Zika and the Bubonic Plague: A Lesson From the Middle Ages

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Wealth and privilege will not protect us from this new plague — and the sooner we recognize that, the sooner we can start figuring out what will.

By Eleanor Johnson


Triumph of Death fresco, circa 1448; Palazzo Abatellis, Palermo, Italy. (Photo: Wikimedia Commons)

Northerners in the Western Hemisphere have been urged not to worry too much about the Zika virus. It will primarily be a problem in more tropical areas, like Guam, Puerto Rico, Central and South America, and the Virgin Islands. People from other areas who travel to those places should take anti-mosquito precautions, of course, but there’s not much to suggest that the Aedes aegypti mosquito will make it to places like Washington, D.C., New York, Chicago, or San Francisco.

Sure, according to the Centers for Disease Control and Prevention (CDC), the mosquito that carries the virus could conceivably reach as far north as New York City. And, yes, experts in infectious disease management warn that the United States is not ready for Zika, but, really, there are good pest management options available, and good medical technologies, and, anyway, the media is promoting awareness. Wear your long pants, use mosquito spray, avoid standing water, and — crucially — avoid traveling to far southern areas, and you will be fine. Zika, one is left to believe, is an illness that will mainly affect the southern reaches of the Western Hemisphere — more specifically, those places’ poorest people.

As a card-carrying medievalist, I am struck by the historical risks of thinking about disease management in this way. When the bubonic plague hit Florence in 1348, Giovanni Boccaccio wrote his Decameron, a collection of tales told by a fictional group of 10 young people who decamped to the countryside to escape the plague. The book implicitly acknowledges that the plague has come from the Near East, via trade routes that linked the Middle East and Asia to Europe — much as contemporary epidemiologists register that Zika has gained a foothold in the Americas because of international travel patterns from Pacific Rim Asia.

Both Zika and the bubonic plague represent nomadic illnesses that show up in an area where they don’t belong; in both cases, the diseases are viewed as avoidable if you’re privileged, rich, and “smart” about staying away.

In both cases, the illnesses are nomadic and have shown up in an area where they don’t belong. And, in both cases, the diseases are viewed as avoidable if you’re privileged, rich, and “smart” about staying away from hotbeds of contagion. Boccaccio’s 10 youths are sufficiently well off to have rolling country estates, and “smart” enough to know that they should leave downtown Florence, the epicenter of the plague. Denizens of the global north, similarly, are urged by the CDC to avoid travel to affected areas if possible, and to take necessary precautions if equatorial travel becomes inevitable. If you’re rich and “smart,” you can avoid this plague too.

Now, in Boccaccio’s fantasy, no one dies: The 10 youths simply spend a grand time telling their stories to each other. But, in reality, the plague wiped out roughly one-third of the population of Europe between 1346 and 1353. Even leaving cities for the country didn’t significantly reduce risk. Being wealthy didn’t guarantee immunity, and being “smart” and avoiding certain people or places didn’t help much either.

Boccaccio’s fantasy was just that: a fantasy. His narrative spools out the logic of what it would be like if rich, “smart,” and privileged people could literally (and literarily) escape the scourge. The reason it was mere fantasy? People didn’t understand enough about the bubonic plague to know precisely how it spread, and so couldn’t really avoid exposure. The handling of sick people and dead bodies was far from sanitary. There were too many situations in day-to-day life when one might come into close contact with a person who was not yet symptomatic but nonetheless ill, and contagious. It just wasn’t really possible to avoid the epidemic.

The similarities between Boccaccio’s approach to the plague all those centuries ago and our approach to Zika now, in our supposedly enlightened and medically advanced societies, are striking. First, although we know that Zika is spread by Aedes aegypti, we learned only a few months ago that the virus is also sexually transmissible. And, since most people who have the disease never show clear symptoms, being certain you are avoiding sexual exposure is nearly impossible, except through abstinence. (Precisely how that sexual exposure works also remains a mystery; no one knows the contagious lifespan of the virus in the body of an infected person.) Second, while we’ve long thought of the aegypti mosquito as living only in far-south regions, the insect has been recently found in considerable numbers in places such as Washington, D.C. Clearly, we do not fully understand the primary vector of Zika. Third, the best course of action for containing the disease is uncertain: How do you combat a disease that’s spread by mosquitoes to people, by people to people, by people back to mosquitoes, and then back to people?

In the Middle Ages, all the uncertainty about the bubonic plague left only one real option: pray. Now, given the current state of medical science, we have a far more effective option: Find a vaccine. Because there are real reasons to think Zika will disproportionately affect nation states that lack the infrastructure or financial wherewithal to conduct extensive medical research, wealthier nation states absolutely must take on the task of finding a vaccine. It is patently the right thing to do, and it is without question in those wealthier countries’ best interests to do so. It is a ludicrous fantasy to think that any nation state or any population will get off lightly in its exposure to Zika.

Wealthier nation states absolutely must take on the task of finding a vaccine.

Bubonic plague, of course, was a far more virulent and lethal disease than Zika. If a disease more like bubonic plague were churning its fatal way through Central and South America and the Caribbean, Congress might be more eager to do something about it — for instance, if Ebola got a real foothold there. Or, let’s be honest, if Zika disproportionately affected privileged, wealthy men, as opposed to underprivileged women, Congress would probably also be much more eager to spend money to find a vaccine.

But Zika is an extremely serious illness, one that threatens to bring a generation of children with severe disabilities into the world, and that, as a result, threatens to disrupt family life, economic life, and social life in affected areas — affected areas which, in fact, may well eventually include your own hometown. No one in Italy thought they’d have a problem with a Near Eastern plague in 1347. Certainly no one in England thought they’d wind up with the same plague. But by the middle of the 1350s, one in three English people had died — people of all socioeconomic classes, of all ages, of all genders.

As of now, there are approximately 300 confirmed cases of Zika-infected pregnant women in the U.S. and its territories, 234 of whom are in the U.S. itself. There have been three confirmed U.S. cases of Zika-related birth defects, as well as three in-utero deaths. A couple of weeks ago, President Barack Obama beseeched Congress to allocate more money for vaccine development. It is imperative that members of Congress stop hesitating, stop luxuriating in the false comfort that, because they are rich, privileged, and “smart,” they can protect themselves, as can their fellow Americans, from this illness. They need a new game plan. Wealth and privilege will not protect us from this new plague — and the sooner we recognize that, the sooner we can start figuring out what will.