17 March 2020 • Faculty Pandemic Explained: Linton on COVID-19 Response and What to Expect Next

A national authority on the history of medicine and immunology, Professor of History Derek Linton reflects on the international response to 2019 Novel Coronavirus (COVID-19) and what history can — and cannot — tell us about the new pandemic.

Linton, who holds the Joseph P. DiGangi Endowed Chair, is the author of Who Has the Youth, Has the Future, which explores German youth policy in the early 20th century, and Emil von Behring: Infectious Disease, Immunology, Serum Therapy, the first major English-language biography of von Behring, who won the first Nobel Prize in Medicine in 1901 for diphtheria antitoxin serum. The later book explores von Behring’s contributions to the study of infectious diseases, basic immunology and drug testing, as well as his relations to the rival schools of Pasteur and Koch, the emergent pharmaceutical industry and the creation of institutes for experimental therapeutic research. Linton received the John Frederick Lewis Award from the American Philosophical Society when the biography was published in 2005.

A member of the Hobart and William Smith faculty since 1984, Linton teaches a range of courses examining the intersections of science, public health and major world events, including World War I and World War II. He is a member of the American Association for the History of Medicine, the American Historical Association and the German Studies Association, and has also served on National Library of Medicine/National Institutes of Health grant review panels for the past decade. He holds a bachelor’s degree from Brooklyn College of the City University of New York and his master’s and doctoral degrees from Princeton University.

What historical precedents should world leaders, governments, and the general public keep in mind in responding to COVID-19? What lessons are there to be learned from the past century?

There really aren’t particularly good historical precedents, although the advice of the WHO is the distillation of effective procedures from the HIV/AIDS epidemic to the SARS episode. The 1918-19 influenza epidemic is being regularly invoked, but I doubt its relevance. Medical historians are often cherry picking to support their favored policies. For example, one article claimed that in 1918, Philadelphia continued business as usual whereas St. Louis proactively shut schools, theaters, and many businesses and banned public assemblies, and therefore fared far better. This example is being used to support rapid social isolation. True, but San Francisco undertook even more stringent measures than St. Louis and had a much higher case fatality rate.

There are some medical remedies from the past that deserve reexamination in light of the absence of a vaccine. One of these is passive immunization — the use of purified antibodies from recovered patients — a procedure developed by the first Nobel Prize winner in Medicine Emil von Behring and the Japanese researcher Shibasaburo Kitasato in the early 1890s in Berlin. I gather that there are research projects underway, including at Johns Hopkins, to revive passive immunization against COVID-19. Second, the first synthetic anti-malarial chloroquine, developed during World War II, has shown some promise as an anti-inflammatory in China against severe cases of COVID-19 pneumonia.

What do you think will be the long-term fallout of COVID-19?

There have been several major epidemics — the bubonic plague of the 14th century, the smallpox and other epidemics of 16th century Meso-and Latin America — that were so devastating that they had long-term effects on demography, social and political systems, religion, art, and even climate. I doubt that COVID-19 will have that sort of impact. This has been true of AIDS as well to some degree, but because HIV is sexually transmitted, its impact has been slower and more drawn out. Probably within a few years, the economic impact of COVID-19 will be overcome, although one hopes that it does result in much greater global preparedness for pandemics of this nature and the allocation of greater resources for public health. There is clearly a need for greater capacity of hospitals and ICUs to be able to handle much larger patient loads in an emergency. COVID-19 probably will have the political effect of aiding nationalist and anti-globalist parties and bolstering economic nationalism. One scenario that deserves attention, however, is that COVID-19 will indeed prove to be seasonal and will disappear with summer heat, only to reemerge with force next fall. It may well circulate for several years, or at least until an effective vaccine is developed, which is certainly not guaranteed. If so, massive periodic disruptions and closing of public institutions may become a way of life for the next several years.

Where have you seen successful responses to COVID-19 thus far?

At least given its dependence on national governments and limited resources, the WHO has been clear in its messaging and did provide test kits early. Its advice to test, isolate and track contacts represents the distilled wisdom of epidemiology. Governments that have followed this advice — most notably Taiwan, Singapore, and even South Korea, after a rocky start — have fared well and contained the virus.

We should be somewhat charitable about deficiencies, since there is a great deal about COVID-19 that we still don’t know (e.g. whether children catch it but are asymptomatic, immunological response, etc.). Probably the best that can be done now is by undertaking containment measures, such as social isolation, to “flatten the curve,” so that the epidemic stretches out and healthcare systems aren’t overwhelmed as they have been in Wuhan and in Northern Italy.

What about policy failures?

Many of the major policy failures occurred long before the outbreak of COVID-19. After all, the glaring deficiencies of international public health have been exposed since the 1990s in weighty tomes like Laurie Garrett’s excellent The Coming Plague (1994), yet there has been little institutionalization of international cooperation and coordination of response since the 1990s. In some respect, the ability to contain the SARS virus and H1N1 probably bred complacency.

The initial dithering, failure to report, and blame shifting in the People’s Republic of China almost guaranteed that there would be a global pandemic. Once the government responded in Wuhan and Hubei province, albeit belatedly and with draconian measures, it did demonstrate that quarantine measures could be effective. The response in Iran was singularly inept as well. The abysmal lack of coordination in Europe has been surprising and should put to rest claims that the EU is some kind of super-government. Nation states have largely had to fend for themselves. Again, as in China, the initial response was inadequate, for example, in Italy, but has been followed by effective measures, but with negative consequences such as doctors having to practice triage in Lombardy. In the U.S., the lack of test kits and the mixed and poor messaging of the administration has endangered public health and will undoubtedly make the epidemic worse than would have been the case with an earlier and more urgent response.