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Journalist finds lessons in the history of pandemics Date: 04/16/20

Beth Skwarecki

By Bara Vaida

As the COVID-19 outbreak shows, infectious diseases consistently rear their head and disrupt human activities. Sometimes these outbreaks change the course of world power and other times, they become a blip on history’s timeline.

For some context about the history of infectious diseases and their impact on humans, it's worth taking a look at Beth Skwarecki’s book “Outbreak: 50 Tales of Epidemics that Terrorized the World.”

Each chapter is about 1,000 words and deftly and succinctly tells interesting tales about infectious disease outbreaks, many of which continue to plague the world (though mostly in low-income countries.) She begins with malaria, which is believed to have first emerged in 10,000 B.C. (so since the beginning of organized human society) and ends with the Ebola outbreak in 2014.

Here’s an edited Q&A with Skwarecki, who is the senior health editor of Lifehacker, about her book and some obstacles that she overcame.

Q: How did you conceive of this book?

A: The publisher (Simon & Schuster) came to me with the idea. They said: ‘We want to go with 50 little stories of pandemics. Can you come up with some and tell us some good stories about them?’ I said okay. But I was thinking, ‘How am I going to find 50 pandemics? There haven’t been a lot of those, but if we did epidemics that would allow me to do a lot more, smaller and interesting outbreak stories.’ They said: 'okay,' and asked me to do it in a timeline style. [See here for the definition of epidemic and pandemic.]

Q: How did the publisher find you?

A: I was blogging for PLOS [an open-access, nonprofit, science, technology and medical publisher.] I was writing for their public health blog and I was connected with some of the other writers in that group. The publisher asked one of them if they wanted to do it and they couldn't do it but referred the publisher to me. I had written a little bit on the stories behind some diseases, and I was always interested in the history of disease and then I fell in love with it. When they came to me with the idea, I was so in.

Q: What were the biggest obstacles in writing this book?

A: My biggest was just the scope of the book. For any one of these epidemics, you could spend a lifetime studying and writing them and I was asked to do about 1000 words for each disease. It was really hard. I spent a lot of time in the library just reading. I would read 3 books and then only write 1,000 words on it. Some were more difficult than others to find the real story about a disease. Another obstacle, which I wasn’t able to completely overcome, though I tried, was that there was lots of information about outbreaks in North America and Europe, but much less when it came to outbreaks in Africa and Asia. I am sure there were excellent stories about these diseases in Africa and Asia, but I could find very few of them. Much of our current medical history is from a western perspective.

Q: What was the most surprising story that you found?

A: I almost feel like every chapter had the most interesting and surprising stories. One that comes to mind is understanding that smallpox immunization has a long history in China, and I first encountered that in a children's book that mentioned the Chinese would blow a little bit of smallpox into the noses of children to prevent them from developing the disease. I was like what?! That is really interesting. I followed up on that and learned about similar practices in the Middle East and in Africa that predated the story we’ve all heard about Edward Jenner inventing vaccination.

Q: What were some of your favorite resources for your book?

A: That is hard. There were so many good books that I read. But I would say among my favorites were: “World Epidemics", which is an encyclopedia of disease , Scurvy, by Stephen Bown, Plague, by Wendy Orent, The Ghost Map by Stephen Johnson on cholera, The Doctor’s Plague by Sherwin Nuland on hand washing, The Miraculous Fever Tree, by Fiammetta Rocco and 1491 by Charles Mann on the arrival of disease in North America and how that changed everything.

Q: As a writer who has looked into history, what advice do you have for journalists covering this coronavirus outbreak?

A: It is interesting. The more we learn, the more we make some of the same mistakes. So for example, with quarantines, throughout history, when a disease breaks out and there is a quarantine, everyone wants to get out of that city or place and then [as they leave, they] spread it outside of that place. We have clear evidence that quarantines don’t always work the way we hope they will.

The other lesson is that there is always class stratification in outbreaks. People want to blame poor people for the outbreak. Those with less income are already at a disadvantage and they are extra screwed over when these kinds of things happen, and that should be written about.

Everyone wants to protect themselves and other people get thrown under the bus. So, we should be reporting on how are people reacting? And how do we want to react? What are the unintended consequences of blaming others? It will be important to write about how this is playing out.

Q: What advice might you have for someone interested in writing a book?

A: For me, this was very much about how to plan and strategize so that I have some semblance of work, life balance. I put myself on a schedule and tried to keep myself on it. I had previously done one of those ‘Write a 50,000 novel in a month’ challenge. I did that as a hobby, so I already had a sense of what a timeline should look like for writing the book. I wrote the book in three months. It was 3 months of nose to the grindstone.

Q: This book was published in 2016, but I think these stories are relevant to the COVID-19 outbreak that has been ongoing since late in 2019. Can you talk more about that in context of history?

A: Yes. There are parallels. For example, there were many times in history when quarantines were problematic or when panic was more of an issue than the disease itself (potentially like now) or where geopolitics made the disease worse (potentially like now).

Q: This makes me think about the disease called leprosy. It was deeply feared when it emerged in Europe back in 1200. People were quarantined in “leper colonies,” but your research showed leprosy wasn’t very prevalent or contagious. Yet for hundreds of years, it was believed to be this horrible infectious disease. Is there any parallel to now?

A: Well, it is interesting. So with leprosy, if you look at the historical perspective of what people said about the disease, you have to ask, was that actually leprosy that they were talking about? People get these impressions (and they have throughout history) of what a disease is and what it does. For a long time, we didn’t know how diseases spread. All we knew was, stay away from people that are sick.

So now today, we know why many diseases spread, but even when there is evidence and science about how they spread, people aren’t necessarily willing to believe it. With COVID-19, there are lots of open questions about it, and we are trying to figure this out in real time, so it’s hard for people to figure out what to get on board with, in terms of what would be most useful to do.