The Politicization of Epidemics in the United States: Comparing the 1793 Yellow Fever Epidemic to the 2020 COVID-19 Pandemic

by Christian Allred

A brief survey of the U.S. response to COVID-19 can elicit the resigned realization that the country is more polarized than it has ever been. The proper way to curtail the disease is in constant debate. Consider the issue of wearing face masks alone: Wearing or not wearing one has become a political statement instead of a widely-accepted public health measure. But this is not the first time the U.S. has been divided on its response to an epidemic. In 1793, yellow fever broke out in Philadelphia, the U.S. capital at the time. Americans were divided along party lines about both the cause for and the proper treatment of yellow fever. This polarization offers a striking parallel to how the U.S. is dealing with COVID-19 today. Though the disease and the political parties are different this time around, the response is strikingly similar: Proposed treatments are politicized for electoral gain.

The 1793 yellow fever epidemic in Philadelphia killed 5,000 people, 10 percent of the city’s population at the time, in just four months. Another 20,000 fled the city, among them many wealthy elite and city leaders, including President George Washington and Pennsylvania governor Thomas Mifflin. Mayor Matthew Clarkson, some doctors, and those who could not afford to leave, stayed behind. Philadelphia was the nation’s most cosmopolitan city with 2,000 free blacks and over 2,000 refugees from the French colony of Santo Domingo, present-day Haiti (Powell 1949, 5). As the virus spread, businesses, churches, libraries, and public offices closed. Trade stopped, and the economy collapsed (Foster 1998, 90). But because Philadelphia was the state and national capital, ample contemporary accounts survive describing the “destroying scourge, the malignant fever” (Carey 1793, 383).” Yellow fever is a viral infection spread by mosquitoes, so named for turning the eyes and skin yellow. Other symptoms include fever, black vomit, lassitude, and hemorrhages, and in the worst case, the virus leads to death. In Philadelphia, victims usually died within four days, and in one case it killed in 12 hours. (Powell 1949, 17, 28-9). Public panic was inevitable.

This plan of the city of Philadelphia and its environs (showing the improved parts), Philadelphia : Published and sold by John Hills, surveyor & draughtsman, 1797.

The year 1793 was still a time of very limited medical knowledge, so Philadelphians turned to folk remedies and diverse treatment methods. Matthew Carey reports people resorting to smoking tobacco, chewing garlic, and using gunpowder and sprinkled vinegar as preventative ointments (Carey 1793, 383). In addition to the various home remedies, doctors developed two major treatment methods: bloodletting and using stimulants. Dr. Benjamin Rush, Philadelphia’s top physician and a signer of the Declaration of Independence, would bleed his patients and administer copious amounts of mercury. The practice of bloodletting had been common for centuries, but it was not only ineffective but also extremely dangerous and often had a deteriorating effect on patients’ health. Of course, that was unknown at the time. The cause of yellow fever was not discovered until 1901, over a century later, when U.S. Army physician Walter Reed found that the disease was transmitted by mosquitoes. With limited medical knowledge and the fear of death, many Philadelphians relied on Dr. Rush’s methods. Others preferred the use of stimulants—quinine bark, wine, and cold baths. Alexander Hamilton advocated for stimulants and attributed his own recovery from yellow fever to the bark and wine cure. Ultimately, there was no consensus on the proper way to treat yellow fever, but fears of contracting the terrible disease ran high.

If limited medical knowledge explains the lack of medical consensus in 1793, politics only exacerbated the discord. Though George Washington would warn against political factions as threatening the stability of the young Republic in his farewell address, the country divided into two parties: The Federalists and the Democratic-Republicans. The Secretary of the Treasury Alexander Hamilton led the federalists, sometimes referred to as “fleeing federalists” for deserting the city to escape infection (Pernick 1972, 134). They supported a strong central government. The Secretary of State Thomas Jefferson led the Democratic-Republicans, who advocated for a limited central government and more state power. However, the two parties did not limit their opinions to political issues. Instead, it seems that their rivalry extended to fields like medicine, as the 1793 yellow fever epidemic will demonstrate.

