The Pest

In 1347 a ship from Caffa, a city in the Crimea on the coast of the Black Sea under siege by Mongol attackers, docked in the port of Messina on the eastern coast of Sicily.  Several of the sailors and passengers on board had taken ill during the passage.  The army besieging Caffa had suffered heavy losses from a disease raging through the camps.  In an effort to maximize casualties amongst the largely Italian population of the port city, the frustrated attackers used catapults to propel the bodies of their dead over the city walls. Life inside Caffa became so intolerable as a consequence of the mounds of rotting corpses that accumulated more quickly than the populace could dispose of them that merchants with the resources to flee abandoned their homes and set sail for Mediterranean ports.

The ship that reached Messina carried several ill passengers and sailors. There was nothing unusual about that except for the severity of the disease afflicting those on board.  Many died within hours of their arrival.  Along with the ill, several rats managed to disembark.  That too was not unusual.  The rats carried fleas, and the fleas bit people. No one suspected these fleas of being any more of a nuisance than those that already dined on the general population.

Over the next few months, tens of millions of Europeans would die from what would be called, “The Pest.” That was unusual, even in an era when no one knew what caused diseases.  It would be five centuries before scientists recognized bacteria as causes of disease and gave the organism responsible for this plague its formal title of “Yersinia pestis.” Even after the identification of this deadly microbe as the cause of the rapidly disseminating disease that nearly eradicated humanity from Europe in the fourteenth century, many suspected there were subtle forces directing or abetting the spread of the plague.  This was an early version of the rationalization during World War I that, “Men fire the rifles, but God directs the bullets.” The notion that carnage on such a massive scale could be truly random was as unthinkable in the fourteenth century as it was in the twentieth century.

As the rats that carried the fleas that carried the plague germs spread across Europe, the best and the brightest minds of the fourteenth century came up with explanations for and safeguards against the plague.  A popular view was that this was Divine retribution for the sins of man (and woman). Prayers were said, sacrifices were made, but the tidal wave of death continued.  Contrition and confession having failed, the next best explanation for the plague was the evil of nonbelievers.  This led to the widespread slaughter of Jews, even though the Jewish communities throughout Europe had been as severely affected by the plague as the Christian communities. Then, as now, when Reason is dethroned, Stupidity grabs the crown. The plague abated despite the absence of any useful containment or treatment measures. The people thanked their gods and returned to their wicked ways.

Since the fourteenth century, there have been many advances in medical and biological sciences but no advances in the nature of man (or woman). A little more than a year ago, America was faced with a plague coming from abroad.  One can argue about where it came from and why it arose there, but one cannot ignore the fact that the government established to protect its citizens failed its people.  I keep a copy of the U.S. Constitution on my desk and check it periodically to see if it still applies to the nation that has evolved since 1789. The preamble states that one of the primary purposes of the institutions established by this document is to “promote the general Welfare.” The men who put this together were familiar with autocratic governments that looked out for a small circle of friends and family and ignored the challenges and suffering of its general population. Even though they were remarkably short-sighted in failing to recognize the horror of slavery and the need to extend equal rights to all the people, male, female, white, nonwhite, native born or immigrant, they did understand that a crisis facing the entire nation needed the attention and timely intervention of the federal government, whether that crisis be an attack by a foreign nation or a disease threatening the lives of its citizens.

The governments of many states have declared the need for state mandates regarding the Covid pandemic has ended. They argue that they have told their citizens what they should do to avoid spreading the virus, and now they will rely on the good sense of their minions to act responsibly. As I hear these governors and legislators speak of their confidence in their voters to act rationally, I wonder if they are just trying out a new comedy routine or abusing drugs.  Surely they have seen the maskless enthusiasts filling stadia for political rallies in 2020, the youthful crowds assembling at Florida’s beaches for spring break in 2021, the ‘faithful’ thousands packed shoulder-to-shoulder at funerals for religious leaders, the millions ignoring safety measures over the past year and overfilling the Intensive Care Units across the country.  Are these the ‘responsible’ citizens who will conduct themselves with the discipline and restraint necessary to end a pandemic?

Fewer than 25 % of adult Americans have received a full vaccination regimen.  Please note that does not include children, of which, I have observed, there are many.  Children need to be vaccinated as well before we can declare a winner in this battle with Mother Nature. The contest is not over.  We are not even at the half-time break. The announcements of these governors are like the half-time shows at the Superbowl: sometimes entertaining but never affecting who wins.

Our celebration of victory is premature.  We have promising vaccines that may get us out of our current dilemma, but neither these vaccines nor the ones that must be developed for the next pandemic cure or protect us against stupidity. Our federal government failed us in 2020, and our state governments appear intent upon failing us in 2021. I agree that the pandemic will end.  Every pandemic ends, regardless of the measures adopted.  The real issue is what shall we have lost before it ends: how many lives, how much real progress, how much commitment to the general Welfare.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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