Dr Geoffrey Todd is a Consultant Chest Physician who has been providing expert Medicolegal reports for Francis Hanna & Company clients in chest disease cases for decades.

In this article which we are sharing, Dr Todd considers how the current pandemic compares to plagues throughout history and provides some thoughtful commentary on the disease and how it is being dealt with. Whilst every death from Covid-19 is a tragedy, Dr Todd considers, if at some point, the cure could be almost worse than the disease?

Covid-19 – The New Plague?

A few days ago Donald Trump referred to the Covid-19 pandemic as “a great and powerful plague”, but how does the Covid – 19 pandemic compare with the great plagues of the past?

In 1347 the “Black Death” or “The Plague” erupted in Western Europe for the first time, to be followed by intermittent deadly outbreaks over the next 300 years.  Death visited major European cities as never before and the populations of major cities such as Florence and London were reduced by more than 50%. 

The Plague (although they did not know it then) was caused by a bacterium known as “Yersinia Pestis”, normally an infection of rodents but which jumped species, via carrier fleas or lice, to humans.  It was highly infectious, very lethal and spread rapidly.

Death, often agonising, could occur within 24 hours but more often after 7-10 days.  Such large numbers of people died that, according to Daniel Defoe (better known as the author of “Robinson Crusoe”), “they died by heaps and were buried by heaps”.  Over 300 plague pits, containing thousands of corpses were dug in London alone.

Although no-one had any idea what caused the plague it was realised that it could be passed on from one person to the next and “quarantine” was widely practised (“quarantine” derives from the Italian for “forty” which was the number of days ships trying to dock at Venice had to remain anchored off the coast to prove that they were plague free).

So, like the plague, Covid-19 jumped species from non-human to human animals, is highly infectious, humans have no inbuilt immunity, quarantine (or social isolating) is very important and death can happen.  But there the resemblance ends.

Plague, depending on the type eg. bubonic (affecting the glands) or pneumonic (affecting the lungs), had anything from a 50 to 90% mortality (meaning that out of every 1000 people who caught the disease 500 to 900 would die). However the Covid-19 average mortality is probably around 0.1 to 0.3% (meaning that out of every 1000 people who catch the disease 10-30 will die).

The other major difference is that plague affected all age groups. According to Defoe, mothers and their babies were found dead together with the marks of plague on their bodies. In the village of Eyam in 1666, over a period of only 8 days, Elizabeth Hancock buried six of her children and her husband while villagers looked on from a nearby hilltop, too scared to approach or help. In contrast, according to the government statistician, Professor Sir David Speiglehalter, Covid-19 is a disease of the over 75s with the young having an extremely low risk of death. For example, here have been only 2 deaths in children out of a population of over 10 million in the UK. There have been 26 deaths in the under 25 age group out of a population of 17 million but at the other end of the age spectrum, 1% of the entire population of over 90s have died in the last 4 weeks meaning their risk of death is 10,000 times greater than young people.

Thus Covid-19 does not really bear comparison with The Plague and actually, in the league table of lethal infections that have afflicted humanity from time to time, it ranks very low.  “Premier league” pandemics include smallpox, cholera, tuberculosis, diphtheria etc.  Even in the twentieth century smallpox had a mortality of more than 40% and in the 18^th century it killed 400,000 Europeans every year.  The mortality for cholera and diphtheria were each more than 50%. In London at the beginning of the 19^th century, 1 in 4 of the entire population died prematurely from tuberculosis and even today 1.5 million people worldwide die every year from this, the most lethal of infectious diseases.

It is not now the case then that we are faced with some new horrific decimating “plague”. Our reaction to this latest pandemic is not shaped by its mortality rate but instead by our changed attitude today to life and death.  In medieval times life was short, nasty and brutal and expectations were low but today the medical mantra often appears to be “no-one must ever die”. In the elderly, every abnormality is often exhaustively investigated and age is no bar to major surgery.

The measures that are being taken to prevent the spread of the pandemic ie. “the lockdown” are drastic and there may be a big price to pay. If it continues or is renewed we could be facing economic melt-down, mass unemployment, levels of poverty and hunger not seen for centuries and possibly even societal collapse.  Although the young are very much less likely to contract this disease, they will ultimately pay the biggest price in terms of debt, unemployment, poverty and mental disease all of which can cause large increases in deaths.

It is estimated that the 2008/9 financial crisis resulted in a million people of working age contracting chronic health problems both physical and mental.

Deaths from unemployment and poverty are often viewed as just a statistic. “Unemployment” or “Poverty” will never appear on any death certificate nor are photographs of such victims likely to appear daily in the newspapers or the 6 o’clock news but surely they are nonetheless equally important.

Although every death from Covid-19 is indeed tragic this pandemic is not exceptional in comparison to the great pandemics of the past except perhaps in one respect – if we do not get the right balance of preventative strategy versus economic consequences there is a possibility that it may be the first pandemic where the measures that are taken have a worse outcome than the disease.

Dr Geoffrey Todd

Respiratory Consultant