I’m not going to refer to “it”. I have read a hundred emails in the past few days referring to “it.” “It” is frightening for all of us. “It” is affecting every aspect of our life. It is coming across my desk as fear for future financial security. It is also causing people to fight over custody issues where the underlying motivation is, “I need to see my kid and make sure he/she is OK.” And I need it NOW.
Panic is our common enemy and panic comes easy when we are told to stay in our homes and close our businesses. Even I was a bit overtaken by Governor Wolf’s decision to close all non-essential businesses effective at eight o’clock last evening. However, once I passed the shock, I realized that the success of public health over my lifetime has conditioned us to think that we can be cured of almost anything. Our success managing public health crises has led us to expect that we will always be safe.
When not practicing law, one of my avocations is the study of medical history. Perhaps this is of slim or no comfort, but I ask that we pause to consider what our ancestors endured and survived. Truth is that from Philadelphia’s earliest days until the early 20th century, our population was regularly decimated by outbreaks of more than a dozen high communicable diseases. These diseases, including smallpox, malaria, yellow fever, typhus, typhoid, diphtheria and cholera appeared on the streets of our cities and towns on a frequent but irregular basis with devastating results. The Yellow Fever outbreak of 1793 is said to have killed more than 10% of the city’s population of 28,000. The same mortality rate would produce 600,000 deaths in our region today. This was at a time when the city might have had only a few dozen physicians who had any formal medical training, and that training informed them that the best way to treat a mosquito borne illness was with bloodletting and purging. Little wonder that 10% died.
Cholera arrived from India in 1832. Lice borne typhus attacked in 1893 and smallpox killed hundreds of returning Spanish American War veterans returning from Cuba. Again, none of these illnesses was well understood. Meanwhile, tuberculosis was a consistent killer year in and year out.
1918 changed it all. Troops returning from Europe came back afflicted with influenza that may have originated at a U.S. base in Kansas. Again, a corrupt government and a lack of attention to public health allowed the disease to go untreated. Then the City decided to proceed with a public parade to raise bonds for the war. 200,000 Philadelphians stood in close quarters and managed to give the virus all the room it could want. In the ensuring weeks 15,000 Philadelphians died, 5,000 in a single week. If there was good news, the flu departed almost as fast as it came (about five months), but just as we fear today, it morphed into two additional waves elsewhere. Before it exhausted itself in 1920, more than 50 million people died worldwide from what was then called the “Spanish flu.” That’s right, 50 million humans on all continents except Antarctica.
On October 3, 1918, schools, theaters, churches and other public meeting places in Philadelphia were closed. Phone operators were so sick that Bell Telephone allowed only emergent calls. By October 12, there were 1,000 bodies awaiting burial, 500 in cold storage at a brewery. This at a time when there was not a single intensive care unit or ventilator available in a City that was 15% more populated than it is today.
These are dangerous times, but they are small beer in relation to what our ancestors faced. They did so in a time when medicine was still in its infancy. The leading works of the time recommended that the “bowels be opened with calomel or saline draught” and those patients should receive 10 grains of Dover’s powder (ipecac and opium) with hot lemonade. No modern physician would endorse such treatment for flu today. Our access to medical knowledge and treating physicians is exponentially greater than a century ago. Yes, we face danger, but we do so immensely better prepared than any other civilization in history.
Spain is currently in a state of lock down. Each night its citizens are appearing on their porches and balconies and chanting the words: “Viva los medicos.” Indeed.
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