Quirks & Quarks·Q&A

A medical historian looks at the historical echoes of the past in the pandemic of the present

In a new book, medical historian Dr. Jacalyn Duffin looks at how COVID compares to our previous experiences with disease outbreaks. She contrasts those events with how this novel Coronavirus spread around the world, the ways we tried to stop it and lessons to learn for when the next pandemic hits.

'COVID-19 has taught us a lot about what we did right and what we did wrong' says Dr. Jacalyn Duffin

A crowded room at night, with several people wearing modern medical masks. In the center of the frame is a man wearing a pointy "plague doctor" mask.
A man wearing a plague doctor mask celebrates Halloween during the COVID-19 pandemic in Hong Kong. This style of mask was worn by doctors during outbreaks of bubonic plague in Europe in the 16th and 17th century. (REUTERS/Tyrone Siu)

The COVID pandemic upended the world. And even though we may like to pretend it's over, we have a long way to go to get back to "normal."

But for people like medical historian Dr. Jacalyn Duffin, much of what has happened over the past few years was, in a way, totally normal and even predictable, because this pandemic followed the patterns of many past pandemics and outbreaks.

Her new book, COVID-19: A History, looks at how COVID compares to our previous experiences, from how this novel coronavirus spread around the world, to how we tried to stop its spread, and even the "infodemic" of disinformation that arose as a result.

Dr. Duffin is a hematologist, medical historian and professor emerita at Queen's University. Here is part of her conversation with Quirks & Quarks host Bob McDonald.

This interview has been edited for clarity and length.

You were on our show back in the year 2000 predicting a big pandemic. How did you know a pandemic was on its way?

I think every historian would have given you the same answer. We were due, perhaps overdue. People were even predicting which germ would be the cause of the pandemic. In 2017, a team in Mexico said the next pandemic will be a coronavirus, and they were right. 

What do you mean when you say, we were overdue?

Pandemics have come with a certain regularity, and it had been a century since we had the influenza pandemic, which is called by the misnomer Spanish flu. So time had rolled along. The world had changed. It was time for another pandemic, a new pathogen, to come along because they are mutating all the time in nature, and humanity doesn't retain its immunity when it's never been exposed to the germs.

A black and white photo of a woman sitting reading a book. She has a mask over her nose which is connected to a machine on a desk.
A woman wearing a flu mask during the 1918 flu epidemic. (Topical Press Agency/Hulton Archive/Getty Images)

As a medical historian, how does the COVID-19 pandemic compare to previous pandemics?

People might not like to hear this, but on many levels we've been lucky. The lethality of the germ wasn't as bad as it could be. SARS was more lethal than COVID-19. We had tremendous supports for people who got sick. If you got sick with COVID and you lived in a developed country, you had a good chance of getting oxygen in a bottle. If you were very sick, you could be in an intensive care unit and intubated and ventilated with a machine. None of these things existed 100 years ago with the influenza pandemic. 

It feels like the reaction to COVID created controversy and disagreement right from the start, whether it was about how the disease spread, how to treat it, even whether it existed at all. Has that happened in past pandemics as well? 

That has happened in every pandemic in the past, and there's nothing unusual about COVID in that way. What we might think of as unusual is the power of social media and the Internet to amplify the kinds of anxieties, the misinformation, the fears and the opposition. These were accessible to everybody in a way that modalities for communicating were not in a more distant past. But objection to public health rules has been there since they were invented. 

Can you give me an example of that from a previous pandemic?

Sure, in the smallpox outbreak when it was endemic in Europe. It was a major cause of disfiguration and death in 18th century Europe, and when vaccines came along, derived from cowpox to prevent smallpox, people were horrified at the idea of sticking something into their bodies that had come from an animal. And there were cartoons made against it. There were outcries. There were societies made to oppose this newfangled procedure in medicine. Yet we know now that with the vaccine, we were able to eradicate smallpox in people. 

And there were protests also against lockdowns during the Black Death, I understand.

