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Transcript: Pandemics: Past, Present, Future

image of influenza hospital in Iowa

 

From Plague to Influenza and HIV, learn about the history of global pandemics in order to better understand the current coronavirus pandemic, a panel discussion with John Brooke, Jim Harris, Thomas McDow, Erin Moore, and Kristina Sessa.

[Listen to the podcast here.]

Transcript begins here:

Dr. Thomas McDow
Welcome to pandemics past, present and future. Coming to you from the history department at The Ohio State University. My name is Thomas McDowell. I'm an associate professor in the department and I specialize in African and Indian Ocean history and the history of HIV AIDS. I will be your moderator. Today we are living through a pandemic that is unprecedented in the lifetimes of nearly everyone alive. We have faced and will continue to face a great deal of uncertainty as the COVID-19 pandemic plays out. We're all figuring things out and trying to make meaning from this novel time. Yet, this is not the first time our species has confronted a pandemic threat for which we have no immunities. History can give us insights about how to live through and rebuild from a pandemic. And at Ohio State we are lucky to have a leading national program in the history of health, environment, technology and science. Historians at OSU and elsewhere, have long studied pandemics, taught their lessons and preached preparation. We believe that now more than ever, insight about past pandemics and how they affect societies is essential for everyone. We are so happy that you've joined us today. And we're delighted to welcome four experts on the history of pandemics from Ohio State University. Kristina Sessa will speak about the Justinian Plaque, John Brooke will cover the Black Death, Jim Harris will address the 1918 influenza pandemic and Erin Moore will discuss HIV AIDS. Thus, we'll be hearing about three diseases over four time periods. And for those keeping score at home, the plagues the plagues are both bacterial while influenza and HIV are like COVID-19 viruses. Now we'll proceed. Each speaker will give us a brief overview of a historical pandemic with slides to augment their talk. After all four presenters have spoken we'll open a discussion to ask the panel to respond to your questions. Many of you submitted questions when you registered. And we also will be collecting questions through the q&a feature during the event. We've received hundreds of questions and we'll do our best to answer as many as we can. Okay, let's go ahead and get started with Kristina Sessa on the Justinian Plague. Tim Sessa is historian of late antiquity, that is the period between the end of the Roman Empire and the start of the Middle Ages. Her most recent book examines daily life in this period. And she's currently working on a project that explores perceptions and responses to disasters, including the Justinianic Plague.

Dr. Kristina Sessa 
Great, thank you, Dodie. Can everybody hear me? Good. Um, thank you. And good afternoon, everybody. So the Justinianic plague is the name we give to the first recorded outbreak or pandemic of bubonic plague in the late Roman or Byzantine Empire. And we first hear about it in our sources starting in 541 AD, and the plague recurred intermittently through the middle of the eighth century. So we call the Justinianic Plague the Justinianic plague because the initial outbreak corresponds with the reign of the Emperor Justinian. And he's the dude in the middle there. Interestingly, Justinian was himself a casualty of the plague. He contracted the disease, although he didn't die from it. And there are two interesting kind of points we can take from that. First, it tells us a little bit about risk factors. And it tells us that age, social status, wealth, access to power, or you know, excellent medical care, were really not big risk factors. The biggest risk factor in terms of getting bubonic plague was where you lived. And for those people who live in dense urban environments, like the imperial capital of Constantinople, where Justinian lived, you are much more likely to contract and die of bubonic plague than if you lived in a less densely populated rural community. Also, as Dodie mentioned bubonic plague is a bacterial infection, which today we can treat very easily with antibiotics. However, obviously, in the sixth century, they didn't have antibiotics. And so the mortality rate for bubonic plague was extremely high people. Sorry, I don't know why I did that, um, people who were between 60 and 80% of the population of people infected with the disease would have died from it. So it's pretty interesting that Justinian didn't, was one of the lucky ones who didn't manage to die. Um, we're going to hear in a few minutes about the transmission of bubonic plague through fleas. So I'm going to talk and tell a little bit about sources and what they tell us about living through plague, as well as a little bit of interesting facts about DNA. So all of those round circle circles around all of these black circles on your screen, these all are cities where we have good literary evidence. We have texts that either refer to the pandemic briefly, or in a very few number of cases, we have very detailed descriptions of the disease itself. And more interestingly, of its impact on the community. And we're, we're especially well informed about the city of Constantinople, which is indicated by the arrow on the screen. Um, and we hear for example, about the trauma of experiencing this we hear about its impact on the community, the interruption of daily life, and the difficulty that people had carrying out routine tasks, like burying the dead and like today where we're kind of overwhelmed with the number of bodies and we can't perform normal our normal funeral rights. Same thing happened during the Justinianic Plague. So for a long time, all historians had to go on in terms of determining what exactly this disease was that people were dying from in the sixth century were Literary Sources. That was until about 20 years ago when scientists got involved and figured out a way to extract genetic material from the teeth of skeletons of people who died in this period. And what they found in that genetic material was the DNA of the pathogen that causes bubonic plague. And this is how we know for certain that this was the disease that is that that we call the Justinianic plague, and all of those squares, those are all set cemeteries where we found that DNA evidence. So  didn't the plague end the Roman Empire. So this is the question. And for a long time, up until really recently, historians thought yeah, it kind of did. It was it was this catastrophic rupturing event that brought about the end of antiquity and the start of the Dark Ages, we thought it wiped out anywhere between 30 to 60% of the population. We thought it absolutely collapsed the economy, decimated the army, was really a factor in the end of civilization. However, we've come very recently to rethink this. And we basically started looking at different types of indicators, more long term indicators that have given us a very different story. And so for example, on your screen, you are looking at a graph that shows us agricultural production. And as you can see, agricultural agricultural production did not fall off during the Justinianic plague. It more or less continued a pace. And so what does this tell us? Well, one of the things it tells us is that even if our witnesses even if the people living through the plague felt like this was the end of the world, it actually wasn't. And that pandemics very often only have localized short term impacts. Not always, but very often. So that's maybe good news for us. The other takeaway is that stories matter how how people in the past talked about plague really impacted how historians for a long time understood it. So as we move through our plague, I think we should think about how we're going to talk about our own experiences. And, and that's and move forward like that. So any event, thank you.

