Jeremi sits down with Dr. Christopher Rose to discuss the coronavirus within the context of historical pandemics.
As always, Zachary kicks things off with his poem entitled, “With an Unspoken Doubt.”
Christopher S Rose is a historian of early modern and modern Egypt and the eastern Mediterranean. He is currently (2019-2020) a Postdoctoral Research fellow at the Institute for Historical Studies at the University of Texas at Austin. He is the author of “Implications of the Spanish Influenza Pandemic (1918-1920) for the History of Early 20th Century Egypt,” forthcoming in the Journal of World History. He is also currently working on a book project titled Home Front Egypt: Famine, Disease, and Death During the Great War, 1914-1919, which examines the impact of World War I on the Egyptian peasantry, focusing on food shortages and disease.
- Christopher RoseDoctoral Candidate (ABD) in Middle Eastern History at the University of Texas at Austin and Adjunct Instructor in Global Studies at St. Edward's University
- Jeremi SuriProfessor of History at the University of Texas at Austin
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Dr. Jeremi Suri: Welcome to our new episode of This is Democracy. Today, we’re going to talk about the history of disease, epidemic, and public health responses in democracies around the world. There’s a long history, in fact, of democracy struggling to address medical challenges, and struggling to formulate public policy around these challenges in a way that’s effective and also democratic. This, of course, is relevant for today as we think about concerns regarding the coronavirus and other public health issues in our society. We are fortunate to have, with us, a good friend and distinguished scholar, Christopher Rose. Hi, Chris.
Dr. Christopher Rose: Hi, Jeremi. How are you?
Dr. Jeremi Suri: I’m great. It’s great to have you here. Chris is a distinguished graduate from the University of Texas PhD program. He finished his dissertation just last year.
Dr. Christopher Rose: I did.
Dr. Jeremi Suri: It’s amazing. It feels good, doesn’t it?
Dr. Christopher Rose: It does.
Dr. Jeremi Suri: Chris is also a teaching assistant. He taught with me in our class on US history, some of you listening might remember having him as a TA. Chris is a scholar of the 19th and 20th century Middle East, but he’s really a scholar of World History. He teaches world history in a very broad sense, with expertise in the Middle East. His new book that he’s working on now that grows out of his dissertation is called On the Home Front: Food, Medicine, and Disease in World War I. He’s currently a postdoctoral fellow at the Institute for Historical Studies and does a lot of his own podcasting, in fact, and he has a great website. If you just Google Christopher Rose, you can see his website with his own podcast, articles he’s written, even a guidebook on being a graduate student. Really cool stuff.
Dr. Christopher Rose: I tried to do a brain dump of everything I wish I’d known when I started.
Dr. Jeremi Suri: There you go. So people won’t make the same mistakes you made.
Dr. Christopher Rose: Exactly. Learn from my mistakes, people.
Dr. Jeremi Suri: Before we enter our discussion about disease, public policy, and democracy, we have, of course, our scene-setting poem from Mr. Zachary Suri. What’s the title of your poem today, Zachary?
Zachary: With an Unspoken Doubt.
Dr. Jeremi Suri: With an Unspoken Doubt. Okay. Well, let’s speak of your unspoken doubt.
Zachary: It is comforting sometimes on Wednesday mornings to feel time slow to interminable seconds on the black clock. Comforting now to watch the dust settle on the roughed tile floor. For we are now beginning to become aware of a new decade, hurdling at viral speed, as novel coronas mix with the new crowns of viral deception. It is cynical to say that pandemics are the future final Armageddon, somewhat absurd to blame nation-states for viruses that originate in snakes or bat soup in a wildlife market in one of our endless urban passages. Sicknesses that cross borders overnight and sleep hidden in the midst of gloomy mornings at quarantined Air Force bases in Southern California. But still, we give them all names like ancient Greeks trying to understand the stars and we draw their shapes under electron microscopes like toddlers trying to learn the fuzzy outlines of the alphabet. The image of a cruise ship docked off Yokohama, the infested prison that was once a floating hotel, and the invisible traces that are always green to us and slimy like a cartoon. Those silent specks that flicker up and down the wooden decks like a premonition. Most of all, though, it is the joking uncertainty with which we all look to the established halls of medicine. The weariness with the ability of thousands of doctors to prevent the rogue cells of snake slime in some Chinese market. The way we stare at the blank semi-purple windows of the state health departments with an unspoken doubt.