The Black Death is very important in this history. The Black Death gave us quarantine. There's a bit of a dispute about where it was first used. But the authorities figured out it was coming from elsewhere, so what they should do is block ships at ports and not let anyone off the ship for 40 days, "quaranta giorn" in Italian. That's where the word quarantine comes from. And this modality was intended to allow the disease to burn itself out, if it was on the ship, or for the people on the ship to declare themselves fully healthy and be allowed to come to shore. 

An old faded illustration showing a scene from a town square in Milan.
An image depicting the torture and execution of accused plague spreaders in Milan, Italy, in 1630. Before it was known rats were an agent in the dissemination of plague, unfortunate victims of the disease in Milan were — because of the ignorance of the people on this subject — tortured and executed. (Hulton Archive/Getty Images)

During the Black Death, the city of Milan invented a lockdown for the entire city. I was surprised when people said when Wuhan was locked down that it was the only time a city had done that. Not true. Milan had been locked down, its gates were closed, and if the disease declared itself in a house, the house was bricked up with everyone inside.

What about the history of vaccines and treatments? How does what we saw happen in the past few years compare to what happened historically?

What happened in preparing the vaccine is nothing short of miraculous. People were saying at the beginning of the pandemic that you need at least 10 to 15 years to produce a vaccine, and that had been true in the past.

What didn't get said often enough, especially if we're talking about the mRNA vaccines that are quite new, is that the spike protein which the mRNA vaccines are conducting their activity with had been studied ever since SARS. There were a number of articles published every year about this little spike protein. It wasn't a lot, but people were working away on it, partly because they were concerned we might get a coronavirus pandemic and so they kind hit the ground running when coronavirus SARS-CoV-2 came along. That gave them a leg up.

A book cover with an off-white background. The title and author are in the middle. At the top of the cover is an illustration of a coronavirus.
COVID-19: A History By Jacalyn Duffin (McGill-Queen's University Press)

The other types of vaccines we have are well-established as modalities and the companies that make them had only to convert their established modalities using other viruses or chemicals to make a vaccine. But, they put their shoulders to the wheel, and they did it remarkably quickly. That's another thing that makes us luckier than people in the past. 

There was something new about this pandemic that you've alluded to already, you call the "infodemic." Tell me about that.

Yes, it's not a term I invented. Dr. Tedros of the World Health Organization used that term very early in the pandemic. What it represents is this massive amount of information that was flowing on the Internet through social media and other resources claiming to be authoritative about the pandemic. And a lot of it was not true. A lot of it was true, and it was really hard for the average citizen to sort through all of this barrage of information coming their way. So that is what he meant by an infodemic.

So is this misinformation a new phenomenon with our social media or is there a history there as well? 

There's absolutely a history there. Yes, there was misinformation about the cowpox vaccine against smallpox. There's been misinformation about other vaccines when they've come along. This is not to suggest that there aren't side effects from some vaccines and that's the risk. If the authorities go around reassuring absolutely everybody of that, there's no problem. 

Denial characterizes almost every pandemic.- Dr. Jacalyn Duffin

What is significant is the proportion of the side effects versus the risk of damage without the vaccine. Billions and billions of doses of vaccines have been given. It is now abundantly clear that vaccines help. More people are going to stay alive, and more people are going to stay healthy with the vaccines than without. 

What do you think is behind this kind of denial that comes up during pandemics where people just sort of almost don't want to believe it's real?

Denial characterizes almost every pandemic. Every pandemic goes through stages, and denial is one, right at the beginning. [Then] anger, also scapegoating and blaming neighbours in other countries, or neighbous next door, for causing the problem. And then there's a stage of hard work and knuckling down and dealing with it. 

The final stage of pandemics, as historians define it, is a new knowledge stage, and I like to think of that new knowledge stage as what we will do, or what people in the past have done, to alter their public health rules going forward.

COVID-19 has taught us a lot about what we did right and what we did wrong, and hopefully when we get to stand back and take a long look at this, we will be able to adjust our public health provision and rules to deal with the next big one.

Produced by Amanda Buckiewicz


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