How the numbers have changed since May 18, 2020, the last time I shared an update about the number of confirmed cases of COVID-19. Sources: Johns Hopkins COVID-19 Interactive Map and the Maine CDC. (Updated 6/8/2020, 10:03 pm EDT)
- Number of confirmed cases of COVID-19 around the world: Was 4,795,941 and is at this moment 7,097,017.
- Number of confirmed cases of COVID-19 in the United States: Was 1,506,840 and is at this moment, 1, 960,642.
- Number of confirmed cases of COVID-19 in Maine: Was 1,533 and is at this moment 2,305.
Since the beginning of the COVID-19 pandemic, Dr. Dora Anne Mills has been sharing information and updates on her Facebook page. She calls them Not-So-Brief COVID-19 Updates. Dr, Mills was the director of the Maine CDC and the State’s Health Officer for 14 years. She is currently the Chief Health Improvement Officer for MaineHealth. Because not everyone is on Facebook or has access to the information, with her permission, I have been sharing some of her updates on the Catching Health blog.
In her previous update, she addressed some of the questions people were asking about easing restrictions and opening businesses, particularly here in Maine. Some states started opening up early, but Maine is taking a more measured, multi-phase approach. What is worrisome is that COVID-19 continues to spread throughout the country. In some areas, cases are declining, but in others, they are rising.
And in the midst of this pandemic, since Dr. Mills’ last update, people have been gathering by the thousands to protest the killing of George Floyd in police custody in Minnesota, and to call for an end to racism and police brutality. The risk of getting infected with the virus that causes COVID is still very real and a big concern is that the protests will fuel new cases. It’s clear that people are willing to take the risk.
It’s not the first time that an uprising has taken place during a pandemic. What does it mean and where might it lead? In her latest update, Dr. Mills considers those questions and also gives us an important history lesson.
UPRISINGS, SOCIAL UPHEAVAL, AND PANDEMICS
Are uprisings and social change new to pandemics? No.
Looking back at the deadliest pandemic known, the Black Plague, provides some insight. Although the plague cycled through Europe about every 20 years for 300 years, claiming the lives of about 20% of the population each time, it extracted its greatest toll during the first significant recorded outbreak, in the mid-1300s. Over a seven-year period, it is estimated to have killed 60% of the European population.
As a quick aside, the plague is a disease spread by rodent fleas and caused by a bacterium, Yersinia pestis. The name Black Plague comes from the swollen lymph nodes, called buboes, that turn black. Rats living aboard ships and commonly found in medieval cities carried the bacterium-infested fleas across Europe and Asia.
Medieval Europe’s economic engine was the feudal system. The foundation of this system was built at birth. Everyone was born into a caste: the serfs, who were a type of slave and who labored producing food and other essential goods and services; the merchants and nobility (including doctors and priests); and the kings.
When the plague swept Europe, the serfs were hit hardest, since they lived and worked in close quarters. As a result, agriculture production came to a halt, and everyone – even the kings – were struggling to find food. Nations stopped importing goods and banned travel in order to control the spread of the plague. That hit the pockets of the merchant caste and caused a widespread deep economic recession.
For the serfs who survived, they were able for the first time to negotiate pay for their work, and some of them changed their work to fill the void left by the depletion of trade. Over time, the nobility and kings tried to return them to serfs. However, a number of so-called “peasant revolts” in the mid-late 14th century successfully showed there was no turning the clock back to the former feudal system.
As it became clear that doctors and priests were unable to provide promised protection from the plague, and some of their practices actually accelerated the spread, many started distrusting previously held beliefs.
The darkness of the Black Plague ignited many reforms in all aspects of life, including the dismantling of the feudal caste system, improvements in local economies and trade, and exploration of new ideas about science and religion. All of this helped pave the way for the advances associated with the Renaissance and the Reformation.
1918 INFLUENZA PANDEMIC
Now, let’s catapult to the influenza pandemic of 1918. Over a period of about a year, this pandemic killed an estimated 50 – 100 million worldwide, 675,000 in the U.S. (out of a population of 103 million), and 5,000 mostly young Mainers (out of a total population of 760,000). However, it too ignited the fires that led to some societal seismic shifts, transforming our country.
