A History of Plagues: From Bubonic to Ebola

A History of Plagues: From Bubonic to Ebola

The Ebola epidemic in West Africa is the worst outbreak of the disease in history, but deadly plagues are as old as society, says Professor Daniel Malamud.

A specialist in infectious diseases at the NYU School of Medicine, Malamud will develop that theme in a talk at NYU Abu Dhabi this evening. Salaam caught up with him about the talk.

"I selected a series of plagues to talk about," he said, "starting with the ones in Biblical times, and then the bubonic plague, and the 1918 flu plague, and HIV/AIDS. I look at the common themes, to see if we've learned anything from those cases. The answer is yes and no."

"Nobody alive now remembers the 1918-19 influenza epidemic," he noted, but it infected at least 20 percent of the global population, and killed some 50 million people. No epidemic since has been nearly as deadly.

But fear is, in a sense, the most virulent disease of all, and initial public reaction to Ebola, in the US and elsewhere, reminds Malamud of the way people first dealt with HIV/AIDS.

"There was real stigma attached to HIV in the early days. Physicians and dentists didn't want to treat people who were infected...They were ostracized. It's the same with Ebola."

This is sadly ironic, because in the US, Ebola can be managed and treated. "There hasn't yet been one case of transmission within the US," Malamud noted.* "And yet this week, when that doctor was released from Bellevue it was like a circus outside, with crowds and news trucks." He was referring to Craig Spencer, a US physician infected while working in Guinea.

"I heard from colleagues there that nurses were starting to call in sick; they were fine but they didn't want their families or boyfriends to know they'd been near an Ebola patient." And yet, he added, the public is much more nonchalant about influenza, although it will kill an estimated 20,000 Americans this winter.

The lesson, he said, is that robust Western public health systems can cope with dangerous diseases, but not with undue public anxiety. "Part of it is the media," he went on. The alarm generated in some media "is not being tempered enough. After all...we have the systems to diagnose and treat it."

Despite the near-hysteria in some quarters, he went on, Western publics have shown little interest in helping stamp out the disease in West Africa, where feeble public-health networks cannot cope. In a way, he said, this is what Thomas Malthus predicted about the consequences of population growth: a lack of resources would lead to high death rates.

"It's strange," Malamud said. "In Haiti, in the 2010 earthquake and later the cholera outbreak, thousands died — and the whole world donated like crazy. But that's not happening this time; the Western populace is not energized in the same way."

Malamud sounded more puzzled than bitter as he summed up: "Now we know exactly how to prevent transmission of HIV, and of Ebola too. Unfortunately, we don't know how to change human behavior. That's the very sad thing: science has done so much, but behavioral science hasn't kept up."

Daniel Malamud is professor of basic science, NYU College of Dentistry and professor of medicine (infectious diseases), NYU School of Medicine. His talk, open to the public, will be delivered at the Conference Centre at NYUAD's Saadiyat Campus at 6:30 p.m. on Wednesday, November 12. Simultaneous Arabic interpretation will be provided.

*In the United States, there have been two travel-associated cases and two locally acquired cases among healthcare workers.