Dr. Jeremi Suri: Unspoken doubt about what, Zachary?
Zachary: Well, I think what my poem is really about is how quick we are to freak out about viruses like the coronavirus, and how scary these epidemics can be, and how they, unlike many other things, inspire a lot of mistrust in the institutions that are supposed to protect us.
Dr. Jeremi Suri: Right, and sometimes counterproductive responses. So Chris, this is a perfect spot to turn to you. Your focus of research in particular is on a major virus outbreak in the early 20th century, the end of World War I. Tell us about that.
Dr. Christopher Rose: Right. It’s commonly known as the Spanish Influenza. Interestingly, it’s not because it came from Spain. We’ll talk about that a bit later on, but it was a mutated form of the H1N1 virus, the same virus that came back about 10 years ago and became known as the swine flu.
Dr. Jeremi Suri: Right.
Dr. Christopher Rose: But it was an unusually long-lived epidemic. It lasted for over two years, went around the world in three waves. It was found above the Arctic Circle, it was found on Pacific Islands. It literally touched every part of the world, with the exception of a small island in the Pacific that was able to blockade its ports and prevent.
Dr. Jeremi Suri: Well, so this is the United States, Japan, Europe, and Egypt, of course, that you’ve studied.
Dr. Christopher Rose: Egypt, which is the case study I’m most familiar with, but they were all overwhelmed by the unusual mortality rate of this virus. Mortality rate basically means the number of cases that end in fatality. Also, the fact that the disease carried off the strongest population. What it did was it triggered an immuno-response and so people who were young and fit, the 10-20 demographic, their bodies were triggered into an over-response and that was ultimately what killed them.
Dr. Jeremi Suri: Wow. So the response to the virus is actually more deadly than the virus itself?
Dr. Christopher Rose: Correct.
Dr. Jeremi Suri: Wow.
Dr. Christopher Rose: Correct. It was a physiological response, and basically, your lungs filled up with fluid and you drowned.
Dr. Jeremi Suri: Wow. More people, as I understand it, we were talking about this before, more people died from the virus than from World War I and about the same number has died in World War II, in fact, right?
Dr. Christopher Rose: Right. The CDC recently published an updated estimate of about 50 million dead.
Dr. Jeremi Suri: My gosh.
Dr. Christopher Rose: Five hundred million infected worldwide, one in 10 people died. The effect was just devastating.
Dr. Jeremi Suri: How did societies respond? That’s really what we want to talk about. We are not here as medical doctors. That’s an interesting discussion too. But from the perspective of historians and people who care about public policy, what was the response?
Dr. Christopher Rose: What’s really fascinating, looking at it in a historical perspective, is how the more things change, the more they stay the same. So when there is an outbreak of something like this, there’s basically three approaches. First is what we call risk mitigation. This is where, for example, sometimes quarantines are used. They’re not terribly effective, unless you can really be sure where the disease originated. But also things like reminding people to wash their hands, to cover their mouths and faces if they cough or sneeze, to stay home from work if they’re sick, in order to basically try to slow down the spread of the virus through any means necessary. The second is the treatment of the sick, which especially at the beginning of the 20th century, people didn’t go to a hospital if they were not feeling well. People generally preferred to be treated at home and hospitals weren’t that pleasant of an environment. You went to a hospital if you needed to have surgery, but for the sniffles, you stayed home. This was actually one of the big pushes, especially in places like the US and Europe, to introduce the hospital as a place of care that you went to seek for something that didn’t involve bleeding, or something cut off, or whatnot. But the idea that the sick had to be quarantined in order to prevent the spread of the virus.
Dr. Jeremi Suri: Treated by medical professionals.
Dr. Christopher Rose: Treated by medical professionals. Then the third is the development of a vaccine.
