire in matters pertaining to the well-being of the poor.

Scholars will examine the general health of our society.

I suspect that historians will examine closure orders in 2020 carefully.

People, as long as they are not elderly, stand an excellent chance of recovering from COVID-19. That changes if a person is obese or suffers from one of a number of comorbidities.

What will historians and future generations make of a society that allows—yes, allows—disconcerting levels of childhood obesity? The highest rates of type 2 diabetes in the world? About a society that spends billions on tickets and TV packages to watch sports, but whose adults can largely not complete a solid hour of light-to-moderate exercise?

The economy is where there are simply no parallels to past epidemics.

Pennsylvania imposed the most stringent state measures against crowds in 1918. Alcohol sales were forbidden, all theaters and athletic venues closed, and most communities took the further step of closing schools and houses of worship. The similarities stop there.

With World War I in full swing, hundreds of thousands of Pennsylvanians toiled every day in mines, mills and factories. Small businesses suffered, but the economy as a whole was not devastated.

With this in mind, I suspect that historians will examine closure orders in 2020 carefully.

Most unknowable of all is whether the historian of 2120 will write about the spring of 2020 as a warning that our society took seriously.

In retrospect, it may appear to historians that some regions may have suffered unnecessarily from shuttering of the economy, though one can never know for an absolute certainty whether the closures prevented worse outbreaks in areas left relatively untouched by the virus. In the absence of testing and tracing, the policymakers of 2020 were loath to take the chance of igniting a new center of viral activity.

In the more strident calls for a national reopening, without even a semblance of adequate testing (something we might get in order relatively quickly) and without a vaccine (which only makes the need for testing and contact tracing more acute), might not the historian of 2120 detect a reprehensible callousness toward the aged and vulnerable?

Put another way, if COVID-19 killed 100,000 Americans between the ages of 18 and 40 in the two and a half months following the March 16 closure order, our national conversation about the economy and closures would be entirely different. In that scenario, our elected officials would likely have been forced by an enraged electorate to commence immediate national testing.

Mandatory mask-wearing and social distancing would be stringently enforced by both law enforcement and through social pressure.

We are in the midst of deciding how the second wave will be viewed.

We haven’t said goodbye to our children and middle-aged peers. Instead, we are in the process of burying a generation of grandparents and great-grandparents while demanding that beaches and bars reopen, post haste.

I am afraid that historians will also suggest that we condemned the generation that fought in World War II and Korea, and stood down the Soviets during the Cuban Missile Crisis, to their graves without even the honesty evinced by Texas Lt. Gov. Dan Patrick who suggested that seniors would be willing to die to keep the economy going for their children and grandchildren.

And we seem to be doing this without the courage and decency to publicly suggest that our elders should have their affairs in order. This is not hyperbole. It is the reality thrust upon us.

Most unknowable of all is whether the historian of 2120 will write about the spring of 2020 as a warning that our society took seriously.

That the America of 2020, regardless of whether a vaccine is developed in the next few months, laid detailed plans during the summer to get testing, social distancing, emergency hospitals and equipment, and contingency plans for schools and businesses in order and weathered the winter of 2020-2021 with as few casualties as could be expected.

Or, will our great-grandchildren discuss in history class, and historians at their conferences and in their books, that the spring of 2020 was just a prelude that went unheeded, that the real trial came during the terrible winter of 2020-2021, when America failed to prepare and lost hundreds of thousands?

The words and actions of the first wave of the Great COVID Pandemic of 2020 are already material for the historian to consider. We are in the midst of deciding how the second wave will be viewed.

Dr. James Higgins is an American studies instructor at Thomas Jefferson University. Trained as an urban historian, his dissertation—Keystone of an Epidemic: Pennsylvania’s Urban Experience During the 1918-1920 Influenza Epidemic—offers him a unique perspective into the COVID-19 pandemic.

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