Dan Snow's History Hit - How Pandemics Made the Modern World

Episode Date: April 9, 2020

Professor Frank Snowden is currently on lockdown in Rome, experiencing at first hand life in a pandemic. For years he has written about the great waves of disease that swept across the world in the past. Now he is experiencing one. I talked to him about what pandemics have done to us. How they have changed our societies, nudged us towards the present and whether this outbreak might refocus us to give previous pandemics the attention they deserve. For ad free versions of our entire podcast archive and hundreds of hours of history documentaries, interviews and films, including our new in depth documentary about some of the greatest speeches ever made in the House of Commons, please signup to www.HistoryHit.TV Use code 'pod1' at checkout for your first month free and the following month for just £/$1.

Hi everybody, welcome to Dan Snow's History Hit. The weather is trolling us here in the UK, I don't know where you are in the world, but in southern England, looking out over this beautiful stretch of water I've mentioned before, the Solent, the English Channel, the sun is beating down, the water is cerulean blue, hardly a ripple on it, and yet, for the first time in my life, I'm not about to be seen. A tragic, tragic state of affairs. But luckily everyone, we can stay inside and listen to podcasts. I mean, what a fantastic substitute for going outside and feeling

the kiss of salt water against your winter-starved skin. Yep, we've got podcasts. And there's another one we're going to do on pandemics. We've got Frank Snowden. He's an emeritus professor of history at Yale University. He's written beautifully about the effect of disease on history, how it's changed the course of history, how it's shaped our historical journey. He's written about cholera, he's written about malaria, and he's written about the plague as well. He is currently, at the moment, in Rome, under full lockdown, under much tighter conditions than I'm experiencing here in the UK.

So it was interesting to talk to him about that, and how that's changed his view of writing history. If you want to listen to all these back episodes of this podcast, they're all available only, only on History Hit TV. It's our digital history channel. It's like Netflix. You just go over there, use the code POD1, so you get 30 days free. And then you get a month after that for just one euro, dollar, pound, wherever you're logging in from. And then you watch your weight, you fill your boots on great history content. Record numbers of people are doing that at the moment, I guess for obvious reasons. So thank you and welcome to all those people. In the meantime, everyone, here is Professor Frank Snowden. Enjoy.

Frank, thank you very much for coming on the podcast. I'm delighted to be here. Thank you very much. First of all, I should ask, you're in Rome, aren't you? I am. I'm in Rome, Italy at this very moment. And what is the situation there in Rome? The situation is that we're under a lockdown, and the terms of the lockdown are quite severe in the sense that one can go outside only for two purposes. One is to go to an essential job that the state has determined is essential. And the other is to get provisions or medications. is essential, and the other is to get provisions or medications. And you can go only within a few hundred meters of your home, and you have to carry a document printed in advance that says why you're

going and where you're going, so the police can stop you. And if where you are doesn't correspond with where you said you would be, then you're deeply in trouble. So the lockdown really isolates you completely. And there are police vans that go through the neighbourhood saying, stay in your home, stay in your home. Frank, you have written about this for your entire professional life. Even so, does it feel shocking to be caught up in it? Because you must have imagined this many times. Yes, it's a surreal experience to be actually living my work. And that is something I probably no one would quite wish to do under these circumstances, I'm certain. On the other hand, one does have to say that there's at least

a kind of interest in it. And I'm certainly, I'm keeping a journal of what I observe and what I see when I do go outside and what I read in the press about the situation in Rome, confirming it with other people's experience. And so it is interesting. And I've been impressed at the compliance with what the regulations and the sense that people have that they're really in it together, because I get to talk to people in the queues at the supermarket and that sort of thing. And I get to see some sort of improvised demonstrations that people have, not against the regulations, but rather to say we're going to come out of this together. And the local newspaper even wrote a moving article saying this was the first time

in three millennia that the people of Rome had actually been obedient. And that rather seems like what I'm observing as well. In your preface to the new paperback edition of your excellent book, you make the really important point that I keep forgetting, that all pandemics are not accidental or random. Can you enlarge on that? Can you explain what you mean by that? Absolutely. I'm convinced that societies create, if we like to call them, pathways for certain viruses or bacteria to exploit. And the pathways that are created are particular to the society itself. An example, in the industrial revolution, there were enormous cities that were unhygienic, overcrowded, without sewer systems, and all the rest, and that created a pathway, shall we say, for typhoid and cholera bacteria, for typhoid and cholera bacteria, which are transmitted by the oral fecal route. But let's say in modern London or modern Rome, with clear and clean water, with modern laboratories, hygiene, and all the rest of it,