Dr. Christopher Rose: The problem being with some of these shorter lived outbreaks, that by the time you can develop a vaccine, the danger has mostly passed. I know on Grey’s Anatomy, when a new virus comes to the hospital, by lunchtime they have a working virus and then they can go back to flirting over surgery. But that’s not how it works in real life.
Dr. Jeremi Suri: Right. So how effective were these measures in 1918?
Dr. Christopher Rose: They were about as effective as any measures really could be. The disease was unusually virulent, and the problem is that when you have a disease that has an incubation period of a few days, you can’t control where it goes. People didn’t know they were affected because they didn’t feel sick yet. Just one or two days will allow the disease to transmit quickly. Again, most of it was playing catch up. Again, the more things change, the more they stay the same is what we in the TSA age refer to as security theater. Where measures are being taken primarily because there is a public demand for the government to “do something”, whether it actually has an effect or not. So there are sometimes huge measures taken, billboards, you’re going to blockade and people are wearing masks in public. Will they actually do anything? It makes people feel better. But can you be said that it has a real impact on how fast viruses spread? I think that’s debatable.
Dr. Jeremi Suri: One of our students has a question related directly to this. Kelly Housley wants to ask about xenophobia and the ways in which often people feel better because they’re targeting certain groups, even if that’s not helping them in terms of their health conditions. Can we play Kelly’s question?
Kelly: How does xenophobia affect how we see disease and how we treat it?
Dr. Christopher Rose: That’s an excellent question and I think really pressing right now because of the fact that the current outbreak as you were talking about coronavirus, has unusually a very specific geographic epicenter, Wuhan, China.
Dr. Jeremi Suri: Right.
Dr. Christopher Rose: We’ve heard all sorts of people commenting in all social media and what not about, they look Asian and therefore they’re being targeted because of the association by appearance essentially. This goes back into the Middle Ages. In Europe, they blamed Jews for the Black Death. The name Spanish Influenza stuck around. People still think it’s because the virus came out of Spain. In fact, it’s much more nuance in that Spain was a neutral country during World War I and its press wasn’t censored. So when the virus hit, Spain’s press was the only press in Europe that could talk about how bad the disease was because everyone else was under censorship.
Dr. Jeremi Suri: They get labeled for doing the right thing.
Dr. Christopher Rose: They get labeled for doing the right thing. Well, and then papers in other countries could print about what was going on in Spain, because they could get away with that. So the notion that the virus came out of Spain proliferated. We even see it in political rhetoric today, where even the specter of disease is US’s anti-immigration fodder. It came up, I think in the last presidential election about diseases coming across the southern border. Mexico, for those who don’t know, has a higher vaccination rate than the United States does, but just that idea. It goes right into fear of the other.
Dr. Jeremi Suri: There’s no evidence that the xenophobia actually helps to control the spread of disease.
Dr. Christopher Rose: It really doesn’t, because viruses don’t discriminate on people based on their race or outward appearance.
Dr. Jeremi Suri: Zachary?
Zachary: How do we react to diseases or outbreaks like the coronavirus or the Spanish flu? While those that are not constantly being in crisis mode and acknowledging the broader issues that we face, like in the United States right now, addiction or diabetes or issues like that.
Dr. Christopher Rose: Yeah, that’s a really interesting question. I was chatting with one of the production staff while we’re getting set up. This year’s strain of influenza actually has a higher mortality rate than the coronavirus. So if you catch the plain old flu that’s going around right now in 2019-20, you face a higher chance of dying from it than you did [CROSSTALK]
Dr. Jeremi Suri: If you’re not vaccinated you’ve exposed yourself to more risk.
Dr. Christopher Rose: Exactly. I think one of the reasons why people get really tense about it is, viruses are very scary, there’s a reason why they’re the villain in so many movies. Viruses are pre-historic. They go back hundreds of million years longer even than the Democratic primary.
Dr. Jeremi Suri: Good one.
Dr. Christopher Rose: As you said in your poem, they were here before us, they’ll be here after us and they’re hard to control. You can’t see them coming. So I think there’s just this fear of the hidden and this goes right back into xenophobia. You are statistically more likely to be hit by a car than you are to even catch the coronavirus, let alone die from it. But I think it’s just that irrational fear that is basic human nature. Keeping it in perspective is always a good idea.
