2020 Barsan Emergency Medicine Research Day

1. When Germs Travel
Coronavirus, Quarantines, and Contagious Crises
Howard Markel, M.D., Ph.D.,
George E. Wantz Distinguished Professor of the History of Medicine
Professor of Pediatrics and Communicable Diseases
Director, Center for the History of Medicine
The University of Michigan at Ann Arbor

2. 4-Act Model of Epidemics
Act I: Progressive Revelation
Act II: Managing Randomness
Act III: Managing Public
Response
Act IV: Subsidence and
Retrospection

3. Major Leit Motivs of Epidemics and Pandemics
Pieter Bruegel the Elder
Triumph of Death (The Black Plague), 1556.

4. Epidemics are
framed and shaped—
sometimes advanced,
and sometimes
hindered— by how a
given society
understands a
particular microbe to
infect and spread to
others.
"Doktor Schnabel von Rom" ("Doctor Beak from Rome").
Engraving, Rome, 1656.

5. The economic losses associated with epidemics can
have a strong influence on public response.

6. The potential for the concealment of an epidemic,
delays in reporting one, or their severity being
ignored or underestimated by the world at large.

7. The movement of people and other living beings
and the speed of travel are essential factors in the
spread of infectious disease.

9. Widespread media coverage of epidemics is hardly
new and an essential aspect of any epidemic.

10. Our fascination with the suddenly appearing microbe that
kills relatively few in spectacular fashion often trumps our
response to infectious scourges that patiently kill millions
every year.

11. Markel, H., Doyle S., Epidemic Scorecard. (Op-Ed Page) The New York Times, April 30, 2003.

12.  Poverty. and its attendant evils, often fuel
the fire of an epidemic

13. Scapegoating or blaming individuals or social
groups for the importation of infection.
Judge, September, 1892

14.  Laws Governing Migration, Individual Liberties, and
Movement to Contain the Threat (real or perceived) of
Contagion

15. The Birth of the Quarantine
In response to the “Black Plague” pandemic of 1347- 1348, Venice
founded the first quarantine island, Lazaretto Vecchio, Santa Maria di
Nazareth Island. In 1485, in response to a successive wave of plague,
Venice adopted the rule requiring that all vessels coming from infected
ports be detained for 40 days, (Quaranta giorno).

16.  Internecine Rivalries and Disputes Between
Local, State and the Federal Government

17. What is the most dangerous response to a
recent epidemic or pandemic?
Profound Amnesia

18. Lead Op-Ed, Sunday, January 26, 2020
Why we should be skeptical of China’s
coronavirus quarantine
“As a historian of epidemics, I’m not
optimistic it will turn out well.”

19. Op-Ed, January 27, 2020:
Will the Largest Quarantine in History Just Make Things
Worse?
“The dirty history behind isolating the sick...
With the Wuhan coronavirus, as with other epidemics past,
quarantine measures may be too much too late.”

20. School Closures,
March 6, 2020

22. Time Magazine,
November 7, 2005
Q: What will be the next deadly pandemic
and how will it unfold?
A: “No one really knows what's going to
happen. Anyone who says they do is either
a fool or lying."
---Howard Markel, M.D., Ph.D.

23. © Howard Markel, 2020