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What Hamburg's Missteps In 1892 Cholera Outbreak Can Teach Us About COVID-19 Response

May 6, 2020
Originally published on May 13, 2020 7:10 am

As British scholar Richard Evans researched the history of pandemics for a book more than 30 years ago, he was struck by the uniformity of how governments from different cultures and different historical periods responded.

"Almost every epidemic you can think of, the first reaction of any government is to say, 'No, no, it's not here. We haven't got it,'" he says. "Or 'it's only mild' or 'it's not going to have a big effect.'"

In nearly every case, says Evans, governments that made these assurances turned out to be wrong — sometimes exceptionally so, as he outlined in his 1987 book, Death in Hamburg: Society and Politics in the Cholera Years, about that city's outbreak 130 years ago.

As the world comes to terms with how governments have responded to today's coronavirus pandemic, some are looking to history to guide them. Evans is a knighted historian best known for his trilogy of books about the Third Reich, but his study of late-19th-century Hamburg also serves as a guidebook with lessons for political leaders managing today's COVID-19 crisis.

Chief among those lessons is the need "to have proper precautions in place," Evans says, "proper measures in reserve to roll out when an epidemic hits. And not to try and hush it up or try and deny its existence. Then it has fatal consequences for many, many people."

That's what happened in 1892 Hamburg. With a population of around 800,000, it was the fourth-largest port in the world and a popular jumping-off point for Europeans wanting to start new lives in America. The German city-state was run by merchant families who put trade and economy above residents' welfare.

About a decade earlier, German microbiologist Robert Koch identified the bacteria present in one of the deadly diseases of the day, cholera, which is transmitted via excrement in water. The discovery that cholera was waterborne had spurred several of Europe's largest cities to invest in filtration systems for their municipal water supplies — but not Hamburg. Its leaders refused to spend anything to treat its city water.

Evans says the city's water supply was so rich in biological organisms that a dissertation from the 1880s — titled "The Fauna of the Hamburg Water Supply" — outlined more than 50 kinds of creatures living in it.

Hamburg's leaders claimed cholera was spread by an invisible vapor no government could hope to prevent. But in August 1892, the excrement of a Russian migrant ill with cholera ended up in the Elbe River, which the city drew on for its municipal water.

"And it was delivered to everyone who had a water supply connection," says Evans. "And 10,000 people died, roughly speaking, within about six weeks. It was an absolute catastrophe."

Hamburg's government waited six days after discovering that people were dying from cholera to tell anyone. By then, thousands were ill. The only way out was to invite Koch, then Germany's top scientist, to guide them.

Authorities eventually were able to rein in the cholera outbreak by imposing restrictions on people's movements, disinfecting homes and ordering people to only drink water from a clean water supply built after the outbreak.

"In a situation of an ongoing outbreak, the attention of the public focuses on the scientists providing information," says Christoph Gradmann, a medical historian at the University of Oslo.

Gradmann says the lesson from Hamburg's cholera epidemic is that health institutions need political support and adequate funding before an epidemic hits. "Countries with strong public health systems are able to respond well," he says. "If you have a big public health system that provides good data, that's a very good thing to have."

A year after the cholera outbreak, Hamburg's fed-up citizenry voted their incompetent businessmen leaders out of office. They replaced the merchants with leaders who belonged to the Social Democrats, a working-class party that prioritized science and health over profit.

Evans says the lesson of having proper precautions in place has important ramifications for other global crises besides the current one — especially climate change. "Ninety-nine percent of the world's scientists know that this is because of human activity and carbon emissions," he says. "And governments have done far too little to deal with it. If this epidemic leads to anything, it should lead to greater, firmer action being taken on climate change."

Esme Nicholson contributed to this story in Berlin.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

RACHEL MARTIN, HOST:

Let's turn now to history for some guidance on how to manage the global coronavirus pandemic. In Germany, some have been recalling a cholera outbreak from 1892.

NPR's Rob Schmitz takes a look back.

ROB SCHMITZ, BYLINE: When Richard Evans researched the history of pandemics for a book he was working on, he came away with a valuable warning that rings true today.

RICHARD EVANS: Almost every epidemic you can think of is that the first reaction of any government is to say, no, no, it's not here. We haven't got it, you know. Or it's only mild or it's not going to have a big effect.

SCHMITZ: In nearly every case, says Evans, governments that have made these reassurances have been wrong - sometimes exceptionally so, as he outlines in his book, "Death In Hamburg" about that city's cholera outbreak 130 years ago.

(SOUNDBITE OF STATE ACADEMIC MALE CHOIR OF THE ESTONIAN SSR PERFORMANCE OF SIBELIUS' "KULLERVO")

SCHMITZ: It was 1892, the year Finnish composer Jean Sibelius premiered his symphonic suite "Kullervo" based on the tragic character of a Finnish poem who realizes the same people who brought him up were the ones who had killed his family. The lesson - don't trust those who take care of you - was a good fit for what was about to happen to the people of Hamburg.

(SOUNDBITE OF STATE ACADEMIC MALE CHOIR OF THE ESTONIAN SSR PERFORMANCE OF SIBELIUS' "KULLERVO")

SCHMITZ: At the end of the 19th century, the city-state was the fourth-largest port in the world, a popular jumping-off point for Europeans heading to America. It was run by merchant families who put trade and the economy above the welfare of its residents. At the time, microbiologist Robert Koch discovered the pathogen for cholera, a disease transmitted through excrement in water.

But Hamburg's leaders refused to spend money to treat its water supply. Instead, they insisted Koch was wrong. Cholera, they claimed, was spread by an invisible vapor no government could prevent. But in August of that year, a Russian migrant waiting to embark for America went to the bathroom in Hamburg. He was sick with cholera, and his excrement ended up in the river - the same river the city drew on for its tap water, says Evans.

EVANS: And it was delivered to everyone who had a water supply connection. And 10,000 people died, roughly speaking, within about six weeks. It was an absolute catastrophe.

SCHMITZ: Made worse by Hamburg's government - it waited six days before telling anyone about the epidemic. By then, thousands were ill. And the leaders of the city had to admit their nemesis, Robert Koch, was right. And the only way out of this mess was to invite Koch himself to guide them.

Christoph Gradmann is a medical historian at the University of Oslo.

CHRISTOPH GRADMANN: In the situation of an ongoing outbreak, the attention of the public focuses on the scientists providing information.

SCHMITZ: He says the lesson is that health institutions have to have political support and be well-funded before an epidemic hits. Historian Richard Evans agrees, and he adds a lesson for political leaders.

EVANS: One of the lessons we need to learn is to have proper precautions in place - proper measures in reserve to roll out when an epidemic hits and not to try and hush it up or try and deny its existence.

SCHMITZ: Evans says this lesson not only applies to today's pandemic but also to global climate change.

(SOUNDBITE OF STATE ACADEMIC MALE CHOIR OF THE ESTONIAN SSR PERFORMANCE OF SIBELIUS' "KULLERVO")

SCHMITZ: Back in 1892, the betrayal theme from the Sibelius symphony played out in Hamburg. After thousands died, Robert Koch and his team imposed restrictions on people's movements, disinfected homes and ordered people to only drink from a newly built clean water supply. A year later, Hamburg citizens voted their incompetent businessmen leaders out of office and replaced them with Social Democrats, a working-class party that prioritized science and health over profit.

Rob Schmitz, NPR News, Berlin.

(SOUNDBITE OF STATE ACADEMIC MALE CHOIR OF THE ESTONIAN SSR PERFORMANCE OF SIBELIUS' "KULLERVO") Transcript provided by NPR, Copyright NPR.