The dreaded hair cut day has come and gone and, like with so many things, it feels a lot better afterwards. That’s a fairly simple and one way story with a happy ending. However, today I was reading a story related to pandemics that isn’t nearly so simple, nor so happy. It’s the story of the village of Eyam in Derbyshire, United Kingdom during the Great Plague, 1665-1666.
The “Great Plague of London” was the last major bubonic plague epidemic in England (with the first being the Black Death in the 1300s and several other plagues occurring inbetween). The 1665 epidemic was far smaller scale than the Black Death, but still killed over 100,000 people in 18 months, of the approximately 5.5 million people then in England and Wales. The UK and Europe were well aware of the effect of plague after a number of experiences, therefore were practised at separating sick from healthy to slow the spread. Eyam has made its way into the history books as, supposedly, a town infected with plague where the villagers chose to valiantly sequester themselves without contact to the outside world, and thus save others who might have become infected. This story is currently doing the rounds, as an example of the virtues of sacrifice. However, there is a very contrary story covered in today’s Economist.
Eyam was a small lead mining village which had around 330 residents in 1665; by the time the plague subsided, 259 of them had died and many houses were vacant. According to the Economist, none of the original sources mention the village choosing to quarantine itself, including the widely-quoted letters of the vicar Mompesson who led the townsfolk in their activities. The sources of the time just ‘note the success of that isolation and the leadership it demanded’. At the time of the plague, quarantine of communities was actually enforced by the state. The touching stories of sacrifice, and star crossed lovers who waved to each other across the quarantine boundary until the man in the village failed to appear one day, were promulgated 200 years after the event and don’t appear to have any basis in fact. In contrast, there are records showing that the the nearby city of Sheffield employed officials to restrict movement and the scale of death in poor households suggest that many wealthier villagers left prior to the imposition of quarantine.
The variants on the Eyam story resonate with me as I read the various reactions of people to the possibility of New Zealand moving to Level 3, and the reactions of other people to those reactions. There is one groundswell of people who are calling for longer at Level 4, because we are not yet ready to leave it. I am not sure that such calls are about people’s in-depth understanding of what is best for the country, or whether people now feel comfortable in the ‘security’ of the ‘known’ in Level 4, amidst the decreasing numbers of cases of COVID-19. We rapidly shifted from the known ‘normal’ to the unknown pandemic, but now a Level 4 Alert is a lot more ‘known’ than a Level 3. This will particularly be the case for those who have assured employment, or are not employed – a shift from Level 4 to Level 3 will not advantage them particularly given its continued social strictures. However this group sees the potential risks. The Eyam story becomes a good one to circulate at such a juncture because it puts the Level 4 ‘stayers’ on the apparent moral high ground, saving others, while those who advocate for the shift can be seen as ‘slackers’, wanting the easy route to perdition for all.
Without a doubt, shifting behaviours, with our Alert Levels, involves a degree of risk in relation to COVID-19, but staying at Level 4 involves a whole plethora of risks also. We tend to weight the risks of the unknown far more highly than the risks of the known and, in this case, our focus is on the risks of the spread of COVID-19 and many other risks tend to be lumped into ‘the economy’, as in, we ‘save lives or the economy’. As our Prime Minister has emphasised, this is a false dichotomy. We are actually saving, or losing, lives in every scenario. If lives is our focus, lives should be weighed for all potential actions. If we stick with greater strictures for longer, we should be including the numbers of lives that may be lost to illnesses undiagnosed or untreated, to suicide, to bubble-stress-induced violence, to depression and consequent illness as a result of unemployment. Can we include misery in our equations as well? The misery of those who will suffer COVID-19, and those who will suffer because others are ill or die from COVID-19, against the misery of those in bubbles which are unbearable, those unemployed who will lose focus, purpose and sustenance? I am not claiming to know where the balance lies, only that many of the calls I hear do not appear to be considering all the weights that should lie in the scales.
A confounding factor in our current situation is one’s degree of belief in elimination of COVID-19; the New Zealand ‘story’ is that we have the chance to eliminate SARS-CoV-2 in our country and the government is designing the rules according to that storyline. I still struggle to believe in elimination as do – far more importantly – Dale Fisher and Chris Smith who were interviewed by Kim Hill this morning. Professor Fisher is leading Singapore’s response to COVID-19, is the chair of Infection Control at their National University Hospital and is head of the Global Outbreak Alert and Response Network for the World Health Organisation. He has direct experience in infectious disease management from the 2003 SARS outbreak in Singapore. Chris Smith is a consultant clinical virologist at Cambridge University.
When asked what their views were on elimination, both conveyed that they believe elimination is highly unlikely for a number of reasons (including the potentially large numbers of asymptomatic people who are infectious and leakage through borders, even on an island), and that cycles of tighter and less tight control of human contacts will be necessary over the next period of time, until a vaccine is developed (a one way track of reducing constraints is not likely to be long term successful). Fisher did note that bringing the numbers to a very low level would give an extended period of time until greater control might be needed again. He also said that the results from the New Zealand elimination experiment were being watched with great interest as they will be highly informative for all those engaged in managing COVID-19.
A interesting final note from Professor Fisher, when asked how he and others in the medical profession could carry on at present, was that “these things end”. He said it was not possible to see the end of the SARS epidemic, nor of the more recent Ebola epidemic in multiple African countries, but both did end – that is the nature of epidemics (as natural as their occurrence). In the same way, however we run our COVID-19 storyline, it will end, one way or another. It will end for reasons which may be within our control, beyond it, or a mixture of the two. Perhaps the final test for each country will be whether the stories we tell post COVID-19 pandemic, will be those stories that inspire us towards the future we wish to inhabit.