From Black Death to COVID-19: Science Advances, the Fear Remains

Pandemics elicit consistent human behavior – hysteria and fear of others

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Home Team Science & Technology Agency (HTX) scientists demonstration the test process of their coronavirus test kit at their laboratory in Singapore, March 5, 2020.
Home Team Science & Technology Agency (HTX) scientists demonstration the test process of their coronavirus test kit at their laboratory in Singapore, March 5, 2020.Credit: EDGAR SU/ REUTERS
Anat Georgy
Anat Georgy
Anat Georgy
Anat Georgy

Shortly after the outbreak of the bubonic plague in Europe in 1347, the Mongols, who controlled the Crimean Peninsula at the time, decided to exploit the pandemic to make further conquests. So when they besieged the city of Caffa, they threw the corpses of their own comrades who had died of the plague over the city walls.

It was effective: The fleas that carried the bubonic bacteria rapidly migrated from the dead to the living and claimed many victims. Today, it is considered the first-ever use of biological warfare, noted Dr. Yochai Wolf in a 2017 article published by the Weizmann Institute’s Davidson Institute of Science Education.

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The bubonic plague, also known as Black Death or the Black Plague, broke out in the middle of the 14th century and served as a gruesome example of the speed with which plagues can spread around the world.

“Although the Black Plague took place long before the era of globalization, it was global and moved from country to country by means of travelers and traders moving across the Mongol empire,” says Prof. Aviad Kleinberg of Tel Aviv University, an expert on the Middle Ages and the author of the (Hebrew-language) book “A Short History of the Medieval West.”

The plague broke out in China. Traders transmitted it via the Silk Route to the Crimean Peninsula and it continued into Constantinople and the shores of the Mediterranean Sea. From Italy, it progressed north deep into Europe, reaching as far as Greenland.

The consequences of the plague were catastrophic: Within 10 years of its outbreak, one-third of Europe’s population had died. “Entire cities were emptied, entire villages were wiped out,” Kleinberg says. An estimated 35 million people died.

The plague changed the face of the global economy. “The waves of Black Death and the tremendous loss of human life, which affected all strata of the population, demonstrated that no one was immune to the disease – not the clergy, not the nobles and not the simple people working in the fields,” says Prof. Moshe Feinsod of the Technion School of Medicine. “It triggered a weakening of the social order, and essentially destroyed feudalism. The value of the worker increased. Although the worker would subsequently be suppressed once more, it was different from the institutional system that had been practiced until then.”

According to Feinsod, shortly before the plague erupted, there had been a brief economic and cultural renaissance in Europe, with growing trade and the establishment of universities in northern Italy. But the Black Death left entire areas of Europe desolate.

“Everything was devastated,” he says, “and there was a need to reorganize, at a level that was slightly more progressive and liberal. This was one of the cornerstones of the Renaissance, which began in the 15th century.”

Man and women with the bubonic plague with its characteristic buboes on their bodies, Medieval painting from a German language Bible of 1411 from Toggenburg, Switzerland.Credit: Everett Historical

Blame the foreigners

“Every 100 years or so, a great plague attacks humankind,” says Prof. Shifra Shvarts, who specializes in the history of medicine at Ben-Gurion University of the Negev. “Some of them are particularly lethal to humanity; others less so.”

One of the examples she offered is the Spanish flu epidemic that struck at the end of World War I. “A great hysteria seized the world, the effects of which persisted even after the epidemic was eradicated,” she says. “But there was ample justification for that, because tens of millions [worldwide] had perished.”

Strangely enough, the consequences of the Spanish flu were never fully investigated. “The Spanish flu may have killed tens of millions of people, but it broke out as World War I was ending, following the horrific massacre of Europe, and was therefore thought of as an appendix to the war,” says Feinsod. “It’s only in recent years that scholars began to study it as a free-standing event, along with its implications.”

Several decades later came the AIDS epidemic, which emerged in the late 1960s and has taken the lives of some 25 million to date. It is still prevalent in parts of Africa. Then came the flu epidemic that began in Hong Kong in 1968, which killed tens of thousands around the globe within a two-year period.