Dr. Thomas McDow 
Okay. Thank you, Tina. We'll now turn to John Brooke to hear about the Black Death. John Brooke is an arts and scientists sciences distinguished professor of history and the author of five books, one of them Climate Change in the Course of Global History, A Rough Journey demonstrates his mastery of global environmental history and situates black death, his topic today as a gateway to modernity.

Dr. John Brooke 
Thank you for joining us this afternoon, I'm gonna turn our attention to the Black Death. The second second pandemic of the same bubonic plague that struck in the time of Justinian, which had mutated into a distinctly more virulent disease in the in Central Asia early in the 1300s. Black Death hit Europe between 1347 and 1351. But had aftershocks that ran all the way to the early 1700s. The plague may have spread from Central Asia to China in early 1200s, but it clearly split from Central Asia to the Black Sea in the late 1340s, where it spread as far as southern England in one year. Traditionally it has been assumed that the transmission of the plague involves the movement of the play of plague infested fleas from wild runs to the household black rat. Increasingly historians are arguing that it must have been transmitted via human fleas and human body lice. Such would explain its fine, its very rapid movement, particularly through Europe. We know a lot about the impact of black death from a documentary record and from archaeological excavations. Within the last few decades, the genetic signature the plague has been positively identified in burials from across Europe. In the late 1340s, news of the plague spread and people knew it was coming. Plague pits such as you see here in the East Smithfield, London were dug before the arrival of the epidemic. The bacillus was deadly and took both rich and poor, rural and urban. The daughter of Edward the third of England died of the plague in the summer of 1348. But quickly at least in Europe, the rich learned to barricade their households against its reach and the poor suffered disproportionately. Strikingly, if a mother survived the plague, her children tended to survive. If she died, they died with her. In sum, after centuries of population growth, a conservative guess is that Europe's population was cut from 85 billion to about 60 million, possibly more, and India may have dropped from 105 to 75 million. China had suffered massively from the Mongol invasions and probably the plague in the previous century. What was the societal impact of the Black Death? Scholarship on Europe in the last 30 years has come to understand it as a critical inflection point, a profound rupture that reshaped the economy, society and culture. We might want to think of this impact in ways broadly similar to those proposed in Naomi Klein's Shock Doctrine. Most immediately, the Black Death drove an intensification of religious belief in practice, manifested in portents of the millennium, in flatulent cults that undermined the authority of the clergy, and in Christian pogroms against Europe's Jews. That same intensified religiosity combined with the deaths of many ministering clergy, fears of sending students on long dangerous journeys, and the fortuitous appearance, where did they come from? large donations coming from people who had just recently died, led to enduring institution building. New universities and colleges that older ones are suddenly founded in considerable numbers. The proliferation of new centers of learning and debate is seen as subtly undermining the unity of the medieval Christianity and setting the stage for stronger national identities and the precursors of the Reformation. The plagues disruptive experience also shaped new directions in medical knowledge. Historian Samuel Cohn has argued that the doctors tended, tending the sick during the plagues began to rebel against the agents. They've learned from their experience that disease was not caused by the alignment of the stars, but from a contagion and they were committed to a new empiricism. Cohn argues that here lay the distant roots of the scientific revolution. Quarantines were directly connected to this new empiricism and the almost instinctive social distancing of Europe's middling and elite households. It has become clear that small pools of plague did get established in Europe for centuries, apparently, while roaming communities in the high pass of the Alps. But it was also clear that at the time that the plague came into the Mediterranean ports by ship. First quarantine was established in 1377 in the Adriatic port of Ragusa and by the 1460s quarantines were routine in the European Mediterranean. Major outbreaks of the plague in in 1665 and 1621 in London and Marseille were the result of the breakdown of these quarantine barriers. From the late 17th century to all the way to 1871 the  Habsburg Empire maintained an armed cordon sanitaire against the plague eruptions coming from the Ottoman Empire. As as it was, with the rise of the National University, the building of quarantine structures against the plague was a dimension of the emergence of state power in Europe. Now, through all this, the common people who survived the Black Death emerged to new opportunities and empty lands, we have fairly good wage data for England, and wage rates rose dramatically and rapidly, as masters look for increasingly scarce labor. The famous French historian Marc Bloch argued that the Black Death brought it into the Middle Ages in a crisis of the revenues flowing from the rich to the poor. And I'm going to stop there.

