COVID-19 vaccination: What we can learn from the great polio vaccine heist of 1959

In a pandemic, vaccines are in very high demand, and this threatens their supply.
(Shutterstock)

Paula Larsson, University of Oxford

We find ourselves at a precarious time in global health. Many people are anxiously awaiting their turn to receive a vaccine for COVID-19, yet roll-out is slow and disorganized, with many countries facing supply shortages.

The conditions are ripe for opportunists to exploit the situation. Reports of unethical line-jumping by wealthy elites have started to surface, while others warn of the potential for a black-market trade in vaccines.

This isn’t the first time people have waited anxiously for a vaccine. The looking-glass of history reveals the uneasiness of emotion that accompanies moments like these, as well as the dark consequences that can arise when evil-doers take advantage of them.

One case in particular stands out as an important lesson for today: when thousands of vaccine doses were stolen by armed men during a supply shortage in 1959.

The polio epidemic

It was the summer of 1959, when the last great epidemic of poliomyelitis swept across Canada. Québec saw the most cases that year, with the newspapers reporting over a thousand cases and 88 deaths.

Although the health authorities in Montréal warned the public about the seriousness of the summer epidemic, they also begged the populace to remain calm. This was far from comforting for parents who feared for their children.

Polio infection could cause permanent paralysis and was deadly in five per cent of cases. Montréalers rushed to the vaccine clinics, sometimes waiting for hours in the rain.

Vaccine production in Canada was limited to only two laboratories, with the majority being provided by Connaught Labs at the University of Toronto. This put intense pressure on vaccine supplies and Québec, like the rest of North America, soon faced a vaccine shortage.

Headline images showing the lone lines of people waiting to get a Salk vaccine. ‘The Montreal Gazette,’ Aug. 11, 1959.
The Montreal Gazette

A planned robbery

By August, Montréal was waiting desperately for more vaccines. It was a great relief when a huge shipment of the cherry-red vials arrived from Connaught Labs at the end of the month. The supply was enough to cover the city, and the surplus was planned for redistribution across the province.

Yet the redistribution never came to pass. One man by the name of Jean Paul Robinson, a temporary vaccine worker, had found the circumstances too enticing. Robinson had been tasked with running vials between the various clinics. He knew there was a shortage and that people were desperate. He also knew where the main supply of vaccine was stored: at the Microbiology Institute in the University of Montréal.

At 3 a.m. on Aug. 31, 1959, Robinson and two accomplices broke into the university armed with revolvers. They first locked the night guard in a cage with 500 lab monkeys. The thieves then broke the lock on the massive refrigerator, looted all the cases of the vaccine and stole the guard’s car as the getaway vehicle. In the end, they made away with 75,000 vials, valued at $50,000 (equivalent to almost $500,000 today). Robinson rented an empty apartment building and stashed his prize.

The crime shocked the country. The next day, the city announced it had completely run out of its vaccine supplies. Reporters seized on the situation, publishing reports of desperate mothers turned away from vaccine clinics in vain.

The provincial police were called in, and a special four-man team of investigators was assembled. They began by interviewing the hapless night guard. He couldn’t identify the culprits — who had been wearing nylon leggings over their faces — but he did overhear them speak about transporting the vaccines. The conversation provided the only lead: it seemed that at least one of the men had been “familiar with medical terms.”

The police soon brought in a medical student for questioning. By the next day, they had seized a supply of fresh vaccine from the shelves of a Pont-Viau drug store. The confiscated vials displayed the same serial number as the missing supply. Yet questioning both the medical student and the druggist led the police nowhere, and over the next few days, all leads ran dry. Worse yet, it seemed that the city was facing an upswing in infections, with another 36 patients admitted to hospital.

The widespread application of the polio vaccine in the 1950s and ‘60s helped bring polio under control in the early 1970s. Canada was certified ‘polio free’ in 1994. This image of polio patients was taken in September 1947 in Edmonton, Alta.
(Canadian Public Health Association)

Risk and capture

Meanwhile, Robinson was trying to figure out what to do with his ill-gotten supply of vaccine. Keeping the product cold was a difficult task — if left unrefrigerated for too long, the vaccine would be useless. He filled the refrigerator (saving one shelf for beer), while the rest of the cases were simply left on the floor at room temperature. Although he had been lucky to sell 299 vials for a tidy sum of $500 to the druggist at Pont-Viau, dispensing with the rest of the vaccine was too risky.

Taking a chance that the police were more interested in recovering the vials than catching the culprit, Robinson placed a call to the public police line. Posing as a concerned citizen, he declared that he had seen a large amount of suspicious cases labelled “Connaught Laboratories” being loaded out of a car on St. Hubert Street in the East End.

The police quickly discovered the missing cases of vaccine, but before they could be used, the vaccines would need to be tested thoroughly. This process could take up to two months, meaning the vials could not be used despite the epidemic. Fresh shipments of the vaccine were not planned to arrive for a few more weeks.

The public met the outcome of the investigation with outrage, with the Montréal Star going so far as to speculate that the police had made a deal with the guilty parties in order to recover the vaccine. Truly, it declared, “in the history of justice in Canada, this case must be unprecedented.” The stolen vaccines were eventually cleared for general use in October.

For their part, the police were far from done investigating. They soon turned their attention to identifying the culprit. They discovered that the man who had provided the police tip was also the man who had sold the Pont-Viau druggist his 299 vials. Evidence continued to mount against Robinson when the janitor of the apartment building identified him. After denying all charges, Robinson fled. He was discovered three weeks later hiding out in a small shed on an “isolated backroad farm.”

The vaccine heist of 1959 shocked the Canadian public and made headlines across the country. ‘Victoria Daily Times,’ Aug. 31, 1959.
(Victoria Daily Times)

‘Beyond reasonable doubt’

Prosecuting Robinson turned out to be a much harder task, and the case eventually fell apart. Although one of his accomplices had originally identified Jean Paul Robinson as the mastermind of the heist, when the trial came around two years later, the witness recanted his original statement (he would later be charged with perjury).

