As the fear of Covid-19 subsides, the urge to travel re-emerges. Airports are packed with passengers, tens of thousands of whom will end up stranded awaiting flights that have been cancelled. Hundreds of thousands will be stuck on highways attempting to make journeys they have planned for more than two years. Despite the excessive time wasted and frustration experienced, we Americans are devoted to the idea of leaving our homes and struggling to get elsewhere. It must be in our genes. We are the descendants of travelers who survived their journeys. We are the multitude who refuse to sit still and enjoy a day at home.

Travel has long been difficult, costly, and dangerous for most of our fellow humans. The danger has been not only for the traveler, but also for the residents of the destination. Europeans brought smallpox, measles, and a variety of other deadly, contagious diseases to the Americas. Even if they had not brought firearms with them, these explorers and invaders would have decimated the indigenous population of the Americas with the biological weapons they unwittingly carried. 

One of our most recent infections, Covid-19, was initially brought to the United States by a traveler. The first confirmed case in the U.S. involved a resident of Washington state who returned home on a flight from China in January, 2020. Cases in the U.S. multiplied rapidly either through other infected travelers arriving with the virus from overseas or through contact with infected individuals already here. Despite fears that the virus would be brought to the U.S. by illegal immigrants struggling to avoid poverty or chaos at our southern border, most of the cases reaching the U.S. from outside its borders were American citizens with the wherewithal to buy a plane ticket or passage on a luxury cruise.

With every epidemic, the affected population is inclined to view the tragedy as part of a sinister plot by foreign agents to destabilize the affected state.  Alternatively, the disaster is attributed to angry gods who must be appeased. Not surprisingly, the sacrifice of healthy, young women is often suggested by senile, old men as the solution to the gods problem. Apparently, the gods prefer sexually-inexperienced women when they are angry.

Most of us now recognize Mother Nature as the real culprit. The plague germ, Yersinia pestis, that caused the Black Death (bubonic plague, pneumonic plague) that ravaged Europe from the Fourteenth Century onward was apparently cooked up in Mother Nature’s kitchen in Asia in the area now called Kyrgyzstan. It was carried by infected fleas that acquired the germ from infected marmots and took it with them aboard a ship that fled the Mongol siege of the Black Sea port city of Kaffa in 1346 and landed in Sicily in 1347. In Sicily the infected fleas bit rats, that helped spread the disease, and people, who rapidly succumbed to the novel infection.

What genetic material Mother Nature used to cook up Covid-19 in still being argued, but what has become clear is that the virus responsible for Covid’s lethality is easily acquired through the air.  Microscopic droplets from an infected individual’s lungs will cause disease in many of the people who inhale the viral particles. A cough can distribute millions of potentially lethal, virus particles into the air. 

What have been called ‘super-spreader events’ are simply events with closely-packed people inhaling what fellow participants exhale. The ideal venue for spreading this air-borne disease is an airplane or a stadium packed with hundreds or thousands of people. That at least one of that multitude has the virus but has no symptoms of the disease is a virtual certainty. Therefore, logic would dictate that everyone on an airplane or at a mass gathering should be wearing a mask to prevent the spread or acquisition of the virus even now as the risk of infection subsides.  Of course, logic has little to do with public policy or human behavior. For more than two years, Americans from every corner of our nation have refused to wear masks and have demanded their right to breathe unencumbered by Twenty-first Century reason. For them, it is still 1347 and the gods will not target them with disease if they have the courage to reject common sense.

This issue of taking precautions to avoid the spread of disease in settings that facilitate the spread of respiratory illnesses preceded Covid by many years. In an overcrowded city, e.g., New York City, tuberculosis is and has been a major problem for more than a century. Yet there is no mandate or recommendation that subway riders packed in more closely than sardines wear masks. We require health workers and other professionals in close contact with the public be tested for tuberculosis on a regular basis, but we do nothing to avoid spread of this disabling and often fatal disease in the general public.

The movement of populations not only increases the spread of diseases to people living in areas not previously exposed to these visitors, but also increases the risk of disease spreading to the visitors. Columbus’s crewmen brought gonorrhea to the Caribbean, but they also acquired syphilis while enslaving and otherwise exploiting the native population and brought it back to Europe when they sailed home.  No one can say how many people in central Africa the explorer Dr. David Livingstone infected in the 1870s with diseases endemic to Europe while traipsing through the jungle, but we do know that the jungle took revenge on him with diseases that had never before been seen in Europe.

Travel has posed risks to humanity from the day the first Homo sapiens decided to explore what lay beyond the rift valley of Africa where our kind first evolved. Our ancestors walked away from their home range for reasons long forgotten. Perhaps it was prompted by climate change.  Perhaps it was an attempt to avoid a lethal disease that threatened the survival of our species and could not be suppressed by a virgin sacrifice. Perhaps it was simply a wanderlust that fostered the spread of our kind to every corner of the planet and beyond. Perhaps if we sit still for a while and think about why we travel, we can figure this out.

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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