Children attend ballet lessons wearing masks to protect themselves from severe acute respiratory syndrome, SARS, in Hong Kong, April 27, 2003.Credit: Vincent Yu,AP

For the most part, the plagues of the 21st century have been less lethal than their predecessors, but they nevertheless evoked widespread media attention, partly due to their economic consequences. For instance, the SARS epidemic in Asia, which began in November 2002 in China’s Guangdong Province, spread rapidly to other countries but disappeared by June 2003 after claiming just 774 victims. The bird flu and swine flu are two recent epidemics.

“In every pandemic, global economic activity is also damaged, especially now, when there is practically no such thing as a local economy anymore,” says Feinsod. “The extent of the harm is a function of the intensity of the damage – how many workers cannot work – and also a question of the media.”

“Due to globalization, you can see how a case that began in China can in very short order cause a panic run on toilet paper in Australia.”

While the coronavirus was limited to a single province in China, the world knew nothing and everything stayed normal. “The moment that it receives huge press coverage around the world, you see economic and social phenomena that conjure thoughts of Black Death,” he says. “Due to globalization, you can see how a case that began in China can in very short order cause a panic run on toilet paper in Australia.”

According to Shvarts, the common thread between all of the large-scale epidemics is that they were global and caused widespread hysteria. “At present, there may be more knowledge,” she says, “but the public still goes into a panic, primarily when it doesn’t know what’s happening and what can be expected, and when the medical system can’t offer concrete solutions.”

Spreading faster

Nadav Davidovitch, an epidemiologist and public health physician who is a professor of health systems management at Ben-Gurion University, says that while epidemics have been transmitted from one country to another in the past, globalization has changed their speed and scope. “It’s particularly significant when a new strain which we have no knowledge about is spreading,” he says.

“Black Death spread through the world on boats,” Feinsod adds. “From the moment that a boat weighed anchor in a city, the bacteria spread at the speed at which [passengers and sailors] could walk. The more humankind advances, the greater the rate of dissemination, so when a virus in a remote region emerges, like SARS in Manchuria, all it takes is a single airplane for it to spread rapidly.”

“Epidemics go hand in hand with globalization, and spread from place to place via trade and tourism routes,” Wolf wrote in his article, noting not just Black Death but also the numerous diseases like smallpox and measles that Europeans brought to the New World.

Today, contagion is faster and easier than ever. As an example, Wolf points to AIDS: The virus passed from apes to humans in Cameroon as early as the 1920s, reaching the Congo. With the development of railroads in the 1960s, it quickly spread throughout the country. In 1967, it was exported to Haiti, and from there to the United States and on to the rest of the world.

A boy lies on a bed as he recuperates from dengue fever at a hospital in Hodeida, Yemen, January 21, 2020. Credit: ABDULJABBAR ZEYAD/ REUTERS

At present, asserts Wolf, the viruses that are causing the most trouble to human beings are those transmitted by mosquitoes, especially in the developing world. He says that the combination of limited research budgets for diseases that aren’t found in wealthier countries along with the more modern, effective routes of dissemination makes it more difficult to wipe out these diseases.

Globalization is not the only factor that links all of these epidemics; public hysteria is another. It has disturbing social implications. “In the spread of epidemics, you can see expressions of xenophobia, such as labeling population subgroups or seeking scapegoats,” says Feinsod.

In some cases, Shvarts agrees, the pressure leads to marginalized communities becoming scapegoats. This was the case during the Black Plague, when Jews were accused of poisoning wells and spreading the disease. As a result, thousands fled Western Europe to the east to escape the anti-Semitism that arose in the wake of the plague.

“I don’t think people are necessarily looking for guilty parties. They are first and foremost seeking explanations,” says Kleinberg. “There were places where Jews or lepers were accused of causing a disease, but in large parts of Europe there weren’t any Jews and the plague nevertheless spread like wildfire.” Customary explanations were that it was the spread of poisonous vapors or a punishment from God. “The Jews were the subjects of only a small share of these interpretations,” he says.

