[Question] Are there historical examples of excess panic during pandemics killing a lot of people?

[Linch]

Common truisms I’ve heard (especially in Feb-March, but still occasionally these days) is that “worry and panic is worse than the disease itself” or that “the most important messaging during a pandemic is “don’t panic.”″

It’s relatively easy for me to find examples of significant potential harms of excess panic (eg, anxiety, agoraphobia and other psychological issues, fear of going to a hospital for other emergencies, racially motivated or otherwise outgroup violence).

But when I look at historical examples of actions during pandemics, it was hard to find *any* examples of lots of additional people dying or a pandemic otherwise made much worse by excess panic, while it was comparatively common to find examples of pandemics made much worse by insufficient worry (NunoSempere has a list here).

If there are historians or history buffs among this group, I’d love to see people provide counterexamples illustrating when excess panic makes pandemics much worse.

[Davidmanheim]

It’s a bit different than what you are looking for, and historical cases are earlier than would be relevant directly, but there were certainly many documented cases of pogroms happening during various epidemics during the middle ages and Renaissance when a minority group (usually Jews) were blamed and massacred.

This isn’t quite what has happened so far, but I can certainly imagine a case where a modern pandemic could similarly exacerbate class or racial tensions leading to violence.

[Linch]

This does seem unusually bad, so would qualify. Strongly upvoted. This makes me more sympathetic to people who were claiming that anti-Chinese xenophobia was the biggest problem with the novel coronavirus, even though I still think they made the wrong call even ex ante.

I’m fine with examples from relatively early historical pandemics, because the current situation is an unusually large upheaval compared to say the Hong Kong flu, so to get a historical sense of what could happen we need more examples of “unusually fast+large upheavals in history”, and I think earlier on maybe people (including myself) are over-indexing a bit on “recent epidemics that are less lethal” (so less good as a reference class) as well as the Spanish flu (which is only one data point).

[Linch]

Though that said when I searched for “pogroms during epidemics,” this paper claims that after the first Black Death, there wasn’t much evidence for plague-based pogroms and other outgroup violence, even during subsequent plagues.

[Will Bradshaw]

That is interesting. My general model is that pre-modern Europeans didn’t need much of an excuse to start killing Jews, so if true this would be a substantial update for me.

There are various things I could come up with that might start explaining the difference, but I’d want to actually read the paper first.

[Linch]

Okay, here’s the conclusion of the paper (emphasis mine):

To date, studies on social violence, hate and disease have focused on less than a handful of pandemics – drawing parallels at times between the Black Death and cholera, in other places between syphilis and A.I.D.S.,and on occasion two or three other diseases. No one has gone beyond these few pandemics to chart comparatively the patterns of disease and hate. No one has compared the levels of violence or intensity of hate with different pandemics in different places and periods; instead, epidemics’ potential for hate has been levelled, so that blaming, perhaps but not necessarily implicit in popular names given to diseases, is placed on the same plane as the genocide of Jews across vast regions of Europe during the Black Death and again of Eastern Jews with twentieth-century typhus. Furthermore, no one has factored to what extent certain characteristics of diseases – rates of mortality, rates of fatality, quickness of death, newness of a disease, mysterious causes, degrees of contagion, gruesomeness and horror of signs and symptoms – determine whether a wave of collective hate and violence is likely to ensue. Instead, both in the popular imagination and the scholarly literature, violent hatred and even pogroms are held to have been pandemics’ normal course, supposedly engrained in timeless mental structures – to use René Baehrel’s words again, ‘certaines structures mentales, certaines constantes psychologiques’.123 Further examples of such scholarly opinion can easily be provided,124 but were these the constant consequences of epidemics? According to my survey thus far, they were not: the Black Death, typhus in late nineteenth- and twentieth-century eastern Europe, plague in the sixteenth and seventeenth centuries (although only in some areas), cholera in places in the eighteen-thirties, in Italy as late as 1911, in Peru andVenezuela to the nineteen-nineties, in Haiti to today, sometimes smallpox, sometimes Yersina pestis, and perhaps to some extent A.I.D.S. in our own time were exceptions but hardly the rule. No matter how contentious the underlying social and political circumstances,how high the body counts, how gruesome the signs and symptoms, how fast or slow the spread or course of a disease, pandemics did not inevitably give rise to violence and hatred. In striking cases they in fact did the opposite, as witnessed with epidemics of unknown causes in antiquity, the Great Influenza of 1918–19 and yellow fever across numerous cities and regions in America and Europe. These epidemic crises unified communities, healing wounds cut deep by previous social, political, religious, racial and ethnic tensions and anxieties. On occasion, it is true, pandemics did split societies with accusations and violence. Historians, doctors and psychologists have yet to map when and where they happened, to measure their intensities, or to examine the complex interaction of factors to explain why some diseases were more or less persistently the exceptions. They have yet to raise the questions within a comparative framework of world epidemics.125 It is now time to construct the databases of disease and hate.

