The measures recommended by Victorian epidemiologist Dr John Snow to prevent cholera contain many that we’re now advocating today in response to Covid-19.
Dr Snow advised better personal hygiene, checking the health of arrivals from abroad, and getting the homeless off the streets — all strategies taken by the UK government over the past few months.
Some cholera measures, however, are now a little more alien to us, such as not dumping all the faeces produced by a family home into a hole in the ground that’s only feet away from a public water pump.
The reason that cesspits are a thing of the past is in large part because of Dr Snow. He tracked and traced the source of the 1854 cholera outbreak in London back to a single water pump in Soho. He had the handle of the pump removed and recommended that all street pumps in London be fastened up and that the city’s water supply come instead from the upper Thames, above the Teddington lock.
Improvements to the water and waste systems of London were made, and applied by other cities in the UK and across Europe. Thus, even though vaccination was not an available medical option at the time, the epidemic was brought under control.
So as London goes into Tier 2 coronavirus measures, we need to recognise that, vital as a vaccine is, it will be just one of the range of public health changes that are needed to contain the virus.
It seems increasingly unlikely that the pandemic will be brought under control without significant alterations to the way we live. These will need to involve containment measures that are consistent, clear, and — above all — coordinated.
Currently, such coordination is lacking even within the UK, let alone on an international level. While Sadiq Khan has lobbied for increased restrictions in London, in Manchester Andy Burnham is standing firm against them and pushing instead for a national “circuit breaker” lockdown, as has just been announced in Wales. Other regional leaders are similarly making their voices heard, while MPs lobby for their local areas.
But there’s a strong argument for going further than either regional or national measures: this pandemic will only be brought under control by adopting a consistent and coordinated approach between major countries.
Britain’s heated debate about national versus regional measures echoes discussions that are taking place across Europe. Last week, European Commission president Ursula von der Leyen called for common rules on quarantines and testing across the EU.
This came as EU countries agreed on a “coronavirus traffic light” system with colour-coded zones based on risk levels. But the EU’s traffic light system is still only a recommendation. And its guidelines will not override national regulations and are only a description of the situation across a continent, where border policies have been fragmented and states have taken strongly divergent routes from their neighbours.
Ultimately, we need to recognise that Covid-19 is a global public health issue, not a regional or even a national one. Von der Leyen’s comments are welcome, but we are still not seeing much consistency, coordination or avoidance of confusion in the approach of major countries.
It’s true that governments are cooperating in sharing information and looking at infection rates. But cooperation won’t stop the virus without concerted efforts to contain it. If countries were actually applying the same containment policies, it’s likely we wouldn’t be seeing such wide national variations between infection rates.
In the end, it’s for politicians to accept the limitations of the science, and balance the need to contain and manage the public health crisis against its impact on the socio-economic environment. That means looking at how people actually behave, and developing strategies that take these social factors into account, rather than relying on pockets of siloed shutdowns.
As an example, look to the anthropologists deployed during the 2014–18 Ebola outbreak in West Africa. They worked with populations to secure their engagement in changing behaviours, including practices around how the dead were buried, and played a major role in bringing the disease under control.
As a young medicines regulator in the UK agency, I worked with virologist Dr David Tyrrell who, together with June Almeida, discovered the coronavirus. Writing in 1992, Dr Tyrrell said: “Acute respiratory infections are a consequence of the social interactions between humans, and these are so valuable that most people would say they regard these illnesses as a necessary evil.”
With the advent of a new and particularly infectious coronavirus, we are now facing the question of whether social interactions between humans will need to alter. And that’s a question that will require an international response and a common public health policy.
Main image credit: Getty