Living through a global pandemic is an extremely intense experience, and the novel coronavirus disease, COVID-19, has affected the world in disruptive, dangerous, and tragic ways. The turmoil and suffering the pandemic has caused are part of what makes it a significant historical event. However, looking back to other outbreaks can give us some perspective on the scary, uncertain time we live in now. To learn more, The Argus spoke over Zoom with John E. Andrus Professor of History William Johnston to get his critical-historical perspective on the crisis.
The Argus: Just to start, what do you study and what class are you teaching this semester that is related to COVID-19?
Professor Johnston: I got interested in the history of disease and medicine; it started really with the history of medicine in Japan. And when I started a Ph.D. program, I started to take courses in the history of science broadly, which I had never done before. There was somebody who was teaching a course on the history of tuberculosis in the United States, and that really piqued my interest at that time. I ended up writing my dissertation and then first book on the history of tuberculosis in Japan. I’ve been interested in that subject for a very long time, and I’ve done work in other areas—history of family and sexuality, things in that direction—but then have come back and have been studying the history of syphilis, history of trachoma, and then most recently—the last few years—the history of cholera in Japan. The course I’m now teaching this semester—I don’t know if I’m going to do it again, I think I’m going to teach the history of flowers and compassion or something, cause it seems like when I’ve taught this course on the history of disease and epidemics, something happens—is “Critical Approaches to the History of Disease and Epidemics.” I had volunteered to teach the CSS [College of Social Studies] Junior Tutorial, and I gave them a choice, and they said they really liked the idea of doing a history of the atomic bomb in Japan, so—are you familiar with the CSS Junior Tutorials at all?
A: I’m not.
WJ: So it’s actually, it’s like a half-semester course. It’s a seven-week-long tutorial, so the first half—we did that. But the second half is when this [the COVID-19 pandemic] got really deep, so to speak, and I gave the class members a choice: We could go ahead with the atomic bomb, or, because I do teach the history of disease and epidemics and know that literature, I said we could do that. One person was ambivalent, and everybody else in the class said yes, let’s do that—they wanted to learn about what’s going on. So really this semester I’m teaching disease and epidemics in the middle of a pandemic [laughs].
A: Do you find it more interesting, or is it a more challenging class to teach now?
WJ: It’s both, really. So our first day of class [of the semester] was January 23. And I knew by then, in fact it was clear the week before that, that this was going to be something big—this could be, potentially, very very bad. It had all the hallmarks already at that point, just looking at what was happening in Wuhan. And so I restructured the syllabus from the way I originally had it. The first book we read for the class was a history of SARS, and the narratives that occurred at the time of the SARS epidemic in 2003…. In particular it looks at the kinds of racist narratives that occur with the rise of epidemics and in that case, much like this case—which is why I thought it would be a good comparison. First of all, [SARS is] a coronavirus…. This one is about two-thirds similar genetically to that original SARS virus. It also had an association with East Asia, and China in particular. So those narratives I was expecting would be popping up in class while we were reading this, and sure enough, [they] did. Y’know, people already saying “You’ve got China virus” kind of thing or “Chinese restaurant, close it down, you’re spreading it” kind of thing, which of course is just racist propaganda. But sure enough, it was there….
The next book we read for the class is one called “Spillover,” by David Quammen, and it’s an excellent book. It’s really about the spillover of viruses from animals—zoonoses—to humans, and looks at about five different examples of this, one of which is SARS itself. We also looked at a number of things, which I figured would be—I originally had had in the course, but I thought, “Well, this will be really reinforced by what we’re seeing here now.” One was a book—have you ever heard of Harriet Washington? She’s a writer, the book we read [by her] is called “A Terrible Thing to Waste.” And that is really about the concept of slow violence: the idea that people are often put into situations which endanger their health, basically. One good example is people who are living downwind from petrochemical plants and often have higher levels of cancer than surrounding communities. This is one example of what [author Rob Nixon] calls slow violence. Poisoning of water from fracking or from mountain-top removal mining, these kinds of things. Another example would be lead poisoning in places like Flint, Michigan, where it’s in the water, but then it’s also all over the country, in the walls of many tenements, they have lead paint. What Harriet Washington discusses in this is how IQ tests have often been [racialized]. There’s been really racist thinking in that what people would point to with IQ tests is, look how much lower African Americans on the average with white people. And she points out, yes, look at the number of African-Americans who are living in situations, who are being poisoned by lead. One of the side effects from lead—it’s a neurotoxin, and it very powerfully affects cognitive ability. People suffering from lead poisoning then have these problems with cognitive abilities, and what it’s really pointing to is the structural disadvantages that minorities often face with regard to health issues. And guess what we’re seeing now. You see it in several places—New York Times, Washington Post, New Yorker—they’ve all had really good pieces pointing out how minorities in the United States, and especially African Americans, are suffering from much higher COVID-19 fatality rates than the rest of the community. But it’s because of a number of things that are structurally there, including poorer nutrition that then increases rates of diabetes and other issues that then make people more susceptible to this. You can see it as part of this narrative of slow violence and the kinds of inequities that Harriet Washington is describing.
A: Do you think there’s any lessons we can learn from historically how different pandemics have been responded to?
