Angst in the time of Covid

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Image: A young girl is given oral polio vaccine – Wikimedia CC

Amid reports of doubters who (still) believe Covid is fake news, this week we examine the history of public protest and vaccine hesitancy in times of contagion.

Those 3,000 or so people who mingled on Sydney’s streets a while back, protesting against the Covid lockdown, protesting about vaccines – it’s nothing new.

In the early 19th century, Joe Public was getting riled up by the spread of cholera and the seemingly poor response by doctors and authorities. There was similar dissent shown when the UK government sought to make the smallpox vaccine compulsory in 1854. There was an ‘anti-mask’ movement during the Spanish Flu and much stigmatisation of polio victims in the first half of the 20th century.

While the threat of cholera has been eradicated in countries with good drinking water and sanitation, there’s still a lot of it about in parts of Africa and Asia.

Cholera is a severe diarrhoeal disease which, if left untreated, can kill within hours. It is commonly transmitted via food or untreated water, particularly in countries with poor sanitation. Even now if you are travelling to Asia or Africa, your GP will advise getting vaccinated.

And here, dear reader, is where the great divide starts; the inevitable chasm between the majority who accept the science and medical advice and those who don’t. There are those who think the Covid vaccine is a plot to de-populate the planet or a conspiracy to control our minds by implanting microchips. Mine has already succumbed, as you can tell.

The first cholera epidemic (1831) emerged in Russia then somehow moved to Scotland, causing considerable angst and consternation. Just absorb this snippet from Wikipedia and put it in the context of Sydney’s Covid lockdown (and protests).

A major riot took place in Aberdeen on 26 December 1831, when a dog dug up a dead body in the city. Some 20,000 Aberdonians (two-thirds of the city’s population, although this number has been criticised as an exaggeration), protested against the medical establishment, who they believed were using the epidemic as a body-snatching scheme similar to the Burke and Hare murders of 1828”.

In the summer of 1832, a series of cholera riots occurred in various towns and cities throughout Britain, frequently directed against the authorities, doctors, or both. Of the 72 cholera riots in the British Isles that year, 14 made reference to body-snatchers (“Burkers”).

Burkers were people who believed that medical authorities were acting in co-ordination with the State to purposefully kill and reduce the population (weeding out the poor and weak). Sounds outlandish now, eh?

Despite oral vaccinations being in widespread use, the World Health Organisation (WHO) recorded 499,447 cases of cholera and 2.990 deaths in 2018, spread across 34 countries. About 75% of cholera cases were attributed to Yemen. As the WHO observes, cholera is most likely to re-emerge and spread in countries affected by war and civil unrest and/or where infrastructure has been damaged by natural disasters.

If you roll back 102 years to the Spanish Flu pandemic, it is not hard to uncover instances of public unrest. They ranged from people stigmatising those who had the virus to complaining about having to wear a mask in public.

Historian Humphrey McQueen says mask wearing was strenuously enforced in New South Wales.

The demand for masks was so extensive that to prevent profiteering, the Commonwealth Government declared butter muslin and gauze to be `necessary commodities’ within proclaimed areas.

Opponents of mask wearing saw them as breeding grounds for infection or as sapping the community’s ‘vital force’. A ‘Bovril’ advertisement alleged that anti-influenza masks were ‘like using barbed wire fences to shut out flies’.

McQueen said there was widespread support for inoculation throughout the country. By the end of 1919, 25% of people in in New South Wales had received two inoculations against Spanish Flu.

“Melbourne’s socialites reputedly arranged `inoculation parties’ where the guests got the needle in turn to slow music and a prize was awarded to the shapeliest arm.

Vaccine hesitancy is no surprise to David Isaacs, Professor of Paediatric Infectious Diseases, University of Sydney.

Writing in The Conversation, he explored the topic from smallpox through to the Covid vaccine.

In 1853, concerned by pockets of poor uptake of smallpox vaccine, the British parliament introduced the Vaccination Act, making infant smallpox vaccination compulsory.

Mandatory vaccination fomented opposition, something we should remember if considering making a modern vaccine mandatory.”
Protests quickly emerged, with more than 80,000 vaccine dissenters marching through Leicester carrying banners, a child’s coffin and an effigy of Jenner.

Eventually, the success of Jenner’s smallpox vaccine silenced the anti-smallpox vaccination movement.

I sometimes look at the smallpox scar on my arm (1955) and wonder why people were so scared of something that could spare you from a disease more contagious than Covid-19, with a 30% mortality rate.

