History in a Crisis — Lessons for Covid-19 - NEJM
by David S. Jones, M.D., Ph.D.
***epidemics put pressure on the societies they strike. This strain makes visible latent structures that might not otherwise be evident. As a result, epidemics provide a sampling device for social analysis. They reveal what really matters to a population and whom they truly value.
One dramatic aspect of epidemic response is the desire to assign responsibility. From Jews in medieval Europe to meat mongers in Chinese markets, someone is always blamed. This discourse of blame exploits existing social divisions of religion, race, ethnicity, class, or gender identity. Governments then respond by deploying their authority, with quarantine or compulsory vaccination, for instance. This step generally involves people with power and privilege imposing interventions on people without power or privilege, a dynamic that fuels social conflict.
Another recurring theme in historical analyses of epidemics is that medical and public health interventions often fail to live up to their promise. The technology needed to eradicate smallpox — vaccination — was described in 1798, but it took nearly 180 years to achieve success. In 1900, health officials in San Francisco strung a rope around Chinatown in an attempt to contain an outbreak of bubonic plague; only white people (and presumably rats) were allowed to enter or leave the neighborhood. This intervention did not have the desired effect.
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