Brian Melican has an interesting article in the April 20, 2020 issue of the New Statesman about three cities and how their failed responses to previous pandemics led to sweeping changes in the structure of the cities: Marseille, France in 1720 during the plague; Hamburg, Germany during the cholera epidemic in 1892; and Östersund, Sweden during the flu pandemic of 1918. It is a familiar story that resonates today about how business and civic leaders put the interests of commerce and low budgets ahead of the best scientific advice of the day, that overcrowding, poverty, unsanitary conditions, and lack of access to clean water and health services contribute to the widespread outbreaks of disease.

In the case of Marseille, that port city had managed to keep the plague at bay for two centuries by an extremely strict system that quarantined ships that they suspected had any cases of the plague. The ships had to stay away from the port for a minimum of 18 days (longer if the authorities suspected other diseases were present) before being allowed to enter the port. So what happened? Commercial considerations overcame these health precautions. A ship bearing cargo that was time-sensitive and valuable for prominent local people arrived and was allowed to slip past the rigorous system and discharge the cargo. As a result, within days the plague started ravaging the city and raged on for two years, killing 50,000 of its 80,000 residents. The ship had to be burned.

The second city was Hamburg which suffered a major cholera outbreak decades after that disease had been eradicated elsewhere. Why? Because the local authorities still clung to he outdated theory that miasmas (bad air) was responsible for diseases rather than poor sanitary conditions, even though by 1892 a strong scientific case had been made for the germ theory of disease for nearly half a century. Hence to keep taxes low, they ignored dealing with the highly unsanitary conditions in large parts of the city and rejected the idea of building a filtration plant to clean the filthy river water that the residents used. The epidemic killed 8,000 people in the space of 10 weeks. The person sent in by the central government to deal with the epidemic was shocked by what he saw of the city’s crowded sectors and put the city under quarantine and created new accommodations to reduce the overcrowding.

Östersund was a remote town in the north of Sweden and the flu of 1918 spread rapidly through the crowded unsanitary tenements built as barracks in haste to house soldiers during the World War I, even though Sweden was neutral in that conflict. The pandemic took hold there and then spread to other regions and led to demonstrations for better working and living conditions that were put down violently. That violence shocked the nation and set in motion the reforms that have led to the current welfare state in Sweden. There are concerns that the Swedish government’s somewhat relaxed attitude to the current pandemic may cause covid-19 to have a greater impact there than on other countries in the region.

The lesson from all three cases is that putting business interests first and ignoring poverty, sanitary conditions, and lack of health facilities are conducive to disease outbreaks and cause major damage. As with almost al catastrophes, poverty and inequality makes things worse.