Woodcut engraving of Turkish funeral

COVID-19 impact: The history of plague and contagion

History professor Nükhet Varlik, a scholar of the history of plague, sees many parallels with the current coronavirus pandemic

As the coronavirus threatens health and upends daily life throughout the world, UofSC Today is turning to our faculty to help us make sense of it all. While no one can predict exactly what will happen in the coming weeks and months, our faculty can help us ask the right questions and put important context around emerging events.

Nükhet Varlik, an associate professor of history in the College of Arts and Sciences at UofSC, studies disease, medicine and public health, particularly in the era of the Ottoman Empire. She has written a book and edited another on plague and contagion in the Mediterranean world.

Banner image above: Pieter Coecke van Aelst, Turkish Funeral from the frieze Ces Moeurs et fachons de faire de Turcz (Customs and Fashions of the Turks), 1553. The Metropolitan Museum of Art, Harris Brisbane Dick Fund, 1928.

Given what you understand of the scope of the COVID-19 pandemic, how does the current societal response compare with that of previous disease outbreaks in human history?

We have watched in fear the videos of people collapsing to the ground, hazmat-suited medics carrying patients. But we’ve also taken heart at seeing doctors and nurses fighting to save lives, the way people are singing songs and dancing from their windows and balconies to keep their community morale high. These are images that have already shaped how we think about the current pandemic. But social responses to epidemics and pandemics can take many forms, both now and in the past, depending on where the outbreak is experienced, how fast the infection spreads, how deadly the disease is and other such factors. It wouldn’t be wrong to say that every epidemic or pandemic has its own character. COVID-19 has its unique personality: We may perhaps think of it as an “anti-social” virus because of the mandate for social distancing.

Perhaps what we will best remember COVID-19 for is the panic-buying of toilet paper and hand sanitizers to the stockpiling of guns.

— Nükhet Varlik

There are other ways the biology of a virus can shape social responses. Diseases with higher rates of mortality and those that kill their victims quickly seem to be more conducive to mass hysteria, social unrest and riots. For example, 19th-century outbreaks of cholera, plague and smallpox, with much higher rates of mortality and quick and gruesome death, stirred up many such riots. Global case fatality rates of COVID-19 are currently estimated at 3 to 4 percent, which suggest that it is unlikely to lead to such massive social unrest, though it helps to remember that we’ve already seen cases of unrest in prisons in Italy, Lebanon and Jordan. Let’s also remember that COVID-19 does not kill indiscriminately; it seems to have a preference for older and feebler individuals, which suggests that it will probably not provoke any such mass movements.

There are also age-old forms of social responses that can appear in any society facing a serious pandemic, independent of social and cultural factors. The broad spectrum of human responses to pandemics includes denial, panic, flight, scapegoating, racism, xenophobia, spreading of false rumors, misinformation, price gouging, profiteering and other opportunistic behaviors (such as promoting false medical recipes for profit), business closing, and even abandoning the sick to die alone — but also empathy, altruism, caring, and helping others. Even though we see examples of these behaviors here and there, perhaps what we will best remember COVID-19 for is the panic-buying of toilet paper and hand sanitizers to the stockpiling of guns, along with people wearing masks and protective outerwear for self-protection. In addition, we can also mention the imposition of travel bans, curfews, isolation and quarantines that turn cities into ghost towns. So this virus in particular has not only major social and economic implications, but also personal ones, since it can exacerbate existing mental health issues or feelings of isolation and loneliness in individuals as well.

In the early days of the COVID-19 outbreak, there were instances of racism directed toward Asians, perhaps because China was ground zero of the virus. How has racism been a factor in other disease outbreaks in history?

Racism, xenophobia and scapegoating certain groups of people are communal behaviors that surface during disease outbreaks, past and present. Perhaps the most infamous example of this comes from the 14th-century Black Death, a pandemic of plague that killed at least 30 to 50 percent of the human population across Afro-Eurasia (the eastern hemisphere) — when Jewish communities in Europe were made scapegoats of the plague. They were accused of deliberately poisoning wells and thus causing the plague, and such associations between plague and Jewish communities led to pogroms in various parts of Europe. Notably, these anti-Semitic discourses in the context of plague seem to have been unique to Europe.

Similarly, western Europeans also held firm to the belief for many centuries that plague came to Europe from Muslim areas in the Middle East and North Africa (they even had a name for it: “Oriental plague” or “Levant plague” — referring to the eastern Mediterranean region). What it meant in practice is that the way western Europeans thought about the plague as something that always comes to them from the “Orient,” and imagining the region and its people as breeding disease, meant that they blamed the Muslim population of the region for being filthy, ignorant, fatalistic and incompetent, and thus disease spreaders. These discourses, both popular and scientific, shaped the perception of how societies understood disease and responded to it for at least the past 600 years. They are not only dangerous for the present (because it informs policy and response), but also for the future, because it leaves a legacy behind.

What kind of a legacy do we want to leave behind for future generations? We are not only giving them more environmental disasters, climate changes and pandemics, but also leaving behind a dirty legacy of xenophobia and racism in the face of natural phenomena that we are all responsible for globally, and which do nothing to actually address the problem, since xenophobic discourses currently seem to be trumping scientifically informed responses.

