Coronavirus pandemic | Your ancestors knew death in ways you never will

A chart famous among epidemiologists and produced by New York City's health department is titled "The Conquest of Pestilence in New York City." The chart tracks and explains deaths in the city from 1805 to the present. (New York City Department of Health and Mental Hygiene via The New York Times)

Donald G McNeil Jr.

Nearly 140,000 Americans have been lost to the coronavirus, and many experts fear that the deaths will only accelerate in the fall as cold weather forces us indoors. By year’s end, half as many Americans may have died as did in the four years of World War II.

And yet we are still arguing over how to prevent this — each state struggling over how much lockdown to impose and what its governor can make its citizens do.

“You know the five stages of grief — denial, anger, bargaining, depression, acceptance?” asked Dr Emily Landon, a coronavirus expert at the University of Chicago medical school. “I think the American people are in all five of them — but different parts of the country are in different stages.”

As death stalks us, especially our elders, have we simply become inured to the idea that many of us are doomed?

The stock market appears to have priced in a huge wave of deaths. In the 2008-2009 recession, it fell 50% and took four years to recover. In March it fell only 34% and has made up much of that ground already. Looked at with Wall Street’s bloodless arithmetic that makes sense: Most of the deaths are among the very elderly and nursing home residents, who no longer travel or dine out or contribute much to the economy, and who are a burden on the struggling Medicare and Social Security Trust Funds.

One can even argue that the acceptance of death as master of us all is part of the human psyche. But because of modern medicine, we have been out of touch with our ultimate fate for generations.

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We’ve all heard of the Black Death and perhaps the Plague of Justinian, events that may have killed up to a third of mankind and rewrote the fates of empires. They seem lost in the mists of time.

But not that long back, our great-great-great-great-grandparents felt the omnipresence of death in ways we will never know.

There is a chart famous among epidemiologists titled “The Conquest of Pestilence in New York City.” Produced by New York City’s health department, it tracks and explains deaths in the city from the early 1800s to the present day.

At first glance, it looks innocuous, like the ups and downs of the Dow Jones index. But the longer you stare at the fine print, the more horrified you become.

This past March, before coronavirus cases began to mount, the annual death rate in New York City was about six per 1,000 New Yorkers. The virus’s first wave added about 2.5 more deaths per 1,000 to that baseline. By contrast, from 1800 into the 1850s, deaths in the city rose in a relentless series of epidemic spikes, year after year, with only brief respites in between.

The annual baseline back then was about 25 deaths per 1,000 New Yorkers, and in some years the toll reached 50 per 1,000. In other words, in bad years, New Yorkers saw twice as many people around them die as usual. And they were used to seeing about four times as much death as we now do.

The sharpest peaks were the cholera epidemics of 1832, 1849 and 1854. But plagues came in waves, sometimes more than one simultaneously: yellow fever, smallpox, measles, scarlet fever, diphtheria, typhus and meningitis.

Other than cholera and typhus, most of those were childhood diseases that adults were immune to because they had survived them, so the chart is a parabola of parental grief, each spike another nail in a hundred small coffins.

The death rate began dropping after the 1860s. New Yorkers — both citizens and doctors — had finally stopped arguing and reached consensus on some basic issues.

First of all, most finally accepted the “germ theory” of disease, acknowledging that it was caused by invisible enemies, not by swamps, trash, manure or the other nuisances that underlay the “miasma theory,” which held that bad smells caused disease. (Only a century earlier, Americans had given up on the “humors theory,” which posited that disease was caused by imbalances among blood, urine, sweat and bile that had to be rebalanced by bleeding, sweating or purging.)

They also agreed that whether immigrants had brought some diseases or simply suffered from them, no one was safe until everyone was safe, so they made public health universal.

As a result, New Yorkers took certain steps — sometimes very expensive and contentious, but all based on science: They dug sewers to pipe filth into the Hudson and East rivers instead of letting it pool in the streets. In 1842, they built the Croton Aqueduct to carry fresh water to Manhattan. In 1910, they chlorinated its water to kill more germs. In 1912, they began requiring dairies to heat their milk because a Frenchman named Louis Pasteur had shown that doing so spared children from tuberculosis. Over time, they made smallpox vaccination mandatory.

Libertarians battled almost every step. Some fought sewers and water mains being dug through their properties, arguing that they owned perfectly good wells and cesspools. Some refused smallpox vaccines until the Supreme Court put an end to that in 1905, in Jacobson v. Massachusetts.

In the Spanish flu epidemic of 1918, many New Yorkers donned masks but 4,000 San Franciscans formed an Anti-Mask League. (The city’s mayor, James Rolph, was fined $50 for flouting his own health department’s mask order.) Slowly, science prevailed, and death rates went down.

Today, Americans are facing the same choice our ancestors did: We can listen to scientists and spend money to save lives, or we can watch our neighbours die.

“The people who say ‘Let her rip, let’s go for herd immunity’ — that’s just public-health nihilism,” said Dr Joia Mukherjee, the chief medical officer of Partners in Health, a medical charity fighting the virus. “How many deaths do we have to accept to get there?”

A vaccine may be close at hand, and so may treatments like monoclonal antibodies that will cut our losses.

Till then, we need not accept death as our overlord — we can simply hang on and outlast him.

c.2020 The New York Times Company

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