the city is no longer vulnerable to Asiatic cholera the way it was in the 19th century. So we're not vulnerable to that disease, but we've created other pathways. And those consist of our world being nearly 8 billion people and huge cities of millions and millions of people all connected through globalization with fast mass air transport so that there are millions of people, businessmen, tourists, refugees, immigrants, all on the move at once so that a disease that breaks out, say, in Jakarta in the morning can easily be in Los Angeles, Mexico City, or London by the evening. And so this is a very different world, and we're quite vulnerable not to Asiatic cholera, as in the 19th century, but rather to pulmonary viruses because they transmit so easily by the air and they thrive in congested

places where human beings congregate. And they're also generated by profusion, by the destruction of the environment, so that we're destroying animal habitat relentlessly. so that we're destroying animal habitat relentlessly. And so human beings are forced into contact with animals in ways that had never been true in human history before. And so that creates opportunities for these viruses, new viruses, to spill over into a human population that has no resistance, that has no experience to them. And that's the story of Ebola, which came from bats. It's the story also of the coronavirus, which also

emerged from a spillover from bat populations. So it's those situations that create opportunities for microbes to arise in our society. Yes, reading your book, I was very struck by the accounts of how Ebola broke back out in West Africa. That was an extraordinary story about deforestation. Yes, absolutely. What happened was that the spillover occurred in rural areas of Guinea when the bats, the fruit bats, which carried, they're immune, but they are reservoirs of Ebola virus. And the destruction of the forest canopy meant that the bats were displaced. The destruction of the canopy occurred through mining and especially the plantation of palm oil. So it's part of the global world. The forests were no longer remote.

They were integrated into the global economy. The bats are displaced and they lived in the gardens and fruit trees in people's gardens right by their homes. And a four-year-old child went to play in the hollow of a tree. And unfortunately, thousands of displaced bats had nested there. And he breathed in the virus that they were shedding, particularly in their excrement. And he fell ill. And then his whole family fell ill, and then in long chains of transmission, the disease was transmitted throughout the country and to the capital city, and then became large-scale Ebola outbreak. That was the story of the Ebola and its relationship to globalization and the destruction of animal habitat.

This happened again with coronavirus, with bats. In this case, wildlife is brought to bush markets in major cities in China, and those bush markets, the wildlife from the forest or bats, for example, are kept in cages and slaughtered in the market. And the markets are enormously congested. And so there's a great opportunity on these unhygienic conditions for a transmission to a human being. And it seems as though the early victims of the coronavirus were regular shoppers at this meat market in Wuhan in a congested neighborhood. And they took the virus from the market to their communities and it began to spread and spread, as we now know. You've done such a huge survey of these pandemic outbreaks. First of all, is it possible to put a number on the number of global pandemics since, for example, let's go back to the Black

Death in the 14th century? Have you got a number in your head? I actually, I don't. And that's partly because these words epidemics and pandemics are rather arbitrary. The dividing line between one and another isn't all that clear. And in fact, if one goes back in time a little bit, not very far, it was very common for physicians and health officials to talk about a pandemic when they were referring to a disease that seemed to be ravaging everyone in a single community, because it meant Pan, all, and Demos people. So all the people in that particular community were coming down with it. And so they called it a pandemic. So if you take into account that the word is used differently historically, it then becomes particularly difficult.

But also, I don't think anyone can say exactly how many waves there were of bubonic plague over several centuries. I don't think anyone has actually totted them up. And I would be very reluctant to advance a figure. I would just say many, many. Clearly, the mortality is the most striking thing about these pandemics and the immediate healthcare impact and demographic impact. What about the political and cultural impacts of these pandemics? Have these been underrated, but gigantic drivers of the historical process? Actually, one of the things that I find most important, a reason for studying for historians, but for everybody

to study these pandemics, is that they touch every area of our lives so that they become a sort of looking glass that can tell us who we are. And the reason is their enormous psychological impact, because they touch the most powerful anxieties that people have about whether we're going to survive. Will our loved ones perish? Will we actually be prepared for our own deaths? What will the repercussions of that be? They strain our beliefs in an all-powerful, benign divinity who would allow such events to sweep away children, innocent people en masse. They touch our community. How do we maintain relationships in the community? How do we, they touch our economic future.

