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Past the Virus - Containing Pandemics Throughout History 

Past the Virus - Containing Pandemics Throughout History 
 Eugenia Tognotti
Full Professor of Medicine and Human Sciences

The history of pandemics is rife with examples of how the past informs the way we respond to health crises today. In March 2020, the world went into lockdown, but similar measures have been used before, with effects that are not unlike those we are experiencing today under Covid-19. In this second episode of the Past the Virus series, Dr. Eugenia Tognotti, researcher and medical historian, dives into the history of curfews, lockdowns and other forms of movement restrictions as ways of containing the major viral outbreaks of humankind.

According to the historians of antiquity, one of the first measures implemented to fight a pandemic dates back to the Byzantine Emperor Justinian. He imposed isolation for both travelers and food coming to Constantinople from North Africa, hit by the terrible plague outbreak (541-542 A.D). 
Over the centuries and up to Covid-19, every pandemic has led to a limitation of rights and freedoms, although to varying degrees. The responses to public health emergencies have evolved and adapted throughout history. But it is really the bubonic plague of the 14th century that set a precedent in the elaboration of a coherent model, which was then perfected in the following centuries. Given the lack of medical efficacy at the time, the only way to keep the plague under control and to limit its spread was a complex and articulated system of quarantines (quarantine stations in isolated little islands, in mainland buildings or in ships at anchor for maritime travellers), cordons sanitaires, the isolation of the contaminated in lazarets, fumigation and disinfection, and the regulation of social categories at risk. Freedom of movement was only granted to those who obtained "a sanitary certification" from the authorities. In Venice, foreigners and passengers coming on ships needed to show a "certificate", to prove that they came from contagion-free places. In times of plague or cholera those who entered the cities were obliged to present a "health certificate" ("Patente di sanità") to the authorities. The idea is not too different from today’s EU Digital Green Certificate. These measures, although with some adaptations, were also put in place during the yellow fever epidemic in the US at the end of the 18th century and the cholera outbreaks in Europe in the first half of the 19th century. 

Isolation, separation, and social control were key tactics during major epidemic emergencies. Through a reorganization of the urban space, the healthy and the sick were separated. Hospitals, lazarets and "isolated areas" became familiar territories for those who had come into contact with the infected, or who came from a contaminated place. The houses where plague cases broke out had to be seized and supervised by armed guards. No one could enter or leave, apart from priests, midwives and doctors, who generally entered homes covered in a large waterproof hooded tarpaulin, long sleeves, gloves and boots. During a cholera outbreak rooms and objects belonging to the sick had to be disinfected with chlorine fumigations - a practice that is not unlike our daily sanitizing habits in the time of Covid-19. The sanitary regulation of the Kingdom of the Two Sicilies, put in place to deal with the cholera pandemic of 1835-36, called for the closure of boarding schools, monasteries, convents, prisons and military lodgings. Convening in the streets was prohibited. The rules of safety and urban control were strengthened on inns, taverns and accommodation of any kind. A curfew was also introduced: no one could move around the city at night. If a person had to do so out of necessity, they were obliged to move about with a lit lantern. 
There was also an important social dimension at the cornerstone of emergency responses. Access to the city was only allowed for the wealthy - homeless people and prostitutes were considered to be carriers of disease. The poor thus had to be controlled.

Quarantines, sanitation and other protective measures were also implemented in Russia, Great Britain and the United States during the second cholera pandemic (1826-37). A rapid spread of an epidemic disease naturally required quick and firm action by the authorities, including prompt mobilization of the State's repressive police force. 

Who Were the Public Measures For? 

Over centuries of health crises, governments have had to enforce quarantine measures, social isolation and other non-pharmaceutical interventions (NPIs), as they were lacking vaccines and drugs. During the 1918 flu, schools, churches, theaters and spaces for public gatherings were closed. In Philadelphia, where the yellow fever hit, the city mostly shut down and quarantined the ill in their homes. A century later, the strategy against the spread of Covid-19 around the world also relied on NPIs: bans on social events and gatherings, a hiatus in national and international travel, school closures, remote working, the closure of theaters and restaurants, national and regional lockdowns and curfews.