Medicine has advanced significantly in the past 100 years, but medical advice for limiting the spread of disease seems to have largely stayed the same. What is the historical perspective on this?

This is absolutely true. The core medical advice for staying healthy in times of epidemics has been relatively stable for at least the past 2,000 years — if not more. Throughout the course of medical history, we see that physicians stressed the importance of preserving health and restoring the balance of humors during disease outbreaks. Often, they recommended eating a well-balanced diet, regular bleeding and purging, and moderation in physical exercise, sexual intercourse, sleep and emotional dispositions. In addition, a multitude of treatments and recipes for epidemic diseases can be found in medical books, such as theriacs, terra sigillata (“sealed earth”) and bezoar stone. People also resorted to astrology, alchemy and other occult sciences and practices for protection and cure; prayers, amulets, talismans, incorporating both pious incantations and mathematical technologies, were especially popular.

The core medical advice for staying healthy in times of epidemics has been relatively stable for at least the past 2,000 years — if not more.

Nükhet Varlik

Based on the prevailing medical understanding that the health of the human body (microcosmos) was conceived broadly within the general environment (macrocosmos), it was believed that one could not be healthy if s/he lived in an unhealthy environment. For this reason, premodern medical advice emphasized three essential elements: clear air, clean water and clean souls. Living in a place with clean air was deemed especially important because it was believed that swamps, dead bodies and corrupting matter could release miasma into the air that contaminated it and caused disease when breathed. Therefore, we see medical advice for either leaving infected places for healthier areas or taking active steps to clean the air, by means of fumigation, removing businesses, such as tanneries and slaughterhouses outside city walls, opening new cemeteries for those who died of epidemic diseases and following different burial protocols: graveyards were to be further away from cities so as not to contaminate the air, opening deeper graves, use of quicklime to cover gravesites, etc.

It would be helpful to remember that the bacteriological revolution (the idea that specific diseases were caused by invisible germs) is only 120-130 years old, and before this time, epidemic diseases were often associated with bad smells and fetid air. Similarly, clean air, water and food were considered crucial for the preservation of health during epidemics. Consuming sour fruits and their juices and generally acidic foods, as well as garlic and vinegar, was considered ideal. And chicken soup was an all-time favorite recipe during such times. The advice was to eat well, but not too much. In addition, one had to sleep well and exercise, but only in moderation. Some physicians recommended avoiding bathing during disease outbreaks, because they believed that it opened the pores on the skin and left the body more vulnerable to disease. Moreover, there were recommendations to behave morally, avoiding sin and maintaining balanced emotions.

Putting all this into historical perspective: Despite all the modern medical advances, when we are faced with a new infectious disease with no known treatment, no vaccine and no pre-existing immunity, the medical advice is not significantly different from that of the past.

With your long-term perspective on global disease outbreaks, what factors in the current pandemic are you most paying attention to?

As a historian of plague, I am deeply immersed in the study of all aspects of epidemic diseases, both in the past and today. I have been paying close attention to the coronavirus outbreak since its very early days in Wuhan, especially because there were a few cases of human pnuemonic plague in China late last year, and I had been watching disease notifications from the International Society for Infectious Diseases for that area very closely at that time. Coronavirus outbreak started as a cluster of pneumonia cases and suspicions about a mysterious disease, but numbers started to increase quickly. Soon after that, Chinese scientists identified the disease pathogen and shared their genome sequencing with the global scientific community. In the meantime, CDC, WHO and Johns Hopkins University's coronavirus database offered updated number of cases and information as the virus started to spread globally. All this information came in extremely handy because I am teaching a course on Plagues and Societies in World History this semester, and I had several opportunities to discuss the current pandemic — which I announced as such weeks ago, but only declared to be one by WHO last week — with my students and compare it to other pandemics in history.

Both plague and COVID-19, like many other infectious diseases, have zoonotic origins, i.e., they are transmitted from wild animals to humans. While in the case of plague, the animal host is often rodents (rats, gerbils, marmots, prairie dogs, etc.), in coronavirus, it is mostly likely bats. Unlike COVID-19, plague is a bacterial infection caused by Yersinia pestis, and has very different mechanisms of transmission. Yet following the current pandemic, tracking its global spread, and reading about the experiences of those affected has been extremely valuable for me, prompting me to re-evaluate historical plague pandemics. In particular, I have been paying close attention to the spread of the infection and the way the virus establishes itself in different localities to cause community spread, especially because this can give us clues about the behavior of pathogens during their silent, slow, invisible phases.

Even though these mechanisms are different from those of plague, I find it helpful to examine those to better understand how I can listen to my historical sources to find clues about that invisible phase. So, in this sense, studying the spread and rhythms of the coronavirus pandemic helps me understand plague better. I find it equally interesting to track the behavior of the virus (its speed of transmission, patterns of epidemiological spread, mortality, etc.) in different contexts to better understand the complex dynamics between pathogens and human societies.

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