The verdicts are now coming in. In Mark Honigsbaum's updated edition of The Pandemic Century, he has included a new chapter on COVID-19. As a historian of epidemics, he offers his judgments about how countries have responded to what he calls “China's Chernobyl moment”. His critique is sharp. For decades, we have known that the world is intrinsically and increasingly vulnerable to pandemics—and yet, “we failed to heed the warnings about Covid-19 and act when our actions could have prevented the outbreak from spinning out of control”. Observing China's reaction, Honigsbaum has “a new-found respect” for how the Chinese Government responded so decisively. By contrast, “the British government has…been too slow to follow China's example” He condemns “the hubris of populist politicians”, but also “the complacency of scientific ‘experts’”—“the government's scientific advisors were not listening”, he suggests. The result? Time was “squandered”. And so, “thousands of lives have already been lost, not due to our lack of knowledge—we have had plenty of warnings—but because of our collective failure, abetted by complacent politicians, to take those warnings sufficiently seriously and to prepare for the pandemic that virologists and other experts told us was coming our way”. Yet we need to go beyond verdicts. We need to consider the possible consequences of this pandemic for our societies. Once again, the past may be a useful guide. Laura Spinney has written the definitive history of the 1918 influenza pandemic, Pale Rider: The Spanish Flu of 1918 and How It Changed the World (2017). She argues that this pandemic, which killed as many as 50 million to 100 million people, left humanity transformed—influenza “resculpted human populations…ushered in universal healthcare…accelerated the pace of change…[and] helped shape our modern world”. The vast number of deaths also precipitated new waves of xenophobia—eg, against Germans, Italians, and Chinese. Governments were accused of not doing enough. As were scientists. An intellectual crisis ensued. There was a striking gap between the extravagant claims for 20th-century medicine and “the dismal reality”. The sense of scientific and medical failure led to a growth in alternative medicine, back-to-nature movements, spiritualism, and new prophets for a post-influenza age. Tensions arose over the interests of communities versus individuals. Those born during the pandemic became “a diminished generation”. Smoking rates increased. A new era of research into the control of viral diseases was born. Virology and epidemiology were established as respectable disciplines. Attention was drawn to those who seemed most vulnerable—victims of poverty and inequality, and those who were malnourished and living in poor housing. Public health was embraced with new political energy. Momentum for socialised medicine grew. “Health became political.” Indeed, health became a measure of the modernity of a civilisation. Spinney even suggests the pandemic brought an end to World War 1 and influenced, adversely, the Versailles peace process. National independence movements were strengthened in India, Egypt, and Korea. The pandemic triggered a “psychological shift” towards pessimism, irony, and absurdity. Art turned to the classical and functional. Positively, and paradoxically, societies thrived after the influenza pandemic subsided. The 1920s saw a period of flourishing economic growth. Why? Spinney speculates that the pandemic left behind a smaller but healthier population. Fertility rebounded. COVID-19 isn't influenza and its human consequences, so far at least, have not been as severe. But we can be sure that COVID-19's effects will be profound and long-lasting. How profound and long-lasting will be up to us. One of Honigsbaum's central arguments is that “the tendency of medical researchers to become prisoners of particular paradigms and theories of disease causation…[blinds] them to the threats posed by pathogens both known and unknown”. And, “it would be a mistake to think that simply knowing the identity of a pathogen and the aetiology of a disease is sufficient to bring an epidemic under control”. Despite these pleas for more modesty, he concludes his survey of pandemics with the comment that, “It is to be hoped that, after Covid-19, no one will be foolish enough to make the same mistake again”. But, as his magnificent history proves only too well, it seems to be characteristic of human behaviour that, indeed, we are foolish enough and we will repeat our mistakes.
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