Dr. Thomas McDow 
Thank you. Thank you, John. We'll now turn we'll now turn to Jim Harris, who will talk to us about the 1918 flu pandemic. Jim Harris received his PhD from Ohio State and has become one of the most popular lecturers in the department, teaching more than 1000 students in the last three years. They're drawn to his knowledge and his global history of vaccines. He writes on influenza and the history of public health in Britain.

Dr. Jim Harris 
Hello, everyone, and thanks, Dodie, for that introduction. I'm going to talk briefly in the next five minutes about the history of the 1918 influenza epidemic for you. The 1980s influenza epidemic caused far more cases than the past pandemics you've heard about in this webinar by by orders of magnitude though the Black Death may have afflicted a percentage of the world greater than the 1918 influenza. In 1918 this afflicted 500 million cases. And conservative estimates say there were at least 50 million deaths from the pandemic. This was 25 times larger than the average flu pandemic. And this flu pandemic had several important unique characteristics to it. One of which was the nature of the deaths. In a typical flu pandemic, and there have been many from the at least five in the last hundred and 50 years. Typically the very young and the very old are subject, are the ones who die most frequently but in 1918, amid the ongoing First World War, those in the prime of life were also particularly particularly died in this pandemic. And that wartime context is really important. And we're hearing a lot about the three waves of the 1918 influenza pandemic, today. And this graph shows those three waves and when they occurred in term, and what we see here is that the second wave was by far the most deadly phase of this pandemic. And I'm going to spend the next few minutes trying to walk us through these three waves very briefly. The 1918 flu pandemic likely first broke out in Kansas at a military, a military base in Kansas, Fort Riley, where a camp cook reported sick in March of 1918. From there, the pandemic would follow troop movements around the globe starting in the United States and moving outward from there. This map shows you the rate of the spread of the pandemic over time beginning in March, and then over the summer months as it moved following US troops to Europe. Then, in August of 1918, the pandemic virus mutated causing that second wave of the pandemic you saw in the previous graph. It struck almost simultaneously in late August of 1918, in three port cities, Boston, Massachusetts, Brest in France and Freetown in Sierra Leone. These were all important military ports, Boston, being a site where troops were deployed from the American Expeditionary Force to Europe, Brest in France, where American troops often landed, and Freetown was an important coaling station serving transatlantic troop movements. This wartime context is really important for understanding the 1918 flu. Because during a war when you need to keep the war economy moving, you can't enact quarantines and social distancing like we're employing in COVID-19 today. In the UK, where my research is primarily focused, the head of public health Sir Arthur Newsome told Britons to simply keep calm and carry on. In the United States they were more proactive, however, in enacting some public health measures. The United States Public Health response is of course varied from locality to locality and afflicted people with very in various disparate populations were afflicted differently. In San Francisco for example, mask wearing was made was compulsory under the law. And the results of that we can and social distancing was enacted in various lengths and in various durations in  various cities and we see from the 1918 flu pandemic, the consequences that had in terms of mortality. And in places like our own Columbus, Ohio, mortality rates were kept very low because quarantine measures and limiting gatherings were kept contained. Whereas in places like Philadelphia, where you see one of the worst cases of the pandemic here, large parades to celebrate the war and to raise morale for the wartime experience resulted in failures of the only effective public health measures you had when you couldn't see viruses at the time, such as was the case in 1918. And we'll talk, I know, more about the legacies of this and the q&a. So I will stop there.