Robinson himself proved imperturbable during courtroom interrogations. He painted himself a public-spirited citizen who had simply tried to “retrieve” the stolen vaccines from the true criminal mastermind: a mysterious man by the name of Bob. Robinson claimed that Bob had set the whole thing up before he had disappeared and escaped justice. The judge eventually ruled that although Robinson’s story was “strange and a little far-fetched,” in the end, “the Crown had not proven a case beyond a reasonable doubt” and he was acquitted.

As millions of people worldwide anxiously await the distribution of the COVID-19 vaccines, this case warns of the possible consequences of disorganized and poorly planned vaccine programs. Those looking to profit from mistakes, shortages and desperation are out there, and it is important that policy makers keep this in mind as vaccination programs are rolled out.

Paula Larsson, Doctoral Student, Centre for the History of Science, Medicine, and Technology, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus vaccine: lessons from the 19th-century smallpox anti-vaxxer movement

English physician and scientist, who was the pioneer of smallpox vaccine, Edward Jenner sees off the anti-vaccinators.
Wikimedia/Wellcome Collection

Steven King, Nottingham Trent University

There is hope a coronavirus vaccine might be ready by the end of the year. But for it to eliminate COVID-19 a critical mass of people must be vaccinated. And if the protective benefits of a COVID-19 vaccine fall off rapidly (as seems to happen with naturally acquired antibodies) maintaining immunity will require multiple vaccinations. So unless people keep renewing their jabs, the critical mass will decline quickly.

How will politicians ensure critical mass and renewal? For UK prime minister Boris Johnson (who labels those who oppose vaccination as “nuts”) and others, vaccination is a matter of duty. There is a logical case (we know people who have died or suffered badly from COVID-19) and a moral case (to protect others if not yourself).

Yet anti-vaccination sentiment focused on the rights of citizens not to act is clear. A recent poll of 2,000 people across the UK found that 14% would refuse to take a vaccine.

The rights of citizens not to act mean that compulsory vaccination cannot be (and has not been) ruled out. The history of other vaccination programmes, particularly the first truly national campaign against smallpox, shows how difficult the balancing of rights and duties will be.

A disappearing act

The 19th-century invention of vaccination created a new national imperative for the UK to combat endemic smallpox. The risk of dying from smallpox for those who contracted it was substantially higher than that for COVID-19 today. Survivors gained immunity but often at the cost of physical scarring and long-term health problems.

Vaccination and subsequent elimination should have been a no-brainer. Yet local and regional outbreaks persisted across the 19th century.

Governments of this period assumed (sometimes incorrectly) that the middle-classes would realise the value of vaccination. The poor and marginal were different. For them, mass compulsory vaccination awaited.

The result was an explosive atmosphere. Rumours of deaths after vaccination and of the rounding up of the poor like animals generated a sustained popular backlash, with some organising under the umbrella of the National Anti-Vaccination League.

An attack on smallpox vaccination and the Royal College of Physicians’ advocation of it, 1812.
Wikimedia/Wellcome Collection

Yet even after vaccination became compulsory in 1853, there were many ways in which, by accident or design, ordinary people citizens avoided the jab. Some people simply disappeared from the records or failed to appear when asked. Those most prone to doing so (those in crowded households or immigrants, for example) were also the groups most susceptible to disease.

Census data consistently undercounts the national population. Undercounting in the 1800s may have missed around 10% of some communities. Even for the 2011 census, around 6.1% of the population is believed to have been missed. Achieving vaccination critical mass is difficult where you do not know the true size of the mass and the most vulnerable are the least detectable.

The poor also “clogged up” the vaccination system. Sometimes they agreed to participate and then did not turn up, a common feature for systems of compulsion where there is no ultimate sanction. On other occasions, as for instance at Keighley in 1882, people would supplement this activity with the sending of anonymous hate mail in an attempt to disrupt the work of local vaccinators.

Fight for their rights

Taking advantage of local tensions was also a useful avoidance technique. “Smallpox riots” in the face of attempts at crude compulsion were frequent and sustained.

Sometimes organised by local agitators, and sometimes spurred on by instances of children dying after vaccination, such unrest varied on a spectrum from small and localised to community-wide and sustained. Riots at Ipswich, Henley, Leicester and Newcastle were particularly notable.

Nor should we forget that vaccination opponents spread rumours about and caricatured vaccines and vaccinators, undermining the credibility of the system in the public imagination. These included one cartoon from the 1880s in which helpless children are shovelled into the mouth of a diseased cow while, at the other end, a doctor portrayed as the devil incarnate shovels dead children excreted by the cow into a cart bound for mass graves.

In July 2020 public figures stand accused of using Twitter to the same effect for COVID-19 vaccination.

Children are fed to a disease-ridden cow creature, representing vaccination.
Wikimedia/Wellcome Collection

Most forcefully, while politicians used the law in order to force vaccination, the law could also be turned against them. Penalties against parents for failing to vaccinate children, introduced in 1853 and strengthened in 1867, were routinely ignored by courts. Compulsory child vaccination was removed in 1898 and the freedom to refuse introduced.

Long-standing opposition to vaccination by some scientists as well as ordinary people crystallised in 1885 with a huge demonstration at Leicester (ironically the recent focus of a British local lockdown). This and ongoing smaller protests across the country forced the government to introduce a Royal Commission to reflect on the whole question of compulsion. The verdict ultimately fell on the side of the rights of the individual.

It is not hard to imagine the 2021 human rights case in which a court must decide on the balance of the legal and collective duty of citizens to get vaccinated against COVID-19 nd the individual right to choose.

Our political and medical elites believe that people will accept moral responsibility: “get vaccinated”. Yet little thought has gone into how a mass vaccination programme works.

We will see some of the lessons of 20th-century vaccination schemes repeated, with public information campaigns and elements of coercion via vaccination programmes in schools and care homes. Nonetheless, the lack of serious credence given to anti-vaccination “nuts” and the resistance that a vaccination programme may generate feels oh so 19th-century.

