Time to Get Serious About Public Health

In Sierra Leone, where recent public health campaigns are saving children’s (and parents’) lives.

by Richard Conniff

The PBS/Channel 13 show “The Open Mind” has just aired its interview with me about my book Ending Epidemics: A History of Escape from Contagion. You can take check out the interview here or if 28 minutes is too big a commitment, take a look at the transcript below

HEFFNER: I am Alexander Heffner, your host on The Open Mind, and I’m delighted to welcome our guest today, Richard Conniff. He’s author of Ending Epidemics, A History of Escape from Contagion. Richard, thank you so much for joining me today.

CONNIFF: Thanks. Good to be here.

HEFFNER: Richard, there’s some dispute about whether three years since COVID-19 struck we’re still in what you could call a pandemic. Where do you come out on that?

CONNIFF: Yeah, I think we’re still in a pandemic in the sense that it’s going to come back again seasonally. It’s going to be global, it’s evolving everywhere, and those who aren’t protected, who haven’t gotten vaccinated will be at risk.

HEFFNER: When you titled your book Ending Epidemics: A History of Escape from Contagion, and specifically you identify epidemic, as opposed to pandemic, that was intentional?

CONNIFF: Yeah, that’s intentional. Epidemics are a lot more common. They occur regionally or in individual nations, and pandemics, where it’s the entire world are relatively rare events.

People, especially in this country take for granted our current state of health
and have no conception of the frequency of epidemic disease in our past.

Richard Conniff

HEFFNER: Take us through, in your mind, whether or not the public sufficiently understands that what we encountered in this pandemic was something that for decades and centuries, many strata of society had suffered in what you call epidemics, as opposed to pandemics. Is that fully understood or was that one of the motivations in writing this book?

CONNIFF: Yeah, I don’t think it’s understood at all. It is the reason I wrote the book that is I think people, especially in this country take for granted our current state of health and have no conception of the frequency of epidemic disease in our past and not even in our distant past. So I think I wrote it partly because I’m old. I was born in the middle of the 20th Century, and my father and my uncle both had polio. When I was five, I was in kindergarten. The polio vaccine became available for the first time. And at that point you know, what had been polio season became summer again. And two years before I was born, there was still smallpox in this country. And whooping cough was quite common. It killed 4,000 people a year in the United States. Children. I shouldn’t just say people. It was children under the age of five for the most part. Diphtheria. I live in New England, and there was a massive epidemic of diphtheria in the middle of the 18th century. Okay, I’m going back ways now, but it’s interesting because entire families, 13 children in one family just gone over a period of days. So yeah, there’s a long history of highly infectious diseases. One other example I had measles. People think measles is a trivial disease now. Doctors don’t even see measles anymore, but measles was a brutal experience about 550,000 kids had it the year I had it. 550 died. And so yeah, these are things that people don’t even think about anymore and don’t think about why we are free of these diseases.

THE FORGOTTEN REFORMER WHO MADE CITIES LIVABLE

Edwin Chadwick, revolutionary thinker

By Richard Conniff

This article is excerpted and adapted from “Ending Epidemics: A History of Escape from Contagion” (The MIT Press)

It’s almost impossible now, thank God, to imagine the squalor of London and other supposedly civilized cities in the first half of the 19th century. As the rural poor moved to jobs in the factories of the Industrial Revolution, they overwhelmed the available housing and the adjacent, untended, and often uncovered, cesspools. Entire families commonly huddled together in single rooms, even in windowless basements. Overflowing sewage at times made entire cities feel as if adrift on a sea of human waste.

The result was a second revolution, for urban sanitary reform, and it succeeded largely through the outsize influence of one peculiar man. Edwin Chadwick, now mostly forgotten, was a barrister, journalist, and social reformer. From the early 1830s onward, Chadwick campaigned for the British government to intervene in matters of public health and welfare. He promoted essential urban services, including public water supply and sewerage, street cleaning, and garbage removal. Chadwick’s work transformed the character and well-being of cities not just in Britain but, by example, worldwide. Along the way, he helped to establish the basis for the modern liberal state. “Few men have done so much for their fellow-countrymen as Edwin Chadwick,” biographer R.A. Lewis wrote, “and received in return so little thanks.”

