A Plague on all Our Houses!

In Shakespeare’s play, Romeo and Juliet, a central theme is the feud between two families, the Capulets and the Montagues. The two lovers are from opposing families – Romeo being a Montague and Juliet a Capulet. In the third act Juliet’s cousin, Tybalt fatally stabs Romeo’s friend Mercutio. As he dies Mercutio utters the curse, “A plague on both your houses!” But of course our current plague (of sorts) is not that discriminating. So I have enlarged Tybalt’s curse as my title for this essay!

In a previous essay I related how the bubonic plague made its way to Europe from China via the famed “silk road”. In the face of the coronavirus pandemic I thought it might be useful to examine some of the history of group illnesses, how they have evolved and what their devastating effect has been on human progress.

Infectious diseases are fashioned by the principles of evolution just as human development is. Germs and viruses rely on successful replication for their flourishing just as humans do. It is no surprise then that those conditions in which human populations have thrived have also provided fertile ground for the development and spread of infectious diseases. In particular, when human populations moved from hunter/gatherer societies to agricultural societies, which resulted in higher population densities, the evolution of new diseases substantially increased.

Hygiene and sanitation (or the lack thereof) were two of the main factors contributing to the development crowd diseases.

Hunter/ gatherers lived in relatively small communities, typically of less than a hundred. Whilst they defecated reasonably close to their living sites their exposure to diseases and parasites emanating from human faeces was relatively restricted due to the fact that they regularly moved camp following game and seasonal availability of various fruits, seeds and edible roots.

On the other hand agricultural communities were larger and locked into fixed locations where there was fertile soil. This means that those early agricultural communities lived surrounded by human waste. Not only was disease promulgated by their close proximity to each other in unsanitary conditions but it was easy for faecal material to find its way into drinking water. Often the problem was exacerbated by the fact that they spread their faeces and urine as fertiliser in the fields where they worked. Because agricultural crops were seasonal, farming communities survived by storing the produce from harvest to tide them over the rest of the year. Disease was also often spread by rodents who were attracted to the farmers’ stored food.

It has been conjectured that life in the early agricultural communities was in fact harder than in the hunter/gatherer communities. Hunter/gatherers had a more varied and healthier diet than their agricultural contemporaries and they did not have the same exposure to the various, hideous diseases that arose from living in close proximity in unsanitary conditions. And early agricultural and pastoral workers were compelled to work longer hours to make a living than hunter/gatherers.

So, infectious diseases catapulted off the growing populations with their absence of sanitation. But they were also given another boost by the development of world trade routes. Diseases that once evolved in a specific location and infected local populations now had the opportunity to spread more broadly.

By Roman times, as I have previously written, the populations of Europe, Asia and North Africa had, by the agency of trade, been joined into one vast breeding ground for microbes. The bubonic plague decimated Europe as a result of these connections closely followed by smallpox.

Of course before modern knowledge of the transmission of disease evolved there was no understanding of how the various diseases might be thwarted. Humans blamed disease on bad air, malicious demons and angry gods and did not suspect the existence of bacteria and viruses. People readily believed in angels and fairies, but they could not imagine that a tiny flea or a single drop of water might contain an entire armada of deadly predators!

Our ignorance of infectious diseases resulted in many tragedies.

One of these was the Spanish conquest of the Mayas of Central America.

On 5 March 1520, a small Spanish flotilla left the island of Cuba on its way to Mexico. Yuval Noah Harari in Homo Deus relates how the disaster transpired.

The ships carried 900 Spanish soldiers along with horses, firearms and a few African slaves. One of the slaves, Francisco de Egula carried on his person a far deadlier cargo. Francisco didn’t know it, but somewhere among his trillions of cells a biological time bomb was ticking, the smallpox virus. After Francisco landed in Mexico the virus began to multiply exponentially within his body, eventually bursting out all over his skin in a terrible rash. The feverish Francisco was taken to bed in a house of a Native American family in the town of Cempoallan. He infected the family members, who infected their neighbours. Within ten days Cempoallan became a graveyard. Refugees spread the disease from Cempoallan to nearby towns. As town after town succumbed to the plague, new waves of terrified refugees carried the disease throughout Mexico and beyond.