The Arch Street wharf, where the first cluster of yellow fever cases was identified. Engraving by William Birch.

The first question to be settled was the origin of the epidemic. The so-called localists blamed unsanitary conditions in the city for the outbreak. Dr. Rush attributed the outbreak to “damaged coffee which had putrified on one of the wharves near the middle or the above district” (Rush 1793, 404). Other so-called importationists blamed the outbreak on the recent wave of French refugees who had reported fevers back home (Pernick 1972, 121). Interestingly, the localist and importationist stances correlated strongly with party affiliation: “With few exceptions the Republicans backed a domestic source of the fever, while Federalists largely blamed importation” (Pernick 1972, 124). One explanation for this curious correlation is the political implications. The central issue of American politics was the French Revolution (Powell 1949, 5). Pro-French Republicans celebrated the revolution’s republican ideals, while pro-British Federalists remained skeptical and feared revolutionary France. As a result, the Federalists were more willing to blame the epidemic on French immigrants from the Caribbean, whom they hoped to quarantine and exclude. Furthermore, Federalists suspected the domestic origin theory to be a Republican attempt at discrediting Philadelphia. Republicans preferred a local origin explanation to welcome French refugees and preserve the lucrative trade with the West Indies. In either case, “the etiological debate revealed . . . a medical community split along partisan political lines” (Pernick 1972, 121).

Hamilton and Dr. Rush worsened the polarization over yellow fever. Hamilton published a letter promoting the bark and wine cure of his Federalist friend Dr. Steven over Dr. Rush’s bloodletting treatment (Hamilton 1793). Soon, other federalists followed suit by publishing attacks on Dr. Rush’s cure, and the proper treatment for yellow fever became a political issue. “By simply declaring long enough and loud enough that bark and wine was the Federalist cure,” writes Martin Pernick, “these editors were able to make a considerable political issue out of a basically nonpartisan dispute” (Pernick 1972, 128). Dr. Rush was irked by what appeared to be Hamilton’s political motives, but he did not deny that his “cures were associated with his politics,” too (Pernick 1972, 129). He promoted his bloodletting treatment as one that “could be practiced by anyone with little formal training,” “the only truly egalitarian form of medicine” (Pernick 1972, 129). No doubt, his Republican ideals flavored his defense of bloodletting, for Republicans championed equality and the common man while opposing the perceived elitist attitudes of Federalists. Giving in to his political impulses had its costs, however. “By imposing his will and politicizing the medical community,” [Rush] became a formidable obstacle to more enlightened treatment by other physicians” (Foster 1998, 92). Whatever the political divide over how to treat yellow fever was initially, Hamilton and Rush only widened it.

In the age of COVID-19, politics again shape how the U.S. responds to epidemics. Both the origins of the virus and its treatment methods are controversial. From blaming the Chinese government for downplaying their case numbers to claiming the virus originated in a Wuhan Lab, Americans’ opinions are divided. If we think back to the 1793 yellow fever outbreak in the U.S., this will not be surprising. Like then, views about the virus have been politicized. The political Right tends to suspect foul-play by China, while the Left denounces such accusations as irresponsible and xenophobic. Much like in 1793, immigration has moved into the spotlight. President Trump restricted travel from China on January 31, 2020 and has conveniently revitalized his ‘hard on China’ stance by blaming the country for spreading the virus to the United States. Not surprisingly, his blaming China has received backlash from Democratic critics like Joe Biden, who vow to “[stand] up to Trump’s hatred and bigotry to defend their immigrant neighbors” (Democrats). From the outset, COVID-19 sparked partisan debate about who was to blame for its outbreak and spread.