This uncelebrated status is no doubt due both to the lowliness of his chief subject — the disposal of human waste — and to Chadwick’s difficult personality. A sanitarian who was a friend described him in the heroic mode: “firm-set massive build,” “resolute expression,” “nose aquiline,” and “the head altogether large, and to the phrenologist finely developed.”

But photographs from the period show a tall, round-faced figure, in mustache and muttonchops, hair smeared in hanks across his balding scalp, peering out from heavy-lidded eyes with something like disdain. Chadwick made a reputation for prodigious energy, and for his command of the facts of any issue he studied. But he was also humorless and uncompromising toward those who disagreed with him. He made little effort to hide his contempt for aristocratic domination or for foot-dragging by corrupt or indifferent politicians.

He was also a bore, “a really outstanding specimen of bore in an age when the species flourished,” according to the otherwise admiring biography by Lewis. “Mr. Chadwick is not an orator,” a friend acknowledged. “When he first gets up to speak without book he looks an orator, but a few moments dispel the illusion.”

In Beijing and Washington, A Breath of Foul Air

Airport ad for a way to breathe in Beijing. (Photo: Richard Conniff)

by Richard Conniff/The New York Times

When friends cautioned me about Beijing’s notorious air pollution recently, ahead of my first visit there, I brushed it off. It was an old story, and having grown up in northern New Jersey in the era of unregulated industrial air pollution and open garbage burning on the Meadowlands, I figured I could handle it. But I began to have second thoughts on the flight in from the north, when we crossed a mountain ridge and the clear air turned instantly to dense smog. It was still 20 minutes to touchdown.

After a day or two in the city, I felt as if I had taken up cigarettes. Same burned-out feeling at the back of the throat, with bits of airborne grit catching on the epiglottis. Same clearing of the throat by soft coughing. It got worse over the weekend, when regulations limiting cars on the road don’t apply. Coming back into the city on a Sunday afternoon was like a slow apocalypse. The air was a filthy brownish gray, and pedestrians, many of them wearing white face masks, walked hunched over as if through a rainstorm. Buildings emerged ghostlike from the haze a half-mile ahead and vanished again behind.

But I was a novice. It turned out that this was a relatively normal winter day for Beijing, with the air quality index at just 269. That’s rated “very unhealthy” by the World Health Organization, and many times worse than the maximum safe exposure level, but nowhere near those headline-making, sky-darkening days when the Beijing index has topped 700.

Back in New Jersey, the air quality index was generally under 50, and it reminded me how lucky we are to have relatively strong laws and regulations to protect our air. These are the same protections that President Donald J. Trump loudly promised during his campaign to undo on his first day in office. Indeed, the new Republican-dominated House of Representatives this month passed a Regulatory Accountability Act, which will give the new president power to roll back an array of governmental regulations, including 50 years of environmental protections — with as little public notice as possible. It could undermine even the Clean Air Act of 1972 and for the first time oblige regulators to put corporate profits ahead of public health.

The disingenuous logic of this attack

Saving Wildlife is Good for Your Health (But It’s Complicated)

(Photo: Wolfgang Kaehler/LightRocket via Getty Images)

I live in one of the towns that gave Lyme disease its name, and yet I also love wildlife. So I rejoiced a few years ago when a study argued that maintaining healthy natural habitats with a rich diversity of wildlife can help keep people healthy, too, by protecting us from infectious diseases. Now two new studies out this week support this theory—though skeptics say they still have their doubts.

The basic idea, first proposed by ecologists Richard Ostfeld and Felicia Keesing, is called the “dilution effect,” and it works like this: for a given disease affecting multiple species—like Lyme disease or malaria—some host animals readily transmit the disease organism to the tick or mosquito that will carry it to the next victim. But other species are dead ends.

In the case of Lyme disease in the western United States, for example, western gray squirrels readily contract the bacteria and pass it on to ticks. But when those same ticks feed on western fence lizards, it kills the Lyme-causing bacteria in the ticks’ blood. That makes the lizards a bad host for Lyme, and good for us. In theory, the greater the biodiversity in any habitat, the more chances