04 May 2020

In the 19th century vaccination was from the church bell-ringer, and if you fell sick you may have been sent to an epidemic hospital outside town. People have combated recurrent epidemics through the ages in different ways. And COVID-19 demonstrates how vulnerable we still are. Historian Hans Nilsson describes the changing ways in which society has dealt with threats to health.

Asian flu in Sweden
Asian flu in Sweden 1957

“People have dealt with disease in different ways at different periods. It’s important to remember that people were not more stupid then than now, but their collective knowledge was different”, says Hans Nilsson, professor of history at Linköping University.

For nearly 25 years, he has conducted research in social history, including historical demographics and the history of medicine and health. He has examined in detail work in public health, which started in Sweden in the 19th century. This means that he has an excellent insight into how both the individual and society have been affected when epidemics have hit Sweden.

Hans Nilsson points out that the way we have dealt with COVID-19 differs in several ways from previous diseases. Not only are the medical conditions completely different, there are also differences relating to how we view disease. One of these is how much attention we choose to give the disease.

“In the 1950s and 60s, Asian flu and Hong Kong flu were widespread. But there was not the same focus we have today on reporting on things in the newspaper all the time. These diseases didn’t receive the same amount of attention.”

Another difference relates to our refusal to accept disease and death. In the 1920s, death was a part of life and nearly all families had one member who had died from, for example, tuberculosis.

“It’s been clear right from the start that COVID-19 is not of the same magnitude as the Black Death. But we are so unaccustomed to people dying that we take it extremely seriously. In our era, it’s not morally acceptable to let people just die. Each death affects us”, says Hans Nilsson.

Urban areas have always been harder hit by epidemics

Urban areas have been affected by disease through all the ages. Just as now, it is in these areas that epidemics get a foothold and can spread rapidly. In the 1750s, so many people in Stockholm were dying of infectious diseases that the town found it difficult to hold a steady population.

At the time in densely populated areas without access to vaccines, antibiotics or a reasonable healthcare system, there was often no other choice than to do what we are doing now – try to isolate the sick from the healthy. In the 1850s, they built special epidemic hospitals outside of the towns and cities, and in the 1950s and 60s, when Asian flu and Hong Kong flu were widespread, it was forbidden to visit folk in care homes and hospital establishments.

Compared with the 1950s and 60s, the restrictions today are much more stringent: back then everyday life could continue in parallel with the pandemic.

“At the time, people weren’t worried about keeping order in the queue at the hotdog stand at a football match. They were more worried by the degree of absence in the team, which was so large that it wasn’t possible to field a complete team and get the match under way. It’s all a question of perspective!”

Poor preparedness through the ages

Asian flu in Sweden168 sick conscripts by asian flu in a sport arena att F 21 in Luleå.The way in which society was unprepared to manage COVID-19 has been criticised, and aspects such as poor preparedness, a failure to protect the elderly better, a lack of available healthcare capacity, and the lack of personal protective equipment. How good has preparedness for disease been in a historical perspective?

“Our preparedness for COVID-19 has been deficient in many ways, but there is, even so, a colossal difference between how society acts today, and the actions available to it. We now work extensively with preventive health, and society is much better organised. The way in which the healthcare system has reconfigured itself has been impressive. When it comes to elderly care, I suggest that we are dealing with failures in the system: many poorly educated, several different accountable authorities, and many temporary appointments.”

When the Spanish flu was prevalent 100 years ago, the situation was different. The First World War had just ended, and military politics was the centre of attention, not a disease that was difficult to get a grip on. People lived closely together, and many men were living in cramped quarters in barracks.

Hans Nilsson believes that we benefit today from the fact that information about COVID-19 comes from one centrally controlled government agency, and the recommendations apply to all. When the Spanish flu was widespread, many decisions were taken at the local level.

“Regimental commanders could decide not to allow the soldiers to travel home. And of course this led to many becoming infected and seriously ill. Just as is the case for COVID-19, more men than women died, but this was mainly because they lived in cramped conditions in the barracks and carried out manual work close to each other.”

In earlier periods, such as the 19th century, it was even more difficult to organise society when epidemics arose. The only agency available then was the church, where attendance was compulsory. The congregation could there obtain information about how to take care of themselves.

“The church also kept a record of who had been infected: you can see this in the old church ledgers. And if you wanted to get vaccinated, it was the bell-ringer you went to.”

On several occasions in history, people have been prepared for various diseases to become prevalent. Even so, society has not been able to get ready. Both in the 1950s, when Asian flu was prevalent, and in the 1960s, when it was Hong Kong flu that was the problem, you could see the diseases spreading through other countries. And yet supplies of vaccine were insufficient.

“Vaccines take a long time to produce, and our economy is based on the stores being kept small. And it’s difficult to be prepared, when you don’t know in advance what you should prepare for.”

Translated by George Farrants

Pandemic: An infectious disease that spreads over large parts of the world and affects a large fraction of the population in each country. 

Epidemic: The spread of an infectious disease through a single country.

Some pandemics:
The Black Death, 1350s
Plague epidemics, 16th, 17th and 18th centuries
Cholera, 19th century
Spanish flu, 1918-1920
Asian flu, 1957
Hong Kong flu, 1968-1970

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