Steven King, Professor of Economic and Social History, Nottingham Trent University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Border closures, identity and political tensions: how Australia’s past pandemics shape our COVID-19 response

Susan Moloney, Griffith University and Kim Moloney, Murdoch University

Tensions over border closures are in the news again, now states are gradually lifting travel restrictions to all except Victorians.

Prime Minister Scott Morrison says singling out Victorians is an overreaction to Melbourne’s coronavirus spike, urging the states “to get some perspective”.

Federal-state tensions over border closures and other pandemic quarantine measures are not new, and not limited to the COVID-19 pandemic.

Our new research shows such measures are entwined in our history and tied to Australia’s identity as a nation. We also show how our experiences during past pandemics guide the plans we now use, and alter, to control the coronavirus.

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Bubonic plague, federation and national identity

In early 1900, bubonic plague broke out just months before federation, introduced by infected rats on ships.

When a new vaccine was available, the New South Wales government planned to inoculate just front-line workers.

Journalists called for a broader inoculation campaign and the government soon faced a “melee” in which:

…men fought, women fainted and the offices [of the Board of Health] were damaged.

Patients and contacts were quarantined at the North Head Quarantine Station. Affected suburbs were quarantined and sanitation commenced.

The health board openly criticised the government for its handling of the quarantine measures, laying the groundwork for quarantine policy in the newly independent Australia.

Quarantine then became essential to a vision of Australia as an island nation where “island” stood for immunity and where non-Australians were viewed as “diseased”.

Public health is mentioned twice in the Australian constitution. Section 51(ix) gives parliament the power to quarantine, and section 69 requires states and territories to transfer quarantine services to the Commonwealth.

The Quarantine Act was later merged to form the Immigration Restriction Act, with quarantine influencing immigration policy.

Ports then became centres of immigration, trade, biopolitics and biosecurity.

Spanish flu sparked border disputes too

In 1918, at the onset of the Spanish flu, quarantine policy included border closures, quarantine camps (for people stuck at borders) and school closures. These measures initially controlled widespread outbreaks in Australia.

However, Victoria quibbled over whether NSW had accurately diagnosed this as an influenza pandemic. Queensland closed its borders, despite only the Commonwealth having the legal powers to do so.

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When World War I ended, many returning soldiers broke quarantine. Quarantine measures were not coordinated at the Commonwealth level; states and territories each went their own way.

Quarantine camps, like this one at Wallangarra in Queensland, were set up during the Spanish flu pandemic.
Aussie~mobs/Public Domain/Flickr

There were different policies about state border closures, quarantine camps, mask wearing, school closures and public gatherings. Infection spread and hospitals were overwhelmed.

The legacy? The states and territories ceded quarantine control to the Commonwealth. And in 1921, the Commonwealth created its own health department.

The 1990s brought new threats

Over the next seven decades, Australia linked quarantine surveillance to national survival. It shifted from prioritising human health to biosecurity and protection of Australia’s flora, fauna and agriculture.

In the 1990s, new human threats emerged. Avian influenza in 1997 led the federal government to recognise Australia may be ill-prepared to face a pandemic. By 1999 Australia had its first influenza pandemic plan.

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In 2003, severe acute respiratory syndrome (or SARS) emerged in China and Hong Kong. Australia responded by discouraging nonessential travel and started health screening incoming passengers.

The next threat, 2004 H5N1 Avian influenza, was a dry run for future responses. This resulted in the 2008 Australian Health Management Plan for Pandemic Influenza, which included border control and social isolation measures.

Which brings us to today

While lessons learned from past pandemics are with us today, we’ve seen changes to policy mid-pandemic. March saw the formation of the National Cabinet to endorse and coordinate actions across the nation.

Uncertainty over border control continues, especially surrounding the potential for cruise and live-export ships to import coronavirus infections.

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Then there are border closures between states and territories, creating tensions and a potential high court challenge.

Border quibbles between states and territories will likely continue in this and future pandemics due to geographical, epidemiological and political differences.

Australia’s success during COVID-19 as a nation, is in part due to Australian quarantine policy being so closely tied to its island nature and learnings from previous pandemics.

Lessons learnt from handling COVID-19 will also strengthen future pandemic responses and hopefully will make them more coordinated.

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Susan Moloney, Associate Professor, Paediatrics, Griffith University and Kim Moloney, Senior Lecturer in Global Public Administration and Public Policy, Murdoch University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus is taking English pubs back in time

A tapster delivers a frothing tankard to seated alehouse customers in this 1824 etching.
British Museum, CC BY-NC-SA

James Brown, University of Sheffield

The announcement by Boris Johnson, the UK prime minister, that pubs in England will be allowed to resume trading from July 4 was greeted with rousing cheers from some. But having a pint in the pandemic era will be slightly different. While two-metre social distancing rules are being relaxed to one metre to ensure economic viability for publicans, to maintain the safety of customers and staff, pubs will where practical be restricted to “table service”.

Standing at the bar is one of the most cherished rituals of the British pub experience – and many people are worried that the new rules could be the beginning of the end of a tradition that dates back centuries. Except, it doesn’t – the bar as we now know it is of relatively recent vintage and, in many respects, the new regulations are returning us to the practices of a much earlier era.

Before the 19th century, propping up the bar would have been an unfamiliar concept in England’s dense network of alehouses, taverns and inns. Alehouses and taverns in particular were seldom purpose-built, but were instead ordinary dwelling houses made over for commercial hospitality. Only their pictorial signboards and a few items of additional furniture distinguished them from surrounding houses. In particular, there was no bar in the modern sense of a fixed counter over which alcohol could be purchased and served.

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Instead, beverages were ferried directly to seated customers from barrels and bottles in cellars and store rooms by the host and, in larger establishments, drawers, pot-boys, tapsters and waiters. The layout of Margaret Bowker’s large Manchester alehouse in 1641 is typical: chairs, stools and tables were distributed across the hall, parlours, and chambers, while drink was stored in “hogsheads”, “barrels”, and “rundlets” in her cellar.