Dr. Jeremi Suri: Exactly point out there’s a tendency for us to focus on that red light warning of that issue and forget about all the other issues that are actually killing more people.
Dr. Christopher Rose: Absolutely.
Dr. Jeremi Suri: Drug addiction and various others.
Dr. Christopher Rose: Heart disease is still the number 1 killer of people in America.
Dr. Jeremi Suri: Suicide in the United States is an enormous, especially among veterans is an enormous issue.
Dr. Christopher Rose: Yes, I mean, the mental health epidemic is really the public health crisis in this country right now.
Dr. Jeremi Suri: One of our other students, Kendrick Lamon, wanted to drill down on the issue of quarantine, because that’s a common reaction. Is one that’s being implemented by the US government as well as other governments right now. Zachary referred in his poem to the quarantining of cruise ships, for example, let’s hear Kendrick Lamon’s question.
Kendrick: I was wondering if any of the quarantined strategies currently being used to combat coronavirus have been used in the past and if so, how effective they were? Thanks.
Dr. Christopher Rose: That’s another excellent question. Quarantines really only work in very specific circumstances. For example, the cruise ship, again, is effective because you have an isolated population on a ship where you know that somebody had the disease and you’re trying to prevent them from carrying it off the ship. At the same time, however, one of the members of the Japanese Health Service who was working in the ship contracted the virus, so it’s still not a 100 percent effective. In the modern era, I would even go back to the beginning of the 20th century. The idea of the cordon sanitaire, which is what we used to call them the sanitary curtain or quarantine was really discontinued because it’s so hard to prevent all movements. I want to say, even a city like Wuhan, it’s 11 million people. It has an international airport with daily flights to Australia, San Francisco, New York, Europe. All it takes is one person to slip through. The fact that the Chinese government has blockaded Wuhan is, on the one hand, they were able to control it, because again, this is very unusual that we were able to pinpoint the origin of the virus to that specific location. But it’s still present in most of the provinces in China, in Japan and in the US, there’s a suspect case in San Antonio today. You can never be a 100 percent certain. All you can really do is try to slow down the bulk of the infection. But as is the case in all of those movies where the virus is the villain, it only takes one.
Dr. Jeremi Suri: So what works? We’ve talked about very effectively, drawing on your research, some of the, shall we say, mistakes that are repeated time and again because they’re so attractive, it makes sense to take out your xenophobic hate on groups and it makes sense to quarantine, but it doesn’t seem to work. What works, Chris?
Dr. Christopher Rose: What really works is increasing awareness of the virus and making sure that people seek medical attention if they actually think they have it or they might have contracted it. Ultimately, what we’re talking about is awareness. There has been a little bit of stifling of some of the media coverage of the coronavirus. I think just because people don’t want to insight panic.
Dr. Jeremi Suri: Right.
Dr. Christopher Rose: But at the same time, if you were to put statistics out there, for example, of the fact that catching it is not a death sentence. If you seek medical care, it is possible to catch this thing and survive, then that reduces the panic levels a bit. Also just reminding people to perhaps wash their hands, not cough out in public, and if you’re in an area where the virus is suspected to be, maybe don’t go to that concert tonight. There are things people can do to limit their exposure.
Dr. Jeremi Suri: Risk mitigation.
Dr. Christopher Rose: Risk mitigation, exactly. Until a virus is developed that’s really all you can do is try to limit your own exposure to it.
Dr. Jeremi Suri: I think this is a central issue for democracies in many areas, not just in public health, how do you inform people without creating panic, but instead creating trust?
Dr. Christopher Rose: That’s also a really good question, and I don’t want to be critical of government public health agencies, but a lot of times the material they put out is very dry, technical, and not easily understood. So speaking in plain language, of course, right now, what we have is a problem with misinformation out there, rumors, conspiracy theories etc., which is completely unhelpful. In order for the information coming out of a government to be effective, there has to be trust with the government agencies. The CDC has done a much better job, I think in the last few years of doing that, but it definitely was a long road.
Dr. Jeremi Suri: Sure.
Dr. Christopher Rose: There used to be, if you were going on a vacation somewhere and you needed to get one of the special shots, they’d give you an information handout from the CDC and it was completely incomprehensible.
