When I was a child in Naples, the trams had signs on them telling people not to spit and also to offer up seats to the “mutilati di guerra” (the war wounded). The first sign always puzzled me. Spitting was terribly bad-mannered, of course, but why was this instruction so much more necessary than any other? It took one of my many elderly relatives to tell me that spitting and coughing into the space where others were could spread disease. And diseases could kill. This was not just about good manners but health. It was obvious to those who had grown up before WW2, had lived through it and WW1, had known a world without antibiotics and vaccines, a world where childhood diseases, some of them quite debilitating and often lethal, were commonplace (my mother and her siblings caught every childhood disease going), a world where pneumonia killed the young, where TB was a lethal disease not a romantic backdrop to operas, where childbirth was still a risk, where formula milk was not available for those mothers too sick to nurse their infants, where cuts were bathed with iodine to prevent infection. (I still remember how it stung and the fierce determination with which it was applied, no matter how loud our childish cries.)
This was a world away from the post-war world I grew up in – where public health and vaccines and cures for all sorts of once lethal diseases were readily available, of antibiotics and astonishing medical developments of all sorts, a world which my generation and those after me have largely taken for granted.
It’s a long time since those signs were common-place or the ones reserving seats for the mutilated. War – such a common backdrop to every generation in the past – has, for those in the West at least, become a limited event, carried out in far-away places by professionals. The wrenching disruptive impact on individuals and societies of war and disease has faded into memory, into history, into books and dramas. We have forgotten that they have more often been normality for most societies and most generations. It has been our immense good fortune to live at a time and, for many of us, in a part of the world where peace and good health – and cures – are the norm and taken for granted. Even HIV is no longer the killer it once was. If that virus could be beaten, then surely this new one will too? We hope so. We should not assume it.
It may not be – or not for a while. In the meantime we will have to learn to live with the realisation that hygiene and cleanliness and care and precautions are necessary, that vulnerability is part of the human condition, that there may not be a pill for every ill. We are – for now and maybe for some time – living in a world and in a way which seems foreign and difficult for us but which would be recognisable to our grand-parents and great-grand-parents. We are more vulnerable than we think. We depend on others. We hide ourselves away when ill to protect ourselves and others. It is not heroic to struggle on when sick. Death comes to the young too.
And even if a vaccine is found, other contagious diseases may develop and spread. Covid-19 is not the first such disease: there was SARS in 2002 and 2003, MERS in 2012. There have been warnings before, not taken as seriously as they should have been. (In 2007 scientists were warning that the presence of SARS-like viruses in bats, the trade in exotic wildlife and a culture of eating exotic mammals were creating a serious risk). This is not to criticise the steps taken now by countries in the face of an immediate problem but rather the previous complacency about the risks being taken and a failure to take action to mitigate or eliminate them.
All the focus now is on viruses and vaccines. With luck, hard work and scientific ingenuity we must hope we will get through this. And then we need to take very seriously indeed the issue of antibiotic resistance and the steps needed to deal with it, set out here. Rocket boosters should be put under those efforts.
If we think 12 weeks of self-isolation, no visits to our favourite venue and having to ration loo rolls a bit of a pain, imagine a world without antibiotics. Most modern medicine would become impossible or much harder or much much riskier. We would be returning to a pre-war world. The past – in this respect anyway – would indeed become our country