19th-century outbreak shows how pandemics end

The study of epidemics has routinely centred around what medical historian Charles Rosenberg calls “dramaturgic structure”: a story of infection that builds to a climax of widespread illness, and then comes to a definitive end. The ongoing Covid-19 pandemic has defied this structure.

But this is not the first time that an epidemic’s impacts have continued past the time that a state society declares that it is over. Epidemics often live far beyond their supposed ends. My research into 19th-century cholera epidemics in Argentina’s northwestern province of Tucumán shows that epidemics often have two incomplete ends: the celebrated end when an authority declares the outbreak over and the muted end brought about by a gradual loss of interest.

Three cholera epidemics befell Tucumán — in 1867–68, in 1886–87 and in 1894–95. Each time, the bacterium vibrio cholerae, which causes the disease, arrived in the province through trade and migration.

During the 19th century, new railroad lines allowed Tucumán’s sugar industry to import improved machinery and attract workers. But they also brought new diseases to the province, including cholera. The gastrointestinal disease benefited from the lack of plumbing in the 19th century that moved human waste in a sanitary and efficient manner.

The first two 19th cholera epidemics paralysed Tucumán’s economy and society. Cholera particularly impacted the popular classes, who lived in makeshift homes built from found materials. Many businesses closed, either from their own decisions or because workers were staying home out. The affluent retreated to their private homes in the mountains, for social distancing and because of the belief that higher altitude was salubrious.

The epidemics also created national political turmoil. In 1887, a mob in the southern countryside rose up against and killed volunteer Spanish Red Cross workers from Buenos Aires, believing free medications were laced with poison. From there, the mob moved throughout the countryside in search of other Red Cross workers. The national government used the attack — and the supposed general mishandling of the epidemic in Tucumán — as a pretext to remove the local government.

On Nov 6, 1894, as summer approached in Argentina, the Tucumán newspaper El Orden reported that the province was “entering the season of the year in which the warm temperature is ideal for epidemics”. The editors urged the local government to enforce preventative measures, calling for street cleaning, draining the pools of stagnant water and for the province’s small cadre of health officials to monitor the living conditions of the popular classes.

The paper reported on the situation throughout the summer. Suspected cases of cholera appeared by the end of November. Then, in March, cases erupted. El Orden reported, for instance, that one man abandoned his sick wife, María Gutiérrez, in front of the sole hospital in the provincial capital, San Miguel.

Despite the newspaper’s careful record, official government documents reported no cholera epidemic in Tucumán in 1894–95. The province’s governor gave an annual address declaring preventative measures successful. He applauded the provincial Hygiene Commission for coming in under budget on a programme to disinfect all people and goods entering Tucumán along railway lines and even suggested that public health conditions in Tucumán had improved. Perhaps fearing a repeat of 1887’s violence, the government rushed to declare the 1894 outbreak over before it had even begun.

In my research, I used El Orden, one of the only sources documenting the 1894–95 epidemic, to track how the muted end of the epidemic — the flipside of the provincial government’s declaration that the outbreak had never even begun — unfolded.

I searched the papers for articles reporting deaths. While the newspaper at first vigilantly documented the epidemic, with cholera dominating its front pages, after a few weeks, its reporting on new cases and deaths became less frequent. Eventually, new cases and deaths were relegated to the back pages, alongside business advertisements and classifieds.

The last cases reported by the newspaper noted 10 peons dying at the mill of industrialist-politician Wenceslao Posse, three at the General Hospital of San Miguel and many more cases in the immediate countryside of San Miguel. From there, discussions of the epidemic evolved into more general concerns about the continued growth of the province’s population and worries over a proliferation of shantytowns, few paved streets, limited potable water access and having one of the nation’s highest infant mortality rates. The public slowly lost interest in cholera, even as deaths continued, evidenced by sporadic mentions buried in the pages of El Orden.

The epidemic’s slow fade-out came from simple fatigue: Actors across the social spectrum were tired of working to prevent the disease and baulked when preventative measures created economic costs. Put another way, for both the celebrated and muted ends, the epidemic ended when the market and public health could not work in sync. The points of reckoning just came at different times for different sectors of society.

Much of the same is seen in the current pandemic, whose endpoint has been anything but clear. As the United States Centers for Disease Control and Prevention and municipalities relax guidelines regarding quarantine and masking, arguing that Covid has reached a state of endemicity, others reject the idea of ending public health interventions and resigning ourselves to a future of regular outbreaks. Still, others argue that the end of the epidemic does not come from lifting restrictions, but from reinforcing measures that protect the vulnerable sections of society, like the immunocompromised, those with vulnerable conditions and the elderly.

The process of calling an end to the pandemic is difficult and uncertain. One lesson from Tucumán is that it is likely not up to us to declare the end of Covid, but to future generations who will look back and see through the contradictions we leave in our historical material.