Dr. Jeremi Suri: Right.
Dr. Christopher Rose: It’s like I actually know a couple of things about public health and I look at it, I go, “I don’t know what this means.” So I think it’s that more frank talk, but also keep it real as the kids used to say. I don’t think anybody says that anymore. I’m showing my age here.
Dr. Jeremi Suri: Sure. The CDC by the way is the Center for Disease Control based in Atlanta. It’s a federally funded agency.
Dr. Christopher Rose: It is. We don’t have a Department of Health in the United States. It is the equivalent of our Department of Health.
Dr. Jeremi Suri: You think it does a good job with these things?
Dr. Christopher Rose: I do think they do a good job. CDC is cutting edge. Like everyone else, they have to search for dimes and nickles sometimes to get their funding. But CDC is trustworthy. I think their public face has needed a bit of a makeover.
Dr. Jeremi Suri: Sure. Agencies go through these.
Dr. Christopher Rose: Agencies go through these.
Dr. Jeremi Suri: Zachary.
Zachary: How do we handle the interaction between disease and politics, and prevent actions in regards to diseases from becoming too political?
Dr. Christopher Rose: That’s an issue of managing politics. Whatever the cause of the day is, will somehow wind up on debate on Capitol Hill, I feel, anymore. So that, again, is where frank talk and public information really comes into help. Because it helps the electorate understand what is reasonable debate on policy and what is being used to set as a political talking points.
Dr. Jeremi Suri: Are these issues better handled at the federal or state level, because the CDC is a federal agency. In your work on the end of World War I, you saw a variety of different kinds of responses even within Egypt itself. Does local tend to be better, does national tend? How do we know if we’re getting the right mix?
Dr. Christopher Rose: I’m going to invoke a word that came up a lot right after 9/11 and fell by the wayside, and that is, coordination. Ultimately, the best response is, the federal agency needs to make resources available. The local agencies are the best ones to employ it because they know their constituency, and they know their territory, and the state agency is the go-between, to step in. Ideally, you want to be in a situation where nobody is stepping on anyone else’s toes and no one is reinventing the wheel. That’s just a simple level of efficient coordination. Ideally, you would then have, for example, the World Health Organization coordinating internationally. There does need to be coordination, for example, between the United States, and both Mexico and Canada, either that’s direct inter-agency cooperation or it’s facilitated through the WHO.
Dr. Jeremi Suri: It’s a really good point, because we often forget how important and how multilateral the international responses are. You’ve had members of the CDC going over to China. We might have difficult relations with China when we’re talking about trade or weapons, but nonetheless, we want our doctors to be there, first of all to help them so the virus doesn’t spread, but also so we can understand it better in our own society.
Dr. Christopher Rose: Right. Interestingly enough, when it comes to the scientific communities, they tend to be a little less territorial in crisis situations like this than other organizations tend to be.
Dr. Jeremi Suri: So I guess our last set of questions are always about how we can do better going forward, how this historical knowledge, how this vast repository you shared with us of historical background, how that can help us to do better as we go forward? What should we be calling for as citizens who want to live in a vibrant democracy with effective health responses, there are going to be future health crises, what should we be asking for?
Dr. Christopher Rose: We’ve been talking a lot about what happens when the next major pandemic like the Spanish influenza takes place. Are we ready for it? I’m not convinced we are. I think we’ve gotten better, but this came up again in the post-9/11 era over concerns that there might be some biological or chemical attack.
Dr. Jeremi Suri: Sure.
Dr. Christopher Rose: The need for efficiency and what not, it’s also now been almost 20 years since 9/11, national security has taken a different form. But it doesn’t have to be an act of aggression. It could literally just be, I think, for example, several of the most recent outbreaks, coronavirus, Ebola, the H1N1, they’ve come out of areas that are developing and where mankind is moving into territory that we didn’t use to occupy.
Dr. Jeremi Suri: Interesting.
Dr. Christopher Rose: We don’t know what’s in those jungles or how we’re facilitating viruses coming out.
Dr. Jeremi Suri: Or what climate change does to change virus.
