I’m not sure where I heard or read this, but it struck me as profoundly true-

‘History repeats itself unless we learn from it.’

I recently finished reading the book “The Ghost Map” by Steven Johnson, which describes the conditions prevalent in 19^th century London, one of the mostly densely populated cities at that time, the multiple cholera epidemics that regularly ravaged the city, and the efforts taken by Dr. John Snow in tracing the source and the mode of spread of cholera, who was first opposed but then helped by Henry Whitehead, a young curate.

The similarities between the cholera epidemics in 19^th century London and the ongoing CoViD-19 pandemic are really remarkable!

To say that London was one of the filthiest cities in the world when the cholera outbreaks were rampant would not be an understatement. The sheer size of the population of the metropolis, along with lack of sanitary waste disposal facilities contributed to the filth.

It may strike us a gross and disgusting, but it was quite common to find cellars of houses overflowing with human excrement. To put it bluntly, the houses were literally filled with shit.

A cloud of stench covered the city, especially along the banks of the river Thames. It is not surprising therefore that the popular opinion of how cholera spread was attributed to the smell. This opinion was not only held by lay people, but was propagated by the great minds of the day, including scientists, policy-makers, and office bearers. This was known as the ‘miasma theory.’

It was believed that cholera spread because of the stench of the filth. Dr. John Snow had an inkling of the way cholera spread way back in 1848. He even wrote about it in several leading journals of that time, but was ignored. Dr, Snow’s opinion was radically different from the prevailing opinion and whatever proof he had gathered in support of his theory would be convoluted to fit the miasma theory.

It took well over two whole decades, despite over-whelming proof for water-borne spread of cholera to be accepted.

The newspapers of the day abounded with quack cures- these ranged from perfumes to get rid of the smell, castor oil and other purgatives to rid the victim of whatever was causing the disease, opium to cause constipation, and blood-letting, again a popular remedy of the day for almost anything.

While some of these cures, though useless were harmless, others like purgatives and blood-letting were only successful in sending the patients much earlier to their graves.

 

Similarities with the ongoing CoViD-19 pandemic

Like with the miasma theory, for over a year we did not really question the origin of the SARS-CoV-2 virus. We accepted the ‘originated from the Wuhan wet-market’ theory despite multiple holes in it, like sheep. It is only a year later that we are asking for a more in-depth investigation.

Why don’t we know the index case or the patient zero of CoViD-19 pandemic despite there being ‘extensive’ investigation, whereas in other similar outbreaks such as SARS and MERS, the index cases have been identified, or at least, we have a fair idea about patients zero in these cases?

Why is SARS CoV-2 spreading so efficiently and so rapidly, whereas its predecessors caused only limited outbreaks? Granted, global travel is more accessible today and the sheer number of people travelling around the globe has also increased, but if the pathogen itself has not adapted to human hosts, can it spread as efficiently as the SARS CoV-2 virus is spreading?

Why, despite searching for over a year, no intermediary host has been found for the SARS CoV-2 virus? The intermediary hosts for SARS and MERS viruses were found without great difficulty: palm civets for SARS and the dromedary camel for MERS.

Last year when the outbreak started, I was given the responsibility of educating the patients and the healthcare workers in the hospital, and I used to say again and again that droplet precautions would be enough to prevent transmission. For droplets, which are large respiratory particles and which settle down within three metres of the person generating them, social distancing works remarkably, and a good surgical mask is effective in preventing spread.

Now a year later, there is evidence that aerosols, which are tiny particles and can remain suspended in the air for a long duration and can travel large distances might play a role in transmission.

Have we downplayed the role of the N95 masks, which are known to be protective in preventing airborne pathogens? How effective are cloth masks?

Most importantly, are we missing an important link in disease transmission?

“You and I may not live to see the day, and my name may be forgotten when it comes; but the time will arrive when great outbreaks of cholera will be things of the past; and it is the knowledge of the way in which the disease is propagated which will cause them to disappear.”

-        Dr. John Snow to Henry Whitehead, the curate who actively participated in investigating the cholera epidemics of 19^th century London.

Until we find the exact mode of transmission, will we be able to stop the epidemic? The one measure that has consistently proved to slow down transmission worldwide is lockdown. What exactly is it about the lockdown that is helping in preventing the disease?

Instead of directing our energies towards all the above, we have been victims of quack cures just like Londoners of 19^th century. What’s more, until very recently, like just till last week, even our national guidelines actively advocated the use of these quack cures, namely the antibiotic doxycycline and the anti-parasitic ivermectin. These tablets were actually given out to patients irrespective of the status of their symptoms if they chose home quarantine. Talk about misuse of antibiotics and spreading antimicrobial resistance!

After all is said and done, the question remains- will those in power really investigate all possible theories for the origin of SARS CoV-2?