January 30, 2020 - 9:31am

Coronavirus is a blast from the past. A reminder of the not-so-distant days when most deaths were deaths from infectious disease.

As recently as 1900, infections killed nearly 1% of the population every year (in England and Wales). In the 20th century that toll was reduced by an order of magnitude.

Vaccines? Antibiotics? Yes, those helped a lot — but, as Jason Crawford reminds us in a fascinating blog post, our progress against pestilence began before those scientific breakthroughs:

 …death rates began to fall in some parts of Europe by 1740 (and in some parts possibly as early as 1670)… declines in disease mortality were a significant part of this. “In contrast to this timeline, very few effective medical treatments were in widespread use until the late 1930s. Before that time, only a handful of vaccines for major diseases were in use (most notably for smallpox); and there were only a couple of effective pharmaceuticals…
- Jason Crawford

So what made the difference before modern medicine? In a word: sanitation. Improvements in things like food handling, sewerage and the disposal of corpses saved countless lives by preventing infections.

The tragedy is that it could have been done a long time before it actually was. For instance, even after the causes of infection were scientifically understood it was decades before surgeons routinely disinfected their instruments (and themselves) between operations.

That is worth bearing in mind before we look down on other countries for failing to act on the practices that help spread disease. Our own recent history, some of it ongoing (e.g. hospital infections), shows that bad habits can be deeply embedded.

Changing those habits means tackling personal, professional and cultural sensitivities. Global concern over the current crisis in China adds national sensitivities to the mix. A cartoon in a Danish newspaper, which replaced the stars of the Chinese flag with representations of the coronavirus has already caused great offence.

However, there are some much more difficult conversations still to come.

Quite rightly, the immediate focus is on containing the outbreak and helping its victims, but sooner or later some tough questions will have to be asked about the origins of the crisis. For outsiders to criticise hygiene at street markets or the consumption of wild animals will probably cause further offence. Foreigners will be told to mind their own business.

But in a world globalised by travel and trade, disease prevention everywhere is everyone’s business.

Peter Franklin is Associate Editor of UnHerd. He was previously a policy advisor and speechwriter on environmental and social issues.