Five customers receive table service from a tapster in this woodcut illustration from a late 17th-century ballad.
English Broadside Ballad Archive

The bar as we know it didn’t emerge organically from these arrangements, but rather from the introduction of a new commodity in the 18th century: gin.
Originally it was imported from the Netherlands and distilled in large quantities domestically from the later decades of the 17th century, but the emergence of a mass market for gin in the 1700s gave rise to the specialised gin or dram shop. Found mainly in London – especially in districts such as the East End and south of the river – an innovation of these establishments was a large counter that traversed their width.

Along with a lack of seating, this maximised serving and standing space and encouraged low-value but high-volume turnover from a predominantly poor clientele. The flamboyant gin palaces of the later 18th and early 19th century – described by caricaturist and temperance enthusiast George Cruikshank as “gaudy, gold be-plastered temples” – retained the bar, along with other features drawn from the retail sector such as plate-glass windows, gas lighting, elaborate wrought iron and mahogany fittings, and displays of bottles and glasses. While originally regarded as alien to local drinking cultures, by the 1830s these architectural elements started making their way into all English pubs, with the bar literally front and centre.

An 1808 aquatint after Thomas Rowlandson, showing human and canine customers standing at the bar in a gin shop.
Metropolitan Museum of Art

As architectural historian Mark Girouard has pointed out, the adoption of the bar was a “revolutionary innovation” – a “time-and-motion breakthrough” that transformed the relationship between customers and staff. It brought unprecedented efficiencies that were especially important in the expanding and industrialising cities of the early 1800s.

In particular, a fixed counter with taps, cocks and pumps connected to spirit casks and beer barrels was more efficient than employees scurrying between cellars, storerooms and drinking areas. This was especially the case for “off-sales” – customers purchasing drinks to take home – which had always been a large component of the drinks trade and still accounted for an estimated one-third of takings into the 19th century.

An 1833 lithograph depicting an ‘obliging bar-maid’ using a beer engine.
Wellcome Collection, CC BY-NC

Posterity has paid little attention to the armies of service staff who kept the world of the tavern spinning on its axis before the age of the bar. But they are occasionally glimpsed in historical sources – such as Margaret Sephton, who was “drawing beer” at Widow Knee’s Chester alehouse in 1629, when she gave evidence about a theft of linen. While skilled – one tapster at a Chester tavern styled himself rather grandly in 1640 as a “drawer and sommelier of wine” – drink work was poorly paid. Staff were often paid in kind with food and lodgings and the work was usually undertaken by people who were young, poor, or new to the community.

The lack of a bar made the job especially challenging. It was physically demanding – in 1665 a young tapster at a Cheshire alehouse described how during her shift she was “called to and fro in the house and to other company, testifying to the constant back and forth. The fact that drinks were not poured in front of patrons made staff more vulnerable to accusations of adulteration and short measure – sometimes with good reason – and close physical proximity to customers when serving and collecting payment meant such disputes could more readily turn violent. For female employees, the absence of the insulating layer of material and space later provided by the bar meant they were much more exposed to sexual abuse from male patrons.

What can the historical record teach proprietors of any newly bar-less pubs? There are, of course, modern advantages such as apps and other digital tools – plus the example of European and North American establishments, where table service was never fully displaced. But there are practical lessons to be learned from the past all the same. Publicans today might streamline the range of drinks on offer and encourage the use of jugs for refills. Landlords could develop careful zoning for their staff – in larger alehouses and taverns tapsters were allocated specific booths and rooms. Most importantly they need to establish and enforce clear rules about behaviour towards staff – especially in terms of physical contact. Better to have premodern pubs than no pubs at all, after all.

James Brown, Research Associate & Project Manager (UK), University of Sheffield

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia and the Spanish Flu/COVID-19 Pandemics

Lockdowns, second waves and burn outs. Spanish flu’s clues about how coronavirus might play out in Australia

National Museum of Australia

Jeff Kildea, UNSW

In a remarkable coincidence, the first media reports about Spanish flu and COVID-19 in Australia both occurred on January 25 – exactly 101 years apart.

This is not the only similarity between the two pandemics.

Although history does not repeat, it rhymes. The story of how Australia – and particular the NSW government – handled Spanish flu in 1919 provides some clues about how COVID-19 might play out here in 2020.

Spanish flu arrives

Australia’s first case of Spanish flu was likely admitted to hospital in Melbourne on January 9 1919, though it was not diagnosed as such at the time. Ten days later, there were 50 to 100 cases.

Commonwealth and Victorian health authorities initially believed the outbreak was a local variety of influenza prevalent in late 1918.

Consequently, Victoria delayed until January 28 notifying the Commonwealth, as required by a 1918 federal-state agreement designed to coordinate state responses.

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Meanwhile, travellers from Melbourne had carried the disease to NSW. On January 25, Sydney’s newspapers reported that a returned soldier from Melbourne was in hospital at Randwick with suspected pneumonic influenza.

Shutdown circa 1919: libraries, theatres, churches close

The NSW government quickly imposed restrictions on the population when Spanish flu first arrived.
National Library of Australia

Acting quickly, in late January, the NSW government ordered “everyone shall wear a mask,” while all libraries, schools, churches, theatres, public halls, and places of indoor public entertainment in metropolitan Sydney were told to close.

It also imposed restrictions on travel from Victoria in breach of the federal-state agreement.

Thereafter, each state went its own way and the Commonwealth, with few powers and little money compared with today, effectively left them to it.

Generally, the restrictions were received with little demur. But inconsistencies led to complaints, especially from churches and the owners of theatres and racecourses.

People were allowed to ride in crowded public transport to thronged beaches. But masked churchgoers, observing physical distancing, were forbidden to assemble outside for worship.

Later, crowds of spectators would be permitted to watch football matches while racecourses were closed.

Spanish flu subsides

Nevertheless, NSW’s prompt and thorough application of restrictions initially proved successful.

During February, Sydney’s hospital admissions were only 139, while total deaths across the state were 15. By contrast, Victoria, which had taken three weeks before introducing more limited restrictions, recorded 489 deaths.

At the end of February, NSW lifted most restrictions.

