Pandemic arguments have echoed through the ages

Progressive reformers called for more social investment, libertarians warned against state paternalism. Those who deviated from the scientific consensus were marginalized and pilloried, while journals such as The lancet denounced their ideas as ridiculous and dangerous.

This was the story, not of Covid, but of cholera that swept through Europe in a series of waves in the 19th century. Starting in India – where it was probably endemic – it spread to British soldiers and from there around the world, one of the unintended consequences of imperialism and early globalization. A first wave in 1817 never reached these islands. A second reached Great Britain and then Ireland in 1831.

The hardest hit town on those islands was Sligo, where a 14-year-old girl, Charlotte Thornley, witnessed unimaginable horror. She survived, moved to Dublin, married a man named Stoker and they had a son, Bram. Charlotte’s bedtime stories about an evil that came as a mist from the east would infect Bram’s imagination and reappear in his novel years later. Draculaas historian Marion McGarry has shown.

Cholera returned in 1848 and again in 1854. By then, a firm scientific consensus had emerged that it was somehow associated with the foul air — or “miasma” — that developed in cities and towns as a result of appalling sanitation. In London, then the largest city in the world, “nightsoil men” had the (well-paid) job of emptying sewers and carting the city’s human excrement out of the city, but most people could not afford their services. Sewers and cesspools overflowed, sewage flowed into the streets. Fixing this became one of the main causes of the great Victorian reformers.

A city-wide sewage system was started. But where did the waste water go? the thames And where did Londoners get their drinking water from? the thames In fact, cholera was not an airborne “miasma” like Covid, it was mainly spread through contamination of drinking water. The reformers’ best intentions and progressive ideas probably prolonged the cholera outbreaks in London.

A rare voice to rebel against this ‘miasma’ consensus was John Snow, the son of a Yorkshire laborer who managed to train as a doctor. Snow had built a successful medical practice pioneering the use of ether and chloroform for pain relief. This experience with gases made him skeptical of the idea that cholera was airborne (after all, cholera primarily affected the intestines, not the lungs).

Snow conducted a series of groundbreaking data collection and analysis exercises that showed that cholera must have spread through the water supply. He is known to have traced a local outbreak in Soho to the Broad Street water pump, where the John Snow pub now marks the location. But the consensus was so ingrained that it took at least another decade—and another cholera wave—before the scientific, medical, and political institutions finally accepted that cholera was a waterborne contagion.

I became interested in the story of John Snow early on in the pandemic. With my other hat on, as a playwright I was looking for a way to write about Covid without writing about Covid and I had the idea of ​​writing a play in the midst of the cholera pandemic of the 1850s, about the competing theories of cholera and how it should be fought. This game, miasmais featured in a short series of rehearsed readings at Dublin’s Richmond Barracks next week, produced by theater company ANU.

History plays are never just about history – they’re always about today. When today’s problems are too close to see clearly, history can provide a lens that allows them to be seen more clearly. That Richmond Barracks was recently a Covid vaccination center should underscore the resonance between the story of cholera and that of our own pandemic. Three elements of John Snow’s story stand out to me today.

1. The use (and misuse) of data

Snow argued that the common factor in the cholera deaths in Soho in September 1854 was water from the Broad Street pump, and he managed to have the pump’s handle removed. It is ironic that this has become the myth of the origin of epidemiology, since Snow’s data were incomplete and his analysis hardly reliable. In fact, it was a large-scale survey of London water company customers correlating with cholera deaths that gave him the conclusive data he needed. Still, the establishment was unconvinced, preferring a competing analysis that found a correlation between cholera deaths and atmospheric conditions.

In retrospect, Snow’s work appears heroic while that of his opponents looks like malpractice, but neither science was robust and most was done in good faith. That we now see Snow’s opponents misled by confirmation bias and groupthink should give us little comfort that we can guard against these weaknesses in our own time. As we put distance between ourselves and Covid, we need to come to some understanding of the role lockdowns play in our safety and should play in any future pandemic. Snow would recognize the mantra we should bring to this debate: Correlation is not causation.

2. The false promise of certainty

There are two levels of uncertainty that cloud many debates about science. The first is the irreducible uncertainty of many sciences (like climate science); The second is the added uncertainty that arises when science is simplified for public use and discussed by laypeople.

The certainty with which 19th-century scholars held supposedly scientific ideas about miasms is ridiculous today. This should give us a break when we’re commenting on complex topics on Twitter.

3. The risk of misinformation

In a revealing Twitter thread, architect and Covid commentator Orla Hegarty traced the origins and spread of a piece of what she called “misinformation” – a misinterpretation of some data from the HSPC that led to an Irish news story with a misleading headline then turned around traveled the world, including in the quotes British Medical Journal (BMJ).

Hegarty’s anecdote is a warning to all of us in the media to be careful about how we use dates and what we quote. Some would see it as evidence of the need for greater restrictions on “misinformation”, but that is not the case BMJ itself became a victim of precisely such restrictions. Overzealous fact-checking by a Facebook contractor resulted in a being restricted from sharing BMJ Story (about bad practices in a vaccine trial).

So there are dangers both with too much content moderation and with too little. Snow provides a useful guide to which is the greater evil. Had there been content moderation and censorship of misinformation in his day, Snow’s work would have been targeted.