Public Health in Perspective: Viewing the Pandemic’s Crisis and Opportunities Through the Lens of History

Although the COVID-19 crisis is often described as unprecedented, there are precedents throughout history that allow us to better understand this pandemic and the various ways people are responding to it.

When my book, “American Plagues: Lessons from Our Battles with Disease,” was published in 2016, the idea that a little-known global illness might alter human behavior and reshape the global economy seemingly overnight seemed far-fetched to most casual observers of epidemiology and public health. Today, it is our so-called new normal.

Past experiences can inform our present response. Consider the yellow fever outbreak that started in Philadelphia in 1793. Nobody knew what caused it. Some thought it was caused by miasmas, which was a term for “bad air” or “bad atmospheres.” It was not until 100 years later that doctors realized it was actually a virus transmitted by mosquitoes. In the meantime, people did all sorts of unorthodox things to cope with the virus, many of which proved wrong.

In 2020, there is abundant media coverage about the failure to find a cure for COVID-19, but in many ways the response has actually been effective. We know what the virus is. We can characterize it. We even know what genes cause it. But we are still learning about how it spreads. The current strategies of social distancing, wearing masks, and more are all based on trying to minimize exposure to, and transmission of, COVID-19. Understanding the nature of the virus will continue to shape how we respond to it.

Smallpox outbreaks in this country predated the 1793 yellow fever outbreak. In fact, smallpox was probably the first pandemic that occurred in this country. We had a vaccine for smallpox well before we knew what was causing it. For many years, the smallpox vaccination was required by law. Many people opposed that mandate, a dynamic which is also playing out today for those who do not wish to be subject to authorities’ directives on coronavirus. Yet there were several episodes in history when laws requiring smallpox vaccination were repealed, the results were predictably disastrous for the spread of smallpox.

There are times during public health emergencies when the public good needs to supersede what individuals view as their fundamental rights. That is a real dilemma. By requiring masks and social distancing, are governments impeding individual autonomy? Yes. Unfortunately, that is the tradeoff. To further complicate matters, this current pandemic has an economic dimension. For far too many Americans, livelihoods are at stake. The country has never encountered such a stark reality before.

The treatment of polio also offers lessons for today. Before the Salk vaccine was tested and became available, people tried some radical and unproven methods for treating and preventing that disease. Unless the scientific community conducts properly controlled trials of vaccines and anti-viral agents, the public will not know what really works and why.

As difficult as the current situation is, it also offers fascinating scientific opportunities — from creating an effective vaccine to finding a cure. This is an opportune time to consider a career in public health, and especially in epidemiology. There is little doubt that the current global crisis will spark greater interest among students in pursuing degrees and careers that focus on solving the world’s most vexing medical problems.

That is why initiatives such as Health Professions Week (HPW) — a free online event for high school and undergraduate students, teachers, advisors, and counselors from November 14-19, 2020 — are so crucial and timely. HPW is anationwide collaboration between today’s healthcare and education organizations designed to provide reliable, accessible resources to explore more than 20 career options in the health professions. The average student knows about the job functions of medical doctors, nurses, and dentists, but the challenges of public health are generally poorly understood. HPW helps students uncover this often-hidden information.

There is an adage that nobody appreciates the value of public health until something catastrophic, like an epidemic, occurs. As daunting as the current crisis might be, the awareness it has created about the need for more public health students and professionals will ultimately benefit society in the long run.

Dr. Stephen Gehlbach is the author of “American Plagues: Lessons from Our Battles with Disease” and a professor in the Family Medicine and Community Health Department at University of Massachusetts Medical School.

By Stephen Gehlbach MD, MPH

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