WJ: There’s a number of things that are just sort of standing lessons, and people who are real specialists in public health have pointed to things over the years. So the idea right now of somebody saying, “Who could have imagined this happening?” Well, I can think of a few hundred people at least, who’ve been saying this for decades. The specific lessons, I mean one of them that’s really important, and this is important with helping out with disease and healthcare in general, is getting to know the cultural values of the population that is being affected by a disease. By that I mean that there are some places where if you just say “We’re going to do X to control the disease,” it may or may not fit within their cultural, their frame of cultural thinking. With this kind of lockdown, for example, how can we make it more effective? And that’s where kinds of anthropological thinking is really quite useful, and that’s where it’s kind of cultural specific in that sense. And that’s always been there, that’s how people who really know public health think these days.
Are you familiar at all with Paul Farmer’s work? There’s a group called PIH: Partners in Health is the name of it. I would urge you to look them up. They have been pushing for trying to get self-sustaining medical care in place in locations such as Haiti and Rwanda, other places where it’s been difficult to establish self-sustaining hospitals and medical schools. To do that, he realized that [his] anthropology training really allowed him to get to understand communities and what they needed, in their terms, in order to deal with these larger issues. So that’s one thing that’s really been standing.
Another is, with something like this, when we’re seeing this kind of pandemic that’s a very fast moving disease through a population, is that central leadership is really important. It’s in places where planning and central leadership have been in place—Germany’s a really good example. China’s an interesting example in that way as well, but in sort of a double-edged way, because local officials in China were afraid of rocking the boat with the central government, and as a consequence they didn’t want to admit that there was an outbreak of this SARS-like disease. That’s when they were trying to hide it. But it was when the central government finally stepped in and said, “No, we’re going to do something here,” and they did something in a drastic way that’s, you know, unthinkable in this country, right? They locked down an area which would be something like the tri-state area in the United States, some huge area like that. Which would be impossible in this country but they could do in China because of the centralized top-down government. I mean, Germany—it’s not drastic like that, but they have very good planning from the get-go, and they thought through what public health structures do we need to have in mind and that’s also what we see historically. When [countries] have the public health structures in place, when they are well maintained, then you get a very quick response to this kind of an epidemic. That’s just really key, and of course we’re missing that right now. And we’ve been missing it—I mean, people are pointing to this administration, but we’ve really been missing it since about the year 2000. By then the United States public health infrastructure let people be individually responsible for their health, that kind of ideology.
A: A lot of people are drawing connections to the Spanish flu of 1918, H1N1. What do you think about that?
WJ: Yeah, that was something I always found really interesting. At the centennial, in the fall of 2018, thinking that, “Oh, it’ll be the centennial. People will be talking about this,” because it was either the or one of the largest mortality events in the 20th century. A lot of estimates put it as more people died in the 1918 pandemic than in WWII, even, and much larger in terms of world fatalities than WWI, absolutely no question. And it was crickets. I did teach this seminar on that, and we had a great class, had about 12 people. Some of the things we learned from that was, again, going back to economic disparities, and what one saw in terms of the way in which the 1918 pandemic went through communities…. In many places in this country, it was when a lot of immigrants had come from Europe, often they were living with six, eight, ten people in maybe two rooms in a tenement, these sort of three story tenements in many places—New York, New Jersey, Massachusetts, Connecticut, etc. That disease would just sweep through these tenement buildings, and again, I just pointed at socio-economic circumstances, crowding, where as people who were living in these larger houses tended to have much less both incidence and mortality from the pandemic. There’s a lot of parallels between the two, including transmission and symptoms. They’re completely different organisms—as you point out, the 1918 is H1N1, avian influenza, and that’s kind of the prototype for every H1N1 since; genetically it’s related to that 1918 virus. This is a coronavirus, of course, but one thing that both of them have is a fairly long period of dormancy where a person is asymptomatic but can be transmitting, and that seems to have been the case in 1918 as well. Another parallel that way is that the onset of symptoms can be fairly rapid, and I think maybe even more rapid in 1918. There were reports of people just feeling symptoms in the morning and then dying by the next morning or even that night. The actual pathology of the disease, apparently, is parallel in that both of them point to what’s called a cytokine storm—are you familiar with that? It’s basically where the immune system becomes hyperactive and causes [inflammation]. Many different kinds. One of them that happens with these is inflammation of the tissue in the lungs and then as a result of this inflammation you end up with pneumonia, and that’s what happens with both of these [H1N1 and COVID-19].
On the one hand it is the viral infection, but on the other hand it’s also the body’s reaction which is causing a lot of the symptoms. So there’s a lot of parallels that way as well. There’s a study that was done in 2007, and I think it was Morens and Fauci, as in our famous Fauci now, that pointed to the difference between the measures taken in Philadelphia and St. Louis. It’s where a lot of the measures for what we’re doing all over the country and even the world have come from, is from this historical example. In Philadelphia they said we’re basically going to ignore this disease, we’re going to have a huge parade to celebrate the soldiers coming home from the war, we’re going to have this glorious patriotic celebration. So they had all these people mixing together on the streets, and at one point they had as many as 700 people a day dying from the influenza. St. Louis, on the other hand, said let’s take a different approach here. They closed down the public meeting places, including churches, theaters, bars, restaurants, et cetera, places where large crowds would form, and tried to encourage—not exactly what we’re thinking of as social distancing now, and certainly not self-isolating in homes as much as we are, but it was along those lines. And when you look at the differences in mortality rates between Philadelphia and St. Louis in 1918, it’s very significant. St. Louis was much better off, and they were practicing what we now call flattening the curve. So there’s some real parallels and lessons that came out of the 1918 pandemic.
This interview has been edited for length and clarity.
Sophie Griffin can be reached at email@example.com