Dr. Thomas McDow 
Okay, thank you, Jim. Now on to HIV/AIDS. Erin Moore is an historian of global health, who has been conducting research in Uganda since 2009. She is currently based at Columbia's Mailman School of Public Health in New York and will be joining the faculty at Ohio State in the fall. In Columbus she'll teach courses, human history, and anthropology, public health and human rights.

Dr. Erin Moore 
Thank you. So the global HIV pandemic flared from 1981 to 2005 as a pandemic, and of course, it's still affecting people all over the world today. The HIV pandemic shares both similarities and differences with COVID-19. And today I'm going to talk about the emergence of HIV in different global populations. The development of antiretroviral therapy or ART, which is now used to treat and prevent the virus, and how access to treatment was a matter of global economic justice. HIV or the Human Immunodeficiency Virus is spread primarily by unprotected sex. The virus was first detected in 1980, in California, among a group of otherwise healthy young men who developed a immune diseases. By June of 1981, the US Centers for Disease Control had reported on the virus of five young men at three different Los Angeles hospitals. And by the end of that summer, they had hundreds of cases, the majority of which were reported from California in New York. All but one of those cases were men and over 90% of those affected stated that they were gay and sexually active. In the United States HIV quickly became understood as a quote, lifestyle disease associated primarily men who have sex with men, an association drawn by national statistics, by activists from the AIDS Coalition to Unleash Power or ACT Up, a long running LGBTQ organization that advocates for the rights of those with HIV and by cultural productions such as Tony Kushner's, Angels in America, which won the Pulitzer Prize for drama. By 1992, HIV AIDS became the leading cause of death for men in the United States. Since the beginning of the epidemic, more than 700,000 Americans have died. Sadly, HIV AIDS has had even more devastating and longer reaching impacts in Sub Saharan Africa. So much so that the association between aids and the African continent is indelible in the public imagination. Africa's first case of HIV was documented in southwestern Uganda in 1982, where it was known locally as Slim Disease, because it causes extreme weight loss. Uganda, a landlocked country in East Africa the size of Oregon, had one of the world's worst outbreaks. By the early 1990s HIV was killing one adult for every three households in its hardest hit regions. A decade later, most people living with HIV and more than 75% of deaths from AIDS born in Sub Saharan Africa. The vast majority of those infections are among young women, ages 15 to 24. And we remain so today. According to UN aids in Sub Saharan Africa, three in five new infections among young people are in girls, whose gendered social and economic vulnerability puts their health at risk. Even with new infections every year deaths from HIV have greatly rescinded. Fewer than half as many people are dying globally now than they were 15 years ago. The availability of antiretroviral therapy or A RT has led to a steep decline in the number of adults and children dying from the virus, yet access to ART was and is unequally distributed both within the United States and globally. In the US researchers had developed effective ART by the late 1980s. But the high cost of medication, originally as much as $15,000 a year, prevented many who needed it from accessing it. To demand affordable Treatment ACT Up organizers targeted Wall Street and the government which eventually established a federal funding mechanism called the AIDS Drug Assistance Program to make ART affordable and widely available. As a result by 1996, the death rate from HIV AIDS in the US began to decline. Researchers have estimated that ART saved over 3 million years of human life in the US between 1989 and 2003. In Sub Saharan Africa however, the high costs of ART prevented access to treatment for more than a decade. ART only became widely available on the continent in 2005 and only after activists pressured first the South African government and then the World Trade Organization to block pharmaceutical companies' patents on the medication. In other words, Africans had access to life saving HIV treatment only 10 years after Americans did with life and death consequences as this graph shows. And while more and more people are managing HIV with treatment, making it more like a chronic illness, UN estimates that 38% of people who need treatment cannot access it. So by way of conclusion, I just quickly say that while it's still too early to tell how COVID is going to play out on a global scale, I think thinking about HIV and comparing COVI to the HIV pandemic should tune us to the importance of equitable access to life saving, testing and treatment at the very least, and even better to the importance of universal health care for all. Thank you.

Dr. Thomas McDow 
And thank you all for these formative overviews, our audience has many questions and we'd like to pose those to you now. Many of our viewers submitted questions when they registered. Thank you for that. We will use those for our first questions, you can also ask questions through the q&a function of the webinar software and I will be able to pose them to our panel. So I guess I'd first like to ask everyone to think, ask everyone to think a bit about the pandemic you study. Both Tina and John talked to some degree about a paradigm shift that might be associated with their pandemic. But I was wondering, if you might say something about the legacy of influenza or of HIV AIDS.