Within two months a third of the population had perished.  When the fleet arrived in March 1520 it was estimated Mexico had a population of 22 million people. By December the numbers had been reduced to 14 million.

As trade routes opened up and explorers discovered new lands, the opportunities for the spread of infectious diseases multiplied.

For example when James Cook reached Hawaii in 1778, he found a densely populated island with an estimated population of a half million people. But interaction with Cook’s crew and subsequent visitors exposed the sheltered population to influenza, tuberculosis, syphilis, typhoid and smallpox. By 1853 there were only 70,000 survivors.

But it wasn’t just the increase in population density and poor sanitation in agricultural societies that resulted in infectious diseases it was our close proximity to animals as well that led to so-called crowd diseases.

In his ground breaking book Guns, Germs and Steel Jared Diamond made the following connections between human diseases and animals:

Measles – cattle

Tuberculosis – cattle

Smallpox – cattle

Influenza – pigs and ducks

Pertussis (whooping cough) – pigs, dogs

Falciparum malaria – birds

The population of the New World was decimated by the introduction of European infectious diseases. Archaeologists have estimated that when Columbus reached the Americas in 1492 there were perhaps 20 million indigenous inhabitants. Within a century or two that population had declined by 95%. In exchange the only significant infectious disease returned to Europe from the New World was syphilis.

Australian aborigines suffered likewise from introduced European diseases.

The chief destroyers of these previously sheltered populations were smallpox, influenza, measles and typhus.

Europeans exploring and colonising Asia and Africa however, because of the high population density in some places on those continents, didn’t have it all their own way and they were forced to contend with malaria, cholera and yellow fever which were endemic in those areas.

So it seems that we have been assaulted by various pandemics for millennia. Today they might be more frequent because of the mobility of our population, but they are generally not as severe because of our enhanced knowledge of biological transmission and immunology.

The bubonic plague was a huge threat to human life and resulted in an unprecedented mortality rate.

In more recent times the so-called “Spanish Flu”, which arrived in Europe in 1918 but spread rapidly around the world killed an estimated 50 million people or more! World War I “only” killed 40 million people!

So as people became more mobile, infectious diseases were able to spread more rapidly. It is interesting that our response to the coronavirus has been to close our borders, attempting to restore the isolation that naturally protected us in the past.

But things have changed in other ways. With a greater understanding of the transmission mechanisms of such infectious diseases we have promoted “social isolation” which severely curtails the virus’s capability to propagate. Yet in doing, so we have removed most people from exposure to the disease. Broader exposure of the general population to pandemics eventually results in “herd immunity” where the immune system of survivors has evolved to resist the particular disease.

Our isolation strategies don’t confer such immunity and as a result the population at large can only remain safe by avoiding contact with carriers of the disease. Most of the developed world has relied on isolation strategies to thwart the virus which still leaves the population vulnerable to subsequent exposure. That is of course until such time that a vaccine is developed. Although many researchers are working on a vaccine there is no guarantee that one will be developed within a reasonable time frame.

To my mind it is inconceivable that we should isolate ourselves until such time as a vaccine is produced. Whilst I wouldn’t advocate completely abandoning social isolation, it is, I think time to back off this authoritarian intervention and restore some freedom of choice and pursue a more pragmatic approach to the pandemic.

Being well into my seventies, I am one of the vulnerable age group. I believe I am sufficiently in charge of my faculties that given good information I can make reasoned decisions about how to limit my exposure. It is of no great moment for my wife and I to plan our menus for the week such that we only need to go to the supermarket once a week (and gladly avail ourselves of the senior’s hour at 7:00 am). But we don’t want anyone to have to go to the trouble to shop for us. We like to go for our morning walk early in the morning and pick up our newspapers without feeling guilty about being outside our house. It works well enough for me to go down to the bottle shop once or twice a week to replenish my wine supply. (Before the pandemic I would walk down more frequently and just grab a bottle or two because it is only a ten minute walk and got me out of the house!) So that amount of social isolation I can manage without feeling unduly restricted. I do however feel unduly restricted when I can’t have my son, daughter-in-law and grandchildren come to dinner. My wife feels unduly restricted because she can’t visit the library and take out a few books even though when she’s there hardly a handful of people share the space with her. Our local coffee shop has resorted to just selling takeaways. We would sometimes walk down and lunch there.  The clientele are hardly so burgeoning so as to make social distancing impossible. There are many other examples I could give where I think our restrictions are unduly conservative and we are killing small businesses as a result.