In the first half of the 20th century, the ‘silent killer’, polio (infantile paralysis) swept quickly through the US and other countries.
The US was desperate for a polio vaccine and it got one, but not without an early setback. Virologists Albert Sabin and Jonas Salk, competed to develop the first polio vaccine.
Salk’s vaccine, made from killed polio viruses, was ready for a large clinical trial in 1954.

Five companies applied to mass produce the Salk vaccine, four major pharmaceutical firms and one Californian family firm called Cutter Laboratories. The trial results proved the vaccine worked, so vaccination began in 1955.

But within two weeks, children who received the Cutter vaccine (but not the vaccines made by the four other companies), started to develop paralysis. Of the 200,000 children given the Cutter vaccine, 40,000 developed polio, 200 were paralysed and 10 died.

The polio vaccination program stalled due to the ‘Cutter Incident’, but the fear of catching polio was so great the public was soon reassured the other vaccines had not caused polio, Prof Isaacs wrote.

I don’t remember being told this story as a child in the 1950s, lining up in a New Zealand schoolyard for the polio needle. New Zealand was as badly affected as Australia, with five polio epidemics from 1914 to 1954, resulting in many deaths and people my age being left with a lingering legacy.

Polio Australia says there are 400,000 Australian survivors of the childhood polio epidemic. At its peak between 1944 and 1954, the virus killed 1000. The highly contagious virus, spread via faeces and nasal mucous, resulted in poor people and those living in overcrowded situations being stigmatised. Then as now, outbreaks were dealt with by closing schools, borders and public facilities like swimming pools. Victims were quarantined and newspapers published a daily tally of polio cases and deaths.

Prof Isaacs compares these stories with the public concern which arose in 2020 about the Covid vaccines, primarily because of the risk of blood clots. He concludes with the ‘greater good’ argument.

In Australia, a concentration on individual risk at a single point in time ignores the benefits to the community of widespread vaccine uptake.

“History tells us the public can tolerate risk of harm from vaccines when the severity of the disease warrants the risk.

I don’t know about you, but my second AZ shot is due tomorrow. I’ll run the risk.

More reading:

The Cutter incident

 

Tales of quarantine and homelessness

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Image: Nurses wearing surgical masks during the 1918 Spanish Flu’ pandemic which killed 15,000 Australians and millions worldwide. State Library of Queensland CC

Had it not been for the coronavirus outbreak (the WHO calls it COVID-19), few Australians would have known of Manigurr-ma, a purpose-built accommodation village 30kms from Darwin.

Manigurr-ma, or Howards Springs as it is zoned by Australia Post, was built in 2012 at a cost of $600 million as part of the Ichthys LNG gas project. Developed by infrastructure company Aecom for the multinational INPEX consortium, the village can house up to 3,500 people in 875 accommodation units, each with four rooms. There is a 1,750-place dining hall, a commercial kitchen which can produce 10,000 meals per day, a licensed tavern, a cinema, medical centre and laundry.

For the next fortnight or so, the village will be home to 266 Australians evacuated from the coronavirus epicentre, the Chinese city of Wuhan. Despite assurances that the risk to the general public is minimal, Howard Springs residents are making their opinions known.

After the LNG plant at Howard Springs became fully operational in 2018, the village was closed, after housing 3,500 construction workers at its peak. In May last year, Ichthys LNG Pty Ltd transferred Manigurr-ma to the Northern Territory government at a ‘peppercorn’ rental. A spokesperson for the NT Government told FOMM a ‘have your say’ campaign was carried out last year.

“Proposals were received from a range of parties, including public feedback for the future use of the Village and its assets. 

‘‘The various submissions will be considered in the final decision by the Government about how the site and its assets will be used”

FOMM notes that the proposal required submissions to be “commercially viable”.

Given that a shortage of housing is a key issue for Darwin’s homeless population, I hope someone threw that particular hat in the ring.

Quarantine, from the Italian Quarante (meaning ‘forty’), has been around since Old Testament days. The word referred to a rule introduced in Venice that all ships suspected of harbouring people with infectious diseases stood offshore for 40 days.

Several small islands off Venice known as Lazarettos were established in the 1600s when plague was rampant. Some of these off-limits islands were later converted to mental hospitals or convents. But as far as the general populace were concerned, they were, and still are, ghost towns.

Most countries had a place where people with leprosy or plague were banished. China had a well-established policy from 600 AD to detain plague-ridden sailors and foreign visitors, preferably at sea.

