key: cord-1047791-afzbq04a
authors: Min, Kay; Lehr, Anab Rebecca; Mema, Briseida
title: Human Amnesia
date: 2020-10-05
journal: Chest
DOI: 10.1016/j.chest.2020.06.004
sha: 04d69fbbb0be562d0ccb5cb5ee0a313b3d3a3fbd
doc_id: 1047791
cord_uid: afzbq04a

nan

Bangs, elephant pants and music beats: déjà vu Election promises, corruption and coups d'état: déjà vu Natural disasters, armed conflicts and pandemics: déjà vu History repeats itself and yet, we seem to forget Human lifespan, a millisecond in humanity's timespan Shall we learn from your past, act in the present and protect your future -Anab Lehr O happy posterity, who will not experience such abysmal woe and will look upon our testimony as a fable.

-Petrarch

In the time of the COVID crisis, we, the "happy posterity," might object to Petrarch's prediction. His testimony refers to the medieval Black Death, which was preceded by other ancient infectious diseases and was a precedent to a litany of future epidemics that included the 1918 Flu Pandemic and COVID. Abysmal woe, loss, and grief remain constants of mass disease, but so too are human resilience, creativity, and survival.

Perhaps the most notorious of all epidemics, the Black Death's devastating effects remain undisputable; an estimated one-third of Europe's population was wiped out by the plague from 1346 to 1350. 1 The plague ravaged a complex world whose response to contagious disease has some resonance today. Some of the best minds in medicine and philosophy worked diligently to find answers. Caretakers, who ranged from family members to medical professionals, administered various remedies to their patients. Suspected carriers were quarantined as a public health measure. But the sheer deadly force of the plague and a critical lack of understanding about the disease's nature and its specific modes of transmission rendered much of these efforts futile. Though its cause and cure remained outside the limits of medieval medicine, the Black Death's horrific symptoms and effects were readily apparent to its contemporaries; literature about the plague offers a window into a world whose experience of large-scale suffering was not unlike ours. Harrowing accounts from medieval writers describe entire towns voided of inhabitants and crippled by lapses in social order. Petrarch wrote mournfully about his unrequited love Laura's death from plague; the premise of Boccaccio's Decameron is the self-isolation of ten people fleeing from Florence to the country; the socioeconomic circumstances from which William Langland's censorious Piers Plowman originates were shaped irrevocably by the plague. Historians today continue to evaluate the extent of the Black Death's consequences beyond the 14th century. 2 Certain outcomes were linked causally to it, like the sharp decrease in the availability of labor, which in turn allowed workers to demand higher wages. In part because of this labor shortage, women started working in fields, which previously was denied to them. In medical learning, the existing emphasis on theory-based understandings of disease was complemented by a growing prioritization of the practical treatment of patients. Still, iterations of the plague haunted ensuing centuries. The image of the 17th century plague-doctor clothed in a long robe lined with wax, a wide-brimmed hat, and a bird-like mask stuffed with aromatic herbs has become synonymous with the strange terror of facing an invisible foe with an indeterminable cause.

Almost 600 years later, the 1918 Flu Pandemic tore through the global population, causing >50 million deaths worldwide; its most susceptible victims included children <5 years old and adults between the ages of 20 and 40 years. 2 Public health measures that included quarantine and restrictions on large gatherings were instituted; however, as in past epidemics, the virus spread rapidly, given the lack of a viable vaccine and antibiotics for bacterial supra infections. 3 The disease is sometimes referred to as the Spanish Flu, a misleading name that arose from Spain's forthright journalism about the illness when much of the world media censored word of the infection to sustain morale at a time of severe global conflict. There is a corresponding lack of its representation in contemporaneous art; works like Edvard Munch's portraits from before and after catching the flu are exceptions to the rule. Personal testimonies, though, survive. In the course of researching his 1974 book The Plague of the Spanish Lady, 4 military historian Richard Collier collected 1700 letters, one of which relates the writer's memory of the funerals of her mother and sister on the same day as the celebrations of Armistice. From these accounts, contemporary readers can see the intersection of two massive global events through the lens of a poignant personal loss. Because of the flu's proximity to modern memory, it is easier to connect the dots and recognize how it ultimately resulted in hard-won advances in public health and medical education, some of which guide responses to infectious disease to this day. Researchers continue to study samples collected from infected soldiers to advance understanding about the nature of the virus.

Sobering statistics like death tolls and highly impacted demographics are easier to analyze in hindsight, after pandemics have passed. In the current fight against the coronavirus disease (COVID), researchers simultaneously are helped and hindered by the enormous amount of data from across the globe that are available at the click of a cursor. As contemporary recorders of our contemporary testimonies, we can relate only updates from the storm that we weather today and guess at COVID's impact for posterity. The efforts and ingenuity of researchers and medical professionals throughout history have advanced our collective understanding of disease to the point that today we no longer fight a completely invisible enemy.

Scientists have uncovered the structure of this strain of coronavirus and how it is transmitted. Possible treatments, vaccines, and containment processes are being tested at a pace and standard of excellence in research that is truly unprecedented. Supportive care makes the likelihood of survival higher in the face of no medication or vaccine. Traditional measures like social isolation and quarantine continue to be foundational strategies in our fight against COVID. We maintain social connection at a distance; we remain isolated and connected at the same time. Human suffering remains constant throughout for the dying and the living. Life's last chapter occurs in isolation. Death happens in isolation with inability to hold and to say the final goodbye. 5 There may no longer be such a thing as a totally unprecedented pandemic. Each virus, its name, and its effects change, but much of human history is marked, scarred perhaps, by recurring outbreaks of infectious disease. That does not change the fact that relative to our life experience, this pandemic is without precedent; our suffering is simultaneously one among many throughout history and unique to us. As individuals endure and carry on from personal losses, humanity collectively endures epidemics and moves forward with knowledge that better prepares future generations to face the challenges of mass disease. Together, we work towards our gradual, imperfect survival.

Plagues and Peoples

Epidemic diseases and their effects on history

The Spanish Influenza Pandemic: a lesson from history 100 years after 1918

Spanish influenza redux: revisiting the mother of all pandemics

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.