The corona crisis is not a medical problem, but a social problem. Nevertheless, Rutte mainly bases his policy on advice from medical experts. Medical historian Rina Knoeff believes that historians should also be listened to.
Historians do not have to wait for the corona crisis to become history. It is precisely now that they can make an important contribution to public discourse, believes medical historian Rina Knoeff. That is why she is organizing the webinar series COVID-19:what can the humanities do? The Groningen Center for Health and Humanities, of which she is director, calls on humanities scientists to consider what they can do in this crisis. “This is not the time to sit on your hands and leave the decision-making to a small group of experts. We have a duty to ask critical questions.”
One of the questions that has been on her mind more and more in recent days:why does the Outbreak Management Team have so much power? According to Knoeff, the corona crisis is not a medical problem, but a social problem. “Medicines currently do not have an adequate response to the crisis,” says Knoeff. “Of course they are busy fighting the consequences of the virus, but until we have a vaccine, we will have to make do with social measures.”
Medical failures
If Knoeff were to be in charge, the Outbreak Management Team would soon be expanded with historians and other experts. “Now the team consists of doctors and epidemiologists who work with statistical models. You may be able to control these easily, but social reality is much more difficult to control. If you look at history, you will see that innovative ideas always failed. That is why I think historians can have a warning function.”
What can a historian warn of what a physician does not see coming? According to Knoeff, history shows that the most brilliant solutions in practice often fail because of social resistance. If you look at history from the perspective of the present, you tend to see the success stories above all. We mainly look at the discoveries in medical science that have brought us to where we are today.
But medical history is made up of failures. That is precisely what we can learn from now, says Knoeff. An example:“At the end of the eighteenth century, British doctor John Haygarth devised a solution against the rapid spread of the deadly smallpox epidemic. People had to keep their distance from each other, stay indoors and, above all, not come near people who are extra vulnerable. Only in this way could a kind of group immunity gradually develop.”
“With today's knowledge, you would think Haygarth's policies paid off immediately. However, it did not have the desired effect. Poor citizens could not afford to keep following the rules, because there had to be bread on the table. The rich could conform to the idea of group immunity, but once they achieved that for their own group, they just as easily pushed aside the restrictive measures.”
Protect the weak
The most important lesson Knoeff draws from history:“We should not underestimate the effect of socio-economic differences. It is constantly said that we must protect the weak in society, but they are currently taking the heaviest blows. If you don't have a lot of money or living space, it is also much more difficult to adhere to the restrictive guidelines of the RIVM. You will therefore have to take extra measures for the homeless, asylum seekers and people in nursing homes. The question is whether that is happening enough now.”
Would things have turned out differently if historians had been on the Outbreak Management Team? “It is of course very easy to say afterwards what could have been done differently. Historians have access to a wealth of information and knowledge, but history does not provide ready-made answers to today's problems.”
“The contribution of a historian is mainly in asking critical questions about the solutions that are devised. A measure may sound perfectly logical to a scientist, but how do we deal with citizens whose livelihoods are endangered as a result? We know, for example, that the cholera outbreak in the nineteenth century led to major riots because the poor population did not want to conform to the measures imposed by doctors.”
Now is the time to add extra expertise to the Outbreak Management Team, says Knoeff. Not only historians, but also other scientists from different disciplines. “If you see corona as a virus that can only be diagnosed and examined by a laboratory, then the solution lies entirely with the medical specialists. We can do nothing but wait for the vaccine. If we approach corona in a different way, we might come to very different solutions."
Power in science
Nevertheless, Rutte mainly bases his policy on advice from medical experts. Why doesn't he listen to psychologists, economists and humanities scientists? You could give a historical answer to that question, says Knoeff.
That answer begins in the nineteenth century, when laboratories increasingly began to shape our understanding of disease and health. Knoeff:“More power came to lie with the medical experts, less with the people themselves. We now see how firmly that power is perpetuated in medical institutions. You don't have corona until it has been diagnosed by a laboratory. Anyone who dies of corona symptoms without being diagnosed with the disease by the lab has not officially died of corona. That is of course remarkable. Yet we all seem to accept that it works that way.”
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We must not forget that medicine is always political, says Knoeff. That may not seem logical at first glance. Scientists discover facts, many people will think. But in doing so, we are doing scientists a disservice, according to Knoeff. The disease Covid-19 is not something that is already ready in reality and only needs to be 'discovered'. “It is a process of definition and power processes are constantly at work in it.”
The distinction between politics and science is therefore not so black and white. Political interests also constantly play a role in medicine. “In Germany, for example, a discussion arose because pathologists discovered that all German corona victims they had under the knife during autopsies had an underlying condition such as cancer or heart failure. Would these people have died of corona without those conditions? Is the coronavirus as deadly for healthy people as the experts claim?”
“The Robert Koch Institute, the German variant of the RIVM, was certainly not happy with these results because their epidemiological models were called into question. They tried to prevent the investigation from continuing. It all settled in the end, but you can see an interesting political power game emerging here – between scientists.”
Lifestyle Medicine
Knoeff emphasizes that there are different medical views. The question 'what is corona and what can we do about it?' has no clear answer. Definitions differ and are strongly culture and time bound. A thought experiment that has regularly crossed her mind in recent days:what would corona have looked like in the early modern period?
“That was the time before the large hospitals and laboratories that can determine whether or not you have corona. At that time, diseases such as corona were not defined on the basis of a bacillus or a virus. There would be much more attention to the symptoms. The solution would then be sought in your way of life and the habits you have taught yourself. Even today, we are not blind to that. We all understand that this virus could spread so quickly because we fly around the world en masse, for example. Perhaps we should think about whether that way of life is still sustainable.”