Dr. Jim Harris 
We're happy happy to talk about the the legacy of influenza. So influenza, we like I said in my presentation, very briefly, we've had numerous pandemics of influenza. We've had several big ones in the course of the 20th century, in 1918, in 1957, in 1968, and in 2009. And these have each inspired further advances in medical research. We couldn't see viruses in 1918. And we didn't have an understanding of a particular etiology of the disease. That research began in earnest because of wartime contexts, especially during World War II. And the legacy of the 1918 flu then was the beginning though it was slow. We didn't see viruses till the 30s. We didn't see viruses till the 30s in terms of new advances in medical research and trying to understand the nature of viruses.

Dr. Thomas McDow 
And Erin, did you want to say something about the legacies I've turned my video off to help the sound quality?

Dr. Erin Moore 
Sure when I think about the legacy of HIV, which HIV pandemic which, of course, is still ongoing in some ways I really think about, I think the legacy of loss suffered both in the United States and in Sub-Saharan Africa. Christina mentioned during the Justinianic Plague the overwhelming amount of bodies that were there to be dealt with in the burial of these bodies. And I think, you know, I think HIV is still very much present in the minds of many people who, the generation of gay men in the United States who lost partners and friends, and it's very much in the minds of the people that I've worked with itself in Sub-Saharan Africa and Uganda who have lost parents, friends and family members. They, in Uganda they refer to HIV as a household disease because at least one person per household has died or knows someone who died. And I think that those legacies of loss that surrounded the HIV pandemic are extremely important to think about with the collective mourning that we only just began here in the United States and will continue to grapple with as COVID continues to take people from us.

Dr. Thomas McDow 
Okay, thank you. I'd like to ask you all to think a little bit about someone who personifies the epidemic that you've talked about. What voices or points of view are most memorable, poignant or important? What was it like for people to live through your pandemic? And I'll start with I'd like to start with Tina and also ask her to address a question that just came through from the audience about the you know, considering the frequency of domestic and international travel today, can the conclusion that the Justinian played was only localized the applicable today's situation? So I'll throw to Tina the question about localized versus today's situation, but then also ask all of you to comment about the personifications of the epidemic that you've talked about.

Dr. Kristina Sessa 
Sure, um, that's a great question. And I think, you know, one of the puzzling things about trying to put together the Justinianic Plague is that we have these kind of isolated sources that suggest that the plague did move. We have literary sources that tell us it's in certain places. And then if you I don't know if you can still see, I won't go back to the map. But we we have found plague all over the western part of the Empire, I mean, as far away as Britain, which was barely part of the Empire in the sixth century. Um, so I do think that we have to still think about in a similarity to today, and that people did move around the Roman Empire. I mean, obviously they did and they brought plague with them. However, obviously, this was not on you know, on a much, much, much smaller scale than what we're seeing today. And the movement of people today is just so much greater because of air airplanes and other much quicker forms of travel. So I think they're, it's, it's both similar, I mean, plague got around through people moving through to travel through trade and whatnot, but not nearly to the extent that that we've had problems today. And terms of memorable people, um, I would definitely have to go to a man named Procopius, who was a sixth century historian who himself lived through the plague. He was living in Constantinople, right alongside Justinian, he did not get sick, but he wrote about it. Um, and I think one of the things that Procopius says that I always come back to is he talks about how, after during the plague, everybody's sort of changed their behavior and and became kind of better people. They became more moral, less greedy, all of those things. And within months of the plague subsiding from Constantinople, everybody went back to their old greedy ways. And I guess from what I take from what Procopius is saying is that what we learn from these kinds of disasters is that we don't learn. And so I if I can sort of put this forward to today, I hope we can learn something from what we're going through, rather than just sort of have these kind of short term fixes, but not really make long term changes.

Dr. Thomas McDow 
Other views on someone who personified the epidemic you're talking about?

