Editor’s Note: Kari Nixon is an assistant professor of English at Whitworth University and the author of the book “Kept from All Contagion: Germ Theory, Disease, and the Dilemma of Human Contact in Late Nineteenth-Century Literature.” Follow her on Twitter @HalfSickShadows. The views expressed here are hers. Read more opinion on CNN.
The way we talk about disease can actually alter how diseases spread. As medical humanities scholar Heather Schell has said, the practice of epidemiology links statistical analysis and pattern formation with the creation of narratives about the impact disease may have on the world. Interacting as they do with pathogens, these narratives themselves can shape the ebb and flow of pathogens for better or worse, as people change their behaviors in response to epidemiological reporting.
In the midst of a coronavirus epidemic, we’re likely to continue to be inundated with statistics, charts and maps tracking the pathogen.
It can be easy to forget in this context of global fear, especially given the likelihood that the number of coronavirus cases in the United States will spike now that testing is more widely available in individual states, that what we are really talking about when we talk about disease is people. That is, the reason we care about disease is because we care about the people it may harm, and therefore epidemiology is as much about people as about disease.
In her 2008 book “Contagious,” Priscilla Wald coined the term “outbreak narrative” to describe the way we talk about emerging infectious diseases (EID); she argues that concepts such as “Patient Zero,” and “Typhoid Marys” (i.e., healthy carriers) can make a good, comprehensible story out of a chaotic reality, but can actually hinder our ability to fight disease.
Numerous outbreaks throughout history have demonstrated, for instance, that when society hopes that a disease will stay ensconced in some “other” population, humanity creates what I call a “social spillover event.” We saw this with the AIDS crisis in the 1980s: The more some Americans insisted HIV was a disease exclusive to the homosexual population, the more, in fact, it spread, among heterosexuals, blood transfusion recipients and the like. To this day, advertisements about HIV preventative medication predominantly feature gay men, perpetuating the myth that other populations need not worry. But microbes will call our bluff every time. They don’t care about our social strata: A body is a body is a body, and the longer we pretend HIV won’t be a problem for the broader community, the longer HIV has (and had) time to spread.
In the 1880s, the disease of the day was syphilis. Victorians largely believed that only sex workers were responsible for the disease’s spread, not their customers. Acting upon this logic, public health measures regarding syphilis were aimed at this population. Unsurprisingly, more and more unwitting housewives and their babies nevertheless began to show signs of syphilis brought home by husbands who had solicited sex workers. The notion that only some people were prone to an illness allowed syphilis to spread so widely in Britain that many became concerned for the future security of the nation.
In fact, the very widespread acceptance of germ theory itself hinged on debates amongst obstetricians about whether or not doctors might have been responsible for the rampant spread of group A streptococcal infections in postpartum women. As doctors in the mid-19th century refused to believe that male medical authority could be a vector of bacteria, women continued to die. Ignaz Semmelweis tracked this epidemiological data and used it to prove germ theory’s veracity. His name is still memorized by medical students.
Polio, which had been fairly endemic (naturally occurring at low rates) the world over as far back as we have records, began to be framed as an urgent public health crisis when it affected affluent American communities, which helped fuel the development of a world-changing vaccine.
History would indicate that it should come as no surprise that Monday, the World Health Organization director stated that during the previous 24 hours “there were almost nine times more Covid-19 cases reported outside China than inside.”
The great thing about living in a virally networked society in a time of viral outbreak is we have the chance to shape our “outbreak narrative” with intention. Even as scientists, doctors, the World Health Organization and the Centers for Disease Control and Prevention in the United States (among many other entities) are doing their own work to combat the novel coronavirus, listening to the voices of professionals in fields such as bioethics and the medical humanities – many of whom are active and vocal on social media – can help the lay public in the present, not just in historical retrospect, if we learn from these retrospective lessons.
There has been a lot of media focus on the Wuhan wet market responsible for this outbreak. These historical examples of disease should urge us to look equally (and now) at the human factors involved in the spread of coronavirus and the xenophobic fears associated with it, because these beliefs impact disease spread. What affects one of us affects us all when it comes to disease, whether we like it or not.
The WHO and global experts are working to combat this disease in the best ways they know how. In the meantime, the general public also has a role to combat misguided fears that perpetuate and possibly even help spread diseases like this. We live in a global neighborhood with one another and with microbes, and given that context, it might be more useful to ask questions like “How can I help?”
The financial market’s profound upheaval and the sudden and recent overbuying of everything from masks to hand sanitizer seem to be at least in part made worsened by an initial belief that coronavirus was something like a foreign or alien invasion, something from without that could be stopped from within. In fact, our health care system is woefully unprepared compared to other nations’ – and we never were exempt; some of our most xenophobic citizens only acted as though thinking that would make it so. And that itself may have enabled an American passivity that helped the disease to get and spread here to begin with.
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We would do well, then, to learn from history now, so we don’t have to wonder later what we might have done better. Because history has shown us over and over again that only by avoiding our knee-jerk instinct at isolated self-protectionism and instead leaning into the shared risk that we all in fact have in a globalized society, can we more quickly ameliorate the effects of pathogens before they fester and emerge in new outbreaks.