North Brother Island in New York’s East River was used for decades as the site of an infectious diseases hospital. A reporter from the New York Post who was recently taken on a guided tour of the now-closed station wrote that the island’s remote location was deemed perfect in the 1880s for a hospital to treat contagious smallpox and typhoid patients.

“Mary Mallon, who earned the name Typhoid Mary by passing the disease to 51 people while working as a cook in Brooklyn and Long Island, was its most infamous tenant. She displayed no symptoms herself, but was quarantined until her death in 1938.”

Sydney’s Quarantine Station at North Head (Manly) took in immigrants who had fallen ill (as well as some residents). As the authors of a book published in 2016 found, some recovered and were released. Some never made it out.

‘Stories from the Sandstone’, published in 2016 by the University of Sydney’s Peter Hobbins, Anne Clarke and Ursula Frederick, chronicled the history of Sydney’s Quarantine Station. The title of the book comes from archaeological discoveries of inscriptions carved into sandstone by some of the 16,000 people kept at North Head between 1830 until its closure in 1984.

In the mid-1880s, infectious illnesses like smallpox, tuberculosis and scarlet fever were common and there was even a recorded case of bubonic plague in 1900. As Dr Hobbins says in the book, as a result of extensive immunisation programmes, effective antibiotics and improvements in the public health system, infectious diseases do not decimate the population as they did in the 1800s or even during the Spanish ‘Flu pandemic of 1918-1919.

The most visible (and possibly the largest), quarantine station in the world in 2020 is the cruise ship Diamond Princess, moored off Japan with its 2,666 guests and 1,045 crew ‘couped (sic) up’ as an ABC report had it, until time dilutes the fear of contagion. Princess Cruises this week confirmed reports of 39 new coronavirus cases aboard the ship, berthed at Yokohama.

“We are following guidance from the Japan Ministry of Health on plans for disembarkation protocols to provide medical care for these new cases,”  the website update states.

The Diamond Princess had been due to leave the Japanese port of Yokohama on February 4, but cancelled the cruise on advice from Japanese health authorities.

The cruise ship’s situation fits the definition of ‘quarantine’ – preventing the movement of those who may have been exposed to a communicable disease, but do not have a confirmed medical diagnosis.

The key difference between Coronavirus (now known as COVID-19) and SARS (Severe Acute Respiratory Syndrome) is that people with Coronavirus are infectious before exhibiting symptoms. This may explain the comparatively higher numbers of people contracting the disease and the overly-cautious approach to quarantine here and abroad.

A Medical Journal of Australia report compiled after the SARS epidemic had abated in 2004 demonstrated the effectiveness of Australia’s border screening. Of the 1.84 million arrivals into Australia during the study period, 794 people were referred for screening to the Australian Quarantine and Inspection Service. Of these, four travellers met the World Health Organisation (WHO) definition for SARS. None of these people were confirmed to have SARS.

The media loves contagion stories about as much as it drools over earthquakes, volcanic eruptions, tsunamis and croc and shark attacks. Are they beating it up? Time will tell. Whatever you read on social media, as of February 13, 2020, 15 Australians had been confirmed as being infected with coronavirus. Five have since recovered.

As usual, the trail of research leading into the history of quarantine stations lured me away from the point I wanted to make.

When the Northern Territory has 12 times the national average incidence of homelessness, how is it there are 875 living units sitting vacant near Darwin (for at least 18 months)?

NT Shelter estimates that 16.5% of Territorians under 16 are experiencing homelessness. The system seems unable to cope, with Shelter’s findings that 48% of people get turned away due to a ‘lack of resources’.

As Australia’s Prime Minister Scott Morrison conceded, we are no closer to Closing the Gap. The policy was announced in 2008 with noble intentions to help bridge the gap between health and welfare outcomes for indigenous compared to non-indigenous Australians. There are no simple answers to the fact that 90% of the Territory’s homeless are indigenous. As a Triple J story revealed, a survey of non-indigenous people in Darwin revealed a lot of ignorance about ‘long-grassers’ – indigenous people who sleep rough.

Larrakia Nation Aboriginal Corporation’s random survey of 300 people found the majority romanticised the notion of sleeping under the stars. Only six people identified a lack of housing, failed public policy and the impact of assimilation and integration policies as reasons for homelessness.

When the last person at Manigurr-ma is cleared to leave, it would be an interesting exercise, at the very least, to trial the centre as a homeless shelter. After all, though homelessness is not contagious, it does have far-reaching effects.