London, 1664
Sometime between 20 and 27 December, Christmas week, a parish church bell rings in London announcing a death; two poor elderly women drop what they are doing and check in at the church. They are the parish’s official “searchers.” The Sexton dispatches them to the place of death and they inspect – search — the body for signs of the cause of death. After inspecting the body, they report to the local constable that the cause of death was plague. No doubt they noted the bulbous telltale signs of plague, black death. The report of death goes up the chain of local government. Next Wednesday, the weekly Bill of Mortality is published. A curious reader would note that there was one plague death in London.
The Bill of Morality for the week of December 20-27 reported other deaths as well. Small Pox or Flox, French Pox (the English term for Syphilis), Childbed (what we call Childbirth); Rising of the Lights (respiratory illness, lungs were called lights back then), and wormes. There were 39 causes of death listed that week. The Bill also reported the number of persons christened and the number of persons buried. Burials always outnumbered christenings. That week 116 boys and 113 girls were christened. Buried were 144 males and 147 women.
Months later, without another plague death, 43 plague deaths were reported from the week of May 30, 1665. The following week that number was 112, the week after 168, the next week 267, the thereafter 470. London was in the early stages of a new plague: Black Death, Bubonic and Pneumonic plague. By the time the plague burnt itself out over 100,000 Londoners were dead. Thousands more had fled London, mostly the well off or political elites. Then came the great fire of 1666.
It was brutal year for Londoners. Households that had a plague death were quarantined. The house was boarded up with the occupants inside, a guard posted outside, a white cross painted on the door, and the words “Lord have mercy upon us” painted on the side of the building. Family or friends provided food or the household paid someone to bring food. The 40-day quarantine was extended with each new infection. Everyone inside died, mostly. Locked up with the fleas hosting the bacteria Yersinia Pestis that jumped to humans once their rat hosts died.
Surveillance and Containment
London’s Bill of Mortality is an early example of municipal governments gathering and tracking data on disease and death. Originally, when it was first established in 1515, the Bill was to track only plague. This information was closely held by London’s government leaders. By 1550, however, the scope of the Bill had expanded to include all causes of death. By the 17th century the Bills were no longer kept secret but published and posted throughout London. One could even buy one for a penny or so.
Today, most governments also conduct disease surveillance, and if necessary, move to contain any outbreaks of communicable diseases, through isolation or vaccination. Given the advent of vaccines, preventative measures have been put in place to prevent outbreaks by creating a ‘herd immunity’ across communities. The elimination of smallpox in the wild is perhaps the greatest vaccination success story. Hundreds of millions of lives have been saved. Smallpox, if you did not know, had a 30 percent fatality rate.
Public health standards have evolved since London’s first Bill of Mortality was published. The gold standard of surveillance, containment, and vaccination, have saved hundreds of millions of lives from premature death from smallpox, measles, polio, and other transmissible diseases. Antibiotics and anti-virals treatments also played a key role in reducing or eliminating deaths where vaccinations are not available.
America’s Public Health Care System in Shambles
Today, that gold standard in America is crumbling under the Trump administration’s deliberate and calculated actions to disable and disrupt the Centers for Disease Control among other public health services. All because Trump has a personal vendetta against the CDC because of his own inept management of the COVID pandemic. Trump lied to the American people, delayed containment, and misled on all fronts regarding masking and treatments. Even going so far as to suggest ingesting or injecting bleach during a live news conference. He expected federal government public health professionals to be loyal to him. They were not.
Certainty after the COVID pandemic receded, lessons learned could of, and should have been, implemented to make our country’s public health care system better. Gutting the system in an act of personal retribution because he thought government organizations were personally disloyal to him, is criminal, dangerous, and outrageously cruel. Children are needlessly dying because of him.
Today, the uncontained measles outbreaks in America are an example of the consequences of deliberately undermining and disabling the trifecta of surveillance, containment, and vaccination. Pennsylvania is experiencing an unprecedented measles outbreak, with four reported deaths. One of whom was a newborn. Texas experienced an earlier outbreak which resulted in deaths as well. Trump’s war on vaccinations is killing Americans.
Despite two serious outbreaks, Secretary of Health and Human Services Robert Kennedy Junior, who oversees America’ public health infrastructure, continues to downplay measles outbreaks, denigrate vaccines, and cripple research funding. He is a one-man plague on America’ health. The causes of death attributed by Pennsylvania’ public health services have even been denied and questioned by Kennedy. As I understand it, the CDC does not list the deaths as measles related. 17th century Londoner’s had more access to information about public health threats than today’s average American it seems.
The Next Global Pandemic
Smallpox was eliminated in the wild, however, smallpox virus samples still exist in vials in two places in the world. One is in Atlanta, Georgia, at the CDC. America has about 451 vials. The other vials of smallpox are in Russia at their State Research Center of Virology. They have about 120 vials. Lost vials of smallpox virus have been discovered, worryingly, over the years. For example, at an NIH lab in Bethesda, Maryland, in 2014, six vials were found. In a lab near Philadelphia, Pennsylvania, 15 vials were uncovered in a lab in 2021. Not a good indicator that all vials of smallpox are “safely” in government hands. Then there is Putin’s Russia.
It would be foolish for any government to weaponize smallpox, to include the Russians. Once unleashed it would end up killing millions of them as well. However, in the hands of a millenarist apocalyptic terrorist group, smallpox may be a weapon of choice, where death is the message and smallpox the medium.
For such contingencies, the U.S. has about 360 million doses of smallpox vaccine as of 2003 stockpiled around the country. Given the degradation of public health surveillance infrastructure, the mass firings of scientists and other experts in epidemiology, and vaccine hesitancy, America’s response would be delayed, slow, inadequate, and uncoordinated. If 100 million Americans were infected by smallpox, at least 30 million would die. Smallpox is a virus, so antibiotics would be useless and there are no approved antivirals for smallpox. Antivirals have been tested on animal test subjects, but not humans, at this time.
The average 17th century Londoner lived in fear of the return of the black death, which appeared periodically. Disease and death were a daily fixture, however, even without plague. In the 15th century half of England perished in the great plague of 1438. They even banned kissing. Whole towns of people disappeared. After centuries of progress, America is going backwards. While the smallpox epidemic envisioned above is remote, it isn’t out of the realm of possibility.
The COVID pandemic should be a cautionary tale, yet, our government is dismantling our system of surveillance, containment, and vaccination. For all intents and purposes, they are invoking God not science to save us. They might as well paint “Lord have mercy upon us” on the side of the CDC in Atlanta…. You know the one with smallpox vials in it.