Even so, the state government did not escape a political attack. The Labor opposition accused it of overreacting and imposing unnecessary economic and social burdens on people. It was particularly critical that the order requiring mask-wearing was not limited to confined spaces, such as public transport.

There was also debate about the usefulness of closing schools, especially in the metropolitan area.

But then it returns

In mid-March, new cases began to rise. Chastened by the criticism of its earlier measures, the government delayed reimposing restrictions until early April, allowing the virus to take hold.

This led The Catholic Press to declare

the Ministry fiddled for popularity while the country was threatened with this terrible pestilence.

Sydney’s hospital capacity was exceeded and the state’s death toll for April totalled 1,395. Then the numbers began falling again. After ten weeks the epidemic seemed to have run its course, but as May turned to June, new cases appeared.

The resurgence came with a virulence surpassing the worst days of April. This time, notwithstanding a mounting death toll, the NSW cabinet decided against reinstating restrictions, but urged people to impose their own restraints.

The government goes for “burn out”

After two unsuccessful attempts to defeat the epidemic – at great social and economic cost – the government decided to let it take its course.

It hoped the public by now realised the gravity of the danger and that it should be sufficient to warn them to avoid the chances of infection. The Sydney Morning Herald concurred, declaring

there is a stage at which governmental responsibility for the public health ends.

The second wave’s peak arrived in the first week of July, with 850 deaths across NSW and 2,400 for the month. Sydney’s hospital capacity again was exceeded. Then, as in April, the numbers began to decline. In August the epidemic was officially declared over.

Cases continued intermittently for months, but by October, admissions and deaths were in single figures. Like its predecessor, the second wave lasted ten weeks. But this time the epidemic did not return.

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How Australia’s response to the Spanish flu of 1919 sounds warnings on dealing with coronavirus

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More than 12,000 Australians had died.

While Victoria had suffered badly early on compared to NSW, in the end, NSW had more deaths than Victoria – about 6,000 compared to 3,500. The NSW government’s decision not to restore restrictions saw the epidemic “burn out”, but at a terrible cost in lives.

That decision did not cause a ripple of objection. At the NSW state elections in March 1920, Spanish flu was not even a campaign issue.

The lessons of 1919

In many ways we have learned the lessons of 1919.

We have better federal-state coordination, sophisticated testing and contact tracing, staged lifting of restrictions and improved knowledge of virology.

Australia’s response to coronavirus has seen sophisticated testing and contact tracing.
Dean Lewis/AAP

But in other ways we have not learned the lessons.

Despite our increased medical knowledge, we are struggling to find a vaccine and effective treatments. And we are debating the same issues – to mask or not, to close schools or not.

Meanwhile, inconsistencies and mixed messaging undermine confidence that restrictions are necessary.

Yet, we are still to face the most difficult question of all.

The Spanish flu demonstrated that a suppression strategy requires rounds of restrictions and relaxations. And that these involve significant social and economic costs.

With the federal and state governments’ current suppression strategies we are already seeing signs of social and economic stress, and this is just round one.

Would Australians today tolerate a “burn out”?

The Spanish flu experience also showed that a “burn out” strategy is costly in lives – nowadays it would be measured in tens of thousands. Would Australians today abide such an outcome as people did in 1919?

It is not as if Australians back then were more trusting of their political leaders than we are today. In fact, in the wake of the wartime split in the Labor Party and shifting political allegiances, respect for political leaders was at a low ebb in Australia.

Australians today may not tolerate the large numbers of deaths we saw in 1919.
James Gourley/AAP

A more likely explanation is that people then were prepared to tolerate a death toll that Australians today would find unacceptable. People in 1919 were much more familiar with death from infectious diseases.

Also, they had just emerged from a world war in which 60,000 Australians had died. These days the death of a single soldier in combat prompts national mourning.

Yet, in the absence of an effective vaccine, governments may end up facing a “Sophie’s Choice”: is the community willing and able to sustain repeated and costly disruptions in order to defeat this epidemic or, as the NSW cabinet decided in 1919, is it better to let it run its course notwithstanding the cost in lives?

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Jeff Kildea, Adjunct Professor Irish Studies, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Before epidemiologists began modelling disease, it was the job of astrologers

Women, representing nature, argue the influence of the zodiac with scholars in this undated 17th century engraving.
Wellcome Collection, CC BY

Michelle Pfeffer, The University of Queensland

The internet is awash with comparisons between life during COVID-19 and life during the Bubonic plague. The two have many similarities, from the spread of misinformation and the tracking of mortality figures, to the ubiquity of the question “when will it end?”

But there are, of course, crucial differences between the two. Today, when looking for information on the incidence, distribution, and likely outcome of the pandemic, we turn to epidemiologists and infectious disease models. During the Bubonic plague, people turned to astrologers.

Exploring the role played by astrologers in past epidemics reminds us that although astrology has been debunked, it was integral to the development of medicine and public health.

The flu, written in the stars

Before germ theory, the Scientific Revolution and then the Age of Enlightenment, it was common for medical practitioners to use astrological techniques in their everyday practice.

Hans Holbein’s Danse Macabre woodcut (1523-25).
Wikimedia

Compared to the simplistic horoscopes in today’s magazines, premodern astrology was a complex field based on detailed astronomical calculations. Astrologers were respected health authorities who were taught at the finest universities throughout Europe, and hired to treat princes and dukes.

Astrology provided physicians with a naturalistic explanation for the onset and course of disease. They believed the movements of the celestial bodies, in relation to each other and the signs of the Zodiac, governed events on earth. Horoscopes mapped the heavens, allowing physicians to draw conclusions about the onset, severity, and duration of illness.

The impact of astrology on the history of medicine can still be seen today. The term “influenza” was derived from the idea that respiratory disease was a product of the influence of the stars.

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Altered mind this morning? Hehe, just blame the planets

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Public health and plague

Astrologers were seen as important authorities for the health of communities as well as individuals. They offered public health advice in annual almanacs, which were some of the most widely read literature in the premodern world.

