In an interview, medical historian Frank Snowden discusses how the coronavirus pandemic mirrors past outbreaks and argues that we must quickly apply the lessons learned today in preparation for the next disease.
Frank Snowden, 73, is a professor of the history of medicine at Yale University and author of the book “Epidemics and Society: From the Black Death to the Present.” Almost 50 years ago, he lived through a cholera outbreak in Rome while doing research there, and he is now stuck in the Italian capital again due to COVID-19, again on a research trip. The historian became infected by the coronavirus, though when DER SPIEGEL spoke with him last Monday, but was doing well, though still under quarantine.
DER SPIEGEL: Years ago, you warned that SARS, avian influenza and swine flu were merely dress rehearsals for something much bigger, a really terrible pandemic that was to come. Were you thinking of a pathogen like SARS-CoV-2?
Snowden: Oh yes, absolutely. And it wasn’t only me who expected a pandemic with such a pulmonary virus. Virologists and epidemiologists throughout the world have warned again and again. I really ask myself: How blind can you be? When Donald Trump now asks, “who could have known,” my answer is: Everyone!
DER SPIEGEL: Why wasn’t the message heard?
Snowden: All too often, this is the fate of Cassandra. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the U.S., explained the situation graphically in 2006: If you live in the Caribbean, climate scientists will tell you that a hurricane is inevitably going to come. They cannot tell you the date, and they cannot tell you how powerful the hurricane is going to be, but it is very important that you prepare for it. It is exactly the same with a pandemic. But what did we do? Following a brief phase of anxiety after SARS and avian influenza, we forgot all about the pandemic threat! So now we don’t have common pandemic policies in the European Union, the World Health Organization is underfunded, and we are lacking hospital surge capacities.
DER SPIEGEL: Some have compared to the coronavirus to the bubonic plague. But when reading about this truly terrible epidemic, one that brought death to Europe for centuries, it makes one feel a bit like a wimp, working from our cozy, Western European homes, don’t you think?
Snowden: (laughs) Nice that you take comfort this way. I’ll join you in being a wimp. And although I take Covid-19 very seriously, I think it should not be compared to the bubonic plague. The plague killed about 100 million people in Europe between 1347 and 1743. Whole regions were depopulated, and it caused a terror that I really cannot see in coronavirus.
DER SPIEGEL: Have we been spoiled by our health-care systems?
Snowden: While we are almost despairing while waiting for a vaccine, the people of Florence probably would have danced for joy if you had told them that there would be a vaccine against the plague in 18 months. But I have been thinking about this. It is not necessarily the deadliest diseases that cause most horror and have the biggest political and social impact.
DER SPIEGEL: But?
Snowden: I think, the impact of new, unknown diseases that suddenly appear out of the blue, like the coronavirus, is especially big – diseases that are medically volatile, like COVID-19. Smallpox, for example, was a horrible disease that killed more than half of those infected, often children, and disfigured most of its survivors. And, of course, people were afraid of it. But at the beginning of the 18th century, people had somehow come to terms with it. It was accepted as fate.
DER SPIEGEL: Similar to tuberculosis?
Snowden: Maybe yes, with the difference, that you do not die rapidly of tuberculosis. Most people wasted away over years. In the 19th century, it was therefore even a bit romantic to have tuberculosis. People would drop dead in public places because of bubonic plague or cholera. Plague doctors were helpless, unable to cope. Similar pictures came from Wuhan via television. I can very well imagine how such exceptional circumstances can fuel political change and economic crises, even if the case fatality rate is comparatively low, as it is with COVID-19.
DER SPIEGEL: Some people even think that China could rise to superpower status because of the coronavirus.
Snowden: Like the U.S. did thanks to yellow fever.
DER SPIEGEL: Excuse me?
Snowden: OK, I think I have to give some background information. Around 1800, the French colony of Haiti was one of the richest colonies in the world because of its sugar plantations that were cultivated by slaves. But the slaves started a revolution. Napoleon, who had ambitions of extending France’s power into the New World, sent more than 60,000 soldiers to strike down the revolution. But most of them were killed by yellow fever. Napoleon had to bury his overseas ambitions, and in 1803, he also sold Louisiana to the United States. That meant a doubling of U.S. national territory – an important step in the direction of becoming a superpower.
DER SPIEGEL: Have superpowers perished because of microbes?
Snowden: Many. The Plague of Athens, a deadly and mysterious disease that spread vesicles across the whole body, contributed to the decline of Ancient Greece. Regarding the decline of Ancient Rome, in addition to many other factors, malaria played a role. Because of climate change, malaria started to spread in southern Europe in the 5th century. Survivors had regular bouts of fever for the rest of their lives and certainly couldn’t work as hard as before, which contributed to the decline of agriculture. In Great Britain, smallpox ended the reign of the House of Stuart, and Napoleon’s army in Russia wasn’t destroyed on the battlefield, but by typhus and dysentery.
DER SPIEGEL: The current pandemic has been accompanied by an ethical drama, such as in the discussion over the measures taken, which have paralyzed public life. Essentially, it is a clash between saving lives and saving the economy.
