In the early days of the Covid-19 pandemic, a tale of two cities circulated widely through social media. It concerned the disparate responses of Philadelphia and St. Louis to the 1918 influenza pandemic, and it went like this: In late September 1918, Philadelphia’s health commissioner, Wilmer Krusen, faced a decision. Doctors reporting to the Department of Public Health had noted the city’s first confirmed case of influenza. Krusen was under pressure to cancel the upcoming Liberty Loan Parade, the city’s chance to advertise and sell bonds to fund U.S. involvement in World War I. But Philadelphia was eager to meet its fund-raising quota, and Krusen encouraged the parade’s organizers to go ahead as planned. On September 28, some 200,000 people crowded onto Broad Street, marveling at the spectacle of marchers and music. Just a few days later, cases of the flu began to rise. Influenza deaths skyrocketed throughout October.
Halfway across the country, St. Louis showed that a different approach was possible. The city required social distancing in early October, a mere two days after its first reported case. Schools and churches closed; streets emptied out. The strict public-health measures worked: At its peak, St. Louis’s mortality rate was just a fifth of Philadelphia’s.
Examining the trajectories of those two cities helps us see how prudent measures can “flatten the curve” — and how politicized decisions can threaten public health. It’s an example of what social scientists call a “natural experiment,” a situation in which “natural” or random factors result in easily comparable scenarios.
I had planned to use that anecdote to kick-start a history-of-medicine class this fall at the University of North Georgia — a clever way to catch students’ attention, I’d hoped. As a full-time lecturer in the department of history, anthropology, and philosophy, I typically taught survey courses in world civilizations and American history. But last spring, I suggested that I also offer my class on the history of infectious disease, adding “If not now, when?” My chair approved the request.
Because none of my students would have been exposed to any history of medicine, “The History of Infectious Disease: Covid-19 in Context” was to start with seven weeks of introduction to the discipline. But the second half of the course was designed to speak to the current moment: In lieu of a traditional research paper, students could write a policy paper from the perspective of a historian advising a present-day institution on the way forward during this pandemic. The assignment would help students practice interpreting the past, and demonstrate how historical narratives could influence present-day policies. I was excited.
As the fall semester approached, however, my enthusiasm began to collapse into worry and frustration. In the spring, the university announced that everyone would return to campus to teach face-to-face in the fall. Everything, administrators said, was Back to Normal. But things were by no means normal. I resumed checking the risk-tracking website CovidActNow.org, as I had every day the previous year. I looked up outbreak data for the county in which my campus was located, and checked Georgia Tech’s event risk calculator to assess how dangerous my classroom might be. I watched the Delta variant creep its way up Florida and into Georgia, even as our Board of Regents doubled down on its opposition to mask and vaccination mandates on public campuses. Was I really going to return to the classroom under such circumstances?
My university’s actions were unwittingly demonstrating the very lessons I was trained to teach. In previous semesters we might, as a class, have assumed that Philadelphia’s 1918 folly would never be repeated, that American leaders would — of course! — take standard public-health measures. This semester, however, there would be no false sense of security. Teaching the examples of St. Louis and Philadelphia would be particularly persuasive, since students were watching similar decisions play out daily in the news. In fact, I could use our own university system as a case study in how political power often wins out over scientific knowledge. This would be a powerful lesson, one students would be unlikely to forget. But did I want to be part of that? Did I want to be associated with an institution deliberately taking such dangerous steps?
Like many historians of science and medicine, I’ve learned to walk a fine line between advocating for science and exercising caution in the face of the discipline’s myriad missteps. For every scientific success story, there’s a corresponding narrative of horror, in which the pursuit of knowledge took place within power structures that willingly sacrificed the well-being — the lives, even — of people of color, colonial subjects, women, and queer persons. Studying the history of medicine has attuned me to how powerful institutions take risks with vulnerable populations. I recognize the calculus of indifference when I see it. I could not ignore the fact that my employer had opted for the role of Philadelphia.