Three lessons from 355 years ago
New cases of the novel coronavirus in the US are nearing the peak, record unemployment filings continue to rise, and cabin fever is rising as well. It is clear that these competing forces are pulling policymakers in different directions. Lawmakers are taking the temperature of the nation as they assess whether to err on the side of protecting the economy or public health. Americans are weighing economic pain against the risks of re-opening too soon. Let’s put these decisions into perspective by examining the lessons from the Great Plague: the last large scale outbreak of the bubonic plague (a.k.a. “The Black Death”) in England from 1665-1666.
There are of course a great many differences between then and now: COVID-19 is nowhere near as deadly as the Black Death; our understanding of diseases and how they are spread is much improved; and we now have Zoom. Nevertheless, some things are universal: human nature has not changed, and both diseases have confronted us with choices about the management of contagious diseases in a free society. In this post we review the top three lessons we need at this point in the Covid crisis from the Great Plague, drawn from Daniel Defoe’s The Journal of the Plague Year.[1]
1 House the sick separately.
Most Americans, including those who develop Covid-19 symptoms, live with others. People who care for ill family members or housemates – or who simply share space with them – run a high risk of infection. There have been some calls to relocate those who are sick, but not at the point of needing hospital care, from shared home-living situations.[2]
There have been negative reactions to this idea at least in part because of how this goal was achieved in Wuhan, where the sick were compelled, sometimes forcibly, to shift to mass quarantine camps.[3] But there are more humane approaches which should be on the table. We should look to the voluntary separation model which effectively reduced transmission within London households during the Great Plague.
Following a smaller outbreak of the Black Death a few decades prior to the Great Plague, the Privy Council recommended that mass internment houses for the sick (called “pesthouses”) be used as a strategy for reducing spread of the disease.[4] Indeed a few such facilities were in operation during the Great Plague. Not only was transmission reduced, Defoe describes pesthouse patients as having received quality care leading to a higher likelihood of recovery. Most relevant for our current Covid-19 context is that patients went to them voluntarily. City officials understood that their society would not tolerate the forced separation of family members:
The magistrates found it proper on several accounts to treat them with lenity and compassion, and not with violence and terror, such as dragging the sick out of their houses or obliging them to remove themselves, would have been.[5]
In a free society, this is a more fitting exemplar of sequestration than the mandatory model used in China.
2 Don’t venture out to top up your non-perishable food stores with fresh foods
With nearly all Americans under stay-at-home orders, making trips out for essentials such as groceries is one of very few permissible reasons for leaving the house. Limits on the number of essentials trips have not been imposed, so while the spirit of “essentials only” guidance is to limit such trips, in reality those who are inclined can go out for groceries at least weekly and still be in compliance. But each trip out is an opportunity to be exposed to the virus or expose others.
Defoe infers that such trips for essentials were the primary channel through which the plague continued to spread. Trips for essentials made by those who either had not stockpiled enough food at home, or were unwilling to go without fresh meat, “brought abundance of unsound people to the markets, and a great many that went thither sound brought death home with them.”[6]
Today, stores are closing early for extra cleaning, but with unanswered questions about the spread of the virus, and many shoppers in some places wearing neither face masks nor gloves, stores’ precautions may be insufficient. This was the case in the time of the plague. Defoe points out that Londoners similarly took considered precautions to protect themselves when out for essentials or selling them:
[I]t is true people used all possible precaution. When any one bought a joint of meat in the market they would not take it off the butcher’s hand, but took it off the hooks themselves. On the other hand, the butcher would not touch the money, but have it put into a pot full of vinegar, which he kept for that purpose. The buyer carried always small money to make up any odd sum, that they might take no change.[7]
But those measures, which are comparably strong to some of the precautions we take shopping today, were inadequate. Those who stayed healthy and safe were those who had stored up enough to eat for at least a month and avoided exposure almost entirely. As we are learning that as much as 50% of novel coronavirus transmission takes place by the day the first symptoms appear[8], avoiding stores which are frequented by the sick, and those soon to be, is still a key component of how spread will be reduced. So when you are next out of tomatoes, rather than braving a trip to the store, crack open that tin of beans. Resolve to “suffer the hardship of living a few months without flesh-meat [or fresh tofu], rather than to purchase it at the hazard of our lives.”[9]
3 Don’t drop precautions as we pass the peak.
We are approaching the peak of new Covid-19 cases in the US, but we have not passed it yet. Nevertheless, beaches have already reopened in Florida. Despite the warnings of public health experts that being past the peak will not mean that we are out of the woods, there is a perception, or for some a determination, that the peak is the green-light for a return to normal life. A similar tension played out during the Great Plague. At this same minute-past-peak point during The Great Plague, many people also had the same strong drive to rush back to normalcy, and acted on it. Woefully, Defoe describes how despite strong admonitions from physicians, Londoners threw off their social shackles and every precaution, joyously jumping back into pre-plague life:
The audacious creatures were so possessed with the first joy and so surprised with the satisfaction of seeing a vast decrease in the weekly [mortality], that they were impenetrable by any new terrors, and would not be persuaded but that the bitterness of death was past; and it was to no more purpose to talk to them than to an east wind; but they opened shops, went about streets, did business, and conversed with anybody that came in their way to converse with, whether with business or without, neither inquiring of their health or so much as being apprehensive of any danger from them, though they knew them not to be sound.[10]
Defoe points to this behavior as the reason the initial decrease in deaths was itself short lived. Reopening society too early led to a second resurgence as many of those who had survived to that point then fell victim to wishful thinking. Astonishingly, during that reopening period the weekly plague death toll which so encouraged everyone was still more than 1000 Londoners; what better demonstration could there be for the power of psychological anchors in our judgments of acceptable risk.
Conclusion
These three lessons do not offer us entirely new options. But they provide a glimpse at how those who faced similar choices fared with the direction they took. When arguments for and against the continuation of our social distancing measures swirl around us daily with increasing force, by looking at relevant histories we can gather relevant data points about how our choices may play out.
Sarah Polcz is a CLB fellow.
[1] Daniel Defoe, A Journal of the Plague Year (2010). First published half a century after the Great Plague, in 1722. While the perspective of Defoe’s narrator is commonly regarded as fictional, the general characterizations of events and attitudes described by Defoe have been often supported by the historical record (see F. Bastian, Defoe’s Journal of the Plague Year Reconsidered, 16 Rev. Engl. Stud. 151–173 (1965).
[4] See Kira L. S. Newman, Shutt Up: Bubonic Plague and Quarantine in Early Modern England, 45 J. Soc. Hist. 809–834 (2012); and Paul Slack, The Impact of Plague in Tudor and Stuart England (Revised edition ed. 1991).
[10] Id, 194-195.