COVID-19 and the History of Pandemics

Pandemics are almost always novel diseases; there are no known treatments. In the absence of specific knowledge of how to control and eradicate a potent new disease, weaknesses in communities, government, medicine, law, and other institutions can be revealed as widespread tension builds in and between vulnerable populations.

This course is a look at the past as a way of understanding the present and planning for future. Here, we will examine past examples of transitions in science and medical treatment, innovations in prevention and therapeutics, and developments in governmental methods of disease containment. We will also consider the past as a cautionary tale, noting how inequities, bigotry, and short-sighted approaches to public health can be exacerbated during moments of uncertainty and fear.

How can we build on past lessons without repeating past mistakes?

Learning Objectives

• To understand the difference between epidemic disease and pandemic disease
• To know some of the ways that past pandemics were handled, or mishandled
• To identify ways in which past understandings of disease transmission or medical authority changed and state power changed the way society responded to pandemic disease

The bubonic plague (or “Black Death”) ravaged much of the Mediterranean, all of Europe, West and North Africa, and parts of the Middle East in the 14th century, killing 25-75% of the population.

Plague is a zoonotic disease; in this case the bacterium Yersinia pestis was carried by fleas who fed on rats, who then introduced it to humans. Once infected, characteristic inflamed lymph nodes called buboes appeared on the body, accompanied by high fevers and the spewing of blood.

Lacking scientific knowledge, the best analysts of the 14th and 15th centuries suspected the bubonic plague was caused by the environmental condition of “bad air,” astrological alignments, or that it was a divine, if wrathful, response to collective human sin.

Bubonic plague still exists today, but with the advent of modern medicine, can be treated with antibiotics and supportive care.

This course delves into the factual history of the Black Death, and at the same time frames the crisis as a way of understanding how broader societies and cultures shift, survive, and evolve.

Learning Objectives

• To provide an overview of origins, causes, and effects of the Bubonic Plague in late-15th century Europe
• To think about the origins and effects of the pandemic within the context of late medieval culture

You probably know someone who still bears the scar of a smallpox vaccination—a symbol of standard 20th century public health practice until the 1970s, when this deadly disease was eradicated worldwide.

Although preventable by means of inoculation, there is no treatment for smallpox, which is caused by a virus, and is spread through direct contact with someone who is infected, or though exposure to contaminated objects such as bedding.

Symptoms include high fever, body aches, and a rash that covers the body with pus-filled blisters that turn into disfiguring scars in those who survive. Archaeologists have found smallpox rashes on mummies from the 3rd century BCE. Other depictions of outbreaks have been recorded in various civilizations worldwide ever since.

This course will lead you through the history of smallpox, from its effects on the American Revolution through other major outbreaks, and through the joint efforts of global health leaders to eliminate the disease completely.

Learning Objectives

• Determine the mechanisms for transmission of smallpox, the methods of containment used by humans, and how humans eliminated the disease
• Evaluate how the lessons of the global fight against smallpox could be utilized by policymakers today to fight COVID-19

Yellow fever is a viral, hemorrhagic disease transmitted by the female Aedes mosquito and is endemic to the tropical regions of Africa and the Americas. 80% of people infected will show no symptoms, while the other 20% exhibit symptoms including jaundice, bleeding, kidney disorders, and coma.

The World Health Organization estimates that 30,000-60,000 people die of yellow fever every year. Vector control—eliminating sources that support mosquito reproduction—and vaccination are key in preventing this disease, as there is no cure.

This course explores the history of the yellow fever in Africa, its passage to and effects over time in the Western Hemisphere, including the United States, and what we can learn from efforts to confront and contain the disease.

Learning Objectives

• To understand the nature of yellow fever and to gain some appreciation of its historical importance, in particular, in the United States
• To learn about some of the social and cultural responses to yellow fever epidemics, including those of the public at large, of medical caretakers, and of the business communities
• To understand how its cause was discovered and what some of the consequences of that discovery were
• To apply all of this to a better understanding of the coronavirus and COVID-19 and apply that understanding to a response to the current pandemic

Until the early nineteenth century, cholera was limited to the delta of the Ganges and Brahmaputra Rivers in India. This rapid-onset disease, caused by the bacterium Vibrio cholerae, was much-feared for its ability to inflict agony and humiliation—victims were gripped by vomiting, uncontrollable diarrhea, extreme dehydration, and oxygen deficiency—before causing death, often within a day.

