COVID-19 Stands on the Shoulders of Giants

In the midst of the COVID-19 pandemic, it is difficult to assimilate the global transformation that has taken place in just a few short months.As we each struggle to make sense of this life-altering event, it might be helpful to reflect on the history of pandemics in general. 

In his book, “Epidemics and Society”, published last year, Frank Snowden does just that.¹ Exhibiting diligence and deep knowledge, Snowden demonstrates how pandemics have shaped history and how history has shaped pandemics.  In doing so, he helps us understand the complex interplay among biological, social, economic, environmental, and political factors as pandemics have come and gone throughout human history.

As an example of pandemics shaping history, Snowden relates the story of Napoleon’s attempt to suppress the slave rebellion in what is today’s Dominican Republic.  The rebels understood that yellow fever, to which most African slaves were immune, could help them defeat the French army. When the French arrived in late winter, the rebels embarked on a guerilla warfare strategy forcing them to stay huddled in the ports until the weather warmed up enough for yellow fever to spread among the soldiers. Within months, the decimated French army surrendered and Napoleon decided that without this foothold in the New World, he would sell the Louisiana territory to the U.S. and turn his attention eastward to Russia and India.  

But history has also shaped pandemics. The bubonic plague in Europe, the most lethal of all pandemics to date, would likely have been dramatically less severe had there not been a robust shipping industry that brought the rats (rattus rattus) that carried yersinia pestis from far flung ports in Asia. Likewise, urbanization facilitated the spread of diseases such as cholera.

Another fascinating theme in Snowden’s book is the impact of pandemics on the gradual development of public health and advances in medicine. He carefully traces the first quarantines in Italy to control the spread of bubonic plague, the development of smallpox vaccine by Edward Jenner, and efforts to improve sanitation in response to cholera. He describes advances in science and medicine that led to Louis Pasteur’s germ theory, the development of antibiotics, polio vaccine, and anti-viral drugs. 

Even with all those advances, Snowden argues that microbes possess formidable advantages in their Darwinian battle with humans: “they enjoy enormous mutability, and they replicate a billion times more quickly than humans.” ²  As this millennium has already seen outbreaks of SARS, MERS, Ebola, Zika, and now COVID-19, there is a compelling need for health care professionals to help find ways to advance our knowledge and skills in managing pandemics.

In our discussions with providers across the country, we’ve been struck by the many examples of courage, commitment and creativity they’ve exhibited in confronting the immediate challenges of this pandemic. Applying that same approach and collaborating across sectors, from providers and health information technology to public health and pharmacy, we can all help define the longer term solutions that will protect us from the ongoing threat of this and future pandemics. 

¹Epidemics and Society From the Black Death to the Present, Frank M. Snowden, New Haven & London, Yale University Press, 2019

²IOM Emerging Infections: Microbial Threats to Health in the United States, Washington, DC: National Academy Press, 1992