Acute stress can sometimes bring out the worst in humanity, and attributing disease to outsiders, to those that seem different from us has, unfortunately, been going on for centuries. It is based on fear, on prejudices and on biases passed down from generation to generation. If we have learned anything during the COVID-19 pandemic, it should be the infectious diseases do not discriminate. Yet throughout the world during COVID-19 Asians and people of Asian descent have been targets of derogatory language, beating, bullying and threats. We like to think of ourselves as so much wiser than our ancestors, but how different are we really to those who experienced other pandemics years, decades, or centuries ago? Here are just a few of the many pandemics that have spread around the world, and how people reacted to them.

The Black Death

Plague doctor. The overcoat was of waxed fabric, the beak of the mask was stuffed with herbs, straw, and spices, and he carried a cane to examine and direct patients without having to touch them

A serious outbreak of bubonic plague, better known as the Black Death, was first recorded in the Byzantine Empire during the reign of emperor Justinian I [527-565 CE], arriving in Constantinople in 542 CE.  To this day, it has been controlled but never eradicated, with 3,248 cases reported worldwide between 2010 and 2015, including 584 deaths.

The plague is caused by the bacterium Yersinia pestis, found in small animals and their flees. Humans become infected when bitten by these flees. The bacteria travel through the body to the lymph nodes, where they multiply. The lymph nodes swell, become painful, and if left untreated can become open sores filled with pus. Untreated, the bubonic plague is often fatal.

A woodcut depicting Jews wrongly blamed for the spread of the plague being burned to death.

A Black Death pandemic raged in Europe from 1348 to 1351, killing approximately 25 million people. Originating in Asia and brought to Europe by Mongol Khan Janibeg, who catapulted plague-infested corpses into the Genoese port of Kaffain in an effort to infect his enemies, the plague was then spread westward to Mediterranean ports by Genoese ships, then spread inland. The rumour, though, was that these deaths were due to an international conspiracy of the Jews to poison Christendom, and that a Rabbi Peyret, from Chambéry, Savoy, had dispatched his poisoners to France, Switzerland, and Italy. As a result, throughout Europe Jewish homes, business and villages were destroyed, and thousands of Jews, including children, were killed by mobs or burned at the stake en masse. And though Pope Clement VI issued a papal bull in July 1348, stating ‘It cannot be true that the Jews are the cause of the plague as it afflicts the Jews themselves’, still the killings continued.

Syphilis

A woodcut from 1689 shows treatment of syphilis by mercury fumigation

Syphilis is a highly contagious, sexually transmitted disease cause by the Treponema pallidum bacterium. Unlike the Bubonic plague, syphilis, if untreated, kills slowly, and so does not cause the same panic as the Black Death. If untreated, it will progress through three stages. The first stage is usually painless, and is when a sore appears on the genitals, the mouth, the anus or cervix. The sore will heal, even without treatment, within three to six weeks. If untreated, the second stage results in rashes, skin lesions, swollen lymph glands, fever, hair loss, muscle and joint aches, headaches and tiredness. Again, these symptoms will disappear even if untreated, though the person remains infectious for up to two years. Then comes a latent phase, which can last up to thirty years before the third stage occurs. In this stage, the disease can affect the brain and spinal cord, the eyes, the circulatory system, the nervous system and the skeletal system. Which symptoms the infected person exhibits depend on which system [or systems] is affected.

Face of a woman with a typical syphilitic nose. Picture: St Bartholomew’s Hospital Archives Museum,Wellcome.

Though many historians theorise that syphilis was a disease brought back by Christopher Columbus and Martín Alonso Pinzón and their crews during the Columbian Exchange in 1492, and others will argue that it was described by Hippocrates in Classical Greece, the first recorded outbreak of syphilis occurred in Europe when Charles VIII, King of France, invaded Italy. Because it was spread by French troops, the disease was then known as ‘the French disease’ in Italy, Malta, Poland and Germany. The French called it the ‘Italian disease’, and the Dutch the ‘Spanish disease’. In Russia it was known as the ‘Polish disease’, and the Turks called it the ‘Christian disease’ or ‘Frank (Western European) disease’, each of these names reflecting the political situation between nations at that time.

