Pandemic

A few key features, like location, infectivity, symptoms, and susceptibility to treatment, together predict the nature and trajectory of an illness among the bodies of its hosts and victims. Alongside a streaming ticker of joke-no-joke headlines, the newly viral game Plague Inc. throws each of these variables into play, allowing you to put strategy to the service of a pathogen whose goal is to kill off humanity. What is that smudge of DNA thinking and trying to achieve by leapfrogging among the bodies it sickens and sometimes kills? Where is it going and why? These are questions we put to characters in fiction and now, it seems, to viruses — with fewer answers but more repetition.

When the events of the last few months sent me looking for outbreak stories, I found I was following the same carefully plotted saga with the same key events, over and over again, in the daily news, in the history books, on TikTok, and in weird plague novels. (Once, I opened the Washington Post app on my phone and, awash in coronavirus updates, felt as if I were playing another round of Plague Inc.) In each story, the antagonist is a pathogen but also the evil of incompetence, and the heroes — well, they are as diverse as cities and bats, and as numerous and frail as we are.

We’re currently living out what may yet become a chapter or a footnote in the next edition of Mitchell L. Hammond’s engaging new textbook, Epidemics and the Modern World. A history professor at the University of Victoria, Hammond follows major contagious illnesses in a roughly chronological order. Each chapter accompanies its biography of a disease with one section filled with relevant primary documents and another focused on science (a happily detailed account of DNA extraction from corpse teeth is a highlight).

Hammond recounts how epidemics have often strained the command of governments, aided rebels, and both stifled and fomented change. Yellow fever, for example, “served as a virus ex machina that enabled the Haitian Revolution.” Local names for syphilis often referenced other places, which “reflected a universal desire to label the pollutant as foreign.” So it goes still: for a while, coronavirus was latched to Wuhan, and, though that city has since left centre stage, racism and fear are still dampening business in Chinatowns around the world. Hammond examines the link between statistics and epidemics, illustrating how the dogged counting of William Farr, the nineteenth-century British epidemiologist, had a decisive impact in combatting cholera. The very idea of an epidemic denotes a story that progresses from beginning to end — and the more you read about mass illnesses, the more repetitive it becomes.

Despite the local character of epidemics (an ancient Greek word connoting “back home”), contagion shows us the connection between worlds at every scale, from personal to global. An outbreak tends to highlight the prowess of a nation’s wonks or turn their incompetence into tragedy, while there is something bureaucratic about the relentless processing power of a nasty bug. Hammond quotes Halfdan Mahler, the former director general of the World Health Organization, who once explained that smallpox eradication was “a triumph of management, not of medicine.”

While disparities in the wealth of nations are a “key dilemma of global health,” varying degrees of social control may also affect outcomes. The more speech is suppressed to prevent awareness of an outbreak, the more that outbreak spreads — a political condition that is costing lives this year. As a destructive influenza circled the world in 1918–19, it seems to have met tacit resignation more than public commentary. Although this silence may have been a strategic effort to suppress news of weakness in wartime, a New York Times editorial from November 1918 offers another explanation: “Courage has become a common possession, and fear, when it exists, is less often expressed than ever before.”

It’s hard to imagine anyone writing this line today. Noisy fears are now our common possession, and there is no world war to distract attention from unlikely threats — at least not yet. Indeed, panic is one of the epidemics we face: many terrible histories are masked by the pointed tip of vaccination, the locus of terror for so many parents because they have no concept of the worse horrors it purges. Smallpox killed some 300 million people in the twentieth century (many more than wars). And we still see high mortality rates from other familiar illnesses: 1.6 million people died from ­tuberculosis in 2017, malaria killed 435,000 people the same year, flu causes 300,000 to 600,000 deaths annually, while cholera continues to kill 100,000. These numbers don’t tend to make the news.

It’s the unknown height of a new virus that causes dread as we search for meaning and predictions. When the risk of mass contagion rears its rodent-like head, it reminds us that the end is nigh — indeed, as near as the place where the sickness started. Suddenly, under illness, the world strains to focus on a city made famous by affliction. If you had looked up Wuhan on Twitter and TikTok in the early days of the crisis, you might have found strange, unruly images like foreshadows of a place under threat. State media accounts of daily life in Wuhan glistened with sick sweetness, and nothing on social media could be verified. Yet the promise of an eyewitness account, unrestricted by authoritarian rule, was too tantalizing to forgo, because reports from the borderlands of quarantine update our calculations of mortality.

