What value do the lessons of the past have in shaping strategies for managing the COVID-19 outbreak? In this article, Guillaume Lachenal and Gaëtan Thomas argue that an over-reliance on the allure of ‘pandemic precedents’ needs to be replaced with an enhanced understanding of the capacity of present crises to resist historical interpretation.
“With such a timely specialization, why aren’t you on CNN right now?,” asked a well-meaning individual at a gathering over drinks a few weeks ago, as the conversation inevitably turned to the coronavirus, which still seemed like a far away phenomenon. “What does the historian of medicine think of all this?”, asked another. Feeling at a loss for convincing responses, the historian could only sheepishly predict that health care systems risked being dramatically overwhelmed. The historian’s discomfort, however, was not a symptom of professional reluctance to make predictions, nor a refusal to embrace the authoritative voice of an expert. In this case, the historian simply did not know.
The coronavirus pandemic offered many medical historians a Warholian moment of celebrity – a meagre consolation in these trying times, that we do not condemn or judge. We have witnessed (and taken part in) an avalanche of articles, videos, and online discussions on the ‘lessons’ and ‘guidance’ drawn from the history of epidemics, which can be applied to the COVID-19 outbreak. The current emergency calls for the recollection of ‘urgent pasts’, just as many recent epidemics have spawned comparisons to past illnesses. Think only of the way the HIV-AIDS epidemic and other ‘emerging diseases’ (Ebola, Marburg virus, etc.) during the 1980s and 1990s have been labelled ‘plagues,’ a metaphorical allusion reflected in the title of Laurie Garrett’s bestselling book, The Coming Plague.
In the vast repertory of past epidemics, the novel coronavirus found its chosen precedent: the 1918 Spanish flu. Experts, then, have evaluated the relative merits of stressing analogy, parallels or difference between the two crises. On the one hand, there are pragmatic teachings about the efficiency of social distancing, based for example on the comparative assessment of public health strategies in different US cities in 1918-1919 (see below the now famous St Louis-Philadelphia comparison, adapted from a 2007 epidemiology article). On the other, one cannot miss the long list of differences between two epidemics and two viruses separated by a century of changes in medical knowledge and techniques, global interconnectedness, economic structures, and so on.
But recollection is not a virtue in itself. Analyses based on precedents prove problematic, as they might orient actors towards outdated strategies. Historian Marc Bloch eloquently described this tendency in his book on the French army debacle in the Second World war, Strange Defeat: “[The French military] became the victims of a false cult, and bowed in homage to an incarnation of experience which, just because it drew in so-called lessons from the past, was almost bound to misrepresent the present.” Just like the history of the First World War was the scenario guiding French generals in 1940, the Spanish flu was everything but forgotten in recent years: rediscovered by public health specialists and historians following the “avian flu” and H1N1 epidemics in 2005 and 2009, it has since been an omnipresent reference in the pandemic preparedness scenarios that have guided global health security in the last two decades.
The “lessons of the past” were known by heart and yet it is hard to overstate how unprepared they left us. Clinicians and epidemiologists have recently pointed how the initial framing of the COVID-19 epidemic through protocols inherited from the 2003 SARS epidemic complicated the response, as they were tailored for a virus with rare asymptomatic infections. In the European context, the containment strategy, initially focused on cases of severe respiratory diseases with a history of travel to Asia, delayed the identification of local chains of transmission, such as the Lombardia cluster. It simply couldn’t hold up in the face of coronavirus’ specific dynamic on the old continent. In the realm of public health too, the awareness of the past may only add to the incapacity to understand the present for what it is: that is more a Badiou-ian “event,” characterized by its resistance to any preexisting interpretative frameworks, than the necessary, teleological “plague” our limitless world is said to have well deserved.
In writing medical histories, analogies have led scholars to pursue shared structures and patterns. In 1989, as the AIDS epidemic was expanding dramatically, Charles Rosenberg published an influential article in which he divided the temporal structure of epidemics into three “dramaturgic acts,” based on his reading of Camus’s La Peste. Rosenberg’s three-part sequence – an initial denial of the situation, followed by a collective production of meaning around the outbreak, and finally resignation and obliviousness – is now being adapted by historians opining on COVID-19. One can question the capaciousness of such categorizations and their specificity to epidemics – wouldn’t most large-scale disasters involve such staged responses, as captured so wittily in this sketch from the early 1980s British comedy Yes Minister? Unfortunately, the AIDS epidemic – the very subject of Rosenberg’s article – is still awaiting closure, and its diverse and long drawn out trajectories across the globe undermine any attempt to outline a clean succession in three acts. As historian Dora Vargha put it, in an apt reflection on Rosenberg’s narrative arc, “Endings are often messier than any international, national or local governing body would care to admit, and most diseases do not map onto neat narratives.”
Such pattern identifications are not limited to an analysis of temporality. Historians reinforce other categories, behaviors and archetypal roles that have emerged across the history of epidemics – minority scapegoats vs bigoted majority actors, heroes vs villains, victims vs culprits. Epidemics fuel tensions in society as fear spreads and social vulnerability increases: sick persons face rejection, false accusations of contamination mushroom. However, before their appearance in historical and anthropological studies, it is important to note that these stereotypical scenarios and roles were manifested in the popular media and discourse around epidemics. One needs to account for how these categories became reified, feeding social expectations around epidemics and ultimately shaping the approaches of social scientists who tend to anticipate the demand for a good story.
The current situation deserves something other than a scholarly ‘spot the difference’ game between more or less recent pandemic precedents. There are alternative strategies for enquiring into the uncanny trade between past and present. One might, for instance, track how past outbreaks have shaped the present conditions, landscapes and protocols of our hospitals and cities, and remained embedded in public memory, where they offer an impetus to analogize between epidemics. By contrast, embroidering the present crisis into a quasi-mythical structure of panic and quarantine has the effect of smoothing over the intricate historicity of pandemic events. Historians need to resist the comforts of comparison, which while seeming innocuous, ironically fall in line with Gwyneth Paltrow’s recent Instagram comment, “I have already been in this movie,” referring to her past role in the film Contagion and her present act of being on a plane wearing a very expensive mask, as COVID-19 looms large. No, we have not yet been in this movie. Maybe it is our responsibility as historians to say it. For history, to follow again Marc Bloch, is a science of change and newness. And our greatest peril is “to think late” (“penser en retard”).
This article was originally published by History Workshop on March 30, 2020