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© Frank


In The Meantime, We Adapt

by Elena Conis
April 13, 2020

This interview with Elena Conis, a writer and historian of medicine, public health, and the environment, was conducted and condensed by frank news.

She is the author of Vaccine Nation: America's Changing Relationship with Immunization.

frank | What does history tell us about moments like this? Where has your mind wandered and settled? 

Elena Conis | I'll answer this by way of a personal anecdote. I'm a former journalist, who got a PhD in history and became a history professor. Now I'm an academic who does a bit of both – history and journalism. One of my journalism colleagues early in this pandemic said to me, “Oh, this must be kind of exciting for you. These things don't really happen in a lifetime.” But it is actually terrifying to me, because my perspective as a historian has been that we have been really lucky that we haven't had to deal with some of the worst infectious diseases that have been behind some of the most persistent and painful pandemics of the past.

We really haven't experienced anything like this in my lifetime. My parents haven't really experienced anything like this in their lifetime. We have to go to our parent’s parents to find examples of diseases that shut down society or really shook us on a global level, the way COVID-19 is now. That is because starting in the 1940s, the era of modern health was ushered in by the creation of some of the most effective antibiotics and means of preventing diseases, like new and effective vaccines. In countries like the U.S. and other advanced industrialized nations. Since then, we've seen our burden of disease shift away from acute infectious diseases, things like pneumonia, tuberculosis, or measles, towards things like cancer, heart disease and other chronic conditions.

When I look at history, I see the diseases that were incredibly scary were mostly infectious diseases.

We had to live with them for centuries before we either found a way to manage them or they petered out. So my perspective is, we're pretty lucky.

This phase of medical resilience we’re in – I haven’t talked to anyone who doesn't think we will figure out a way to medically respond to this. What about cultural resilience? 

Let me answer that by focusing on one pandemic as an example. 

In the early part of the 20th century, polio had been around for a while, but it suddenly became an epidemic. It began to terrorize U.S. cities and towns. There was a polio season that typically started to appear in the spring, lasted through the summer, and then died down when the weather got cold. The scary thing about these polio epidemics was that they not exclusively, but largely, affected school aged children. In the worst cases they caused paralysis – sometimes it was fleeting, sometimes it was permanent, sometimes it was partial, and sometimes a person could be paralyzed from the neck down for life.

One of the ways we responded to that was very cultural. President Franklin Roosevelt contracted polio. Historians now think it was actually a different disease, but at the time the American public understood that he had polio, and that he recovered and went on to be president of the United States. He created a national philanthropy called the National Foundation for Infantile Paralysis, later renamed March of Dimes Foundation, to combat polio. The American public was so inspired by his story and by his recovery, and so frightened of the disease, Americans turned out in droves for fundraisers for this foundation. Some people donated as little as 10 cents, because everybody felt empowered to contribute. People at the very, very local level, in all kinds of communities, held fundraisers and events to support the cause of both caring for and treating polio patients – and finding a cure.

They would send iron lungs to communities that needed them most and fund the creation of polio wards. Iron lungs helped paralyzed patients breathe. The foundation would oversee the fundraising for the purchase and manufacture of  iron lungs and then their distribution to the communities hardest hit. You saw incredible civic participation and communities turning out to help each other. This went on for more than a decade until we finally came up with an effective polio vaccine. 

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What do you anticipate the COVID vaccine trajectory to look like? Do we go back to ‘normal’ life and address the virus whenever it reemerges? 

Here, I think history is again, a helpful guide for tempering our expectations. A vaccine would be wonderful; we would be so lucky to come up with a vaccine and unbelievably fortunate to have one in 18 months. That, too, would be pretty unprecedented. 

We can go back to a pandemic disease that most of us above a certain age can remember. We were really hopeful for a vaccine for HIV in the 1980s, and we still don't have a good one. We are 40 years in and we still don't have a good one – but we have changed our behaviors. Conversations about exposure and testing became the norm in relationships, condoms became more accepted among a certain generation, and we came up with medications that can drive the viral load down in an individual.

We've adapted to this virus in all these other ways, at least in the U.S. 

Right now, we are putting a lot of hope into a coronavirus vaccine, but past examples tell us that we need to be thinking about this in lots of creative ways. We've already relied on tools like quarantine and isolation, which are 600 year old tools, to try to manage the spread of infectious diseases. It's anybody's guess right now what the real effective tool will be, and how long we'll have to work with the current tools before we come up with others.

And we adapt in the meantime. The indefinite isolation required to mitigate such an infectious virus is daunting I think.

Yeah. If you think about something else that was this contagious, like the flu in 1918, the pandemic flu – it was this contagious, it kind of just petered out. We didn't have a very good response to it. And it had a horrible, horrible toll. But the flu as everybody knows is seasonal; the flu virus is constantly changing. There are some historians who would say that we did change socially and culturally in response to the 1918 flu. But, I see more continuity than changes in terms of how we acted as a society.

Certainly polio had the effect of shutting down towns. When there was a polio epidemic, people would cancel their seasonal festivals, and tell all the churchgoers to stay home, and close the schools and the parks and the swimming pools and theaters. After the vaccine, life went back to normal. Even in between polio epidemics, things in communities were open for business. People were a little bit hesitant, especially when they heard about polio outbreaks in neighboring towns, but for the most part they went back to normal.

We may be living with the current changes for a while.

People may be skittish about big groups. People may be skittish about going into certain public places without masks until we have a better handle on the spread of coronavirus. For now, it's hard to say how we will have changed when we come out on the other side of this.