A venerable answer to this craving, Daniel Defoe’s 1722 A Journal of the Plague Year purports to be an eyewitness account of the 1665 epidemic in London, but it is more properly understood as well-researched fiction. Weak on structure, it occasionally gives itself over to lists of numbers, mortality by the week, by the street, tallied up and parsed, as though (and I think we believe this still) counting could neutralize the threat of the incomprehensible. That the book is largely a collection of anecdotes about individual deaths makes it a most accurate depiction of an epidemic, which above all makes a series of people drop dead who otherwise might not have. There is no single story arc to follow when the hero and the antagonist are both one little microbe infecting thousands — but still we hunt to dispel unknowing.

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Early in the present outbreak, every time I heard of Wuhan and strove to learn more about it, I would think of Oran, the coastal Algerian city whose “ordinariness is what strikes one first” in Albert Camus’s The Plague. If novels uncover the mystery of individual characters, this one uses illness and the frame of quarantine to reveal the character of a city. Once the town has been closed and, as in Wuhan, its residents cower indoors, Camus describes how “silence, sunlight, dust, and plague have the streets to themselves” — words to caption photographs of vacant avenues in China. In its emptiness, Oran, too, looks like a place on holiday, lapsed into a state of torpid irony. The residents feel exiled to live only in the present, consigned to a dream world where their very neighbourhoods bespeak a cordoned-off past and an uncertain future.

Camus’s novel itself has always been anachronistic: the antibiotic cure for plague was released the year it was published, 1947, and the disease never infected Oran to anywhere near the degree the author imagines. Rather than a fictionalized historical account, the book is more legible as an inquiry into the moral consequences of contagion and the limits of shared feeling within its circle. The townsfolk “act as if they had no feelings as individuals,” and “no longer were there individual destinies; only a collective destiny, made of plague and the emotions shared by all.” In The Plague, as now, “this calamity was everybody’s business.” One character even suggests “the one way of making people hang together is to give ’em a spell of plague.” Is this also true when the community under threat is a global one, beset by what seems like a medieval level of racism and mistrust? Another character, bent on escaping throughout the book, finally realizes plague has made him part of Oran, “whether I want it or not.” Now with all the little daily windows we can open onto everywhere else, it’s harder to know whether we’re part of something, and harder to feel separate.

Oran is laden with eyewitnesses to its disaster, and, just as we now have countless casual reporters on social media, most of the characters in Camus’s book are writers of some kind. The secret narrator, Dr. Rieux, pushes officials to acknowledge the plague and provides us with a truth-telling counterpart to a hero of the present crisis, the ophthalmologist Li Wenliang, who raised an alarm about the coronavirus among his colleagues in December, before being silenced by Chinese authorities and eventually succumbing to the illness himself. Camus’s Rieux bears witness as he selflessly attends to his patients while his wife dies of tuberculosis outside the walls of the quarantine. He knows “his task was no longer to cure but to diagnose” and dispense information. Eyewitness, grim reaper, and, above all, registrar, he laments that he exists only “to detect, to see, to describe, to register, and then condemn.”

Plague reduces Rieux’s medical abilities to counting, and indeed, the outbreak breeds a sudden and new interest in vital statistics in Oran. He obsessively checks a dying child’s pulse so as to feel he is accomplishing something, while another character complains, “The only thing that’s left us is — accountancy!” Camus suggests that habits of numbering differentiate the value of human and animal lives: unlike dogs, he writes, “men’s deaths are checked and entered up.” (After Australia’s wildfires this year, horrific estimates emerged of more than a billion animal deaths, suggesting that attitudes to tallies may have shifted.) The strongest signal that the epidemic is waning is when the weekly numbers “showed a decrease.” Numbers are the main indices of an epidemic. Then as now, every change in quantity — eighteen countries more, so many hundred deaths, fewer cases this morning — is monitored like the precise height of a fever and used to diagnose the span of contagion.