First, it is important to realize that World War I was intricately related to this pandemic. With soldiers being hauled across Europe and the U.S. as well as being ferried back and forth across the Atlantic and bunked in clogged barracks and foxholes, the virus easily hijacked on them, spreading the pandemic at a fast pace. In fact, more American soldiers died from the pandemic than from war injuries.
In American communities, the war and pandemic created major workforce shortages. 4.8 million Americans, including 32,000 Mainers served in World War I, the vast majority being young adult men. Additionally, men, including those not serving in the war, were 35% more likely to die from the pandemic than women, for reasons not well understood.
As a result of the shortages, women started joining the workforce. They included the first American women enlisted into the U.S. armed forces – 13,000 who were allowed into active duty with the Navy. Although they served stateside, they received the same pay as men and were treated as veterans after the war.
Women also went to work elsewhere to help with the war effort, including manufacturing munitions, shoes, coats, and blankets in Maine mills.
By 1919, as the pandemic subsided and the war had ended, women’s role in the workplace was elevated, including in those fields from which they had been previously banned, such as textiles and munitions. By 1920, women made up 21% of the American workforce, 25% higher than it had been previously. World War I was a major driver. However, the 1918 pandemic clearly contributed significantly.
Although women’s suffrage movement had organized decades earlier, the 1918 pandemic and World War I ignited its fire. 41 years after it was first introduced, Congress approved the women’s suffrage amendment on June 4, 1919, and sent it to the states for ratification. The 19th Amendment granting women the right to vote was adopted by Maine in November 1919, and officially became part of the U.S. Constitution August 18, 1920. Not long afterward, in 1922, Dora Pinkham of Fort Kent was the first woman elected to the Maine legislature, and in 1923 Wyoming elected the first woman governor in the U.S.
Fast forward to the 1980s. Nearly 40 years ago when the US CDC first published a report about a rare pneumonia afflicting previously healthy young gay men in California, the HIV/AIDS epidemic sprung into the public eye, tainted by the lenses of fear and stigma. Fear grew because of its silent spread, especially among young people. And stigma sprouted because of the virus’s predilection for gay men, others in the LGTBQ community, hemophiliacs and others receiving blood transfusions, injectable drug users, and people of color. Despite its spread across the country and into diverse populations, it wasn’t until 1985 that President Reagan even acknowledged the pandemic.
As HIV/AIDS dispersed across the globe, the evidence grew especially strong that discrimination, stigma, and inequalities fuel epidemic spread. As people are marginalized, they are less likely to have access to or engage with effective prevention education, testing, and treatment. They are less likely to disclose risk factors such as their sexual orientation. These societal forces such as discrimination and racism have been called a syndemic, i.e. forces that additively increase negative health consequences.
However, HIV/AIDS also gives us examples of how to successfully address these forces during an infectious disease epidemic. ACT UP (the AIDS Coalition to Unleash Power), Gay Men’s Health Crisis, amfAR (American Foundation for AIDS Research), GLAD, Larry Kramer (who recently passed), Elizabeth Taylor, Elton John, Ryan White, and many others are just a few examples of organizations and activists who stepped up to address anti-gay discrimination and the epidemic. From overturning sodomy laws to obtaining funding for risk reduction strategies (e.g. needle exchange programs and comprehensive sex education in schools and communities) to building support for LGBTQ youth and young adults, to addressing marriage equality, activism related to the HIV/AIDS pandemic fueled diverse accomplishments, all strengthening equality and community.
Among the activists in Maine, Frannie Peabody shined a particularly bright light. As an 80-year-old grandmother who lost her grandson to AIDS in 1984, she stepped up, and for the next 18 years raised awareness and money for prevention and treatment of AIDS as well as advocated for gay rights legislation. Serving as the Grand Marshall for the annual Gay Pride Parade in Portland for a number of years, she taught many that improving human rights was part of effective disease prevention and treatment.
While the gay rights movement was already growing before the HIV/AIDS epidemic, especially after the 1969 Stonewall Riots, some believe the tragic impact of the pandemic on the gay community, along with the increase in stigma and inaction by government, further ignited the gay rights movement in the following decades. This fire then paved the way for marriage equality passed by a number of states and decided by the 2015 U.S. Supreme Court decision.
