Pandemics and their impact on socio-political life and healthcare

By Monidipa Bose Dey

From the Athenian plague (430 BCE), the Antonine 165-180 CE and Justinian plagues (541-542 CE), the bubonic plague of the 14th century, to the Spanish flu outbreak in 1918, the effects and repercussions of pandemics on the various societies have been lasting, sometimes initiating changes in the ways how societies functioned at that time. While significant portions of the population die in pandemics; overall societies don’t die; they survive by modifying the existing social norms that help them to cope with the pandemic stress and fight back. The likelihood of pandemics has increased over the last 100 years owing to increased global integration and travel, rapid urbanization, and increased exploitation of the natural environment.

Besides the gradual shifts in socio-political narratives, what many nations have experienced during pandemics is the sudden increase in religiousness of a society as a whole, or a gradual switchover from one faith to another. This is primarily because people while trying to understand the unexplainable turn to religion to de-stress in situations that they cannot control or fathom. The change in religions, as was seen after the Antonine and Justinian plagues, has also occurred because spiritual heads of the new faith have used the weak morale of common people at the time of pandemics as an opportunity to spread their faith. However, these effects are gradual and the changes are often spread over centuries. The almost immediate effect of pandemics is a back-breaking stress on the health systems, while also stressing many other aspects of a society, which will be discussed in brief here.

Health sector impacts

The direct impact of pandemics on the health sector of a nation can be catastrophic. In 14th century Europe, the Black Death wiped out almost 30–60 % of the European population of that time. More recently, the AIDS pandemic has killed more than 35 million people since the time it first appeared in 1981.

Pandemics, more often than not, tend to affect the elderly and the young, the latter being the economically active section of any society, which in turn leads to impacts on the economy of a country. Sometime infectious diseases show chronic long term effects, which can become widespread during a pandemic, directly affecting the general health and well-being of a society.

There are many indirect health impacts too during the pandemics that include decreased access to routine care owing to various factors. As for example, in the recent West Africa Ebola epidemic (2014), owing to restricted access to routine care (health workers being diverted to tackle Ebola patients) many patients suffering from malaria, tuberculosis, and AIDS died; adding almost 11000 deaths in Sierra Leone, Liberia, and Guinea. These additional deaths, indirectly related to the overburdened health care system caused by Ebola, nearly equaled the 11,300 deaths which were caused directly by the Ebola virus in the three aforementioned countries. In the 2009 influenza pandemic, an increasing admission for pneumonia and influenza patients was seen somehow statistically related to a greater number of deaths owing to heart attacks and strokes. While such statistical relations can be made, during an ongoing pandemic it is almost impossible to differentiate between the deaths that are occurring directly due to the pandemic disease and the ones that are indirect casualties of the stressed out healthcare system.

Besides the stress of overworked medical staff, another major impact on the health system during a pandemic is the inevitable problem of understaffing and the unavailability of health workers owing to illness and deaths among these people. Being the front line workers providing care to the pandemic victims they face constant exposure to the disease, and for this reason often the fatality rates are high among such health workers. As for example, during the West Africa Ebola outbreak in 2014, Liberia saw the deaths of 8% of their health service providers (doctors and nurses) from Ebola.

Socio-political effects

A study of the history of epidemics and pandemics show that these disease outbreaks have the potential of disturbing the functioning socio-political orders, leading to clashes between citizens and states, disintegration of state capacity, and large-scale population migration and displacement. All of these were seen during the bubonic plague of 1896 that had disastrous effects on the Bombay Presidency. The Assistant Commissioner of Pune, W C Rand, who was at that time tasked with implementing the Epidemic Disease Act of 1897, initially made genuine efforts to provide relief by setting up quarantine camps and hospitals, while disinfecting plague-affected areas. However, as the situation worsened, he adopted brutal measures, which stripped Indians of their dignity. Rand and his men (young doctors backed by the army and police), would publicly strip men, women and children in order to inspect sensitive body parts like their groins and armpits for signs of the bubonic plague. Infected individuals would be forcibly quarantined or shifted to hospitals. Often buildings, food, clothes and other properties of the affected individuals were ruthlessly burnt and destroyed, without their permission, during the process of disinfection. Additionally many citizens in Bombay refused to believe that they were infected and refused to go to hospitals and quarantine camps. Sometimes, their protestations would cause large-scale chaos. The brutal steps taken by the British administration and the indignities they heaped on the local people led to a build-up of outrage, which soon turned explosive with the added fear of the unknown disease. Once the reality of the plague began to sink in, panic ensued, and thousands fled from Bombay, taking the plague with them. As public outrage grew with each passing day about the indignities, it had far reaching consequences, and in June 1897 Walter Charles Rand and Lieutenant Ayerst (Rand’s military escort) were assassinated.

In the pre-modern world, pandemics led to powerful socio-political upheavals, which were caused by large number of deaths that resulted in sudden demographic changes. As for example, in America many indigenous tribes and communities were completely wiped out by the introduction of smallpox and other diseases, which led to a complete collapse of the existing indigenous socio-political orders, making them fall easily to the brutal European conquest. When Black Death gripped Europe in 1347, it wiped out almost 50% of the total European population of that time. By the time the pandemic turned less lethal by the early 1350s, the European socio-political world had changed dramatically. Before the Black Death’s arrival Western Europe was an overpopulated feudal society, with cheap labor, serfs who had no freedom and no motivation for improving life qualities or productivity, and a lack of social mobility. However, with large number of deaths, there ensued labour shortages, which made the farmers free from their feudal lords with more power to bargain. The acute labour shortage also led to invention of new technologies among agricultural communities, which helped in increasing productivity to a large extent. Many labor-saving devices were also invented at this time, such as, water pumps, weapons with gunpowder, and the printing press. At this time many farmers moved to towns for better earnings, and entered the trade and commerce world. As they succeeded and became wealthy, a new social class was created, which is now termed as the “middle class.” The newly rich middle class in turn became patronages of art, culture, literature, and science, which led to a boom in creativity- an era that is now known in history as the Renaissance.

While none of the presented impacts is to prove that the current COVID-19 pandemic will create seismic outcomes, certain lifestyle changes such as social distancing is definitely showing some effects on the existing social norms of human exchanges. Globalisation too is taking a pause, as nations were forced to shut down borders for fear of transmission, and the fear still remains as the second phase is yet to recede. COVID-19 is also breaking down the old established practices of work from offices, which could affect the concept of big cities built around work hubs, large office spaces, public transport systems, etc., in the future. These coupled with the developments on the economic front can perhaps bring about significant changes similar to the ones that transformed the European social picture during the Black Death.

(The author is a well-known travel, heritage and history writer. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)