The First Digital Pandemic
Finding hope and gaining perspective on COVID-19
If you are searching for perspective or hope during our current pandemic situation, this article may provide you with some. Human history has been marked by semi-frequent plagues, pandemics, and viral threats — this time is no different. But, the light at the end of the tunnel is that WE are different. WE are technologically capable. WE are more knowledgable. And, WE will innovate our way through this, together.
We are in the midst of, perhaps, the first viral pandemic of the Digital Age. Even the H1N1 flu pandemic of 2009 was still only a few years after the first iPhone. Since then, mobile technology, cloud-based computing, and the digitization of our world have accelerated dramatically. Times are tough, but there is a light that will guide us through the trying and potentially dark days ahead.
To gain perspective on this, let's take a short trip to another time when humans had just recently emerged from the dark ages — a time where science and technology were distant.
I present to you the Isenheim Altarpiece (Figure 1) — a 16th-century work of art by Matthias Grunewald. At the time I first wrote about this piece, I was an art history student at Wake Forest University and I was very interested in the intersection between early hospital environments and northern renaissance art. This was a time in my life before I found myself deeply interested and involved, first, in modern healthcare management and policy, and, now, in digital health innovation. But, I still hold onto my appreciation of art as a window into the past.
Unexpectedly, the COVID-19 situation has brought my early art history interests into a strange intersection with my education and expertise in modern healthcare. To understand how, let’s take a brief journey into the historical context of the Isenheim Altarpiece — and, humor me on this.
The Altarpiece was commissioned in the early 16th century for the altar of the church of the Monastery of St. Anthony in Alsace, France. During the 16th century, most hospitals were operated by the Catholic Church and with good reason — they were places where people went to die. At the time, in Europe, death was inextricably linked to Christianity. What we know today as the field of Medicine did not really exist, so when someone got sick they either got better or died, but there was little else that could be done. Most died.
At St. Anthony’s, there was a hospital for the sick. The Isenheim Altarpiece was created with the intent of bringing solace and comfort to the sick. If you look closely (and with sufficient understanding of Medieval Christian symbolism) there is a very clear allusion to history’s most famous pandemic — the Black Death. We notice this allusion in two places: 1) in the sick and contorted depiction of Jesus on the cross who resembles a plague patient and 2) in the people depicted on the side-wings. On the far left of the image below, you can see St. Sebastian, and, on the right, you can see St. Anthony.
Both of these Catholic saints are associated with disease and plague. St. Sebastian was largely associated with and often invoked to ward off the bubonic plague — which ran rampant and unchecked across Europe during this time. The bacteria Yersinia pestis, powered by rat transmission, was a societal and cultural hegemon throughout Europe for many years resulting in the well-known “Black Death” or simply “The Plague.”
Like St. Sebastian, St. Anthony was the patron saint of his namesake disease known as St. Anthony’s Fire or otherwise known as ergotism. Ergotism was a disease that resulted from long-term exposure to a fungus that was common on rye and other varieties of grains. Both the plague and ergotism resulted in terrible symptoms like pustules, skin discoloration, and a very sick-looking clinical presentation.
Both of these conditions, at the time, resulted in significant suffering and almost certain death. Thus, in bad condition, patients were transported to the local monastery or church-operated hospital to live out the remainder of their days in the care of monks, priests, and nuns. For this purpose, art, like the Isenheim Altarpiece, was often commissioned by the church to serve as a point of religious comfort for those afflicted and likely to die.
At the time, death and the subsequent unity with a loving God was a source of comfort. The suffering of Jesus, depicted by Grunewald in this altarpiece, was a point of fixation for those laying in hospital beds searching for hope and salvation from their condition. This work of art was a direct result of one of humanity’s most famous plagues and its historical context gives us some perspective on our collective human progress. During the time this painting was created, there was little humanity knew how to do in order to stop the spread and impact of the disease — art and religion provided the only hope.
The Black Death was one of the first well-recorded pandemics. It was a big problem and quite the pandemic, though at the time the world was much, much smaller with a population in the millions rather than the billions.
Without medicine, modern science, or biotechnology, the plague was seen as a plight from God, with good reason, because without a cure or vaccine it ravaged Europe for many years.
Fortunately for us, SARS-CoV-2 has hit humanity at a vastly different time in the evolution of humanity. Things are quite different than the days of the Isenheim Altarpiece.
Here are some key differences and reasons to find hope:
We are a far more globalized and interconnected world
Here is the bad news. This difference really dings us. Back in the 16th century, there was little movement across regions and major geographic areas except for some major trade routes that did bring the plague to other continents — but, very slowly. In his time period, Europeans were just beginning to spread across the world and most people remained in the same communities for their entire lives with limited long-distance travel.
In today’s globalized world, airplanes quickly transport viruses across continents leading to rapid spread. That’s how SARS-CoV-2 quickly found its way across the world and to impacting countries on every continent. Our modern transportation technology and the global economy have helped viruses spread rapidly across the world.