Almanacs provided readers with tables for astrological events for the coming year, as well as advice on farming, political events, and the weather.

The publications were also important disseminators of medical knowledge. They explained basic medical principles and suggested remedies. They made prognostications about national health, using astrology to predict when an influx of venereal disease or plague was likely to arise.

These public health predictions were often based on the astrological theory of conjunctions. According to this theory, when certain planets seem to approach each other in the sky from our perspective on earth, great socio-cultural events are bound to occur.

When Bubonic plague hit France in 1348, the King asked the physicians at the University of Paris to account for its origins. Their answer was that the plague was caused by a conjunction of Saturn, Mars, and Jupiter.

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Predictions from above

Astrological accounts of plague remained popular into the 17th century. In this period, astrology was increasingly attacked as superstitious, so some astrologers tried to set their field on a more scientific grounding.

In an effort to make astrology more scientific, the English astrologer John Gadbury produced one of the earliest epidemiological studies of disease.

In London’s Deliverance Predicted (1655), Gadbury claimed his contemporaries couldn’t explain when plagues would arrive, or how long they’d last.

Gadbury proposed that if planets caused plagues, then planets also stopped plagues. Studying astrological events would therefore allow one to predict the course of an epidemic.

He gathered data from the previous four great London plagues (in 1593, 1603, 1625, and 1636), scouring the Bills of Mortality for weekly plague death rates, and compiling A Table shewing the Increase and Abatement of the Plague. Gadbury also used planetary tables to locate the planets’ positions throughout the epidemics. He then compared his data sets, looking for correlations.

Gadbury found a correlation between intensity of plague and the positions of Mars and Venus. Plague deaths increased sharply in July 1593, at which point Mars had moved into an astrologically significant position. Deaths then abated in September, when Venus’s position became more significant. Gadbury concluded that the movement of “the fiery Planet Mars” was the origin of pestilence and the “cause of its raging”, while the influence of the “friendly” Venus helped abate it.

Gadbury then applied his findings to the pestilence plaguing London at the time. He was able to correlate the beginnings of the plague in late 1664 and its growing intensity in June 1665 with recent astrological events.

He predicted the upcoming movement of Venus in August would see a fall in plague deaths. Then the movement of Mars in September would make the plague deadlier, but the movements of Venus in October, November, and December would halt the death rate.

The black death in London, circa 1665. Creator unknown.
The black death in London

Looking for patterns

Unfortunately for Gadbury, plague deaths increased dramatically in August. However, he was right in predicting a peak in September followed by a steep decrease at the end of the year. If Gadbury had accounted for other correlates – such as the coming of winter – his study might have been received more favourably.

The medical advice in Gadbury’s book certainly doesn’t stand up today. He argued the plague was not contagious, and that isolating at home only caused more deaths. Yet his attempt to find correlations with fluctuating mortality rates offers an early example of what we now call epidemiology.

While we may discredit Gadbury’s astrological assumptions, examples such as this illustrate the important role astrology played in the history of medicine, paving the way for naturalist explanations of infectious disease.

Michelle Pfeffer, Postdoctoral Research Fellow in History, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Fleas to flu to coronavirus: how ‘death ships’ spread disease through the ages

Cushing/Whitney Medical Library

Joy Damousi, Australian Catholic University

One of the haunting images of this pandemic will be stationary cruise ships – deadly carriers of COVID-19 – at anchor in harbours and unwanted. Docked in ports and feared.

The news of the dramatic spread of the virus on the Diamond Princess from early February made the news real for many Australians who’d enjoyed holidays on the seas. Quarantined in Yokohama, Japan, over 700 of the ship’s crew and passengers became infected. To date, 14 deaths have been recorded.

The Diamond Princess’s sister ship, the Ruby Princess, brought the pandemic to Australian shores. Now under criminal investigation, the events of the Ruby Princess forced a spotlight on the petri dish cruise ships can become. The ship has been linked to 21 deaths.

History shows the devastating role ships can play in transmitting viruses across vast continents and over many centuries.

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Rats in the ranks

Merchant ships carrying rats with infected fleas were transmitters of the Plague of Justinian (541-542 AD) that devastated the Byzantine Empire.

Ships carrying grain from Egypt were home to flea-infested rats that fed off the granaries. Contantinople was especially inflicted, with estimates as high as 5,000 casualties a day. Globally, up to 50 million people are estimated to have been killed – half the world’s population.

The Black Death was also carried by rats on merchant ships through the trade routes of Europe. It struck Europe in 1347, when 12 ships docked at the Sicilian port of Messina.

The people of Tournai bury victims of the Black Death.
Wikimedia Commons

Subsequently called “death ships”, those on board were either dead or sick. Soon, the Black Death spread to ports around the world, such as Marseilles, Rome and Florence, and by 1348 had reached London with devastating impact.

The Italian writer, poet and scholar, Giovanni Boccaccio, wrote how terror swept through Florence with relatives deserting infected family members. Almost inconceivably, he wrote, “fathers and mothers refused to nurse their own children, as though they did not belong to them”.

Ships started being turned away from European ports in 1347. Venice was the first city to close, with those permitted to enter forced into a 40-day quarantine: the word “quarantine” derives from the Italian quarantena, or 40 days.

By January 1349, mass graves proliferated outside of London to bury the increasing numbers of dead.

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Army and naval ships, as well as travellers around the globe, also carried cholera pandemics throughout the 19th century. In the first pandemic in 1817, British army and navy ships are believed to have spread cholera beyond India where the outbreaks originated.

Egyptians boarding boats on the Nile during a cholera epidemic, drawn by CL Auguste (1841-1905.)
Wellcome Collection, CC BY

By the 1820s, cholera had spread throughout Asia, reaching Thailand, Indonesia, China and Japan through shipping. British troops spread it to the Persian Gulf, eventually moving through Turkey and Syria.

Subsequent outbreaks from the 1820s through to the 1860s relied on trade and troops to spread the disease across continents.

At war with the Spanish Flu

The Spanish influenza of 1918-1919 was originally carried by soldiers on overcrowded troop ships during the first world war. The rate of transmission on these ships was rapid, and soldiers died in large numbers.