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Numbers of deaths are not the only statistics to watch, however, as maladies also infect economies. “Commerce, too, had died of plague,” writes Camus. Today, coronavirus is both an economic ailment and a human illness, as the whispery word “recession,” a sound to hush children or the sick, starts growing louder. Now that the global market risks stalling due to an outbreak of disorder at a neighbourhood one, the borders between scales of human exchange begin to falter. As Defoe writes of London’s markets in plague time, “a great many that went thither Sound, brought Death Home with them.” Hammond, drawing upon the work of Robert Peckham, of the University of Hong Kong’s Centre for the Humanities and Medicine, illustrates the questions pandemics raise: “What is a ‘global event,’ and how can we describe the interaction of local circumstances with forces that influence the whole world?” For those concerned about China’s slow reaction to a few illnesses possibly tied to Huanan Seafood Wholesale Market, this question resonates.

Epidemics make infected landscapes newly distant and, once they broach the confines of an individual’s body, all too local. The rise of germ theory, Hammond explains, meant that “now the cause of disease was located within the human body rather than an unhealthy landscape or atmosphere,” while tuberculosis fostered a belief that has become entrenched, “that an alignment exists between self-control, good health, and effective social membership.” This link grows stronger in every nervous shuffle away from fellow subway riders who cough, and Camus’s description of public transit illustrates what it’s like to take the bus these days: “The passengers all try to keep their backs turned to their neighbours, twisting themselves into grotesque attitudes in the attempt — the idea being, of course, to avoid contagion.” These gestures seem like desperate attempts to confirm individuality just as an outbreak is revealing our common frailty.

Costume, too, puts up hopeful boundaries around individuals. As the people of Oran go to the opera, “evening dress was a charm against plague,” while medical workers speaking through face masks resemble “a colloquy of statues.” As Hammond puts it, “Images of protective suits and face masks symbolize medical authority and government intervention against epidemic diseases.” In this era of mass mobility and disinformation, photographs of people in haz‑mat suits can be circulated as tokens of both a legitimate response to illness and its opposite, a falsification, while costumes become another wager against the unknown, another ritual practised for salvation.

In Edgar Allan Poe’s parable “The Masque of the Red Death,” outbreak trolls and taunts us and ridicules us for the hope we store in costumes and other trinkets. To escape the Red Death, a lethal illness ravaging the country with bloody lesions, Prince Prospero self-quarantines in a castle that holds a cruise ship’s worth of pleasures. He hosts a masquerade to celebrate nothing more than decadence, but the Red Death shows up dressed as itself. Empty inside, the outfit is bait that, taken, kills everyone.

Poe quotes that New Testament prediction of the subtlety of apocalypse in describing how the Red Death arrives “like a thief in the night.” No theft but of life, in the case of a microbe, the infiltration alone, the trespass against the body, is the sum of the crime. Prospero’s masquerade is now duplicated in the crowds of people wearing ineffectual masks, which medical workers actually need but which are worn by regular folk for a feeling of magical protection and to show social conformity. These outfits set up personal boundaries to match quarantines and the walls going up around nations. As borders and buildings close around the world, they mirror efforts to costume away disease, as though by closing off the seams of a nation we could plug ours, too, and every border crossing by mouth, by nose, by sea, or by land.

Defoe’s observations of sick people roving the streets, or his suggestion that quarantine backfired by encouraging infected people to flee, or Hammond’s point that mobility brings medicines as well as illness — all could be excerpts from a hist­ory of today, as we hear of medical workers dying due to a run on prophylactic supplies, of people being turned away from hospitals (and even tests) or flouting quarantines. Living in the future (as we do) means we are inured to novelty. Now in a time of constant innovation and release, alongside the spread of a novel coronavirus, novelty is bred not in the truly new but rather in the return of the old: planes falling from the sky, outbreaks of measles, locusts, dictators. Camus’s characters experience a feeling of incredulity when they realize they are facing plague, despite living in a highly modern and boring town. “Yet always,” he writes, “plagues and wars take people equally by surprise.” As once-steady systems (democracy, antibiotics, seasons, Boeing) falter due to lapses in oversight and care, it feels as though the effects of a great complacency are upon us: this century may yet be even more devastatingly marked by a willingness to take the advances of the last two for granted. This is a shock not of the new but of the old, and we are feeling it now: what modernity makes wondrous, miraculous, and horrific is that the banal disasters we thought we’d banished have a return ticket.