Kleinberg adds that there was no organized search for a scapegoat, but in nearly every case where the ruling authority doesn’t functioning properly, racism rises to the surface and people exploit the opportunity to rob and murder.

The global hysteria also has economic consequences. Even if the future of the coronavirus pandemic is not yet clear, it is already an example of this: Within only a few weeks, the global aviation and tourism industries have collapsed, and many businesses in other sectors are showing strains.

A subway customer uses a tissue to protect her hand while holding onto a pole as COVID-19 concerns drive down ridership, New York, March 19, 2020. Credit: John Minchillo,AP

Uncertainty will pass

“So far, only a few thousand have died worldwide,” says Shvarts. “Most of the anxiety derives from uncertainty, which will dissipate as soon as things become clearer or an immunization solution is found.”

Kleinberg, who spoke to Haaretz from quarantine, which he had been placed under since returning from Rome a few days earlier, agrees with Shvarts. He says the bubonic plague had several facets, some of which were extremely violent. The coronavirus is different. “In the Black Plague, anyone who was infected with the virus, in 99% of the cases, he or she would die. In the case of the coronavirus, one’s chances are practically the reverse: As of now, 98% of patients will recover.”

So how is it that the whole world is in a state of hysteria? The answer, Kleinberg says, may be found among those who are profiting from the situation. “The hysteria is guided from above, perhaps due to the righteous motives of those dealing with the issue, but it could be that there’s a complex system of narrow interests at play. The moment that the virus is declared to be of abiding importance, the resources for finding a remedy are unlimited.”

Netanyahu as he tells Israelis they should cover their mouth with a tissue when coughing, during a press conference on March 11, 2020.Credit: Ohad Zwigenberg

Kleinberg agrees that hysteria builds on the knowledge that no one has control over their risk of contagion: “You can be standing next to someone who looks perfectly fine, and it turns out that he’s a carrier who’s now infected you. Lack of control produces anxiety.”

He offers the example of traffic accidents. Every day, people in Israel die due to traffic accidents, but no one has died from the coronavirus. Yet no one would think to stop using a car to avoid an accident. When drivers go on the road, they believe they have control over their driving, whereas they have no control over being infected with the coronavirus.

“An epidemic is seemingly just a matter of definition. It’s classified according to the number of persons infected with it and the severity of their disease. But the commentary on it, and how it will affect society changes, varies in accordance with the acquisition of tools for dealing with it,” says Davidovich. “When it comes to the coronavirus … you have to bear in mind that our conditions of existence are much better than in the past, in terms of sanitation and the separation of water from sewage.”

Davidovitch says that the spread of an epidemic such as this one was predictable – “We’re inadequately prepared, and the international health regulations assume that.” The reason, he says, are the conditions that contribute to creating epidemics of this sort, like the environmental changes and the increased contact between animals and humans, which cause the transmission of viruses. In this instance, the virus was initially found in bats.

The spread of an epidemic such as this one was predictable – “We’re inadequately prepared, and the international health regulations assume that.”

“The big difference between epidemics in ancient and modern times is the large body of knowledge that’s been amassed about the source of the diseases,” Wolf says in his article. “This provides humankind with the ability to develop ways of contending with them, such as immunizations, antibiotics and improved hygiene. In the Western world, diseases such as tuberculosis, which used to claim many victims, have been greatly constrained thanks to antibiotics and improved sanitation, but they continue to be highly lethal in poorer countries.”

Additionally, Wolf argues, the establishment of institutions such as the UN’s World Health Organization enables global oversight of epidemics as well as treatment. Globalization has had positive effects, not just negative ones, on the spread of diseases. Other organizations such as the American Centers for Disease Control deal with the outbreak of diseases on a national scale. Such institutions did not exist in previous centuries.

Nevertheless, Wolf claims that a serious new danger lies in epidemics created by biological weapons. “Many countries maintain viruses and other generators of diseases for military applications,” he writes. “Accidents in the course of which such weapons find their way into the outside world have already occurred.”