The rest of the paper documents many epidemics he looked at (going back to before common era Athens and Rome) which did not end up in the expected violence. I think I have a more balanced view of whether it’s possible for excess panic to cause major problems during a pandemic now, and I’m still surprised that there isn’t more.

I’d like to see

a) a study of how much those incidences of outgroup violence were primarily a result of panic (as opposed to eg. opportunists, since during the Black Death Christians appeared at least as invested in confiscating a lot of possessions from Jewish people) and

b) a similarly comprehensive study of how many epidemics/​pandemics resulted in bad things happening from insufficient worry or officials hiding information.

I also weakly suspect that some cases of a) and b) are tied together, eg. excess panic/​panic synchronization happening because officials have lied about the situation earlier on.

[Linch]

Why was this comment downvoted? :O

[Lukas_Gloor]

I only came to this thread by accident and saw that I’m apparently the culprit (it showed a weak downvote). I don’t even remember reading this comment nor the thread and I rarely downvote people anyway. Maybe I misclicked while I scrolled through random comments yesterday. I hope that doesn’t happen too often. :)

[Linch]

No worries! :)

[Linch]

Yeah perhaps I should be less credulous?

[itaibn]

historical cases are earlier than would be relevant directly

Practically all previous pandemics were far enough back in history that their applicability is unclear. I think it’s unfair to discount your example because of that, because every other positive or negative example can be discounted the same way.

[melkumew]

Well, it’s quite naturally people experience anxiety because of the current situation. I also think we are still to face major economic and health care changes. It occurs we already have a high unemployment rate and health system problems. Even now people become vulnerable to alcohol, drugs, and other stuff, as well as mental illness progression. According to this blog https://​​addictionresource.com/​​ the number of addicted people is increasing.

[Lancer21]

I think that sort of stuff happened during every pandemic in Europe up until the 19th century, but the Netherlands, during the Renaissance, were a very devout country, and a plague outbreak happened during the 16th (or 17th?) century.

So, people all came together to pray. In the enclosed space of a church. And conducted special services for people sick and dying. You can guess where it led...

[Tessa A 🔸]

I’ve seen claims before that the CDC’s response to the 1976 H1N1 epidemic had long-term negative public health consequences, but after a few minutes of looking for evidence of this, I’m not sure it’s true.

In the fall of 1976, based on fears that a January outbreak of swine flu was going to become a 1918-scale pandemic in the coming season, the CDC vaccinated around 25% of the American populace. However, new cases of H1N1 weren’t appearing, people were developing Guillain–Barré syndrome after being vaccinated, Ford lost the election, and the whole program was abandoned. The received wisdom (e.g. this Discover article) seems to be that this was viewed as a disaster and increased distrust of government vaccination campaigns.

From what I can tell from this article on Influenza Pandemics of the 20th Century and the the CDC’s 2006 reflections on the vaccination program, though, the public health officials involved in the campaign feel like they reacted reasonably given the information they had? (Most of the world did not mount mass vaccination campaigns, and it was not an unusually bad flu season.)

Anyway, leaving this as a comment rather than an answer, since this was an overreaction to the H1N1 strain that existed, but I don’t know if it was an overreaction to the information accessible in February 1976, and it’s not clear that it had terrible consequences.

[Davidmanheim]

The issue with 1976 is that they reacted reasonably when considering only short term questions of public health, but plausibly overreacted from the perspective of longer term ability to keep the population healthy.

The book by Neustadt and Fineberg is the classic historical case study, and was a well done postmortem. It does a good job talking about the points on both sides of the issue, and why the decisions were made as they were: https://​​www.nap.edu/​​catalog/​​12660/​​the-swine-flu-affair-decision-making-on-a-slippery-disease

I would argue that given information available, they made the approximately correct decision, but the costs were higher than they expected in a way that they could have predicted, had they thought more about public reaction to failure. I will note that it’s very likely this failure had far less predictable but very significant consequences over the next 50 years, given that the fear and overreaction afterwards is part of the background of most of the people skeptical of vaccines, and plausibly created or fed the initial fearmongering.

[Will Bradshaw]

This (not wanting to lose credibility by being perceived to overreact) was my thought as well.

I’m not claiming this is the case, but I think if a public health person said “we’re worried about causing panic” when they actually meant “we’re worried about being seen to overreact”, I would consider that quite dishonest.