One New Zealand rifleman wrote in his diary in September 1918:

More deaths and burials total now 42. A crying shame but it is only to be expected when human beings are herded together the way they have been on this boat.

The SS Port Darwin returned from Europe, docked at Portsea, Victoria. Soldiers are waiting to pass through a fumigation chamber to protect Australia against the Spanish Flu.
Australian War Memorial

The flu was transmitted throughout Europe in France, Great Britain, Italy and Spain. Three-quarters of French troops and over half of British troops fell ill in 1918. Hundreds of thousands of US soldiers travelling on troop ships across the Atlantic and back provided the perfect conditions for transmission.

The fate of cruising

A new and lethal carrier in the 21st century has emerged in the pleasure industry of cruise ships. The explosion of cruise holidays in the past 20 years has led to a proliferation of luxury liners plying the seas.

Like historical pandemics, the current crisis shares the characteristic of rapid spread through ships.

The unknown is in what form cruise ships will continue to operate. Unlike the port-to-port trade and armed forces that carried viruses across continents centuries ago, the services cruise lines offer are non-essential.

Whatever happens, the global spread of COVID-19 reminds us “death ships” are an enduring feature of the history of pandemics.

Joy Damousi, Director, Institute of Humanities and Social Sciences, Australian Catholic University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Museums are losing millions every week but they are already working hard to preserve coronavirus artefacts

The Smithsonian Institute closed all of its museums due to the worldwide COVID-19 coronavirus pandemic.
Shutterstock

Anna M. Kotarba-Morley, Flinders University

The COVID-19 pandemic has no borders and has caused the deaths of hundreds of thousands of citizens from countries across the globe. But this outbreak is not just having an effect on the societies of today, it is also impacting our past.

Cultural resources and heritage assets – from sites and monuments, historic gardens and parks, museums and galleries, to the intangible lifeways of traditional culture bearers – require ongoing safeguarding and maintenance in an overstretched world increasingly prone to major crises.

Meanwhile, the heritage sector is already working hard to preserve the COVID-19 moment, predicting that future generations will need documentary evidence, photographic archives and artefacts to help them understand this period of history.

Closed to visitors

The severity of the pandemic, and the infection control responses that followed, has caused great uncertainties and potential long-term knock-on effects within the sector, especially for smaller and medium-sized institutions and businesses.

A survey published by the Network of European Museum Organisations (NEMO) and communications within organisations such as the International Committee for Archaeological Heritage Management (ICAHM) show that the majority of European museums are closed, incurring significant losses of income. By the beginning of April, 650 museums from 41 countries had responded to the NEMO survey, reporting 92% of them were closed.

Large museums such as the Kunsthistorisches Museum in Vienna and the Rijksmuseum and Stedelijk Museum in Amsterdam are losing €100,000-€600,000 (A$168,700-A$1,012,000) per week. Only about 70% of staff are currently being retained on average at most of the institutions.

Museums (both private and national) located in tourist areas have privately reported initial losses of 75-80% income based on the Heritage Sector Briefing to the UK government. Reports are also emerging of philanthropic income fall of 80-90% by heritage charities with many heading towards insolvency within weeks.

Cambodia’s Angkor Wat heritage site has lost 99.5% of its income in April compared to the same time last year.

Meanwhile, restorations to the cathedral of Notre-Dame de Paris came to an abrupt halt due to coronavirus just prior to the first anniversary of the fierce fire that damaged it. Builders have since returned to the site.

The situation is especially dire for culture bearers within remote and isolated indigenous communities still reeling from other catastrophes, such as the disastrous fires in Australia and the Amazon. Without means of social distancing these communities are at much higher risk of being infected and in turn their cultural custodianship affected.

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The right to culture

It is interesting to think about how this crisis will reshape visitor experience in the future.

The NEMO survey reports that more than 60% of the museums have increased their online presence since they were closed due to social distancing measures, but only 13.4% have increased their budget for online activities. We have yet to see more data about online traffic in virtual museums and tours, but as it stands it is certainly showing signs of significant increase.

As highlighted in the preamble of the 2003 UNESCO Declaration:

cultural heritage is an important component of cultural identity and of social cohesion, so that its intentional destruction may have adverse consequences on human dignity and human rights.

The human right of access to and enjoyment of cultural heritage is guaranteed by international law, emphasised in the Human Rights Council in its recent Resolution 33/20 (2016) that notes:

the destruction of or damage to cultural heritage may have a detrimental and irreversible impact on the enjoyment of cultural rights.

Article 27 of the Universal Declaration of Human Rights states that:

everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.

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Protecting heritage is a human right

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In the future, generations will need the means to understand how the coronavirus pandemic affected our world, just as they can now reflect on the Spanish Flu or the Black Death.

Preserving a pandemic

Work is underway to preserve this legacy with organisations such as Historic England collecting “lockdown moments in living memories” through sourcing photographs from the public for their archive. Twitter account @Viral_Archive run by a number of academic archaeologists is following in a same vane with interesting theme of #ViralShadows.

In the United States, the Smithsonian’s National Museum of American History has assembled a dedicated COVID-19 collection task force. They are already collecting objects including personal protection equipment such as N95 and homemade cloth masks, empty boxes (to show scarcity), and patients’ illustrations.

The National Museum of Australia has invited Australians to share their “experiences, stories, reflections and images of the COVID-19 pandemic” so curators can enhance the “national conversation about an event which is already a defining moment in our nation’s history”. The State Library of New South Wales is collecting images of life in isolation to “help tell this story to future generations”.

Citizen science is a great way to engage public and although such work is labour-intensive it can lead to more online traffic and potentially fill in financial deficits by enticing visitors back to the sites.

The closed Van Gogh Museum in Amsterdam, Netherlands on March 22.
Shutterstock

Priorities here

The timing of the COVID-19 pandemic – occurring in the immediate aftermath of severe draught, catastrophic fire season and then floods, with inadequate intervening time for maintenance and conservation efforts – presents new challenges.