Are we going to, is the world going to end? Are we going to starve to death? Will we be unemployed when all of this is over? There may be violence spilling out as a result of it. How do we explain the event? Does it fit into our worldview, our scientific ideas, or is it at odds with it? Is this something new that's never been seen before? And no one knows when and if it will end. Will it destroy the entire community? Therefore, it affected politics. It deeply affected culture and the economy.

And so if you look at the landscape of a major European city that was repeatedly scourged by plague, like Venice, you see that every, the landscape, the cityscape, is the right word, of Venice is profoundly changed. What we see in modern Venice is that if you're on the Grand Canal, the main sites that you see are churches that were built in the 17th century to mark the survival of the city and to thank God that the plague had finally passed. And so the cityscape that you see is determined by the plague, the Church of the Redeemer, the Church of San Rocco. Then if you go inside these locations, take the San Rocco, the Grand School of San Rocco,

as it's called, what you find is that the Venetian city authorities commissioned the greatest artist of the 17th century in Venice, that is Tintoretto, to rival the Sistine ceiling by creating a great cycle of plague paintings to decorate this. And so the greatest artistic pieces of 17th century Venice largely reflect this plague experience. Indeed, the gondolas are said to be black because they bore, they were used to bear the bodies of people in the 17th century and dispose of them. So Venice is like this, but if you go across Europe, Central Europe is filled with plague columns. If you look at the art of the period, the whole iconography is saturated with this idea of sudden death and plague. If one sees bones, skull and crossbones, to remind you that life could end suddenly, presumably with plague. Or you see an hourglass with the sands running out, or else you

see a flower that's wilting, and that again is to remind you that the reality is sudden death. Or if one sees Bruegel's paintings, they're about a sort of apocalyptic scenes of the end of the world with the great reaper coming and sweeping everyone away. So the art of the period is saturated with references to these plague aspects, these anxieties that people have about plague, and providing advice, this is religious and moral advice, of what you should do. And there are priests from the pulpit who explained to people how they should prepare to meet their death in time of plague. And repentance was an essential part. And then there were paintings also of who should be there at the time of your death.

So this was very much on everyone's mind. And it would be hard to imagine that it wouldn't be if you had that sort of horrible cataclysm going on. And it's embedded in the art. My bookshelves are full of books in which 17th and 18th century historians talk about the importance of war in building modern states. The fiscal military state, longterm borrowing, funded by taxation, overseen by parliaments, building states that were able to fight war on titanic scale and take over the world and all that kind of stuff. Do you think that we need to think about pandemics in those terms as well? I mean, to what extent are modern states shaped by these pandemic waves that we've been through? Right. That's a very interesting question. And I do indeed believe that we as historians are

probably guilty of focusing only on war in that respect and the rise of the modern state, or not only, but perhaps overly, and ignoring some other factors of which diseases are an important element. Now, I don't want to replace the old narrative, which a new one that says that just diseases provoke the modern state. That isn't my point. I want to say instead that diseases had a very important role along with other causes and that what happened with regard to the rise of the early modern state was that the need to defend large areas, let us say the Republic of Venice or Florence and Tuscany, because there wasn't an Italy, these were the units in which the peninsula was divided, were repeatedly scourged with plague

because they were at the center of the Mediterranean trade routes. And so a port like Venice was always exposed and constantly scourged. And so they began to set up public health measures and those would include such things as the building of a major hospital system, lazaretos, they were called. They also created health magistrates, who are the ancestors of our boards of health or departments of health, and they were endowed with legal authority to take emergency measures. So we see a legal authority with broad powers being created. We see the need for a navy because if you're going to quarantine, and this was another feature, ships coming to Venice were held in the harbor at a special quarantine station for 40 days

