Shaping a Pandemic Narrative

when i was a graduate student a good many years ago and looking for a dissertation subject, I came across America's nineteenth-century cholera pandemics—and stopped looking. I was already interested in urban and religious history, as well as the history of science, and I soon decided that America's response to cholera constituted an ideal research site for pursuing and configuring these interests. Cholera evoked such a general and intense level of fear and articulate response that it constituted a natural site for historical research.

In the 1980s, AIDS was to provide another such sampling device. As I write these words, we are living through yet another such traumatic and demanding occasion for critical analysis and humility. Issues such as public policy, social and religious values, structured inequities, environmental realities, and attitudes toward sickness and death are all illuminated and uniquely configured in response to the unique biological characteristics of the infectious agent. Thus the timeliness of the decision to republish "In Time of Plague," at once documentation and reflection on that late twentieth-century pandemic, as we cope with and try to understand the "interesting times" in which we live today. Their infectious agents differed, as did their clinical courses and characteristic symptoms, but both cholera and AIDS attracted widespread concern, admonition, and reflection. Particular victims were blamed, public policies judged, social relations scrutinized, religious authority both embraced and questioned.

Pandemics cannot be ignored. They command our collective attention in a way that a generation's normal crop of sickness and accident does not. It is in this sense that disease has always been a timeand-place-specific configuration of the biological and the specifically historical, a hybrid entity. It was as true in the era of Hippocrates as it is today. Much of disease incidence is perceived as perhaps unlucky, but normal—to be expected in a world of varying fortune and misfortune. But pandemics are different. They are novel and disquieting, unfamiliar and often deadly. Tuberculosis killed far more nineteenthcentury Americans than cholera ever did, but had nowhere near the emotional and institutional impact. In novelty and lethality, cholera was signal, while tuberculosis was noise—like malaria in some locations, or chickenpox, measles, and infant mortality almost everywhere. Pandemics demand to be thought with as well as about.

As I reflect on COVID-19, our still unfolding crisis, a number of things have become clear. One is the sheer velocity and scale of events, a reflection of both our world's technological capacities and its interdependencies. Another is a widespread conviction that this novel virus will be a powerful change agent—even though we are as yet unable to predict the scale and direction of that change. America's healthcare system, its structured inequality, its racial caste system—these have all become unavoidably visible in the past few months, as have the problematic aspects of the federalist system of government that Americans have so long taken for granted. And, as with AIDS and cholera, the nature of the infectious organism itself creates possibilities and shapes a unique pandemic narrative. I refer, for example, to the protean quality of responses elicited by the coronavirus—an elusive reality in which some infected but contagion-spreading individuals display few or no symptoms, while others are beset by a diverse, florid, and sometimes fatal assortment of symptoms. AIDS, as we are in retrospect well aware, was characterized by a very different clinical picture as well as a differently perceived pool of victims—one that elicited a differently structured social narrative. Pandemics help us think about the body in particular times, spaces, and social locations, as well as the elusive yet implacable nature of what we call disease.