There have been, as far as I can ascertain, no record of mass violence against a particular group in regards to syphilis. But though more subtle than with other pandemics, people infected with syphilis often faced – and still face – discrimination and prejudice and are often treated as outcastes. And because this is a sexually transmitted disease, women in particular are often thought to be promiscuous. At the end of the 19th Century, calls were made in the US to restrict the immigration of lower classes because of the fear of sexually transmitted diseases, then in the early 20th Century, and especially during and just after WWI, Victorian repressed sensibilities resulted in campaigns to close down red-light districts, especially in the UK and US, and draconian laws were passed related to prostitutes.

Cholera

Though the germ theory of disease had been proposed as early as 1500’s by Girolamo Fracastoro, the idea was not widely accepted until 1860 when French chemist and microbiologist Louis Pasteur was able to prove that air contains minuscule living organisms, too small to be seen except through a microscope, and that these micro-organisms were responsible for diseases. Diseases micro-organisms could travel through air, water or physical contact between humans and non-humans. But even though Pasteur had proven this, still people often preferred to blame others. In the case of cholera, however, it was not another race but authority figures and particularly doctors that were blamed.

Front cover of French journal ‘Le Petit Journal’

To date, there have been seven cholera epidemics. The first originated from Ganges Delta in India in 1817. By 1820 it had spread through Burma [modern-day Myanmar], Ceylon [modern-day Sri Lanka], Thailand, Indonesia and the Philippines. It then made its way to China in 1820 and Japan in 1822. It also reached the Persian Gulf, Turkey, Syria and Southern Russia, finally coming to an end six years after it had begun.

The second epidemic began around 1829, and spread along trade and military routes to Eastern and Central Asia and the Middle East. It made its way to Moscow, Finland, Hungary, Poland and Germany. By 1831 it had reached Europe and England, where press reports led people to believe more cholera victims died in hospital than in their homes. In Liverpool, rumours soon spread that victims taken to hospital were killed by doctors who needed their bodied for dissection, resulting in several riots. And when stockpiles of chlorate of lime were discovered in the cellars of the aristocracy in Europe, rioters interpreted this as proof their wells were being poisoned, and so slaughtered them.

By 1832 Cholera had reached America and Canada, and would spread over the continent, eventually reaching Latin America in 1833. It then died out and re-emerged sporadically throughout several countries, finally subsiding in 1851.

There would be four more cholera epidemics between 1852 and 1923, the third [1852–1859], spreading through Asia, Europe, North America and Africa, being the deadliest.  The seventh cholera pandemic began in Indonesia in 1961, spreading across Asia, the Middle East and Africa by 1971. Since 1990, most of all cholera cases are from the African continent, except for the 2010-2011 outbreak in Haiti, following the earthquake of 2010.

The red ribbon is a universal symbol of awareness and support for people living with HIV and AIDS

AIDS

AIDS [Acquired Immune Deficiency Syndrome] is caused by HIV [human immunodeficiency virus], a virus that attacks the immune system, over time leaving the body unable to fight off infections and disease. There are two types of HIV – HIV-1 and HIV-2, with HIV-1 being the more virulent. It is transmitted through the exchange of blood, semen, pre-seminal fluids, rectal fluids, vaginal fluids, and breast milk. HIV has most often been spread through unprotected sex, the sharing of needles for drug use, and through birth. HIV transmission is only possible if these fluids come in contact with a mucous membrane [found inside the rectum, the vagina, the opening of the penis, and the mouth], with damaged tissue or is injected into the bloodstream.

Most scientists believe HIV-1 is closely related to SIVs [simian immunodeficiency viruses] found in the wild ape populations of West Central Africa, and that the viral mutation and jump from ape to human occurred in the late 19th and early 20th Century, probably brought about through the practice of hunting bushmeat.