Sure the statistics suggest we need to be careful of how we manage people of my age group and older. The coronavirus death statistics are overwhelmingly of older people. It would seem that it doesn’t pose an undue threat to those less than sixty years of age. But we need to be careful that in sheltering the more vulnerable from exposure to the virus we don’t propagate a greater disaster. The extreme measures we have taken to shelter the vulnerable elderly is putting such a dampener on our economy that we have put many younger people out of work. Now that might sound a reasonably insignificant outcome – but it is far from that. Many who become unemployed might spend years on the dole queue. Some will become suicidal, suffer depression, commit domestic violence, and succumb to alcohol and drug dependence and so forth. So in closeting a demographic nearing the end of their lives we could well be visiting a far greater disaster on our society.

The extreme measures taken by governments to enforce social distancing were probably necessary to begin with. But as we work our way through they are now bordering on authoritarian and paternalistic.

Surely, most of us are reasonably aware of the risks that confront us. There are many regional areas with no indication of coronavirus infection. Why not let them go back to work? By all means educate them on how to minimise the risk of infection by appropriate use of social distancing and rigorous sanitisation.

More generally the government needs to be especially aware of the needs of small business. Surely it is not beyond the wit of our small businesses to manage their enterprises safely. After all these are the ones with most skin in the game. It is all very well for health department personnel and police officers and others to pontificate about public safety when they are in secure government employment. If the government persists much longer with the lockdown, many small businesses will go to the wall and their owners will not only lose a livelihood but quite often their houses as well having mortgaged them to the bank to secure capital. And don’t forget a goodly percentage of private sector employment comes from small business.

And surely the police force have more productive things to do than to move people on in public parks for sitting alone and sunning themselves, or sitting on a park bench to eat a kebab. And what likelihood is it that someone fishing at the end of a pier or judiciously distancing themselves whilst playing a round of golf or borrowing a book from the local library will reinvigorate the pandemic?

We have trusted our governments to come up with strategies to protect us from the worst of this pandemic. Perhaps it is time that they should trust us (given sound advice and guidance) to re-engage with the world.

It could be argued (and it is an argument that I could personally accept) that the coronavirus was a potentially deadly epidemic and the world (and more particularly, Australia) has been largely saved from its potential horrors by swift acting governments (with some notable exceptions). But the longer we lock up the economy the bigger the price we will have to pay. And unfortunately that price will be largely paid by the younger generation.

Now as a result of that early intervention COVID-19 presently affects a minuscule fraction of the world population. It can’t begin to be compared with the devastation wreaked by the Bubonic Plague or the Spanish Flu. To date cases of infection by the virus worldwide have killed a hundred thousand or so out of a world population of nearly 8 billion people. In Australia, where our current population is a little over 26 million, with a death count of 70+ people we have had to deal with a fatality rate of less than 0.0003%. Whilst any death is tragic, it can be readily seen that our coronavirus response could soon become disproportionate at great economic cost with diabetes, heart disease, obesity and cancer providing a greater risk of mortality in the general public than COVID-19.

4 Replies to “A Plague on all Our Houses!”

  1. During the recent Queensland Local Government election, I understand over 40% of the voters voted early (not postal votes). That means they physically went to a pooling booth, personally wrote on a piece of paper and placed it in a ballot box. In the context of this pandemic, most polling booths could be described as confined spaces.

    No one contracted Covid-19. No staff. No members of the public. No Politicians or their helpers. Whatever measures they put in place worked.

    There must be lessons we can learn from that experience that we can apply to overcome the massive social and economic problems we are also currently also facing.

  2. Ted
    I agree with the thrust of your argument. The authoritarian approach has the usual “one size fits all” fabric which does not credit us oldies for our sense or experience. Like you as children we navigated both polio and dengue fever epidemics. Also my wife and I have lived in places where malaria is endemic and visited places where rabies and hemorrhagic dengue were endemic We survived it all. Surely our experience enables us to reschedule our lives so that we can both meet the requirements for stopping the spread of diseases while maintaining good safe social interactions as well as maintaining our mental health without being locked in our homes.

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