Infectious diseases have long afflicted us. Without warning, viral and bacterial pathogens surge with devastating impacts only to subside and even disappear. Now it is our turn.
We must decide as individuals, communities, and nations how we respond to COVID-19. To improve our decisions, we must learn from those who came before, from China, South Korea, Italy and an expanding list of countries.
It is thought that in In 429 B.C., the first recorded epidemic struck Athens, spread from Egypt through the Persian Empire. The plague devastated the Athenian fleet. Pericles, Athens’ brilliant statesman, died of the plague.
In 1348, rats escaping from ships docked in Italy started dying. People started dying. The epidemics of “Black Death,” bubonic and pneumonic plague, killed over 40 million people, or one-third to one-half of Europe. Outbreaks continued. In 1603, London’s death toll was 43,154, nearly one-fifth of the population.
Indigenous people of the Americas, including Puget Sound and the Columbia River Basin communities, died from measles, smallpox, and other microbes probably first carried in the 1400s by Euro-Americans. Epidemics killed untold numbers of indigenous people, giving Euro-American nations a foothold.
Modern times have had influenza viruses of the 1918 “Spanish flu” and 2009 H1N1, and coronaviruses: 2002 “Severe Acute Respiratory Syndrome” and 2012 “Middle East Respiratory Syndrome.”
In the early years of the HIV/AIDS epidemic, patients were dying with rare infections and malignancies. As with COVID-19, delays in facing the spread of HIV had devastating consequences for infected patients and communities worldwide. Learning more, we moved beyond fear of contagion to therapies preventing and managing HIV as a chronic disease.
Epidemics can change the course of history.
The World Health Organization (WHO) first reported a pneumonia of unknown cause in Wuhan, China, on December 31, 2019. On March 11, the WHO declared coronavirus a pandemic. None of us has immunity for this new virus. We have no vaccines and no approved medications.
Who is carrying the virus? We do not know; carriers may have no symptoms. We struggle with who and how to test for the virus. An ER physician colleague was recently on hold for five hours – five hours! – trying to order a COVID test. Testing availability is improving, but we have far to go for adequate testing and follow-up.
Longstanding concerns about our hospital reserves now evolve into anxiety as we try to prepare for a projected weekly doubling of cases: will we have enough hospital beds? Ventilators? Masks and other personal protective equipment (PPE)? How will we staff ERs and hospitals when staff becomes infected? How will we manage hospitals already near capacity?
We knew a pandemic would come – they have before. We were warned of this novel virus in early 2020. What happened? The exploding sickness and death in the United States is a result of a stunning failure of federal leadership: failure to prepare, stock sufficient PPE, sound the alarm, rally public action, and institute comprehensive testing and contact tracing.
If pestilence is not enough, add the cratering of our economy and impacts on millions of Americans and their families. As COVID cases and deaths climb, economic indicators plummet. What we learned from prior epidemics: that economic health and public health are inseparable. A tiny virus brings the United States’ economy to its knees.
Former U.S. Secretary of Defense Donald Rumsfeld said, “You go to war with the army you have, not the army you might want or wish to have.” We were not prepared to go to war with COVID-19. History will judge harshly decision-makers who have starved United States’ public health, leaving us vulnerable.
In our democracy, we should hold decision-makers accountable for lives ruined or lost, for shuttered economies. We can and must support leaders who have the humility to listen to scientific expertise and make informed decisions.
Most importantly we must focus on the work at hand to protect our communities, our families, and — yes — ourselves.
I have a special request to health care professionals: join your local Medical Reserve Corps (MRC) and volunteer. MRCs arose from the Sept. 11 attacks. The Vashon MRC is part of a national network of volunteers organized to improve the health and safety of their community. The MRC network comprises approximately 175,000 volunteers in 850 communities. We will be more resilient if we build our public health capacity, including strengthening our volunteer health professional networks.
With COVID-19, major efforts are underway to develop a vaccine and medications. For now, with the full human toll still to come, we remain steadfast with the message of caring for our communities, our families, and our patients: “cure sometimes, treat often, comfort always.” Be smart, stay safe, don’t spread the virus.
John Osborn is a physician who provides care for Veterans at a Seattle emergency room and volunteers as co-coordinator of the Medical Reserve Corps on the island.