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Pandemics and Social Change.

Pandemics are never politically correct. They have a way of barging in and exposing the ugliest truths about societies and human tendencies. In the book, Epidemics and Societies, Snowden1 recounts the social, political, and psychological toll of pandemic diseases from bubonic plague or Black Death in the fifth century to more recent epidemics such as tuberculosis and AIDS. Beginning in the fifth century and in succeeding outbreaks of bubonic plague in Europe, there was mass hysteria, the scapegoating of groups, especially women, economic collapse, and social disorder. The 1700s and 1800s gave rise to devastating outbreaks of smallpox, cholera, and typhoid fever, and the 1900s hosted the pandemics of Spanish flu and AIDS, with many of the same social dynamics prevailing. Here, we are in the 21st century confronted with a new corona virus that has catalyzed the same fear, denial, hysteria, conspiracy theories, scapegoating, economic distress, and social disorder as previous pandemics. Yet, there is a silver lining. Every pandemic since the fifth century has catalyzed human ingenuity, resulting in some of the most dramatic improvements in living conditions, mitigation strategies, and ultimately health. Early pandemics in large European cities highlighted problems with sanitation, water available for drinking and cleansing, overcrowded housing conditions of the poor and working class, and inadequate nutrition. In 1842, Chadwick, a contemporary of Florence Nightingale, published a report that correlated “unsanitary living conditions” experienced by the poor to the development of disease.2 This report inspired Nightingale to focus on improving hospital environments through hygiene, light, fresh air, and good nursing care. Once it was finally established that pandemic diseases were caused not by foul air or evil spirits but rather by “germs” and “viruses,” vaccines and other interventions were developed. Smallpox is the only infectious disease that has been eradicated to date. Science continues to focus on the dynamics of familiar organisms that cause cholera, tuberculosis, and AIDS and new ones such as the corona viruses with an eye to eradication or, at least, effective containment. The daily distribution of data on the incidence and death rate of COVID-19 has highlighted its disproportionate effects on minority groups, Hispanic, and black Americans. This disproportionality is related to higher rates of chronic illness such as obesity, diabetes, and hypertension among these groups and to living conditions, nutrition, and economic status. The current pandemic is also shining a light on the health and wellness of direct caregivers and the shortcomings of the US health care system. Hopefully, positive change will put us in a better position for the next pandemic, which is sure to come. Think about what you are doing differently since the onset of COVID-19, not only with social distancing but also with the quality of your own self-care. Think about how you are living your life. I am!