What Is and Was an Epidemic

My interest in epidemics began more than a half-century ago with an undergraduate's random walk through the University of Wisconsin's history offerings—where I stumbled upon a medical school course on the history and geography of disease. It was there I first came across references to America's nineteenth-century brushes with cholera. The course's subject matter helped lure me away from a pre-med major and into history. In graduate school at Columbia I turned my back on a planned dissertation on the American Revolution in the colony of New York and fastened on a then quirky and unfashionable thesis subject, America's recurrent nineteenth-century cholera epidemics. What attracted me was the focus contemporaries placed on those frightening episodes; children died every year of summer diarrheas, their elders of tuberculosis and kidney disease. But, as I always explain to students, this was background noise, part of the texture of life. Cholera was something quite different—not endemic, performatively deadly, and novel—signal, not noise. This very episodic social visibility was and is in fact a defining characteristic of an "epidemic." It implied a story, a stage and performance, a beginning and end. It also demanded contemporary response and reflection and thus an abundance of sources for the historian. Morbidity and mortality did not in themselves constitute an epidemic.

It never occurred to me as a student in the 1950s that my generation would experience, and thus help constitute, a parallel set of events. But then a generation later AIDS taught us that epidemics could manifest themselves in the form of narratives quite different from that of America's cholera outbreaks. Biology was an unpredictable casting director, and the AIDS virus performed quite differently from the cholera vibrio; it elicited different symptoms, a distinctly different course of illness, and pattern of transmission. The conspicuous focus on the gay community during the first decade of the perceived AIDS epidemic was, for example, quite different from the hostility shown toward the urban immigrant population during America's nineteenth-century cholera epidemics. But both cholera and AIDS were parallel events in the sense of being ultimately and conspicuously visible as social phenomena with a perceived beginning and a narrative structure turning on gradual perception and ending in the diminution of a widely shared sense of crisis and threat. Each elicited a very different configuration of policy and attitudinal response; and thus each constituted a powerful tool for social analysis, a way of thinking about and understanding the society in which they were acted out.

As I reflect on our most recent—ongoing—pandemic, I have become increasingly aware of the way in which pandemics are in some ways similar in their impact and social perception, yet necessarily different. Our current epidemic has elicited a revealing and deeply controversial array of responses, a drama enacted around the frightening, ever-shifting configuration of biological events and human social arrangements that constitute an epidemic—elusive yet defined by its intense emotional impact. Like cholera or AIDS, COVID-19 provides a sampling device, but as it has become increasingly clear—a stress test as well. In the United States it has highlighted the ambiguities of federalism, the tenacity of social inequality, and the political and structural conflicts built into policy formation. And such realities provide an occasion for international—comparative—insights as well. We live in a world of rapid movement of people and things, of complex supply chains and just-in-time deliveries, of the movement of workers as well as electronic information. Our stage is a world stage and, on that climate-change defined stage, varying local manifestations provide what I have described as a natural sampling device, illustrating diverse configurations of people, of policy, and of resources institutional and intellectual. It is a world as well of biotechnical sophistication, of basic science and translational forms capable of identifying pathogens and elaborating responses in ways unimagined in 1832. Those novel realities have the capacity to shape the course of an ongoing epidemic and create a revealing array of policy options as societies respond to the perceived crisis.

We...