because that's what with the biblical were, the importance of 40 days, not because of an understanding of incubation periods. I mean, the Israelites wandered for 40 years in the desert. The Christ was tempted for 40 days and so forth during the Passion. So 40 was a very significant number. And so they impounded the vessel, the passenger, and the crew for 40 days. To do that, you needed a navy because frightened sea captains might well decide that wasn't their idea of what they were going to do for the next 40 days. And you also needed to be able to feed all of these people, and you needed to keep the most recent arriving ship separate from the ones that were already there. So these were massive institutions, and they required a great bureaucracy and taxes. Similarly, you might build military, that is land troops, manning a sanitary

cordon around your city, and cities repeatedly did that. And so you have the need for new authority for public health structures and institutions. You need taxation and all the rest of it. And so this helps to mold the powers of an emerging early modern state. Or to give you another example, it doesn't stop with the end of plague in Western Europe. With, say, Asiatic cholera, the sanitary movement that arose in Britain meant an enormous expansion of the power of the state because the state to carry out those measures needed enormous taxation to retrofit British cities. needed enormous taxation to retrofit British cities. Imagine doing that all over Britain with sewers and clean water. And then they wanted housing regulations that you have to meet certain sanitary standards.

You have to have connections to the house, to the sewer system. You have to whitewash the outside of your house. And so the state is now actually entering the home and regulating it. Now, I'm not saying that this is a terrifying thing. Sometimes this is, I say, the rise of the modern state. People are thinking this is necessarily an authoritarianism. But that was by no means its major effect. It was actually a benevolent exercise of power to organize public health and the protection of people. And so I don't think we should say, for example, that 19th century Britain became heavily authoritarian because it set up a

sanitary regime to protect, to save the lives of millions of British people. I think that was a benign and necessary exercise of power. And the modern state actually is a useful thing to have. It's not simply a matter of oppression. So I think we're grateful in many ways. Our postal systems, our parks, you know, there's so many things that are not authoritarian about it and that one would like to love. Land a Viking longship on island shores, scramble over the dunes of ancient Egypt, and avoid the Poisoner's Cup in Renaissance Florence. Each week on Echoes of History, we uncover the epic stories that inspire Assassin's Creed. We're stepping into feudal Japan

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What about 1918, 1919? I mean, I don't know enough about how enduring were the public healthcare innovations of that period. Well, I think that the 1918 pandemic of influenza, the Spanish flu, created a number of enduring features. Again, this was what I would call a benign exercise of state power. They had lockdowns, they banned, they enforced social disciplining, the wearing of masks, coughing, sneezing etiquette. And so we can see the emergence of a more powerful public health system. And with that, some of the things that we observe today with coronavirus, that during the Spanish influenza, social distancing was practiced. It was large assemblies of people were banned, that church services were banned. Any gatherings in pubs or other places where you might meet groups of other people were also closed, were shuttered during this period. People, as I walk

today down the streets of Rome, on my way where I'm allowed to go, the supermarket, everyone is wearing a mask, and I do too. That was something you'd see in every city in many parts of the world. If you looked at pictures of the city of New York or Philadelphia or Boston, people are all masked. And that was a very important part of the way in which people of the time sought to contain this disease. So I would say these are enduring public health strategies and practices that are being invoked today. And it's not just the Spanish influenza. It goes all the way back to plague. And indeed, plague costumes are rather

like the protective sort of spacesuits that you see people wearing in a modern hospital to protect the health care workers from Ebola or from this coronavirus. So these legacies are part of our culture and they demonstrate, and this is that we talked about how they demonstrate our human nature, and one can talk about how they demonstrate our human nature. And one can talk about the negative side of human nature. And certainly there are many pathologies, witch hunting, pogroms. All of this came about during times of plague and epidemics. But also we see very positive sides. And the use of intelligence, of science, to understand these events, to enable humanity to combat them,

seems to me a wonderful use of human intelligence. And that's part of the story of humans' relationship to pandemic disease. We owe medical science, modern medical science, the germ theory of disease, for example, that's fundamental to it, to the modern biomedical paradigm. And one can't understand its emergence without this background of pandemic diseases. So there is a positive side. There's a silver lining in a very, very dark cloud, is what I'm trying to say. Can I ask, let's finish up now by doing some very recent history. Why were we unprepared for the emergence of COVID-19? in actually shockingly small reasons that have to do with human nature and lack of providence. The most surprising and disturbing statement in the course of COVID-19 so far, to me at least,