The federal government reports that in the financial year 2018-19, Australia generated A$60.8 billion in direct tourism gross domestic product (GDP). This represents a growth of 3.5% over the previous year – faster than the national GDP growth. Tourism directly employed 666,000 Australians making up 5% of Australia’s workforce. Museums and heritage sites are a significant pillar to tourism income and employment.

Even though the government assures us “heritage is all the things that make up Australia’s identity – our spirit and ingenuity, our historic buildings, and our unique, living landscapes” its placement within the Department of Agriculture, Water and Environment’s portfolio shows lack of prioritisation of the sector.

Given the struggles we are already seeing in the arts and culture sector, which has been recently moved to the portfolio of the Department of Infrastructure, Transport, Regional Development and Communications means that the future of our heritage (and our past) is far from certain.

Anna M. Kotarba-Morley, Lecturer, Archaeology, Flinders University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Face masks: what the Spanish flu can teach us about making them compulsory

Red Cross nurses in San Francisco, 1918.
Wikimedia

Samuel Cohn, University of Glasgow

Should people be forced to wear face masks in public? That’s the question facing governments as more countries unwind their lockdowns. Over 30 countries have made masks compulsory in public, including Germany, Austria and Poland. This is despite the science saying masks do little to protect wearers, and only might prevent them from infecting other people.

Nicola Sturgeon, the Scottish first minister, has nonetheless announced new guidelines advising Scots to wear masks for shopping or on public transport, while the UK government is expected to announce a new stance shortly. Meanwhile, US vice president Mike Pence has controversially refused to mask up.

This all has echoes of the great influenza pandemic, aka the Spanish flu, which killed some 50 million people in 1918-20. It’s a great case study in how people will put up with very tough restrictions, so long as they think they have merit.

The great shutdown

In the US, no disease in history led to such intrusive restrictions as the great influenza. These included closures of schools, churches, soda fountains, theatres, movie houses, department stores and barber shops, and regulations on how much space should be allocated to people in indoor public places.

There were fines against coughing, sneezing, spitting, kissing and even talking outdoors – those the Boston Globe called “big talkers”. Special influenza police were hired to round up children playing on street corners and occasionally even in their own backyards.

Restrictions were similarly tough in Canada, Australia and South Africa, though much less so in the UK and continental Europe. Where there were such restrictions, the public accepted it all with few objections. Unlike the long history of cholera, especially in Europe, or the plague in the Indian subcontinent from 1896 to around 1902, no mass violence erupted and blame was rare – even against Spaniards or minorities.

Face masks came closest to being the measure that people most objected to, even though masks were often popular at first. The Oklahoma City Times in October 1918 described an “army of young women war workers” appearing “on crowded street cars and at their desks with their faces muffled in gauze shields”. From the same month, The Ogden Standard reported that “masks are the vogue”, while the Washington Times told of how they were becoming “general” in Detroit.

Shifting science

There was scientific debate from the beginning about whether the masks were effective, but the game began to change after French bacteriologist Charles Nicolle’s discovered in October 1918 that the influenza was much smaller than any other known bacterium.

The news spread rapidly, even in small-town American newspapers. Cartoons were published that read, “like using barbed wire fences to shut out flies”. Yet this was just at the point that mortality rates were ramping up in the western states of the US and Canada. Despite Nicolle’s discovery, various authorities began making masks compulsory. San Francisco was the first major US city to do so in October 1918, continuing on and off over a three-month period.

Alberta in Canada did likewise, and New South Wales, Australia, followed suit when the disease arrived in January 1919 (the state basing its decision on scientific evidence older than Charles Nicolle’s findings). The only American state to make masks mandatory was (briefly) California, while on the east coast and in other countries including the UK they were merely recommended for most people.

San Francisco gathering, 1918.
Wikimedia

Numerous photographs, like the one above, survive of large crowds wearing masks in the months after Nicolle’s discovery. But many had begun to distrust masks, and saw them as a violation of civil liberties. According to a November 1918 front page report from Utah’s Garland City Globe:

The average man wore the mask slung to the back of his neck until he came in sight of a policeman, and most people had holes cut into them to stick their cigars and cigarettes through.

Disobedience aplenty

San Francisco saw the creation of the anti-mask league, as well as protests and civil disobedience. People refused to wear masks in public or flaunted wearing them improperly. Some went to prison for not wearing them or refusing to pay fines.

In Tucson, Arizona, a banker insisted on going to jail instead of paying his fine for not masking up. In other western states, judges regularly refused to wear them in courtrooms. In Alberta, “scores” were fined in police courts for not wearing masks. In New South Wales, reports of violations flooded newspapers immediately after masks were made compulsory. Not even stretcher bearers carrying influenza victims followed the rules.

England was different. Masks were only advised as a precautionary measure in large cities, and then only for certain groups, such as influenza nurses in Manchester and Liverpool. Serious questions about efficacy only arose in March 1919, and only within the scientific community. Most British scientists now united against them, with the Lancet calling masks a “dubious remedy”.

These arguments were steadily being bolstered by statistics from the US. The head of California’s state board of health had presented late 1918 findings from San Francisco’s best run hospital showing that 78% of nurses became infected despite their careful wearing of masks.

Physicians and health authorities also presented statistics comparing San Francisco’s mortality rates with nearby San Mateo, Los Angeles and Chicago, none of which had made masks compulsory. Their mortality rates were either “no worse” or less. By the end of the pandemic in 1919, most scientists and health commissions had come to a consensus not unlike ours about the benefits of wearing masks.

Clearly, many of these details are relevant today. It’s telling that a frivolous requirement became such an issue while more severe rules banned things like talking on street corners, kissing your fiancé or attending religious services – even in the heart of America’s Bible belt.

Perhaps there’s something about masks and human impulses that has yet to be studied properly. If mass resistance to the mask should arise in the months to come, it will be interesting to see if new research will produce any useful findings on phobias about covering the face.

Samuel Cohn, Professor of History, University of Glasgow

This article is republished from The Conversation under a Creative Commons license. Read the original article.