More striking than the debate over where COVID-19 originated is the polarization over how to treat the virus. Not unlike folk remedies for yellow fever, various home treatments for COVID-19 have been spread over social media: gargling with warm water and salt or vinegar, holding your breath for 10 seconds to see whether you can do it without coughing or difficulty, and drinking water every 15 minutes. Again, these dubious methods illustrate what happens when fear is coupled with insufficient medical knowledge. But medical experts have promoted scientifically-tested treatments, too. Unfortunately, there could not be any less consensus on their validity and efficacy. While some Americans have agreed to a life of social distancing, quarantines, face masks, and even business closures, others are ready to adopt nearly any new remedy purported to treat the virus. The Center for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) have quickly rejected many of these drugs as dangerous or at least ineffective. But a split medical community keeps questioned treatments in play.

Remdesivir, originially developed for treating Ebola, is perhaps the first hotly contested COVID-19 treatment. In May, “after a randomized trial showed it reduced the time to recovery on average by four days,” the FDA approved Remdesivir for emergency use. By the end of June, President Trump had authorized the Department of Health and Human Services (HHS) to invest in Gilead Sciences, the company producing Remdesivir. Trump secured nearly all of Gilead Science’s projected production, 500,000 treatment courses through September 2020. In July, in a letter to the HHS, six senate Democrats criticized Trump’s adoption of Remdesivir as costly and ineffective (Raid on Remdesivir). As the timeline shows, Remdesivir only became politically relevant after President Trump’s endorsement, not the FDA’s emergency-use approval. As a result, the polarized U.S. government has only mystified the value of Remdesivir. The drug has since been deemed ineffective by The World Health Organization (WHO), while the FDA granted it full approval for hospital patients over the age of 12, further proving a lack of consensus by major health organizations.

FDA Building. The FDA campus is located in Silver Spring, MD.

Perhaps the most politicized proposed coronavirus treatment to date is hydroxychloroquine (HCQ). To be clear, HCQ is not a new drug. It has been used to treat different autoimmune diseases for decades. The FDA approved HCQ for emergency use in treating COVID-19 on March 28, and President Trump advocated for the drug’s use, taking it himself to prevent infection (Finley 2020). But there is no consensus on the drug’s validity. Insufficient time for testing has led to few trial studies, and those we have give inconsistent results. Some support the drug’s efficacy, some condemn it, and some even suggest the drug is harmful. In response to the New England Journal and Oxford work and a British Medical Journal study that found no benefit from the drug, the FDA rescinded its emergency-use authorization on June 15. Subsequent studies reaffirmed the benefit of HCQ: Studies in the Journal of General Internal Medicine and the Henry Ford Health System showed that the drug significantly cut the death rate for COVID-19 patients.

Unfortunately, the “politicized environment has produced dubious science and erratic policy” (Finley 2020). On the one hand, Dr. Anthony Fauci, the U.S. government infectious-disease expert, cautioned that HCQ is ineffective in treating COVID-19 and may have negative side effects, while Democratic presidential candidate Joe Biden warns that drugs pushed by Trump are “dangerous” and “unproven” (Joe Biden). On the other hand, some doctors challenge restrictions placed on HCQ. A video by America’s Frontline Doctors featuring Dr. Stella Immanuel went viral for promoting HCQ before social media platforms took the video down, citing misinformation. Though Dr. Immanuel’s views are questionable, she is not the only doctor to promote HCQ. Dr. Harvey A. Risch, a professor of epidemiology at the Yale School of Public Health, claims it is the key to solving the pandemic crisis. He laments that “the medication has become highly politicized” and says that “for many, it is viewed as a marker of political identity, on both sides of the political spectrum” (Risch Newsweek 2020). He predicts that sociologists of medicine will study HCQ in the future as a “classic example of how extra-scientific factors overrode clear-cut medical evidence” (Risch Newsweek 2020). These extra-scientific factors are partisan divisions. And unfortunately, they have clouded the medical discussion surrounding COVID-19. This recognition led the Henry Ford Health System to publish an open letter declaring that an objective discussion about HCQ has become “impossible.” With experts on both sides of the HCQ debate disagreeing so fiercely, it is no wonder Americans are split not only politically nowadays, but also on issues like medical treatments of a new virus.

