As a scholar of historical epidemics — plague, cholera, Spanish flu — I have tried to imagine the reactions of men and women who lived the experience of devastating epidemics. But I never imagined that I would find myself living a little piece of history, isolated in my home in Sardinia as lockdown measures are extended throughout Italy.
The coronavirus is not, at the moment, comparable to those other epidemics I’ve studied, but it is spreading around the world, provoking anxiety, fear, panic, riots and a hunt for northern Italians who are alleged to have fled south before the latest government measures took hold. The harassment of travelers brought me back to the 1884 cholera epidemic, when local officials in some southern regions (Calabria) were forced to ask the interior minister not to let trains enter stations because they could not preserve public order.
But COVID-19 has once again emphasized the fact that epidemics are not a memory from the pre-industrial past. The severe measures adopted in China strongly suggest that the ancient, basic concept of quarantine is still valid. In the absence of a targeted vaccine, general preventive interventions still have to be relied upon.
The strategies recently adopted in Italy have their roots in the past. From the onset of the Black Death in 1347-48, Italian cities implemented a complex health defense system, which was an example to other European countries. The cornerstones of this health defense system lay in quarantine, sanitary cordons, lazarets (quarantine stations), disinfection and social regulation of the population at risk. Medicine played no part: its impotence in dealing with epidemic diseases left health defense to the initiative of the civil authorities.
In fact, the first to refine a system of defense against disease was Venice which, because of its particular geographic location and its great importance as a commercial center, was dangerously exposed to the plague arriving by sea. But while the waters of the lagoon were a corridor for the passage of an epidemic, they were also a natural cordon sanitaire that facilitated an efficient quarantine system as a bulwark against the disease for the rest of Italy.
Today, this natural barrier does not work against the coronavirus. For blocking COVID-19 it may be necessary to adopt a version of the social distancing measures used at the time of plague in Venice in the case of a suspected contagion on a ship: From an isolated canal, the captain was taken in a lifeboat to the health office, where he was kept in an enclosure and he looked out a window to view the clerk. The conversation took place at a safe distance; this was based on the mistaken hypothesis that pestilential air spread diseases, but it did fulfill the objective of neutralizing possible direct contamination through breathing. The recommended distance for coronavirus in the guidelines today is one meter. I could not verify in the historic records what distance was suggested by the Venetian health magistrates!
Another historical parallelism — taking into account World War I and the fact that nobody had ever seen a virus at the time — is partially possible with the 1918 Spanish flu. In Italy, schools were closed, and also cinemas, theaters and meeting places. Restaurant hours were reduced. Public gatherings were prohibited, and also funerals and religious ceremonies. No confessions were heard, and the clergy was directed to disinfect sacred vestments. The descriptions of Italian cities in the autumn-winter of 1918, with dark and deserted streets, illuminated only by pharmacy lights, are similar to those images the television sends us now, with the closed doors of churches and the streets and squares deserted. The cordons around the so-called “red zones” and the at-home quarantines of people suspected of having contact with coronavirus seem to belong to the past. Freedom of movement, in areas at risk, is allowed upon presentation of a certificate — something travelers at the time of the plague and cholera would recognize.
There was also a dark side of quarantine. Quarantine and isolation helped lead to discrimination against the weakest social groups, not to mention minorities like Venice’s Jewish population. Throughout the centuries, from the plague to cholera in Italy in the 19th century to SARS in China in 2003 to Influenza A in 2009, quarantine measures have often translated into massive control of the movements of people and things. The severe emergency measures already in place in northern Italy (which is the most affected part of the country) have been extended to the whole of Italy, including the islands. Those who defy government rules face serious consequences.
Traditionally, Italians enjoy life. This means big families, long dinners, lunches, big hugs, kisses and close contact. It is difficult for us to change in a few days our ancestral behaviors. The epidemic heavily affects daily life: there is a before and after. The word virus, from the Latin for poison, now releases all its metaphorical strength. Since the closure of my university, I am strictly following the instruction of health authorities to stay home. No walks in the park, aperitifs with colleagues, no cinema and theater. My time is spent messaging with colleagues about moving a conference, organizing lessons for the second semester, and dealing with colleagues who are using e-learning platforms for online teaching.
However, I am confident that Italy will make it out of this dark hour — and with the data we are accumulating and the lessons we learn, we will be able to better manage similar emergencies when this one is history.
Historians’ perspectives on how the past informs the present
Eugenia Tognotti is an expert in public health and quarantine, and a professor of history of medicine and human sciences at the University of Sassari (Italy).