Over centuries of health crises, governments have had to enforce quarantine measures, social isolation and other non-pharmaceutical interventions, as they were lacking vaccines and drugs. 

In each pandemic, the most affected by these public restrictions have been the poor, the homeless, the ethnic minorities and the invalids. As a result, death would first hit the most miserable neighborhoods of the cities, which were densely populated and lacked sanitation. During the 1918 influenza pandemic in India, under British colonial rule, the disease did not strike everyone equally. Most British people lived in large houses with gardens, compared to the lower classes of city-dwelling Indians, who lived in densely populated areas. 12-13 million people died, and bodies accumulated with no one to take care of the situation. 

In some areas, the funeral rites and religious ceremonies forbidden to the poor were granted to the rich. In the Kingdom of the Two Sicilies a decree of June 30, 1837 established that the corpses "of people distinguished by dignity, by birth and by character," could be buried separately from mass graves and "with religious funeral honors". The corpses of the poor were at best gathered in the dead of night and transported to mass graves in large carriages. Today, Covid-19 has equally exposed the widening and persistent inequalities in our society. Developing countries suffer the most, and within these it is those who relied on the informal sector, women, and the displaced who have the shorter end of the stick. 

Top-Down State Intervention

With each pandemic, the response to health emergencies has required a strong centralization of power. This has happened in different ways and in various political regimes. Restrictions have been stricter in undemocratic countries with an oligarchic political structure. An example is China, during Covid-19, but also in 2003, during SARS. 

Compared to other affected countries, there was a stronger control over the social sphere, with for instance town-level governments authorized to isolate travelers from infected areas, and in charge of enforcing quarantines on people suspected of contact with patients. Driven by political zeal, local government officials sealed off villages, apartment complexes, and university campuses, quarantined tens of thousands of people, and set up checkpoints to take temperatures in the fear of a massive outbreak of SARS.

With each pandemic, the response to health emergencies has required a strong centralization of power.

By May 7, 2003, 18,000 people had been quarantined in Beijing. In Guangdong, 80 million people were mobilized to clean houses and streets. In the countryside, virtually every village was on SARS alert, with roadside booths installed to examine all those who entered or left. Recourse was also made to repressive police measures using severe punishments for those who had violated the regulations of forced isolation. People who spread "rumors" about SARS could be jailed for up to 5 years. The media were strictly controlled in order to prohibit the spread of harmful information. 

In the absence of vaccines, non-pharmaceutical public health measures are extremely effective in mitigating the risk and impact of pandemics. But top-down NPIs induce profound behavioral changes, block many social activities, and therefore have enormous socio-economic costs. The pandemic has put power back into the hands of leaders, although some policymakers have remained slow to accept responsibility for their decisions. Ample criticism can be made towards the mistakes of overly centralized governmental strategies. Engaging the public in the decisions could have helped build and maintain trust, which is all the more important in an emergency, when civil liberties are put at risk. The loss of public trust has had a detrimental impact on health and more specifically on the adherence of the public to the sanitary rules and to the vaccination campaign.

A New Precedent

All this being said, no pandemic in recent history has caused permanent changes to society and or an irreversible erosion of civil liberties. They have, however, left considerable traces in history. For example, in India, the Spanish flu became an example of the British injustice that spurred the fight for independence and influenced the launch of Gandhi's Non-Cooperation Movement. Moreover, the biggest pandemics have produced great advances in medical and scientific knowledge. Cholera improved urban planning for sanitary facilities (aqueducts and sewers) and sanitation, and eventually led to an effective vaccine developed in the late nineteenth century.

As regards Covid-19, for the first time, lockdown measures were implemented simultaneously and successfully around the world. The pace of scientific research has been unprecedented. Research groups worldwide have quickly advanced in studying biology of the virus, others have developed diagnostic tests and investigated public-health measures. Scientists raced to find treatments and create vaccines in record time. Fundamentally, although many of today’s restrictive measures are not new, Covid-19 has marked an important break with the past.




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