Abstract
Over the past few months the mainstream media has been taken over by the unfolding events of the COVID-19 pandemic, pursuing ever more convoluted strands of what appears increasingly like a Shakespearean tragedy. A myriad of plots, subplots, characters with their strengths, incompetence, peccadilloes and weaknesses, cock-ups and conspiracies, fight each other for column inches across the respectable mainstream media, the tabloids and the newly emerging online media formats alike. These ‘hot off the press’ accounts are the first cuts of history. They will undoubtedly be followed in due course by academic and journalistic analysis, scientific papers and dissertations, novels and films. With some exceptions, what is missing so far are the first-hand accounts and interpretations that have followed previous epidemics, most typically those caused by plague.
Perhaps the most famous account of an epidemic of plague is Daniel Defoe's Journal of the Plague Year, published in 1722 and describing a diarist's experiences of when bubonic plague struck the City of London in 1665. 1 Although this was the plague, rather than influenza or a variant on SARS virus such as COVID-19, the themes described and the impacts on everyday life have strong resonances of London and the rest of the UK in 2020. One of the earliest manifestations was the flight of the wealthy to their country properties, taking the infection with them. Certificates of health were issued to facilitate their passage from the capital and they left behind the poor who experienced the worst ravages of the epidemic.
Defoe comments that there was much speculation on the causes of the visitation that ranged from the rational, focussing on the rapidly growing population of the city with its concomitant overcrowding, especially in the poorer areas, to the fanciful foretelling of disaster by the appearance of comets and stars, together with more mystical, religious and magical explanations. The measures described include what we would now call ‘social distancing’ with pedestrians avoiding too close a contact with households where plague was believed to be harboured.
Much attention is given to the statistical impact of the plague on the mortality rates of the local parishes as measured by the published Bills of Mortality. Of contemporary interest, given the criticism of the published figures of daily deaths from COVID-19, is Defoe's observation that the numbers of ordinary burials, in which the plague was not mentioned as a cause of death, increased substantially from the time the plague first began in the parish of St Giles in the Fields and St Andrew's Holborn. This resonates with the alternative databases currently being proposed for COVID, in particular the value of comparing all-cause mortality, rather than restricting comparisons to those where COVID-19 appears on the death certificate, with that for the same time period over the past five years.
John Barry's account of The Great Influenza is a tour de force by a journalist whose books tackle large historic themes in an analytic, yet accessible way. 2 His other books include Rising Tide: The Great Mississippi Flood of 1927 and How it Changed America. 3 In addition to providing a gripping account of the unfolding of the 1918–1920 Influenza Pandemic from its origins in Texas to its global impact over the next two years, Barry provides a highly educational account of how the United States medical schools moved away from quackery and religion to embrace science and play a central role in the emergence of virology as a key biological discipline, through the establishment of Johns Hopkins University in 1876 – an initiative in which TH Huxley played a key part. The Great Influenza provides especially rich insights into the personalities, characters, strengths and weaknesses of many of the giants of American medicine through close interrogation of their backgrounds and biographies.
Perhaps, however, the most intriguing book that gets under the skin of pandemic and its political and social dimensions is Albert Camus's The Plague, first published in 1947 and never subsequently out of print. 4 It is generally regarded as Camus's greatest work.
Ostensibly based on an epidemic of plague in the Algerian coastal town of Oran, where Camus had lived, The Plague is a novel which describes many of the themes that we are now familiar with having lived with COVID-19 for these past months: vacillation about the calling of the epidemic; conflicts over quarantine and lockdown (with the city gates being locked and policed); the vulnerability of the poor and of those in collective living settings; the pain of separation, of families and of lovers; complacency; the individual versus the group interest, self-preservation; the role of prophecy and of religious congregation in disease transmission; censorship of the press and news management; arguments over the science; the handling of mass death; rows and uncertainty over calling an end to the epidemic.
It's all here and all brought to life through the device of a diarist recording mass observations on life in the town and through the biographies of a group of men whose lives are interlinked, a common thread being provided by the work of Dr Bernard Rieux, caring for the victims of plaque and struggling with his own personal dilemmas. And it is while reading The Plague that the penny drops. For while on the face of it this is a novel about a vicious epidemic, in reality it is an allegory based on Camus's experience of living in France during the German occupation and his being part of the French Resistance.
For the rats that bring the pestilence to Oran are a manifestation of evil that reveal the corruption and inequality of life in the town, the resistance to the plague requiring moral courage to face up to unspeakable crimes that go unchallenged and the need to do and say the right thing in the face of complacency, inertia and social injustice. It is fundamentally a novel about the problem of evil and the existential dilemma of whether we are prepared to do anything about it. After 10 years of deliberate austerity that has undermined the resilience of our health and social care, and public health systems and exacerbated the gross inequality in the country, The Plague speaks as loudly to the UK today as it did to its post-World War II audience when it was published in 1947.
Dr Rieux's thoughts as he listened to the cries of joy around the town when the end of the epidemic was called on January 25th, 194_, are thoughts we should reflect on when our own epidemic finally comes to an end: ‘Rieux recalled that this joy was always under threat. He knew that this happy crowd was unaware of something that one can read in books, which is that the plague bacillus never dies or vanishes entirely, that it can remain dormant for dozens of years in furniture or clothing, that it waits patiently in bedrooms, cellars, trunks, handkerchiefs and old papers, and that perhaps the day will come when, for the instruction or misfortune of mankind, the plague will rouse its rats and send them to die in some well contented city.’