How humans have reacted to pandemics through history – a visual guide
From arguments about masks to riots outside hospitals, history shows some common threads in the human response to pandemics
Infectious diseases have wreaked havoc on human communities since ancient times.
From smashed crockery in ancient Syria to attacks on doctors in 1830s Britain, there are many documented examples of the despair and chaos experienced by those who lived through pandemics.
Our journey through the ages looks at the spread of disease in three case studies, and then explores a historical view on how we think about pandemics today.
Circa 541 to mid-eighth century
The plague of Justinian
"People may have experienced traumatic shock"
The Justinianic plague began in 541 and returned periodically until the middle of the eighth century. It is estimated to have wiped out as many as tens of millions of people, although due to the limited evidence it is difficult to know the true scale.
The disease was caused by a bacterium called Yersinia pestis, which is passed on by fleas and rodents. It is understood to have spread across central Asia, Europe and the Mediterranean. Recent genetic research into different strains of the bacterium that caused the plague has uncovered new evidence of it in sites across Britain, Germany, France and Spain.
Sites of genetic evidence
Documented outbreaks 541–750
Sample found
near Cambridge
Illyricum
Southern
Gaul
Greece
Samples also
found in Germany,
France and Spain
Sites of genetic evidence
Documented outbreaks 541–750
Sample found
near Cambridge
Samples also
found in Germany,
France and Spain
Asia Minor
& Bithynia
Illyricum
Thrace
Spain
Southern
Gaul
Greece
Mesopotamia
Palestine
North
Africa
Egypt
Populations at the time are thought to have largely believed the plague was an act of God. Prof JN Hays, the author of Epidemics and Pandemics: Their Impact on Human History, says people may have thought God had scourged regions and their atmospheres, and to counter this they tried to clear the air.
He refers to an example of widespread breaking of pottery in Syria in the seventh century: “There was a deliberate smashing of pots; people making a clamour. This may be an illustration of a population experiencing traumatic shock. It might have been done in panic but also might have been done to somehow disturb and clear the atmosphere.”
Mid-14th century
The Black Death
"Foreign merchants were violently attacked"
The Black Death spread across Europe, the Middle East and northern Africa in the mid-14th century, wiping out somewhere between a third to half of the population. The pandemic was caused by the same lethal bacterium that caused the Justinianic plague.
It was able to spread across trade routes, reaching Europe via the trading centre of Italy in 1347. Recent advances in DNA research have linked the Black Death to other branches of plague that circulated Eurasia around that time.
Moscow
Golden
Horde
Yuan Great
State
Chagatai
Khanate
Ilkhanatet
Mecca
Fengxiang
Dai Viet
Champa
Genoa
Venice
Moscow
Bolgar
Golden
Horde
Yuan Great
State
Alexandria
Beijing
Chagatai
Khanate
Ilkhanate
Mecca
Fengxiang
Tibet
Canton
Dai Viet
Champa
Contemporary understandings of the Black Death drew on ideas of sin and apocalypse, acts of God and alignments of the planets. Many people turned to prayer. Prof Adrian R Bell, a financial historian at Henley business school in Berkshire, says Catholic priests formed something of a frontline in Europe. “In the 14th century there was a big demand for priests. Everyone who was dying had to be given the last rites, which meant the death toll among priests was huge and it was likely they had to fast-track replacements.”
There is also evidence that people tried to make sense of the devastation by scapegoating outsiders. In England there were violent attacks on Flemish merchants and weavers. As Bell explains: “There were riots against the Flemish as people tried to deal with the unexplainable. This also happened later during upheaval around the peasants' revolt, which came after decades of trauma from population loss and class conflict – people attacked outsiders for no reason other than that they were different.”
Early 19th century
The second cholera pandemic
"People wanted the certainty of expert knowledge"
There were six cholera pandemics in the 19th century. Originating in India, the disease first reached Europe in 1831 during the second pandemic, via military and trade routes. In Britain, the disease was first recorded in Sunderland, from where it spread across the country, killing 32,000 during 1831-32. It remains a widespread and deadly disease today in places where people do not have access to sufficient sanitation and clean water.