But, our interconnectivity is not always a bad thing when it comes to what are always inevitable viral events.
Information technology and internet communications
While our globalized world has aided in the spread of pathogens like SARS-CoV-2 due to air and other travel, the world-wide-web has accelerated the exchange of information. Data and communications can be transmitted to anyone with access to a smartphone or computer almost instantaneously.
News of the novel virus was available globally shortly after it emerged into the human population in Wuhan, China. The genome of the virus was sequenced within weeks and made available to researchers around the world shortly afterward — here is the gene sequencing of a strain from Nepal. The ability to communicate clinical, public health-related and biologic data between researchers, governments and healthcare organizations is crucial to our response.
When it comes to sharing data and information, we are reaping the benefits of the digital age. Once information is created from data, analyzed, and received; it can then be communicated via the same digital mediums. Our digital-enabled world has allowed the masses to receive important communications instantly via news press conferences, social media campaigns, text messaging, and emails. In a human-to-human virus spreading situation, communication with the masses is critical to containing the virus.
A quick glance at social media will show you the tremendous reach that is possible in a matter of weeks. “Social distancing” became a household term within a very short amount of time. Rapid digital communication helps communicate the importance of adherence to mitigation strategies. People are wearing masks quicker, they are following physical distancing measures, and they are donating needed supplies because they know what, where, and when it is needed — all thanks to our digital connectivity.
In the 16th century, in order to achieve the same effect, it would have required a tremendous number of carrier pigeons.
Modern Biotechnology, Medical Science, and Digital Health
Our information exchange and communication also allows for the human-innovation machine to switch into full gear. When the virus was first identified, the work to quickly sequence the genome and structure began.
This rapid analysis allowed biotechnology companies to begin working on diagnostic tools, vaccines, and treatments — things that did not exist in the 16th century. Major and small biopharmaceutical companies and medical device manufacturers announced research efforts, clinical trials, and offered their unparalleled scientific resources to help.
Outside biotechnology, our medical researchers and clinicians began studying the clinical presentation of the disease. They continue to publish new studies in the New England Journal of Medicine and JAMA to effectively communicate results to the field. Diagnostic protocols were developed, treatment algorithms were outlined, and health professionals worked collaboratively across borders to understand how to best help their patients.
Our healthcare payment and delivery organizations mobilized resources, albeit sometimes too slowly, and prepared to handle the influx of new cases. Hospitals are seeking to protect and expand their limited ICU beds with life-saving ventilators. Frontline healthcare professionals continue to show us their training, dedication, and knowledge obtained from years of study, experience, and research. Nurses across the world are reminding us why they are consistently the most trusted and respected profession.
Our public health institutions, though stifled by lack of investment and funding, fell back on their training and years of research. Our epidemiologists, emergency response experts, and virologists were ready to answer the call — despite their warnings of this event falling on deaf ears. But without hesitation, they answered the call for which they have spent years studying and preparing.
Technology companies quickly went to work to provide accurate information and to facilitate communication from public health officials. Facebook, Google, Amazon, and Apple have sought ways to assist and to communicate reliable information to their massive user-audiences.
Start-ups have developed chatbots, triage tools, maps for testing centers, and advanced analytics. Digital health companies are offering telehealth to ensure access to needed services remotely. Digital therapy companies are providing mental health services during this tough time. Nurse staffing companies are helping to meet the demand for nurses and respiratory therapists by quickly providing supply. Analytics companies are helping to track the spread of the disease.
Demand for personal-protective equipment (PPE) has resulted in shortages. 3M is producing millions of N95 masks. Smaller companies are ramping up production. Apple is making face shields. To ensure ventilator availability, GM and Ford are building them instead of cars.
The human innovation engine is alive, well, and never more capable of rising to the occasion. While nothing happens instantly, given enough stress and a great need, we have always answered the call.
Life-support Medical Technologies
When COVID-19 results in severe respiratory failure, ventilators keep people alive while their bodies fight the disease. When physicians think about immediate threats to life, the ability to oxygenate the body is crucial and threats to oxygenation are often the #1 concern with any acute medical condition.
Through the power of human ingenuity, we developed these machines to breathe for us when our bodies are unable. This was certainly not available during the plagues of the middle ages, and, thus, those archaic hospitals where people went to die have transformed into places where we have the power to support life.
This pandemic may be one of the most trying times for those alive, today. The direct threat to life, the potential for economic ruin, and the stories of our friends and families directly affected make this a major world event.
But, we are not beholden to the progression of the disease like the populations alive during the 16th century. We are not merely at the mercy of an invisible illness. This time, things are different.
The spark of innovation that marks what it means to be human is alive and well. The recent centuries after the scientific revolution of the 18th century have proven that the human experience is one of evolution marked by tremendous desire to gain mastery over our world. Standing on the shoulders of the people before us, we have never been more equipped to face the challenge of this virus.
While viral growth is exponential, I offer that our technology and innovations are too.