Dr. Christopher Rose: Or what climate change. We know there are viruses frozen in the tundra that and are going to thaw out. So it’s just one of those things where we always need to be one step ahead. We may not be able to anticipate what the virus is going to be, but we can anticipate how we’re going to respond for the next health crisis.
Dr. Jeremi Suri: What capabilities should we be cultivating?
Dr. Christopher Rose: So are we prepared for a major health crisis? Are we prepared to deploy doctors to a certain area? Are we prepared to curtail public transportation? The Chinese did it very effectively, but China’s authoritarian regime. You can easily imagine that if they tried to shut down, for example, DFW, Dallas Fort Worth International Airport, which is one of the busiest in the country, that the first thing that somebody would do is sue.
Dr. Jeremi Suri: Or just shutting down highways to stop people from driving somewhere.
Dr. Christopher Rose: Again, quarantines are marginally effective, but what you want to do is slow down the spread of the virus until you can develop what you need to contain it.
Dr. Jeremi Suri: It seems to me that this brings us back to a discussion we had during the Cold War about civil defense.
Dr. Christopher Rose: Correct.
Dr. Jeremi Suri: There it was, how do we respond to a nuclear attack? But one of your great insights, Chris, is that some of the most deadliest and threatening “foreign actions” are things that actually come around disease vectors. They’re not evil actors, they’re from medical and health crises and having a civil defense capability, how do we respond? Is I think what you’re talking about.
Dr. Christopher Rose: That is in fact exactly what I’m talking about is, we tend to focus on the potential for a bad human actor. But throughout history, our biggest death tolls have come around as the result of viruses.
Dr. Jeremi Suri: Right. Preparing for that should probably be a priority.
Dr. Christopher Rose: Yes.
Dr. Jeremi Suri: Zachary, do you think this is something that can interest and motivate young people to think about and get involved with?
Zachary: I think so. I think one of the benefits of the coverage of viruses like coronavirus and other recent viruses, is that it really reminds us that even though we live in a very developed country, where these kinds of health crisis rarely touch us, that we really need to be prepared and vigilant about making sure that we all stay safe and healthy and that we do our part to contributing to the larger health of the community.
Dr. Jeremi Suri: That would involve, again, building capacity, as Chris said, to react to circumstances with supplies, with available doctors, infrastructure. But it also involves developing a knowledge-base so you’re aware, but not panicking or spreading false rumors, right?
Dr. Jeremi Suri: I remember growing up in New York City in the 1980s during the early part of the AIDS epidemic, and one of the real issues then we didn’t call it fake news. But it was all the misinformation about AIDS. Kids who came to school saying that their parents had told them they could get AIDS by being in the same room with someone or being in the same subway car with someone. Quite frankly, just connecting into everything we talked about, the xenophobia, the racism, and the mistreatment that came out of that, that was also counterproductive for health purposes.
Dr. Christopher Rose: Absolutely. The HIV epidemic was and remains one of the, I think, classic case studies in what not to do in terms of public response. We remember when the virus first originated, it actually had a different name. It was gay related immunodeficiency, GRID. So literally it was right there in the name and so people literally assumed that if you weren’t homosexual, you are not at risk. It turned out, actually, that was the highest risk population.
Dr. Jeremi Suri: That’s right. I remember hearing people say that, that your sexual preference determined whether you’re at risk or not. They were saying that on TV. I think many people became infected because they didn’t understand that they were also at risk.
Dr. Christopher Rose: Yes. Absolutely.
Dr. Jeremi Suri: So I think this is this is so important. Chris, thank you for sharing your knowledge and I hope others will read your work and go to your website.
Dr. Christopher Rose: Thanks.
Dr. Jeremi Suri: To learn more about this. Zachary, thank you as always, for sharing a thought-provoking scene setting poem. I want to thank our listeners for taking an issue that often is treated in hyperbolic and technical terms, and actually thinking about it historically and opening our minds to the ways in which history can help us as Chris said so well, to at the very least avoid repeating the mistakes of the past. Thank you for joining us for this week of, This is Democracy.
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MALE 3: The music in this episode was written and recorded by Harrison Lemke and you can find his music at harrisonlemke.com.
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