ScienceThe COVID-19 reporting is supported by the Heising-Simons Foundation.
Sixteen months of the pandemic seemed disorienting and arduous, but along the arc of human history, COVID-19 marks just another inflection point. Epidemics have punctuated the timeline of humanity for centuries, causing panic and killing millions of people, whether the culprit is plague, smallpox or the flu. And when infections decline, their imprints on society may remain, some short-lived and others long-lasting.
In a series of press articles over the next few months, Science will examine how a new normal is emerging in the scientific world. Of course, COVID-19 is always with us, especially outside the minority of countries now enjoying the fruits of widespread vaccination. Yet, as the pandemic enters a different phase, we ask how research can change, how scientists navigate these waters, and in which directions they choose to navigate.
While the past doesn’t necessarily portend the future, the story of the epidemic sheds light on how change is unfolding. “Historians often say that what an epidemic will do is reveal the underlying flaws,” says Erica Charters, a medical historian at the University of Oxford who studies how epidemics end. But how we respond is up to us. “When we ask, ‘How is the epidemic changing society? This suggests that there is something about the disease that will guide us. But the disease has no action like humans do.
Past epidemics have prompted scientists and doctors to reconsider everything from their understanding of the disease to how they communicate. One of the most studied, the bubonic plague, ravaged Europe in the late 1340s as the Black Death, then sporadically struck parts of Europe, Asia and North Africa during of the next 500 years. Caused by bacteria transmitted by bites from infected fleas, features of the plague included grotesquely swollen lymph nodes, seizures, and organ failure. The cities were powerless against its spread. In 1630, nearly half of the population of Milan perished. In Marseille, France, in 1720, 60,000 died.
However, the simple recording of these figures underlines the extent to which medicine has reoriented itself in the face of the plague. Until the Black Death, medical writers did not systematically categorize illnesses as separate and often present illness as a generalized physical imbalance. “Diseases were not fixed entities,” writes Frank Snowden, historian of medicine at Yale University, in his book Epidemics and society: from the black plague to the present day. “The flu could turn into dysentery. “
The plague years sparked a more systematic study of infectious disease and spawned a new genre of writing: plague treatises, ranging from concise quarantine pamphlets to long catalogs of potential treatments. Treaties appeared in the Islamic world and in Europe, says Nükhet Varlık, a medical historian at Rutgers University in Newark. “It’s the first disease that gets its own literature,” she says. The disease-specific commentary has been expanded to address other conditions, such as sleeping sickness and smallpox. Even before the invention of the printing press, treaties were apparently divided. Ottoman treatises on the plague often contained marginal notes from doctors commenting on a particular treatment.
The plague and subsequent epidemics also coincided with the rise of epidemiology and public health as disciplines, although some historians question whether disease has always been the driving force. From the 14th to the 16th century, new laws in the Ottoman Empire and parts of Europe required the collection of the death toll during epidemics, Varlık explains. The plague also accelerated the development of prevention tools, including separate quarantine hospitals, social distancing measures and, at the end of the 16th century, contact tracing procedures, says Samuel Cohn, historian of the Middle Ages and of Medicine at the University of Glasgow. “All of these things that a lot of people think are very modern… were designed and developed” at the time. The term “contagio” took off as authorities and doctors sought to determine how the plague had spread.
Cholera, caused by bacteria in water, devastated New York and other areas in the 1800s. It led not only to new sanitation practices, but also to lasting public health institutions. “The statistics had proved what common sense already knew: in any epidemic, those who had the least chance of surviving were those who lived in the worst conditions,” wrote medical historian Charles Rosenberg, today. professor emeritus at Harvard University, in his article. influential book The years of cholera: the United States in 1832, 1849 and 1866. To improve these conditions, New York City created its Metropolitan Board of Health in 1866. In 1851, the French government organized the first of a series of international health conferences that will span nearly 90 years and help to guiding the founding of the World Health Organization in 1948. Cholera “was the stimulus for the first international meetings and cooperation in public health,” Rosenberg now says.
Meanwhile, efforts to decipher the disease continued: although physicians who viewed germs as culprits remained in the minority in the mid-1800s, the disease “was no longer an incident in a drama of moral choice and spiritual salvation, ”but“ a consequence of man’s interaction with his environment, ”Rosenberg wrote. Fleas were identified as vectors of plague during a global pandemic in the late 1800s and early 1900s, and the concept of insects as vectors of disease has influenced public health and epidemiology ever since. then.
A curious mixture of memories and forgetfulness is at the origin of many epidemics. Some quickly fade from memory, says David Barnes, a medical historian at the University of Pennsylvania. The 1918 flu, which killed an estimated 50 million people worldwide but was also eclipsed by World War I, is a classic example of a forgotten ordeal, he says. “One would expect it to be a revolutionary, transformative, yet very little changed trauma” in its wake. There has been no significant investment in public health infrastructure, no gigantic injection of money into biomedical research. Although the 1918 pandemic helped stimulate a new field of virology, this research progressed slowly until the arrival of the electron microscope in the early 1930s.
In contrast, the emergence of HIV / AIDS in the 1980s left a powerful legacy, says Barnes. A new breed of patient activists fought fiercely for their own survival, demanding rapid access to experimental treatments. They ultimately won the battle, reshaping the policies for subsequent drug approvals. But, “It wasn’t the epidemic itself – the damage, the death toll from AIDS – that made this possible,” Barnes says. “They were organized and persistent activists, truly beyond anything our society had ever seen.”
It is through this lens of the human agency that Barnes and other historians envision the potential scientific legacy of COVID-19. The pandemic, like its predecessors, has shed light on uncomfortable truths, ranging from the impact of societal inequalities on health to waste in clinical trials to paltry investments in public health. Questions arise about how to strengthen the laboratories – financially or otherwise – that have been immobilized by the pandemic.
In the wake of COVID-19, will researchers reshape what they study and how they work, potentially accelerating changes already underway? Or will what Snowden calls “societal amnesia” take hold, fueled by the desire to leave a pandemic behind? The answers will come over the decades. But scientists are starting to shape them now.