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Dyan Elliott on teaching about pandemics

Professor Dyan ElliottLast year Dyan Elliott, the Peter B. Ritzma Professor of the Humanities, thought that students should know more about the medical catastrophes of the past. So she designed an introductory course to history called “HIS-200: The Black Death and Other Pandemics” to teach in Winter 2020. Further comment is superfluous.

Here Professor Elliott shares her experiences in thinking about the class before COVID and then teaching it while she and her students experienced the first major pandemic in over one hundred years.

Can you describe the class and what it covers?

I’m a medieval historian by training, and I was initially trying to get more people interested in medieval stuff, and death and disaster seem to sell. The Black Death, which hit Europe between 1347 and 1350, was the biggest pandemic on record. In fact, we still have outbreaks of the bubonic plague, which is the disease responsible for the Black Death. And then I thought that the course would be more appealing if it was transnational or maybe even transhistorical: let’s look at all different kinds of pandemics. So in addition to the Black Death, we examined smallpox, focusing mostly on the New World and the ways that European colonists killed off the First Nations with poison blankets and such. And then we studied cholera outbreaks in mid-19th-century London and 20th-century Venezuela and Haiti; tuberculosis and the rise of the sanatorium in Europe and the U.S.; malaria and mosquitoes in India and Italy; AIDS in Africa and the United States, and so on. We ended with the coronavirus, even though we obviously weren’t planning on it. The last class was originally going to be on Ebola.

So the class focused on both the scientific and social aspects of the pandemics.

I would always begin by describing the bacterium or the virus. But I’m not a doctor. I am more interested in the historical implications of what these pandemics do to people and how they respond, and in the successes and failures that we’ve had over time. In point of fact, the only thing that we’ve ever absolutely gotten rid of was smallpox, which was officially declared to be eliminated by the World Health Organization in 1980. That’s the only one we’ve ever beaten.

There are many other diseases that we will probably never be able to eliminate — like the bubonic plague, which has reservoirs in animal populations that we will never be able to get at. And then there are other things that remain challenging — like viruses that keep mutating.

What really fascinates me is the way that different bacteria and viruses work very hard to stay viable. In the 19th century, for example, cholera was so deadly that its human hosts died very quickly. But it mutated into a milder form in the 1960s, and many carriers were asymptomatic, as we now see with COVID-19. People who don’t know they have it can spread it. That’s also what happened with cholera in Haiti after the 2010 earthquake. It was spread by United Nations peacekeepers who may not have known they were sick, or at least did not know they had something as serious as cholera.

What got you interested in plagues and pandemics in the first place?

To be completely honest, my original concern was that nobody was paying attention to the distant past. I wanted to show students the ways in which the past is still with us and informs the present.

And we began at a very early point in time. The first real sighting of the bubonic plague was in the 7th century during the Byzantine empire. The emperor, Justinian, was trying to conquer the western part of the Roman Empire, which had been overrun by Germanic barbarians. So this is one of those great “what if” questions — if Justinian’s armies hadn’t been decimated by the bubonic plague, would the Roman Empire have been reunited? Could it have continued?

Disease creates such interesting sorts of questions. Maybe this will be the fall of our empire. We don’t know.

With regard to the ways that people respond to a pandemic, what themes seem consistent throughout history?

The degree of denial and blame-shifting are pretty consistent.

For example, cholera was initially spread by fecal ingestion — at least, the classic or so-called “Asian” cholera was. But when the less-lethal form emerged, [University of Maryland microbiologist] Rita Colwell argued that it could subsist in a water supply without a human host, going dormant and then flaring up under certain conditions. People glommed onto that theory to explain the cholera outbreak in Haiti. But then there was all this investigative reporting that showed in fact that there was a United Nations base that had actually dumped feces directly into a river that was a main water source. There was a lot of back-and forth and blame, and eventually the UN did accept responsibility, but they never made any kind of repayment.

And so today, with COVID-19, we are hearing a lot of conspiracy theories. Some people in China are saying this might be an American invention, while President Trump has been calling it the “Chinese virus” and blaming runaway labs. There are always efforts to scapegoat certain segments of the population. During the Black Death, the Christian majority accused Jews of poisoning wells. When there was an outbreak of the plague in 19th-century India, they blamed the poor. During the AIDS crisis, evangelical Christians blamed the gay community, believing they were being punished for their sinful ways.

So people tend to want to assign blame for pandemics.

I think so. Or to push the blame away from self.

Another thing I find very interesting — and we saw this with the development of germ theory — is that you see people competing rather than collaborating with each other. For example, in the 1800s, Louis Pasteur and Robert Koch both tried to go after cholera at the same time. Some of Pasteur’s men got sick in Egypt in 1883, and when they finally returned home, they learned that Koch had moved on to India and made a breakthrough. What they didn’t do was collaborate. And we saw that same kind of competitive thing happen between the English and the Italians with malaria, between the Europeans and the Japanese with the discovery of Yersinia Pestis (the pathogen for the bubonic plague), and even between the Americans and the French during the AIDS epidemic.

