COVID-19 is not the first pandemic to reap havoc and tragedy around the world, and it won't be the last. Every few decades or centuries, a deadly new disease, or the mutation of an existing one, appears in a heartbeat and spreads just as quickly, destabilizing millions and killing many. In terms of combatting outbreaks, what has humanity learnt since The Black Death ravaged Europe in the mid-14th century? What progress has been made to safeguard society? The answer is twofold: a lot and not enough. Vaccines can take months, more likely years, to develop and yet, one positive is that pandemics have triggered vast investments in innovative health and medical developments, so better preparing the world for the next. Here are a few examples:
1. Foundations of the modern hospital
The Black Death, or Bubonic Plague, ravaged Europe in the 14th century when 12 ships from the Black Sea docked at the Sicilian port of Messina in October 1347. The bacteria, or bacillus, that triggered the plague is known as Yersinia pestis, an airborne disease which can also spread through bites from fleas and rats. Over the next five years, the pandemic wiped out an estimated 100 million people, the equivalent to two-thirds of Europe’s population.
‘Hospitals’ in Europe had, until then, operated as extensions of the Catholic Church and were designed to treat the poor and needy. The word itself originated from the French "Hôtel-Dieu", meaning “hostel of God”. Nuns and clergy would treat the sick, patients were encouraged to confess their sins before God, and medical treatments mostly consisted of herbs and ointments.
As the Black Death decimated communities, tens of millions of infected people rushed to these hospitals in desperate search of treatment and care. The black plague and the ensuing panic marked a significant turning point for the role and life-saving importance of the institution we know and respect today. The religious hostels of the 14th century have since morphed into a modern-day total of almost 20,000 facilities across 177 countries.
2. Quarantine as a Strategy Against Disease
As a result of COVID-19, we are all familiar with the concept of ‘social distancing’, and its effectiveness in helping prevent the spread of an epidemic. Figuring it out has taken time though, 650 years to be precise. The first known use of ‘social distancing’ was in 14th century Venice, in an effort to combat the spread of The Black Death. At the time, Venice was one of the world’s international trade hubs, and its harbour one of the busiest. Fearful of the disease reaching its shores, port workers would order incoming ships to dock in the port for a quarantine period of 40 days before they were allowed to disembark. The word "quarantine" derives from the Italian word for ‘forty’, namely 40 days of isolation. The other condition was that the crew had to demonstrate they were free of any symptoms before disembarking. It was later discovered that the port workers' quarantine period was correct, as the length of time between exposure to the Black Death and developing symptoms is a maximum of 37 days.
The quarantine imposed in Venice was declared a success and the other major ports adopted the practice. Quarantining has since been used to slow the spread of diseases and to determine whether people develop symptoms. Years later, Venice established what is considered to be the first quarantine hospital, or lazaretto. History repeated itself this year as Japan refused entry to the Diamond Princess cruise ship and ordered its passengers to quarantine for several weeks.
3. The Invention of the Vaccine
Smallpox had terrorized mankind since the Pharaohs and taken millions of lives in the process. It was not until the late 18th century, and the quick observations of a British doctor, that a vaccine was developed as a protection against disease. In 1796, as the smallpox epidemic gripped Europe, Dr. Edward Jenner noticed that milkmaids who contracted cowpox were less likely to fall ill to smallpox. Cowpox is manifested in lesions and blisters on cow udders, and while it can infect humans who come in contact with an infected animal, its symptoms are less severe than smallpox and are similar to the symptoms of a mild flu.
In a revolutionary idea for the time, Jenner scraped the puss from a blister that had grown on an infected cow's udder and inoculated it into both arms of an eight-year-old boy, James Phipps, the son of Jenner’s gardener. A single blister grew on the child’s hand, he developed mild symptoms yet did not lead to full-blown infection. Two months later, Jenner repeated the experiment, this time injecting the boy with smallpox matter. Young Phipps did not become ill, nor did he develop any symptoms. As a result, Jenner discovered a whole new world of preventative medicine. Jenner coined the term, ‘vaccination’, from the Latin vaccinus, meaning of or from the cow. Once vaccinated, a patient develops antibodies that make them immune to cowpox, but they also develop immunity to the smallpox virus. The vaccines proved so successful that, in 1980, the World Health Organization declared smallpox as the first disease to be eradicated by vaccination.
4. The Establishment of a "Ministry of Health"
The Spanish Flu of 1918 was a severe pandemic that infected 500 million people and killed an estimated 50 million around the world. Five years later, the Soviet Union established the People’s Commissariat for Health, what would later become the model for Ministries of Health around the world. England, France and Germany followed suit, as countries moved to a more centralized and population-focused healthcare system, where the state plays an active role in protecting its citizens' health and wellbeing.
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So, how will COVID-19 impact global healthcare? There are already signs of a seismic shift in the industry as demand intensifies for homecare solutions and the latest in digital health technology. As bright as future innovations may appear, we would be wise to heed the lessons from 14th century Venice, quarantine and play our part to “flatten the curve.”