was President Trump's statement, how could we have known? To which I would respond that everyone should have known, and it's surprising everyone didn't, that from 1997 and the avian flu pandemic of that year, public health authorities said that the great threat for the future was, in fact, pulmonary virus, viral pulmonary diseases, and that it was essential that the world prepare for them. In 2005, Anthony Fauci, who is now a major figure at the National Institute of Health, testified to the U.S. Congress that it was like this. He said there's an analogy, which is if you live in the Caribbean, the meteorologists will tell you that a hurricane eventually is an inevitable occurrence that you will encounter, but you don't know when it's going to come. The

weather forecasters can't tell you that at a distance, and you don't know how strong the next hurricane is going to be, but it's going to happen. And he said the virologists can tell you that we've created all the conditions for the next pandemic of flu or of another pulmonary virus, and it's going to strike us, and it's inevitable. We don't know when. We know it will be soon, and we don't know how severe it's going to be, but it could be even worse than the Spanish influenza. This was 2005. Similarly, in 2018, the World Health Organization commissioned a study of world preparedness for a new pandemic disease. And what happened was the report came back with a very stunning title, and the title was A World at Risk. The World Health Organization said the world is about soon to be stricken with a new pandemic. We can't tell you if it's next year. It turned out literally to be the next

year. And we can't tell you how horrible it's going to be, but it is going to be a threat that's come. So we must take steps and we must do it now to prepare the world. Now, what happened is that the World Health Organization, Dr. Tedros, its director general, uses an analogy and says human beings have reacted in the years when the warning was sounded in 1997 until now, that is, what, a quarter of a century and more. They've used that time in a sort of feast and famine way. When there is suddenly a threat, then funds are voted and people organize and pharmaceutical companies try to develop vaccines and all the rest. And the world is very concerned. This happened with SARS. It happened with Ebola.

But right suddenly afterwards, people fall victim to amnesia and the funds are cut. And all of the response is dismantled, literally dismantled in the United States. To take that example, it was only in 2018 that the head of the preparedness system in the national security, the person who would be responsible for preparing the United States for this sort of disaster, for this sort of disaster was redeployed. That was Admiral Tim Zimmer, and the staff and structures that were in place were dismantled. And this goes also to a lower level. The state governments in the United States also began cutting their preparedness funds. Pharmaceutical companies stopped making it a priority to develop vaccines. And another feature is that many, some countries, industrial countries even, don't actually have a health system that enables the health authorities to know when a disease has broken out

because people who are poor, who want insured, don't have access to care. And so instead of reporting their illness, they hide it because they're afraid of being devastating cost that will come as an effect. And one can see that playing out certainly in the United States at the moment. And Dr. Tedros again said that one feature of preparedness is that every person on the planet needs to have access to health care. And that's not simply, although it is partly for humanitarian reasons, but in addition, that is a step of enlightened self-interest because what happens to the most vulnerable people in the world will happen to all of us in the time of a pandemic. And so not having an adequate health system that includes everyone means that the sentinels are stood down and the health officials don't know what's actually happening on the ground in communities throughout the world. And the last point I would say is that Bruce Aylward, the Canadian epidemiologist who led the World Health Organization mission to China,

China, that is just a few weeks ago, came back and he was asked the question, what is it that we need to do in order to be prepared as a world? He said, the first essential thing that needs to happen is we need to change our entire mindset. Unless we do that, we won't be prepared. We need to accept science. We need to realize that we have to invest. We have to do that not just now, but on a sustained basis in perpetuity. And if we do that, if we cooperate internationally, if we build healthcare systems, then we can and will be prepared, but we have to be willing to do that and draw the lessons of the past. And quoting Albert Einstein, Albert Einstein said,

one of the marks of stupidity is to continue doing the same thing over and over and expect a better result. Well, we've not been prepared for the various outbreaks of SARS and Ebola and now coronavirus. So are we going to continue to do that? That would seem to me highly unintelligent and very negligent. Thank you, Frank Snowden. Your book is called? It's called Epidemics and Society from the Black Death to the Present. Go and get it, everybody. Thank you very much for coming on the show, and good luck to you there in Rome. Thank you so much. Goodbye now. Hi everyone, it's me Dan Snow. Just a quick request. It's so annoying and I hate it when other podcasts do this, but now I'm doing it and I hate myself.

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