Historians Draw Lessons From Coronavirus Pandemic and Earlier Outbreaks

COVID-19 has many parallels to earlier outbreaks including lack of preparedness, healthcare inequities, and politicization of pandemics, medical historians say.

Medical historians say there are pivotal lessens to be learned from the coronavirus pandemic and previous widespread outbreaks.

The coronavirus pandemic is the worst infectious disease outbreak in the United States since the 1918 influenza pandemic, with each virus claiming more than a half million American lives. There are instructive parallels to be drawn between the coronavirus pandemic and outbreaks such as the 1918 flu, a quartet of medical historians from Michigan Medicine's University of Michigan Medical School says.

Preparation and health equity

Howard Markel, MD, PhD, director of the Center for the History of Medicine at the medical school, says the coronavirus pandemic has illustrated the necessity to prepare for global pandemics in the future.

"We have to be on guard and fix the things that led to this pandemic. This is the worst crisis of our lives, and the biggest collective experience since the Great Depression. If this doesn't teach us once and for all to start preparing for pandemics in the modern world, where an outbreak anywhere can go everywhere, I don’t know what will," he says.

Investing in public health is like investing in public safety, Markel says. "I have a firehouse two blocks from where I live, and I have never called it. But I pay my taxes and I'm glad it's there in case we do need it. That's what we have to be doing with public health at the local, state, national and international level."

Inequity has taken a heavy toll in lives during the coronavirus pandemic and earlier outbreaks such as the typhus epidemics two centuries ago in London, he says. "The poor don't get sick because they're bad or unworthy, they get sick because they're poor, living in crowded conditions, without access to healthcare."

In terms of inequity, history is repeating itself during the coronavirus pandemic, Markel says. "Now we have a different pandemic and what a surprise, the poor are more affected than the wealthy. But what I fear is that like pandemics and epidemics past, the last act of this one will be amnesia, and going back to life like it was."

Parallels to earlier pandemics

There are several similarities between the coronavirus pandemic and the 1918 flu, says Powel Kazanjian, MD, PhD, chief of infectious diseases at the medical school and a medical historian. "A surge of infection that overwhelms capacity is similar with 1918 flu, as is the government downplaying of infection that led to a lack of concerted, centralized guidelines, and the loneliness of social isolation."

Placing personal liberty and economics ahead of public health concerns is common in the history of infectious disease outbreaks, he says. "I am not surprised by the differences in the adherence to social distancing guidelines by individual states, or the prioritization of economy over public health issues—a that has been seen before."

Public health interventions

Public health recommendations targeting behavior such as social distancing and mask wearing proved effective in both the coronavirus pandemic and the 1918 flu, J. Alexander Navarro, PhD, assistant director at the Center for the History of Medicine says.

Public health measures "had a major positive impact on the case count and death toll in those places that implemented them early, used multiple interventions, and kept them in place for as long as possible," he says.

The coronavirus pandemic and earlier outbreaks show the necessity of funding public health, Navarro says. “When budgets are tight, public health spending is low-hanging fruit. That is, until a crisis suddenly pops up and we need to call on a robust infrastructure that has been allowed to crumble."

Pandemic politics

The coronavirus pandemic is generally comparable to the 1918 flu, but the influenza pandemic is not the best prior U.S. example of politicizing an outbreak, says Joel Howell, MD, PhD, Elizabeth Farrand Professor of the History of Medicine and director of the medical school's Program in Society and Medicine.

"The obvious, and most comparable, is the 1918 flu pandemic. But there are lessons to be learned from comparisons as well to the onset of AIDS, especially in the ways that the epidemic was used to justify a set of political and moral beliefs," he says.

Political leaders including members of the Reagan administration targeted the gay community in the early phase of the HIV/AIDS outbreak in the 1980s.

History tells us that there will be more major infectious disease outbreaks, Howell says. "This will not be the last pandemic. We need to be ready for the next one, which could be a lot worse."