So now, we’re talking about finding a vaccine for COVID-19. I hope the research community is moving forward in a spirit of collaboration, rather than in a bizarre nationalistic way of trying to get credit for scientific breakthroughs.

Is there anything positive we can glean from the past about our prospects right now?

I would say that in a lot of ways, human nature doesn’t change. People will always be trying to balance things like greed against safety or the economy against safety. We’re seeing efforts to close down boundaries and to quarantine, but keeping people out doesn’t usually keep the pandemic at bay, though there is a certain logic to it. Social distancing is, in fact, kind of a contained quarantine.

There’s so much fear and suspicion not only around disease, but around medicine as well. That also seems to be a recurring theme throughout these plagues and pandemics.

That’s right. That’s another thing that doesn’t change. There’s no evidence, for example, that some of the drugs that are being promoted, like hydroxychloroquine, are helpful, and they could potentially do a lot of harm. But people have always come up with these different kinds of nostrums. In the medieval sources, you can find recommendations to eat acidic things, because they thought that the acids could somehow kill whatever it was in the body that could harm you. Newspapers ran ads for inhalers promising to “cure” tuberculosis, using poisonous powders like mercury nitrate. Maybe some of those people were operating in good faith. But I also think there have always been people who, in times of disease, think “wow, I could really make a fortune here.”

And denial. There will always be a degree of denial, that this can’t hurt us, it can be contained, that sort of thing.

Is that common to pandemics? An initial feeling that we’re immune somehow?

Interestingly, not so much with the Black Death. It was so unprecedented and so quick that the population was in shock. The disease seemed to spare no one. It was seen as God’s punishment for humanity’s sinfulness. But historically, we see that wealthy people can isolate themselves from disease more effectively than the poor, so perhaps they can afford to be in denial. Even in the first rush of the Black Death, the records suggest that the members of the nobility and the higher clergy emerged more or less unscathed by comparison.

Smallpox was probably more egalitarian. But once the Europeans had an immunity, they could use it as a biological weapon against the First Nations, and they did. By and large, wealth does shield you from certain things. Cholera is caused by bad water supplies. And who has bad water supplies? The poor, right?

And now you can predict which people will get hardest hit by COVID-19 on the basis of their postal code. So the wealthy can often cushion themselves against these horrible social tragedies.

Do you see a pattern in how pandemics come to an end? How do they finally get under control?

The McKeown thesis suggests that the biggest improvements in healthcare have arisen not through medicine, but through improvements in public health and sanitation. There’s a lot of truth to that. Eliminating cholera, for example, is really about practicing good hygiene and ensuring that the water supply is clean. And to some extent, you could say COVID-19 emerged due to failures in public health — through the wet markets in China and in over-populated cities worldwide.

But COVID-19 does seem bizarrely contagious. It seems like the virus can “live” independently for a really long time. That’s not completely novel. After a medieval rat got infected with the bubonic plague, for example, a flea that infested it could survive in a cartload of hay for several days. But still, for a virus to be able to live so long on stainless steel or plastic, as the coronavirus apparently can — that’s amazing. It shows how “smart” viruses seem to be. They’re not really alive, but they do take on life. Once they invade a cell, they multiply and multiply.

It seems like we’ve essentially shut down our society and our economy in an effort to combat this pandemic. Did previous societies come to a screeching halt every time there was an outbreak of the bubonic plague?

The Black Death was spread by trade, and there was in fact a kind of a social breakdown for three or four years when things were really bad.

You can see this in Giovanni Boccaccio’s Decameron, which was completed in 1353 in the wake of the Black Death. It begins with a very graphic and horrific description of the Black Death in Florence. In order to escape the plague, a group of aristocrats (which in Italy was the merchant class) got on their horses and rode out to a deserted villa, where they sat around telling each other stories. So they certainly weren’t in town doing business as usual.

And the thing about the bubonic plague is that it’s endemic to an area, so it would recur for centuries, always creating economic havoc. When the bubonic plague recurred in 17th-century Barcelona, the city was quarantined and everything ground to a halt.

How did you incorporate the emergence of COVID-19 into the class?

We mostly stuck to the syllabus. When the course ended in early March, we didn’t know much about the virus: it had just been named COVID-19, and President Trump was still calling it a “hoax.” So I talked about the news coverage: the geographic spread of the virus, the plight of those huge cruise ships, the spread of the virus throughout that church in South Korea, etc. I showed them a series of news clips, and then we had some cake to celebrate the end of the quarter. It said “Pandemic 2020” and had a little red coronavirus on it. Now that things are so bad, it sounds like I have a very macabre sense of humor.

But nobody knew how bad things were going to get — though after teaching this course, maybe I should have known. I held a review class during reading week, but then we started getting notices saying that exams were optional, and soon we were told that spring quarter would be taught remotely.

Will you teach the class again?

I will be on leave in 2020-21, but I will offer it the year after that. I’m sure there will be an ardent group ready to hear about pandemics. It did seem weirdly serendipitous that I taught the class this year, though, considering that I am a medieval historian who generally works on church history. But I wanted to teach a class that would show that the distant past is very interesting and pertinent. And I think this course did that.

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