131
Duddingston
The first case was recorded in Sunderland, October 1831
Cholera riots took place in Liverpool and other cities
80
Goole
100
50
100
50
131
Duddingston
The first case was recorded in Sunderland, October 1831
Cholera riots took place in Liverpool and other cities
80
Goole
48
Bilston
Mortality from cholera was high and people died soon after being infected. Makeshift hospitals were set up in most major cities but there was resistance to this state intervention: riots broke out and doctors were attacked. People were suspicious of medics, who they had to pay for treatment, and afraid of their bodies being taken for dissection if they died.
Dr Katrina Navickas, a historian of 19th-century protest at the University of Hertfordshire, says corpse-related horror stories also added to a climate of fear. “People didn’t trust the doctors, they didn’t trust the government, and they were wound up by body snatching stories in the press. On top of this, Mary Shelley’s Frankenstein was a popular novel at the time, so there was a lot of gothic imagery around bodies and corpses.”
A lack of knowledge about the disease may have exacerbated the frantic atmosphere. It was not established until later in the century that cholera was spread through water rather than air, and as a result it was unclear how the medical profession or state could cure it. “They weren’t sure how cholera spread, they were just really scared and that’s partly why there were riots. People wanted the certainty of expert knowledge but they just didn't have it then,” says Navickas.
Can history help us understand the present?
Some medical historians suggest that the study of earlier pandemics can enhance our insight into the context around infectious dieases in the 21st century.
Monica H Green, a professor of medical history, says historical analysis of even the first plague pandemic can help our understanding of how disease moves today. “Bacterial pandemics are different to viral pandemics, but they still move to human populations. In terms of human activity and the way humans respond to threats and change, the study of ancient plagues can enrich our understanding.”
In this final section, Dr Caitjan Gainty, a historian of 20th-century medicine and technology at King’s College London, provides a historical perspective on four pandemics of the past century, highlighting some points of comparison in terms of how we think – and talk – about disease.
Our graphic below indicates the scale of deaths associated with these four selected pandemics, including the first four months of the coronavirus.
deaths so far
1918 - 1919
Spanish flu
Between 20 million and 50 million people were recorded to have died during the Spanish flu, the most devastating influenza pandemic of the past century. For Gainty, one of the most striking comparisons is the public health response:
“During the Spanish flu pandemic, they quarantined. They erected emergency hospitals. They had arguments about the usefulness of masks. Amid all of the remarkable progress we’ve seen in other areas of health, our public health response is largely unchanged. Our expectations about public health are remarkably different from other areas of healthcare.”
1981 - present day
HIV/AIDS
The HIV/Aids pandemic began in the early 1980s and has so far resulted in the deaths of more than 32 million people.
Gainty suggests the ongoing HIV/Aids pandemic illustrates how political the designation of a pandemic can be. “HIV/Aids is not really on our pandemic radar. Initially, this invisibility was the result of the well-known prejudices that crept in very early on regarding who contracted – and how they contracted – HIV/Aids. Today it results from the fact that HIV/Aids follows pre-existing lines of inequality. In addition to acknowledging its victims as equal to those of any other pandemic, understanding HIV/Aids as a pandemic helps us confront our own health biases, something that the current coronavirus may or may not accomplish.”
2009 - 2010
Swine flu
There were more than 18,500 lab-recorded deaths from swine flu during the pandemic, but statistical modelling suggests the true extent of deaths could have been as high as 570,000.
It was not unusual for the rhetoric around swine flu to be closer to that of national security than healthcare.
“The language of preparedness and national security brought into common use during the cold war applied nicely to infectious disease. In the post 9/11 context, this language moved from useful metaphor to actual policy, quite explicitly in the US, where natural disasters and epidemic disease were placed in the remit of the Department of Homeland Security. Swine flu, like coronavirus today, was not just like a threat to national security. It was an official adversary.”
2020
Coronavirus
There have been 217k recorded deaths and more than 3 million confirmed cases of coronavirus since January. Gainty says that in comparison with historical pandemics, one of the most striking things to emerge so far is how little states did to prepare for it, despite watching it develop in China for months:
“In the past there wasn't the same kind or speed of communication about the movement of disease. It is not difficult to understand that in 1918 news about disease travelled more slowly and that responses were consequently slower. It’s harder to forgive unpreparedness, though, today. It begs the critical question: if it wasn’t more information that was needed to manage this crisis, what was it?”
