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‘Our’ pandemic and its aftermath

Luis Dias

Exactly a century ago, the world was gripped by another pandemic, the 1918 ‘Spanish flu’ pandemic. No, it had nothing to do with Spain (it was merely reported first by the press in Spain, neutral in World War I (WWI) and therefore exempt from military censorship) just as COVID-19 has nothing to do with China (in your face, Trump!). It had the world in its deadly grip (50 million deaths!) for two whole years. A sobering thought; one hopes ‘our’ pandemic ebbs away a lot sooner, with markedly fewer fatalities.

How did Goa fare in that pandemic? From ‘Health and Hygiene in Colonial Goa 1510-1961’ by Fátima da Silva Gracias, one gets an idea of its impact from the fact that in Siolim (my mother’s village, incidentally) alone, “eight to ten persons died daily. The inhabitants of this territory in panic would run away at the mere sight of a dead body being carried away.” (Is there any residual oral history of those terrible times, or has the link been broken by death and migration?) 

Some considerations resonate even today: the government not acting swiftly enough to implement preventive or controlling measures; “acute shortage of provisions” (due to panic buying by citizens? Or closure of the border with British India? Or both?); directives to refrain from sneezing in public or to use a handkerchief to cover the mouth; funerals held privately; free medicines to the poor at some hospitals; and “free machilas” (palanquins, I guess the ‘flying-squads’ of their time) to the “two physicians in charge of the epidemics”.    

I’ve just finished reading ‘Outbreak: Plagues that Changed the World’, a really gripping book by Bryn Barnard. It looks at six of the most extraordinary pandemic-causing diseases: bubonic plague, cholera, yellow fever, tuberculosis, smallpox and influenza. 

They do have some common features. All of them (except for smallpox which has no host other than humans) co-existed with birds or animals, sometimes for centuries, and at some point, crossed species, with devastating consequences. The crossing-over was either caused, or accelerated, and disseminated, by one or more of the following: poor sanitation and hygiene; overcrowding; all of these reflective of poverty (“the elephant in the room”) and compounded by it; societal upheaval caused by war, fleeing refugees, poor nutrition and famine; and ‘exploration’ (whether motivated by trade or domination) to ‘new worlds’, into forests and habitats that had hitherto been untouched by humans. 

Take bubonic plague: Historically it had “been confined to populations of rats in isolated mountain regions, one in South Asia and the other in East Africa. When human activities like war and trade and disturbed these ancient reservoirs, the plague escapes its natural confines.”    

Furthermore, all of them have left their mark on our world, sometimes for the better, sometimes not. The Justinian Plague (541-542 AD) so weakened the Byzantine Empire that it never recovered. The Black Death (1347-1351) decimated Europe’s population, irreversibly overturning its social structure. But while it raged, Jewish populations were made scapegoats, with horrific pogroms. 

(We have modern-day parallels, of racist attacks on ethnic Chinese abroad and people from the North-East in India over coronavirus).

The third plague pandemic (1894) killed 13 million people and has not really been declared ended, although under control. To quote Barnard, “a global Black Death” is a “remote nightmare”, but “not impossible.” A drop in vigilance and sanitation standards and it could flare up.

Cholera outbreaks are even more directly connected to sanitation and hygiene. Indeed, it catalysed the development of modern sanitation.

Barnard blames the British empire directly for spreading cholera, invading and connecting hitherto isolated areas. 

The lethal cocktail of pathogens (hepatitis, influenza typhus, typhoid, diphtheria, measles, mumps, and smallpox carried by ’explorers’, conquistadores and ‘pioneer-settlers’ from the ‘Old’ World to the ‘New’ was “like the detonation of a biological bomb” (Barnard calls them “virgin soil” epidemics) to a native population with no prior immunity to these, among which smallpox was the most devastating. Barnard terms it the “decisive factor” in the Spanish conquest of Mexico and Peru, the Portuguese invasion of Brazil and the colonisation of the Caribbean.

Conversely, yellow fever became the white colonists’ scourge, but the African slaves brought from across the Atlantic had prior immunity. Barnard remarks how “the same people who had once concluded that Native Americans were inferior because they died from European disease now assured themselves that blacks were suited to slavery because they were immune to yellow fever. The logic of bigotry is a marvellously malleable thing.” The disease crushed the sugar industry in Haiti and hastened its independence. It scuttled plans for the Panama Canal until a cure and vaccine could be devised.

Between epidemics, the virus has found a permanent reservoir in the New World tropical forest, cycling between tree-dwelling monkeys and their mosquito parasites. But each time a tree is cut to clear more land for habitation or agriculture, the prospect of another epidemic increases.

Indeed, an article in this month’s Scientific American reinforces the message: 

Destroyed habitat creates the perfect conditions for Coronavirus to emerge, and COVID-19 may be just the beginning of mass pandemics. Please read it; it should scare us all into action.

Barnard discusses the variolation versus vaccination debate in combating smallpox in Asia and Africa; it reminded me of my great-grandfather Gen. Dr Miguel Caetano Dias (1854-1936) in championing the cause of vaccination in Goa during his tenure as Director of Health Services (1902-1913). That period saw several outbreaks of smallpox, cholera and plague. His energetic anti-plague campaign and sanitation policies earned him the Ordem de Avis and other commendations. 

His eldest son Colonel Dr Vítor Manuel Dias (1892-1949) would do him proud in the same post, culminating in the Saneamento da Velha Goa (Sanitation of Old Goa), combating malaria and other communicable diseases, the exertion of which brought about his own premature death. In terms of outbreaks, Goa seemed to be in a quiescent phase under his watch, in the 1940s.

Barnard reminds of the etymology of quarantine, from the Italian ‘quarantena’, for forty days, the isolation period of plague-infected ships and peoples in Venice, inspired by the forty-day period of Lent. It’s ironic that our own mass home quarantine overlaps so closely with the Lenten season. 

On March 24, World Tuberculosis Day, WHO reinforced its pledge to “ensure no one is left behind” in ending “the world’s largest infectious killer.”

Barnard ends his book with some sobering thoughts. Most wonder drugs soon encounter microbial resistance. The Red Queen (from Alice in Wonderland) hypothesis states that “organisms are constantly struggling to keep up with one another in an evolutionary race between predator and prey species.” It’s counter-productive to think of human health and disease in military terms, as a ‘war’’. In a warfare-obsessed world, we think we can ‘beat’ microbes. “Trouble is, nobody told them.” They’re living beings like us, and adapt for survival over generations. Our generation turn-over is measured in decades, theirs in hours. “In an evolutionary race, they always win.”

What will a post-COVID 19 pandemic world look like? Will it lead to a more equitable social order, at home and abroad? Epidemics have helped abolish serfdom in Europe, and slavery in the New World, but left India’s caste system intact.

Will social distancing persist as an after-effect in a microbe-wary world? 

Will we learn not to mess with nature? Destroy pristine landscapes (driven by logging, mining, road building through remote places, rapid urbanisation and population growth), and the species you are left with are the ones humans get the diseases from. As the Scientific American article warns “We can’t predict where the next pandemic will come from…The only certain thing is that the next one will certainly come.” 

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