The big question: When will this all end?
Trying to pinpoint end of pandemic ‘will be a long and difficult process’
When will the COVID-19 pandemic end? And how?
According to historians, pandemics typically have two types of endings: the medical, which occurs when the incidence and death rates plummet; and the social, when the epidemic of fear about the disease wanes.
“When people ask, ‘When will this end?,’ they are asking about the social ending,” said Dr. Jeremy Greene, a historian of medicine at Johns Hopkins.
In other words, an end can occur not because a disease has been vanquished but because people grow tired of panic mode and learn to live with a disease. Allan Brandt, a Harvard historian, said something similar was happening with COVID-19: “As we have seen in the debate about opening the economy, many questions about the so-called end are determined not by medical and public health data but by sociopolitical processes.” Endings “are very, very messy,” said Dora Vargha, a historian at the University of Exeter. “Looking back, we have a weak narrative. For whom does the epidemic end, and who gets to say?”
In the path of fear
An epidemic of fear can occur even without an epidemic of illness. Dr. Susan Murray, of the Royal College of Surgeons in Dublin, saw that firsthand in 2014 when she was a fellow at a rural hospital in Ireland.
In the preceding months, more than 11,000 people in West Africa had died from Ebola, a terrifying viral disease that was highly infectious and often fatal. The epidemic seemed to be waning, and no cases had occurred in Ireland, but the public fear was palpable.
“On the street and on the wards, people are anxious,” Murray recalled recently in an article in The New England Journal of Medicine. “Having the wrong colour skin is enough to earn you the side-eye from your fellow passengers on the bus or train. Cough once, and you will find them shuffling away from you.”
Black Death, dark memories
Bubonic plague has struck several times in the past 2,000 years, killing millions of people and altering the course of history.
The disease is caused by a strain of bacteria, Yersinia pestis, that lives on fleas that live on rats. But bubonic plague, which became known as the Black Death, also can be passed from infected person to infected person through respiratory droplets, so it cannot be eradicated simply by killing rats.
Historians describe three great waves of plague, said Mary Fissell, a historian at Johns Hopkins: the Plague of Justinian, in the sixth century; the medieval epidemic, in the 14th century; and a pandemic that struck in the late 19th and early 20th centuries.
The medieval pandemic began in 1331 in China. The illness, along with a civil war that was raging at the time, killed half the population of China. From there, the plague moved along trade routes to Europe, North Africa and the Middle East. In the years between 1347 and 1351, it killed at least one-third of the European population.
That pandemic ended, but the plague recurred. One of the worst outbreaks began in China in 1855 and spread worldwide, killing more than 12 million in India alone. Health authorities in Mumbai burned whole neighbourhoods to rid them of the plague. “Nobody knew if it made a difference,” Yale historian Frank Snowden said.
It is not clear what made the bubonic plague die down. Some scholars have argued cold weather killed the disease-carrying fleas, but that would not have interrupted the spread by the respiratory route, Snowden noted.
Another hypothesis is that the bacterium evolved to be less deadly. But the plague never really went away. In the United
States, infections are endemic among prairie dogs in the Southwest and can be transmitted to people. Snowden said that one of his friends became infected after a stay at a hotel in New Mexico. The previous occupant of his room had a dog, which had fleas that carried the microbe.
Such cases are rare and can be successfully treated with antibiotics, but any report of a case of the plague stirs up fear.
The end of one disease Among the diseases to have achieved a medical end is smallpox. But it is exceptional for several reasons: There is an effective vaccine, which gives lifelong protection; the virus, Variola minor, has no animal host, so eliminating the disease in humans meant total elimination; and its symptoms are so unusual that infection is obvious, allowing for effective quarantines and contact tracing.
Forgotten influenzas The 1918 flu is held up today as the example of the ravages of a pandemic and the value of quarantines and social distancing. Before it ended, the flu killed 50 million to 100 million people worldwide. It preyed on young to middle-aged adults — orphaning children, depriving families of breadwinners, killing troops in the midst of the First World War.
After sweeping through the world, that flu faded away, evolving into a variant of the more benign flu that comes around every year.
It ended socially, too. The First World War was over; people were ready for a fresh start and eager to put the nightmare of disease and war behind them.
Until recently, the 1918 flu was largely forgotten.
How will COVID-19 end? Will that happen with COVID-19?
One possibility, historians say, is that the coronavirus pandemic could end socially before it ends medically. People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smoulder in the population and before a vaccine or effective treatment is found.
“I think there is this sort of social psychological issue of exhaustion and frustration,” Yale historian Naomi Rogers said. “We may be in a moment when people are just saying, ‘That’s enough. I deserve to be able to return to my regular life.’ ”
It is happening already; in some states, governors have lifted restrictions, allowing hair salons, nail salons and gyms to reopen, in defiance of warnings by public health officials that such steps are premature. As the economic catastrophe wreaked by the lockdowns grows, more and more people may be ready to say “enough.”
“There is this sort of conflict now,” Rogers said. Public health officials have a medical end in sight, but some members of the public see a social end.
“Who gets to claim the end?” Rogers said. “If you push back against the notion of its ending, what are you pushing back against? What are you claiming when you say, ‘No, it is not ending.’ ”
The challenge, Brandt said, is that there will be no sudden victory. Trying to define the end of the pandemic “will be a long and difficult process.”