Dr. John Brooke 
I was gonna make a comment about the speed of movement. And it's really not much different than the speed of movement between the age of this Justinianic Plague and the Black Death. I mean, essentially, they're the same technology. It's nothing drastically different. What probably was different was the virulence of the disease. There had been genetic changes, and it probably was a somewhat different disease have a somewhat different kind of trajectory to it. Now, but it's so so you know, really on a level playing field. But if we were, we'd look at a disease that we have skipped, which is cholera, in the 19th century. The speed of movement is the speed of the steamship. And so when we talk about what's been happening to us right now, and the movement of in the last 10 years really with the movement of diseases by air travel, we can look at the 19th century and look at this, look at the steamship context and the sudden impact of cholera in waves coming out of out of the Bay of Bengal and into the global system having huge impacts that clearly, you know, transportation and movement does matter. And it's a combination of both the virulence of the disease and the vehicles that we put in place to, ha vehicles, to put to put the disease in motion. And I'll just defer for for personification I'll just talk about a anonymous orphan who survived the Black Death and great trauma and probably was psychologically damaged but inherited some property from you know cousin so-and-so and ended up in, what happened in the wake of the Black Death was for about 150 years people did okay. They did better they'd had in the past there they were bigger people via archaeology shows they were larger and healthier. So I don't want to make an analogy to today but in the Middle Ages of the it's very clear that the generally a Malthusian pressure was released and people were people did a little better for about two centuries.

Dr. Jim Harris 
I like to constantly think about 1918 in as I tried to highlight in my presentation, the wartime connection. And when I was doing my research on these interconnections, I came across the memoir of an artillery officer in the British Army, whose name was Richard Foot. And I think an anecdote that I reference in in Richard Foot's memoir is particularly insightful and in thinking about how people of different social classes in the case of this anecdote, an officer in the army versus enlisted men experienced this pandemic differently. And in his memoirs, he describes how he was on the march in Germany in the after the war ended but in the occupation. And he was feeling awful as he experienced the symptoms of flu and had to stand in formation and so forth. But then he says he was able to leave his unit after after they perform the ceremonial introduction in the city. And he was able to rest in the second floor of a baker shop, and lied infirm for a couple days. But he then goes on to describe how his friend and enlisted man Fitter Othen is the soldiers name was forced to keep on the march because he was a lower rank. And he ended up dying before he gets to field hospital as a result. And so different classes experienced this and different social circumstances greatly impact how one experiences a plague. And I think that anecdote is a very vivid example of that.

Dr. Erin Moore 
In my case, for in HIV case, there are a number of activists or people who have embodied and taken on the cause of AIDS activism. But I kind of wanted to think about the about personification in terms of high risk kind of categories for, for the medical, for, for medical interventions. And I think that there because I think that there's something important like there's an important distinction here between HIV and the rest of the pandemics that have been described, which is that HIV is, of course, mostly transmitted through by through sex, otherwise intravenous drug use. So there is a way in which individuals' social behaviors could be altered or intervened upon, which has led to, which has led to a number of interventions that tried to intervene in the behaviors of, for example, sex workers, men who have sex with men more generally. And so I think that I'm kind of trying to highlight the the way that these kinds of character types have emerged. In terms of medical intervention, in order to suggest that these behavioral interventions often attach often attach behaviors to certain kinds of people as opposed to looking at their the broader economic contexts that are kind of creating the conditions in which people are, for example, having sex for money. So, yeah, that's my answer.

Dr. Thomas McDow 
Okay, fantastic. We're getting a lot of questions from the audience about the time period that ended the pandemic that you're talking about. And Erin's already said that, of course, the HIV AIDS pandemic is or epidemic is continuing in some ways, but for especially for those who didn't have, they didn't have medicines to do so. And I'd like to ask you to think about that. And also to say, the end of the pandemic that you've talked about, and also to what life looked like immediately after your pandemic and how we might think about our own process of emerging from the crisis. So start to think about what stopped or ended the influenza epidemic. And what did life look immediately after what did life look like immediately afterwards.

Dr. Jim Harris 
In the case of 1918, it actually continues on until this winter of 1919. The pandemic petered out naturally by and large it it, in fact, it came and infected, it devastated and then it went away. That's what happens with flu. It's it's the typical flu cycle on a much, much bigger scale. In terms of what life looked like afterwards, the pandemic as one historian Alfred Crosby in a bit dated book, but still important book, he calls it America's forgotten pandemic. Until relatively recently, we kind of ignored it in, in sort of broad, historical context historians specialists have continued to think about it, but it was kind of neglected. And now the impact is the last huge, huge mortality scale has made it have its comeback as it were in terms of the popular imagination. It's really hard to disaggregate the legacy of the immediate legacy of the flu from the war, the rebuilding in the early 1920s, economic downturn, economic recovery and whatnot. Just,  they exacerbated one another.

Dr. Thomas McDow 
Someone else want to jump in there to think about how your plague or how your epidemic ended, and how we might think about the process of emerging from crisis.