Although the HIV/AIDS pandemic is far from over, incidence and death rates have dramatically decreased since they peaked in the early-mid 1990s. Today, in the U.S., over 1.1 million are living with HIV; about 38,000 are diagnosed each year, and about 16,000 die each year. More than 700,000 people in the U.S. with AIDS have died since the beginning of the epidemic. HIV continues to exert a disproportionate impact on men who have sex with men and on racial and ethnic minorities. Nearly 70% of people living with HIV are men who have sex with men. 42% of newly diagnosed people with HIV are Black (yet are 13% of the population), and 27% Hispanic (yet 18% of the population). In Maine, like the rest of the country, the incidence is much higher (about 10 x higher) among Blacks than Whites. There are about 1,700 people in Maine living with HIV.
Tragically, many African countries inherited colonial laws that criminalize same-sex intercourse, and this seems to contribute to ongoing stigma and discrimination that appears to be fueling the epidemic there, including dissuading those at high risk from being tested or treated and health care providers from offering treatment.
The Black Plague led to the dismantling of the feudal caste system, including freedoms and increased quality of life for serfs, improvements in local economies and trade, and exploration of new ideas about science and religion. These transformations ignited the way to the Renaissance and Reformation. The 1918 influenza pandemic in the U.S. fueled women’s rights, including the passage of the 19th Amendment giving them the right to vote. The HIV/AIDS pandemic further incited gay rights, paving the way toward marriage equality.
Today, we face a syndemic:
• a pandemic with COVID-19;
• widening socioeconomic disparities that are rapidly increasing because of the pandemic; and
• rising awareness, restlessness, and indignation regarding racism in our country.
The cumulative number in the U.S. with COVID-19 who are projected to die by the end of this month – four months into this pandemic hitting the U.S. – represents one-fifth of the deaths HIV/AIDS has mounted in almost 40 years and one-fifth of the deaths from the 1918 influenza pandemic that occurred over a year’s time in an era when the population was less than one-third of today’s. As with HIV/AIDS, racial and ethnic minorities, including Native Americans, Blacks, and Hispanics, are disproportionately infected and severely impacted by COVID-19. For instance, Black Americans comprise 13% of the U.S. population, but 24% of the deaths from COVID-19.
With the pandemic’s screeching halt to travel and trade, unemployment has surged to record levels not seen since the Great Depression. In grocery stores, nursing homes, and food processing plants, we have learned quickly who our essential service workers are, especially as they have fallen ill. Socioeconomic inequalities and racial/ethnic disparities that have steadily worsened the last several decades are now gaping wounds as the pandemic burns.
It is no wonder that fires ignited across the country and the globe as we watched in shock as George Floyd gasped for air and was killed in broad daylight. Although there is a long appalling legacy of such horrors, including Selma, Birmingham, Watts, Rodney King, Michael Brown and Ferguson, Eric Garner, Freddie Gray, Breonna Taylor, this time seems to be different. We hope so.
Pandemics unveil the wounds of injustices in societies. They also ignite the fires of renaissance and reform. We are in the early chapters of this current pandemic:
• Chapter 1, Flattening the Curve, March – April 2020;
• Chapter 2, Co-Existing with Covid, May – June 2020.
What will our next chapter be? As I stood – masked and distanced – in the back of a protest last week, I looked across a sea of energized and diverse youth. I realized that in some ways, they are the authors of the next chapter. Many were there to protest police brutality. Others focused on racism and injustice more generically. They were also trying to take precautions against the pandemic, including handing out masks and hand sanitizer. And they provided free food and water to anyone.
Fires are ignited. What paths will they lead to?Dora Anne Mills, MD, MPH, FAAP
Listen to a podcast of this update
Dr. Mills’ daughter started a podcast where she has been reading her mother’s updates: Not-So-Brief COVID-19 Updates from Maine.
1918 INFLUENZA PANDEMIC
- The U.S. Military and the Influenza Pandemic of 1918-1919
- How the 1918 Flu Pandemic Helped Advance Women’s Rights
- WWI Maine Centennial
- The 1918 Influenza Epidemic’s Effects on Sex Differentials in Mortality in the United States
- Fighting an Epidemic in Political Context: Thirty-Five Years of HIV/AIDS Policy Making in the United States
- Obama, Marriage Equality, and the Health of Gay Men
- How HIV Impacts LGBTQ People
- HIV/AIDS data
- The Basics
- Anti-homosexual legislation and HIV-related stigma in African nations: what has been the role of PEPFAR?
- Timeline of HIV/AIDS
- Frannie Peabody