On August 23, the FDA approved convalescent plasma treatments for emergency use against COVID-19. These treatments involve taking antibody-rich plasma from those who have survived the virus and using it to treat infected patients. President Trump criticized the FDA for not approving the treatment sooner, while scientists worry that the FDA gave in to political pressure from Trump to approve the treatment (Marcus 2020). FDA Commissioner Dr. Stephen Hahn, in turn, defended the administration’s decision to approve the plasma treatments, explaining that the authorization was based on “sound science and data” (CBS News 2020). Once again, science has come into question in a polarized climate. In the case of convalescent plasma treatments, the opposition rests on it only having emergency-use authorization. Critics urge the need for more thorough testing. Specifically, they want a randomized controlled trial, the gold standard of approval. But with time ticking and people dying from COVID-19, such a trial seems like an impossible luxury, hence the FDA’s emergency-use authorization. Where Trump seeks to expedite COVID-19 treatments, his political enemies warn against rushed medicine that is ineffective or harmful.

Leading up to the presidential election, President Trump has pushed the development of a vaccine. Again, some worry that a vaccine’s development and availability to the public will be rushed without sufficient testing, fearing “the FDA might cave to pressure from the White House to issue an Emergency Use Authorization, or EUA, for a coronavirus vaccine to boost the president’s chances of reelection” (Weise 2020). The growing concern of a premature vaccine release prompted the heads of nine biopharmaceutical companies to pledge that they will fully vet any potential vaccine before submitting it for FDA approval (Weintraub and Weise 2020). Dr. Peter Marks, the head of the FDA vaccine group, promised not to release a vaccine under political pressure (Weise 2020). Dr. Fauci stated that it was unlikely a vaccine would be ready by the US election, despite the CDC asking States to be prepared by November. Even after contracting the virus himself, Trump highlights his recovery as proof that the virus is not that bad and will go away to boost his reelection prospects (Jacobs 2020). Ultimately, the real cost of politicizing COVID-19 has been a loss in public trust in medical experts and institutions. Whenever a vaccine does become available, it will inevitably magnify political divisions and be met with both criticism and praise.

Looking back to another epidemic in the U.S. over 200 years ago, we should not be surprised by the current political polarization around the COVID-19 virus. Though medicine has advanced, the U.S. is no more united against epidemics than it was in 1793. The presidential election will most likely solidify those divisions and neither a Trump victory nor a Trump defeat will unify Americans against the virus. As shown, the 1793 yellow fever epidemic gives ample precedence for the divided fight against both origins and suitable treatment of novel diseases. Fear, limited (trust in) medical knowledge, and already steep political factionalism are once again bringing about an ineffective and questionable response to the current health crisis. The nation’s staunch attachment to individualism, democracy, and the two established political parties are also deepening the division in a time when unity is needed. What Dr. Rush observed two centuries ago still seems to be true today: “the people rule here in medicine as well as government” (Pernick 1972, 129).

 

Author: 

Christian Allred is a Master’s student of American Studies at the Heidelberg Center for American Studies. He hopes to have a career in writing and teaching American literature. His hobbies include reading, songwriting, and being outdoors.

Get in touch on LinkedIn

 

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Header Image:

Four illustrations showing the progress of yellow fever in Observations sur la fièvre jaune, faites à Cadix, en 1819, Etienne Pariset and André Mazet, Paris, 1820
National Library of Medicine #65030500R. Public Domain.

Images:

Hills, John, and John Cooke. This plan of the city of Philadelphia and its environs showing the improved parts. Philadelphia: Published and sold by John Hills, surveyor & draughtsman, 1796. Map. https://www.loc.gov/item/2007625050/.

“The Arch Street ferry in Philadelphia.” By William Birch, 1800. Independence National Historical Park. Public Domain {{PD-US-expired}}.

“FDA Sign & Bldg 21 at Entrance.“ By the U.S. Food and Drug Administration, 2010. Public Domain {{PD-USGov-FDA}}.


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