British colonization of India, religious pilgrimages among members of various Indian sects, and the advent of long-distance transportation combined to initiate the spread of cholera throughout the rest of the world, leading to seven successive cholera pandemics, beginning in 1817 and still existing in modern times.

In this course, you will study specific cholera outbreaks, see the trajectory of public and cultural perception of the disease over two centuries, learn about the crucial role of sanitation and its proponents in mitigating the disease, and explore how inequality of resources leaves certain populations, governments, and economies vulnerable in its wake.

Learning Objectives

• Identify the mechanisms of transmission of cholera and how doctors came to understand the epidemiology of this disease
• Account for the discrepancies between the ways that scientists, public health authorities, governments, and the public at large understood and therefore responded to cholera
• Evaluate how nineteenth-century responses to cholera could provide both positive and negative models for policymakers today to combat COVID-19

The influenza outbreak of 1918 began for victims as a set of familiar, seasonal flu-like symptoms: high fever, body ache, and cough. But those infected suffered a new set of alarming symptoms as well: severe headaches, bleeding from the nose and eyes, and cyanosis, a distressing lack of oxygen signaled by blue lips and fingertips. Some patients coughed so violently they tore abdominal muscles. Autopsies of the dead revealed more: blood on the brain, damaged kidneys, and lungs that were said by World War I surgeons to look like those of soldiers who had suffered gas attacks.

The Centers for Disease Control and Prevention report that the 1918 flu, an H1N1 virus of avian origin, is estimated to have infected about one-third of the world’s population, and to have killed 50 million people worldwide.

This course will lead you through the three waves of the global influenza infection (Spring 1918, Fall 1918, and Spring 1919), reveal the role of the military in the spread of the disease across the globe, review therapeutics available and protocols implemented at the time, and document how corrupt politics and government mismanagement especially harmed vulnerable populations already struggling amidst the crisis.

Learning Objectives

• Understand what caused the 1918 pandemic, how it spread in different countries and communities, and the effects of different policies on the spread of the virus
• Learn the ways in which historical contingency—the war, political leadership, medical knowledge—shaped the way the influenza pandemic played out in 1918
• Examine the successes and failures of containment in 1918 and draw conclusions about effective policy for today

In January of 2020, following confirmation of thousands of new cases of novel coronavirus infection that were first noticed the previous month in China, the World Health Organization declared “a public health emergency of international concern.” The epicenter of the outbreak was Wuhan, a Chinese city with a population of more than 11 million. There, in an effort to contain the spread of the virus, authorities cut off travel and access into and out of city. In the United States, President Donald Trump’s administration restricted travel into the U.S. by foreign nationals who had recently been to China.

The beginning of February saw the first death from the coronavirus outside of China. Soon after, the disease caused by the virus was named COVID-19 (a neutral acronym for “coronavirus disease 2019”), and cases could be found worldwide.

What followed in the U.S. and around the world was a domestic, economic, and political upending never before seen in modern times as millions of people were infected with COVID-19 globally, hundreds of thousands died from the disease, and, as tens of millions lost their jobs due to government-imposed lockdown measures, economies ground to a halt. As societal inequities were revealed, tensions among various groups rose, with pockets of negative sentiment directed at people of Chinese and Asian descent, who some unfairly targeted as being responsible for the crisis.

This course is designed to familiarize you with the experiences of Chinese people and Chinese living in the United States during the COVID-19 pandemic and to present you with some of the responses of the Chinese Communist Party (CCP) to the pandemic as it unfolded.

Learning Objectives

• Appraise the response of the CCP in response to the COVID-19 crisis
• Compare the response of the CCP to that of other pandemics throughout history
• Based on information extracted from this course, outline components of a model approach that countries could apply to the COVID-19 crisis