Abstract
There’s never been a health story like it…except for the ones that went before
Colleagues have insisted that Covid-19 must be the biggest medical story of all time. I can see why. Covid-19 has become the journalistic equivalent of carpet bombing. Never before in peacetime has a story been reported with such intensity, day after day, week after week. But in our understandable fear over whether or not we will “get the virus” (five members of our family have had it), it is easy to lose sight of the wider picture. There have been far bigger medical stories than Covid-19.
Almost one million people died from HIV/AIDS in 2017 alone, according to the Global Burden of Disease study. This was in just one year out of nearly 40 since HIV/AIDS first became news in the early 1980s. It was estimated recently that nearly 37 million people were living with HIV globally and more than 35 million people had died from HIV/AIDS-related illnesses. How quickly we forget in our preoccupation with the present.
But there was an even bigger pandemic – and perhaps this is really the biggest medical story of all time. The 1918 flu pandemic is estimated to have killed between 50 and 100 million people. Laura Spinney, author of The Spanish Flu of 1918 and How It Changed the World, described it as the “greatest tidal wave of death since the Black Plague, perhaps in the whole of human history”. It is said to have infected 500 million people, a third of the world’s population. But how should we define “big” in the context of news? Is it just about the numbers? Of course not. Paradoxically, or perhaps not, stories about individuals often resonate far more than those about a mass of people. (To be pedantic, these are almost always stories within bigger stories.)
No one has illustrated this more eloquently than the late Mother Teresa of Calcutta. Able to communicate with anyone from politicians, dignitaries and world leaders to the poorest beggars, Mother Teresa said: “If I look at the mass, I will never act. If I look at the one, I will.”
There is no better example of the power of one than nine-year-old Kim Phuc. On June 8, 1972, she was severely burnt by napalm in a misplaced air strike. I am sure you will recall the picture. She was photographed running naked from her village quite literally into the eye of history. One of the most famous images of the 20th century, this picture was credited with turning international public opinion against the Vietnam War.
The likelihood of such stories emerging from the1918 pandemic were low. First World War censors restricted reporting in Germany, France, the UK and United States to “maintain morale”. Journalists were free to report the epidemic’s impact in neutral Spain. When the Spanish king was struck down, many newspapers were finally able to report what was happening. This created the false impression that Spain was the epicentre, hence the misleading name “Spanish flu”. One theory is that “patient zero”, the first person infected, was an army cook in Kansas.
Press censorship helped the virus travel further and faster at an unprecedented rate during the largest-ever global migration via troop ships and other transports. The spread was exacerbated further by large concentrations of people in confined spaces, such as congested barracks, damp trenches and military hospitals with cheek-by-jowl bedding. The troops were especially vulnerable because a unique feature of the epidemic was that the 20-40 age group was especially vulnerable – in most epidemics, the elderly are high risk.
In assessing stories retrospectively, it is necessary, I believe, to examine their legacy. Chairman Mao’s mantra was that there could be “no construction without destruction”. The 1918 global flu epidemic was the catalyst for national health services in many European countries, while the toxic amalgam of the Great Depression and the Second World War ushered in the modern welfare state.
What was it, aside from the mortality figures, that made HIV/AIDS such a big story? Like Covid-19, it began in illness and death with a new and unknown virus without a specific treatment. Like Covid-19, it was driven by the fear of uncertainty and a mortality rate that went up and up. Like Covid-19, it encouraged xenophobia. Unlike Covid-19, it also encouraged homophobia of the most toxic kind. Unlike Covid-19, it was a slow burner, initially attracting very little media attention. As happens so often in the history of medicine, early cases were considered to be isolated extremes in the spectrum of established illness.
In 1985, four years after the HIV/AIDS story broke, the Royal College of Nursing, traditionally a cautious organisation, predicted that one million people in the UK would develop HIV/AIDS within six years unless the disease was checked. This was the curtain-raiser for a series of cataclysmic warnings about mass deaths. Anyone who lived through the 1980s will recall the highly controversial “Don’t die of ignorance” advertising campaign. A volcano erupted under darkened skies. Doom-laden images of cascading rocks led us to a tombstone. “There is now a danger that has become a threat to us all,” warned actor John Hurt in a chilling voice-over. “It is a deadly disease and there is no known cure.” The words etched on the blackened grave were then revealed: “Don’t die of ignorance.” The government was accused of panic-mongering, though the campaign was hailed a success.
Its legacy was an end to “Trust me, I’m a doctor”
But it was the reaction to HIV/AIDS by individuals and organisations that made it such a huge story. The dons at one Oxford college banned a centuries-old tradition of passing a “loving cup” of wine around the table. Police in Scotland burned and compressed a car that had been stolen by someone thought to be infected. A householder burned his bed and bedclothes after an intruder took a nap during a burglary at the house. There were calls to exclude from school children with haemophilia who had been infected through infusions of Factor V111, a blood-clotting protein.
There were dozens of such stories to keep the media bandwagon rolling. Perhaps the most famous of them all was Princess Diana shaking hands with an HIV/AIDS patient without gloves (shock horror) to challenge the notion that it could be passed from person to person by touch.
The legacy of the HIV/AIDS story, apart from landmark treatments such as anti-retroviral therapy? The AIDS Coalition to Unleash Power (ACT-UP), formed in the 1980s, stands out as the most significant “direct action” campaign since the anti-Vietnam war movement in the 1960s. HIV/ AIDS patients demanded to be kept in the picture about treatment options. Arguably, this was the single most important development in patients’ rights in the 20th century and a nail in the coffin of medical paternalism. It was the catalyst for thousands of advocacy groups for patients with a wide range of diseases, from depression to breast cancer.
There are, I believe, other contenders for the “biggest ever” medical story. For example, the first heart transplant in 1967 by Christiaan Barnard was the most controversial operation in medical history. There will be further viral pandemics. There will never be a heart transplant to match the very first. Many people thought the operation could not, or should not, be performed for either technical or moral reasons.
The heart, after all, holds a special place in our psyche. Tony Bennett, you will recall, left his heart in San Francisco, not his brain or his liver. No other organ of the body commands so many quotations: there are heroic hearts, kind ones. pure ones, hearts of oak, hearts of stone, hearts of steel. Barnard himself brought a rich tabloid dimension to the story. Few people in history have risen from relative obscurity to global superstardom as quickly as Christiaan Neethling Barnard. Overnight, armed with a broad smile, ready wit, tousled good looks and a talent for ad libbing, he became the biggest name in medicine since Hippocrates, the father of modern medicine, some 2,500 years ago.
It may seem contradictory that during one brief visit to Rome he could be received by the Pope and have a one-night fling with Italian film star and international sex symbol Gina Lollobrigida. But Chris Barnard was a bundle of moral contradictions. He was an outspoken opponent of South Africa’s anti-apartheid laws. He advocated euthanasia as a humane and compassionate end to human suffering. He was also, according to his colleagues, a loud-mouthed tyrant. But his surgical legacy lives on. More than 3,500 heart transplants are performed worldwide each year, about 200 in the UK.
Perhaps Covid-19 will be remembered as the biggest medical story of all time. Let us hope not. This would not be good for humankind. Speculation about legacy has already started. It seems the media cannot get enough of Covid-19. It is perhaps the ultimate super-spreader.
