Thursday 19 March 2020

Covid-19 and the Black Death

The corona virus Covid-19 is a strange phenomenon. On the one hand, it has caused the global shut-down of much that makes the modern world function, both socially and economically – theatres, restaurants and cafes, leisure venues, workplaces and now schools, bringing the world into ‘uncharted territory’ and forcing us to live in unfamiliar ways which may make us re-think our modes of work and travel quite radically. On the other, it is an infection with two very different outcomes, depending on who contracts it, combined with a very rapid infection rate and a relatively long asymptomatic incubation period during which the disease can be transmitted to others. Because it is a virus, and an unknown one at that, there is no simple cure – antibiotics (and antibacterials, please note) do not work against viruses. It seems that most people under 70, unless they have underlying health issues (there is an official list of 10, including diabetes and asthma, which are suffered by many of the under-70s), will experience quite mild symptoms which clear up after a week or so – unpleasant, perhaps, but not in any way life-threatening. If we only had to deal with those, there would have been no problem. But the vulnerable, the elderly and those with specific health issues, can be affected very severely, with some needing hospital treatment at the level of intensive care, and some do not survive. It is for the sake of these people, the severity of whose illness will overwhelm the NHS if the epidemic is left unchecked, that the government has taken such radical measures. And I do not disagree with them.

However, we must keep a sense of perspective. For one thing, many vulnerable patients, particularly among the elderly, do not survive a bout of influenza, which is why these folk are invited to have a ‘flu jab every autumn. Once we have a vaccination for Covid-19, we should be able to downgrade its significance to that of influenza, though I doubt we shall get rid of it altogether. This is a temporary shut-down of normal life, to slow the rate of infection and allow us to weather the storm. It is like putting up the flood defences before the river breaks its banks, or reefing the ship before the severe gale hits you. When the storm has passed, it is possible to return to ‘normal’ life, though you may have learned valuable lessons from the losses sustained. For another, this is not the worst epidemic the world has suffered. Many people are looking back to the Spanish Flu of 1918–1920, which killed millions across Europe in particular. But we could also look back further, and consider the Black Death.

It just so happens that (quite by coincidence) I am in the later stages of writing a novel set against the background of the Black Death in the fourteenth century. It has been a rather strange experience, writing this as the Covid-19 death rate mounts, and as the crisis hits various countries. You can almost feel the fear, not only of the disease itself (which as I have said, only a relatively few actually need to fear) but also of the disruption and the uncertainty, particularly economic uncertainty, that it has brought. However, this all fades into insignificance if you look at the Black Death scenario.

When the Black Death (not called this until the eighteenth century – contemporaries referred to ‘the Great Mortality’ and ‘the Pestilence’) arrived in Europe from Asia, where it was endemic, in 1347, nothing like it had been seen since a previous epidemic of the same disease in the sixth century. It arrived first in southern Europe, then raced across Italy and France to arrive in southern and western England in the summer of 1348. It spread across the British Isles and the rest of northern Europe through 1349 and 1350, finally petering out. It seems to have consisted of two or perhaps three forms of bubonic plague – the classic type with the growths (buboes) which killed 60% of those who caught it, a chest version (pneumonic plague) which attacked the lungs, and which had a near-100% death rate, and the rare septicaemic plague which killed people so fast that many never knew they actually had the disease but collapsed and died within hours of contracting it. The disease bore most heavily on the young and children, and up to half the entire population died in the two years that the plague raged across the continent – imagine the effect of this on the economy and society in general. Compare these statistics with a consistent death rate of 1 in 30 (less than 4%) of confirmed Covid-19 cases, where unconfirmed mild cases almost certainly outnumber the confirmed ones, especially in the UK where no attempt has been made to confirm the illness in many of the self-isolating individuals who have identified the symptoms in themselves. A fair number of these will not even contact the 111 service, except possibly via the internet, but will simply wait to recover and then return to work.

Add to this comparison the fact that in 1347–1350 no one knew what caused the illness or how to combat it (not even washing their hands!), there was no medical science as such to advise governments, no mathematical models to guide, no ways of treating even the symptoms or improving people’s chance of survival. The Paris medical faculty, who informed the physicians of the day, put it down to ‘miasma’ – bad atmosphere – and an unfortunate conjunction of planets in 1345. Most people couldn’t afford the services of a doctor, but even if they could, it made little difference to the outcome. Even the herbalists, who offered pharmaceutical aid to the poor and rich alike, had no answers. Only flight gave any chance of avoiding the disease, and even then it was quite common for those who fled to take the contagion with them to the unfortunate place they chose as refuge.  I think you can see that really by comparison Covid-19 is not the terror that some might think.

The fourteenth century had no broadcast media and no printed press, which may perhaps have been helpful. Rumour is certainly bad, but continued focus on a problem such as we have at the moment in the news media is possibly worse and is increasing the public fear of Covid-19 as a ‘killer virus’. As the American president F.D. Roosevelt famously said in another context: “We have nothing to fear but fear itself.” Fear dampens the immune system, thus causing the body to fight the virus less effectively, so even in a physical sense, never mind a psychological or social one, it is to be resisted. All this will pass.

The extraordinary thing that, in Black Death England at least, where many of the best historical records survive for the fourteenth century, what you might call the Spirit of the Blitz made perhaps its first appearance. People helped each other– not universally, perhaps, but in significant numbers – in spite of the risks to themselves. Priests went about their duties to their parishioners and many died as a result of taking the infection from them (it is on the records of new appointments to benefices that most estimates of the death toll depend). Government went on, and local administration went on too. Rents and fees were paid if possible, and rebates were asked for (and generally granted) where necessary. Manorial and town records were kept up to date by a succession of officials. We Carried On. So we can now as well.

I’m glad to see that the Anglican Church, though sensibly cancelling gatherings for worship, is keeping its church buildings open for private prayer. The atmosphere within them is often saturated with centuries of prayer and worship, giving it a numinous quality that many will find helpful in these difficult and stressful days. I applaud this move, and hope that the church authorities will make sure this continues. Although many have rejected faith, yet in extremis some will find faith offers something that atheism, agnosticism and materialism does not. I know I do.