Snowden: That sounds very familiar. Because of cholera, regular international conferences were held from 1851 to about 1910 to discuss how the spread of this disease could be stopped – for example, by ship quarantines or travel bans. The economic problems caused by these measures were also explicitly discussed – such as that a five-day quarantine would render the use of the Suez Canal no longer worth it.
DER SPIEGEL: That sounds like some of the arguments that are being made today.
Snowden: Oh yes, and there are more examples. In 1720, a ship carrying precious fabrics from Smyrna and Tripoli arrived in the port of Marseille in Southern France. While still at sea, eight sailors, a passenger and the ship’s doctor had already died of the plague. Usually, quarantine lasted 40 days, but in this case, under pressure from local merchants, it was shortened to 10 days and the precious fabrics were not burned. As a result, more than half of the 100,000 inhabitants of Marseille died of the plague. The shortened quarantine time was played down with the term “small quarantine.” It reminds me of Donald Trump, who played down COVID-19 by initially referring to it as the “common cold” and the “flu.”
DER SPIEGEL: So, there are some parallels between the coronavirus pandemic and the plague after all?
Snowden: Maybe yes. For example, that the superrich are now fleeing from the coronavirus to remote places, just like 10 young people fled from the bubonic plague to a villa outside of Florence in the famous book “Decamerone,” by the Italian author Giovanni Boccaccio. Also, the fact that China and the U.S. are now trying to scapegoat each other for the pandemic reminds me of the plague: During the bubonic plague prostitutes and Jews were scapegoated, which resulted in terrible pogroms. And in the historic novel “The Betrothed,” by Alessandro Manzoni, the story is told of four Spaniards who were cruelly executed, because they had been accused of intentionally spreading the plague. With cholera, it was the same: A historic illustration shows how angry American citizens tried to defend their country against immigrants, that might be infected with the disease. Now, with coronavirus, Chinese-looking people have been verbally insulted or even physically attacked in many countries.
DER SPIEGEL: The bubonic plague grew so bad, that many people even lost their belief in God. What is the coronavirus doing to the beliefs we hold in our secular society?
Snowden: I think it calls into question our belief in globalization. We now realize how vulnerable we have become through globalization. I think this pandemic really touches the greatest anxieties of our psyches, the greatest worries we have as humans. But globalization is not an act of God. We created it ourselves. By creating the myth that we could grow our economy exponentially and infinitely, by almost 8 billion people living on earth, excessive travel, environmental pollution, by pushing back nature more and more, we created almost ideal conditions for the coronavirus to emerge, spread and hit us especially hard.
DER SPIEGEL: Can something positive grow out of the pandemic?
Snowden: Yes. We are at a crossroads now. If we fall back into nationalism, as is currently taking place, we are giving away the chance to really promote change. From avian flu to SARS, to Ebola to the coronavirus, all these diseases emerged from zoonotic spillover. We have contact with animals to a degree and extent that never happened before in human history. Have we not had enough examples? How many times do we have to suffer before we say: Oh, there is a pattern here? That we have to stop expanding our habitat more and more?
DER SPIEGEL: Do we need a green economy?
Snowden: Yes, it seems to me that environmentalism and public health have to go hand in hand. But that involves not thinking as nations. Microbes do not respect national borders. We have to think as a species – as a species that lives in a world of microbes.
DER SPIEGEL: But what about science? Can’t science protect us from epidemics?
Snowden: Without doubt, science has made a lot of progress, and we see this every day now during the coronavirus pandemic. During the plague, people thought the disease was a punishment of God, which caused real terror. And in 1973, when I was in Rome for the cholera epidemic, the Italian minister of health was so superstitious, that he did not rely on hygiene measures alone while visiting a cholera hospital, but made the sign with his hand behind his back, to ward off evil. These times are long gone, and even in comparison to SARS 17 years ago, science has made a lot of progress.
DER SPIEGEL: But not enough?
Snowden: The problem is that we do not use science in a constructive way. After SARS, a platform could have been built that would have made it possible to make a coronavirus vaccine very rapidly now. But it was not done. Not, because the science was inadequate, but because there was not a profit in doing so. In the pharmaceutical industry, everything is about making a profit. And this is also the problem of the health-care sector. Pandemic preparedness does not bring profit like invasive procedures. So, nobody took preparedness seriously. And in many countries, also in the U.S., millions of people have no access to the best standard of medical care. We are seeing the horrible consequence now. One lesson from this pandemic is: Medicine has to be a human right!
DER SPIEGEL: Do you agree with Louis Pasteur, the pioneer of infectious disease research, that microbes will have the last say?
Snowden: I think that will depend on whether we are willing to learn from past mistakes. We know what our vulnerabilities are that pave the way for pandemics like the one we are living through now. We have the capacity to collaborate and the tools to prevent future pandemics, or at least make them less likely to happen. But will we act? I really hope so. But I am not sure. Just think of how terribly slow climate protection is progressing!
DER SPIEGEL: Yet in contrast to the consequences of climate change, the coronavirus cannot be ignored so easily.
Snowden: You are right. Perhaps we will change now that we are so directly affected by the coronavirus. Isn’t it the essence of Greek drama, that learning is possible for human beings, but that it usually comes through suffering?
DER SPIEGEL: Professor Snowden, thank you for this interview.