Hammond’s book, which closes with HIV/AIDS, does not cover the postmodern outbreak, but that, with its particularly twenty-first-century character of disinformation and instant global reach, is what we are now living out. While Defoe and Camus examine relations between public and private realms under plague and define cities through a perimeter of infection, now we find it harder to limit the scope of virality, and epidemic (a nation-sized problem) jumps to pandemic (a global one) in moments. Now, stifling and failed quarantines on cruise ships (floating cities, they call them, castles to charm Prince Prospero) have written a sequel to David Foster Wallace’s diabolical treatise on their absurd pleasures, “A Supposedly Fun Thing I’ll Never Do Again.” New cities and worlds online, spreading hatred, disinformation, life-saving intelligence, and hope, become visible as fresh circles of contagion, where success is already defined as virality. The reach of infection comes closer and thins the divide between meme and actual illness.

Our present disease has crept past borders around cities and nations, just as it seeps through walls between people and species. It’s no longer Wuhan’s alone, but everyone’s, along with an ongoing intimation of collective mortality. Camus ends his novel by suggesting that its point has been to explain what plagues teach us: “that there are more things to admire in men than to despise.” Plague Inc., which has now been banned in China, gleefully needles us with this inquiry into our own worth, too, as it makes us play to win by obliterating everyone. The spread of illness that spares no one raises the question of what makes humanity itself worth saving — a ­question we may try to answer but cannot use to plead our case with a virus.

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Hammond concludes Epidemics and the Modern World by referencing an American report, from 1992, that predicted most future epidemics would spread to us from wildlife as a result of “activities that disrupt boundaries between humans and other animals.” This is being borne out: SARS and Ebola are hosted by bats, as is, it now seems likely, the novel coronavirus. This relation is embedded in the history of the word “virus,” which was originally thought of as a poison passed from animals to humans: viruses have always located us in a wider network of species. Ancient Sanskrit texts “attributed disease to the actions of deities or demons.” Now we blame it on wildlife.

Epidemics break down borders between nations and people but also, as they spread across species, between us and animals, reminding us of our common plight. Hammond explains that the long-term nutritional impact on humans of an earlier cattle epidemic may have increased the mortality rate of fourteenth-century plague. Likewise, while people gave cows tuberculosis, cowpox, a mild cattle infection, gifted humans with immunity to smallpox, leading to the invention of vaccination — a ­treatment named after the Latin word for cows. In other words, rather than always being vectors of contagion, animals also protect people, and, though we forget it, virulence goes both ways.

In both Defoe and Camus, cats and dogs are killed or banished with the arrival of plague, and their absence becomes evidence of its presence. After the epidemic ends, the only dog left in Oran is killed by an irrational gunman in an end-stage fit. This death is the outbreak’s last meaningless punishment meted out to an innocent life, and also the final retaliation by humans on their animal kingdom scapegoats.

Historically, rats have been a harbinger of mass human loss. The story of the Pied Piper, who came to the town of Hamelin to charm them away and who, unpaid for his services, ended by taking the children, too, is most certainly a parable for plague. The presence of the disease among rats has long been known, and Hammond explains its persistence in murine populations in mountainous regions and its transmission to people via infected fleas and lice. Camus’s book opens with the death of a rat that presages what’s to come, a mass die-off that unleashes the fleas that decimate the city. Dead rodents litter the streets of Oran as its citizens try to pretend, despite their “extravagant forebodings,” that this isn’t a bad sign at all. The novel closes with the doctor’s reminder of a secret that he suggests endures, virus-like, in books: that the time might come when plague “roused up its rats again and sent them forth to die in a happy city.”

Rats promise human deaths, but this special status is now being given over to bats, and the excess of attention as a result of being identified as a common vector of disease is revealing a certain hitherto unrealized mystery in the world’s most diverse mammal. As we attempt to locate menace, it helps that bats resemble tiny devils. Perhaps viruses would, too, if they had faces and eyes, and we could see them. Medicine may explain illness by pinpointing minuscule disrupters as agents of evil. Yet, faced with the uncertainty of why a particular calamity has struck, it’s easier to blame something with a face.