Dr. Kristina Sessa 
I'll start and then John can go on. So we don't really know how the symbiotic plague ended. We are sources like per copious talk about a cycle of a three or four month period where it was really bad. And then it just kind of mysteriously leaving on I should say, it probably never went away entirely because as I mentioned, the plague came back over, you know, in waves for the next 200 years. Um, in terms of what life looked like right afterwards. Well, I think it was probably pretty awful. We have lots of descriptions of people, people dying, people abandoning where they're living to leave to try to go leave the city, get some place where you might be away from all the dying, there was a vague understanding of contagion in in the ancient world. And so people kind of got that on people leaving behind all of their all of their wealth. And in fact, one of the things that our sources talk about, are people taking advantage of this people stealing the money or goods or animals from people who had died or had to run away during the plague. So it seems like it was extremely chaotic, um, and a lot of opportunistic behaviors of people trying to sort of get a win out of somebody else's loss. And, you know, I, you know, to what extent we see that right now with price gouging, hoarding, things like that. I think we definitely saw those kinds of behaviors in during the Justinianic Plague. But John, do you want to pick up and talk about the Black Death?

Dr. John Brooke 
Okay, um, yeah, a couple of things. I want to I want to talk about the Black Death. I also want to talk about a question that came from the floor, which relates to all of this in a big picture. What is striking about the Black Death is the I would argue the long term, there are these huge echo effects, which I haven't even talked about, that reaches all the way to, you know, huge epidemics in North America and the Americas, you know, as a distant aftershocks. But immediately, I think, what's interesting listening to Tina's description of what happened in the in the ancient world, it's actually the state worked better. And what is striking, I mean, I was just reading about about the aftermath of the Black Death once again, and you know, the things were kept under control. The state worked, they actually dug their trenches before the plague got there. And, and I think this is where I want to segue to a bigger topic which is the question of governance, the question of the effectiveness of governance and what is striking is in fact, how marginally effective it really was during the Middle Ages and in the in the year in the decades years following, among other things, of you know, the foundation of the quarantine, the dimension of state power and the enforcement of the quarantines. So, we have a question one of my students Dave Burgunsey who asked a question about poverty, what have why'd why are we still why does the COVID-19 epidemic striking the poor so hard now, and you know, this does have to do with the central legacy of all of these epidemics, which is that, really, over the course of the 19th and 20th centuries, we developed an infrastructure called public health. All brands are governed to deal with the great epidemics of the past and they kept things more or less under control. And what we've done is let that fray and we've also allowed into public office, people who do not think government should exist. And I would point out that that is the way to death. It will destroy us if we let down our guard. And I'm gonna say one more thing. Many, many years ago, I spent, I spent about eight months out of the country, including spending time in India Afghanistan. And I came back to this country and said, Oh, we live in a bubble. We live in a world protected by the great legislation and the great efforts of the progressive period. And we are letting it go. We are PERS piercing our own bubble. We have pierced the bubble. And we are now part of the world. Nobody likes that. Well, one of the reasons that happened was that we let down our guard and we government has failed as the national government fails in a enormous way. So I will let you all draw what lessons you will.

Dr. Thomas McDow 
So actually, Erin, can I can I direct that to you? Because one of the echoes we see here is of people being feeling let down by government. The HIV AIDS in the early 1980s disaffected in US government response, how might you put that in contrast to what John just said?

Dr. Erin Moore 
Um, wait, I mean, I I totally agree that we that HIV was a into the question. So that kind of ended the epidemic of HIV is over, it's over for those who can afford treatment and you can access treatment. So it's still ongoing and the numbers in both in the United States and globally showed that it is the most economically vulnerable who are still at risk of acquiring HIV and that he can't find treatment. And this I think, just as john was saying, is a failure of public health and public health systems more generally. And yes, so in that way, I think that the HIV pandemic. I mean, it's it's striking how, at least in the US context how similar kind of like their racial and economic categories are the overlap between COVID and the men who are at risk for HIV, mainly African American men are at higher risk for thyroid, both of those for for acquire and both with COVID. Of course, it's because of the existing conditions like hypertension and type two diabetes, but the fact that those conditions exist and can be and exist in, in higher rates among certain groups of people is itself a failure of unequal access.

Dr. Thomas McDow 
Okay, just in terms of thinking about where we are now with COVID-19. To understand the present and to look towards the future, like given what we what we know about past pandemics, how would you teach the current one? You You are all very skilled teachers. What are the stories to tell the takeaways for students the thing, the important things to focus on? How would you How would you conceptualize a course on COVID-19 that would also pull out themes that you've talked about another pandemics?