The first verified case of HIV is from a blood sample taken in 1959 from a man living in Kinshas, in the Democratic Republic of the Congo, and many of the first cases of AIDS were also from there. At the time Kinshas had a high population of migrants and sex trade workers. From there AIDS spread via transport links to other parts of Africa and to Haiti.

By the early 1980s AIDS was reported among homosexual men in New York and California, and it became known as the ‘gay disease’. By mid-1982, researchers realised the disease also infected haemophiliacs and heroin users, and in September of that year the disease was finally named AIDS. By 2019, 38 million people were living with HIV/AIDS worldwide, and 690,000 people had died of HIV-related illnesses. Until now, AIDS was believed to be treatable but not curable. However, in March 2020, a man in London became the second person to have been confirmed as ‘cured’ – ie: been HIV-free for 30 months without the need for antiviral medications – after receiving a bone marrow transplant.

At the beginning, because little was known about AIDS and how it was transmitted, people were afraid of contagion, whilst other associated it with behaviours they did not approve of, such as homosexuality, drug usage and sex work or infidelity. They saw the infection as a direct result of loose morals or personal irresponsibility. As a result, AIDS sufferers were discriminated against in relation to employment, housing, and access to medical care. Others were shunned by family, friends and the wider community, or faced harassment, abuse and violence at school, at work, or in their community. As a result, many suffered psychological damage, feeling shame and worthlessness, and entertained thoughts of suicide. By 2014 seventy-two countries had HIV-specific laws that prosecute people living with HIV for a range of offences, by 2015 thirty-five countries had laws that restrict the entry, stay and residence of people living with HIV, and seventeen countries will deport individuals once their HIV positive status is discovered. Many are denied health and human rights – for example, in a 2012 survey of six countries in the Asia-Pacific region, 37.7% of women living with HIV reported being subjected to involuntary sterilisation. A country by country reports of discrimination against people with HIV and Aids is available via the People Living with HIV Stigma Index

H1N1 flu or Swine Flu

H1N1 flu was also called Swine Flu because is a common infection in pigs worldwide. People who work with pigs or are in the proximity of pigs can developed swine flu. An individual cannot acquire swine flu from eating pig products such as bacon or ham. It is an acute disease of the upper respiratory tract, causing inflammation of the upper respiratory passages, trachea, and possibly the lower respiratory tract. Symptoms can range from mild flu symptoms to severe respiratory symptoms and possibly death.

In March 2009, two children in North America – neither of whom had been in contact with pigs – were diagnosed with Swine Flu. By April of that year further outbreaks of Swine Flu occurred, though health officials reported that it had infected people as early as January 2009 in Mexico. It then spread rapidly around the world so that by June 2009 the World Health Organisation declared it a pandemic after seventy-four countries and territories had reported laboratory-confirmed infections. By the end of 2009 two vaccines had been developed and administered in more than a dozen countries.

Radio Host Michael Savage

And just as with other pandemics, people were quick to demonise the other – this time Mexicans, who were seen as the cause of the disease. Internationally, Peru, Ecuador, Argentina, and Cuba suspended all flights to Mexico. In Colombia and Chili, Mexican sports clubs were refused stadium hires, and China quarantined seventy-one healthy Mexican citizens for two weeks, even though none has presented symptoms and most had had no contact with infected people or places. But it was in the US that demonising rhetoric flourished. Radio host Michael Savage floated the theory that Al Qaeda was using Mexican immigrants as carrier ‘mules’ to bring the virus into the U.S, as did nationally syndicated radio presenter Neal Boortz, and the late Madeleine Cosman referred to Mexican immigrants as pathogen-ridden ‘deadly time bombs’ at major anti-immigrant conferences. And in the streets, Mexicans were sworn at and attacked, and their businesses boycotted.

In wanting to understand and avoid illnesses, people will often differentiate between ‘us’ and ‘them’, often the result of pre-existing prejudices. It seems easier to single out a country or group of people rather than a virus or bacterium – pointing the finger at outsiders is so much easier than trying to understand the science of an illness… #pandemics  #COVID-19  #SpanishFlu  #plague

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