Dr. Jim Harris 
I teach a whole course on the history of disease. I believe our new colleague, Arun is going to actually teach this course in the fall. So I'm very excited to collaborate with her. But I teach a course in the history of disease. And I asked the students pretty much every lecture and to frame the whole course around the question of how is disease have a social impact? So not just thinking about raw, raw numbers raw, you know, graphing cases, infections, deaths, etc. But thinking about these actual human impacts, how have they changed? social structures, how they changed class, organization, how they thought influenced how humans treat each other. there in that course I talked about the diseases my colleagues have talked about as well. And in both the case of the Black Death in particular and HIV, there was a great deal of stigma in the immediate aftermath of, of, of those of those diseases, as as various populations were victimized and demonized by the masses in the initial wave of these pandemics. And I think we need to be careful being empathic and using history to teach empathy and to not stigmatize carriers or patients of this disease. And so I would ask students to continue to think about how is this affecting daily life in an ongoing way.

Dr. Thomas McDow 
Other thoughts on teaching this Current pandemic.

Dr. Kristina Sessa 
Yeah, I would sort of go back to something I said earlier about stories, and about how we narrate a pandemic when we're in it. And one of you know, some of the sources from the just Indiana play, they just they described the the plague in terms of divine judgment that the plague is basically God's judgment of man. And, and his punishment for for sinful behavior. And this was a very dominant narrative. That makes a lot of sense for the time. And I guess I'm a little bit disturbed by some of the narratives that that we're throwing around narratives about Chinese secret labs, manufacturing viruses to, you know, take over the world, these kinds of narratives that are so you know, patently false but yet, are being perpetuated But our but have a lot of power. And and I think we need to think about again how are we going to tell this story of COVID. And so that would be the way I would try to teach it, looking at the stories and how we help people are narrating it as we're in it. So that would be my two cents as of late antiquity historian.

Dr. John Brooke 
I'm really quickly I would just repeat a point made before the store those stories will be political. We could I'm ready to bet the people are putting the other courses, maybe not in history departments, but in other departments on the politics of COVID that this has a political dimension that says a governance dimension all these epidemics do we manage nature as it comes at us? And the question is not just what's its its social and cultural framing, but how do we how do we we mobilize resources to to handle the challenge

Dr. Erin Moore 
and my cyber teach in addition to whatever what my colleagues have said, which are, which are great coaches, I also want to be sure to focus on kind of the difference between epidemics or pandemics as events and then the longer structure of public health. Right. So in order to understand like, why certain people are getting sicker than other people, and to understand that as as a longer that has a much deeper history in the in the context of the United States and globally.

Dr. Thomas McDow 
Okay. With my eye on the clock? I realize we're getting close to the end. But here we have four distinguished historians who Think about pandemics and have thought about the past. I'd like to turn to you for some advice on how we prepare for the next pandemic in the time, so given what we what lessons we should take, how, how do we prepare for the next? Who'd like to start?

Dr. Kristina Sessa 
Or why not. And so, in ancient Rome, there was no such thing as public health. There was no such thing as the CDC. And that tells us a lot about the problems that they had. So my advice is we need to invest more in our institutions of public health period.

Dr. Thomas McDow 
Other thoughts?

Dr. John Brooke 
Yeah, just simply, you know, global coordination really, really matters. Again, diseases, nature does not respect political boundaries and we operate we think we're operating in some kind of world of chopped up boundaries and it doesn't, you know, we have to think globally. We have to act globally. I'm gonna sound like a broken wheel here are broken record, excuse me mixing my metaphors, as I echo what Tina and john basically just said, which is what we've learned through the Peck through the history of past pandemics is we've gotten faster and responding. We share information more, and we're in a we are in a global world. We live in a global world, labs can sequence diseases much faster than Well, we couldn't even see viruses there. 100 years ago, right now we can sequence viruses and gene sequences in months. And so but that takes coordination that takes global cooperation that takes tremendous financial and human resources to do and so preparing requires continuing to invest in build up these, these global systems like the World Health Organization.

Dr. Thomas McDow 
Okay, I think we are about out of time. So,  thank you all, for joining us today. I'm going to close by thanking Kristina Sessa, John Brooke, Jim Harris and Erin Moore for sharing their expertise. Please join me and give them virtual applause. We would also like to thank all the people in the College of Arts and Sciences who made this possible, especially Clara Davidson, the history department, the Harvey Goldberg Center for Teaching Excellence and the magazine origins, current events and historical perspective for their sponsorship. And once again, thank you, our audience for your excellent questions and for your ongoing connection to Ohio State. Stay safe and healthy. And when in doubt seek advice from our health professionals. Thank you so much for joining us today.