On August 28, 1854, a six-month-old girl known to history as "Baby Lewis" fell ill with cholera in the London neighbourhood of Soho, at that point one of the most densely populated, and poorest, neighbourhoods in the city. Bacteria from her stool contaminated a well on Broad Street, and within a matter of days, the most terrifying outbreak of cholera in the history of London had erupted. By the time it ended, several weeks later, one-tenth of the neighbourhood's population had died.
The story of the Broad Street outbreak is perhaps the most famous case study in public health and epidemiology, in large part because it led to the revolutionary insight that cholera was a waterborne disease, not airborne as most believed at the time. But there is another element of the Broad Street outbreak that warrants attention today, as popular anxiety about Ebola surges across the airwaves and subways and living rooms of the United States: not the spread of the disease itself, but the spread of information about the disease.
It was a full seven days after Baby Lewis became ill, and four days after the Soho residents began dying in mass numbers, before the outbreak warranted the slightest mention in the London papers, a few short lines indicating that seven people had died in the neighbourhood. (The report understated the growing death toll by an order of magnitude.) It took two entire weeks before the press began treating the outbreak as a major news event for the city.
Within Soho, the information channels were equally unreliable. Rumours spread throughout the neighbourhood that the entire city had succumbed at the same casualty rate, and that London was facing a catastrophe on the scale of the Great Fire of 1666. But this proved to be nothing more than rumour. Because the Soho crisis had originated with a single-point source - the poisoned well - its range was limited compared with its intensity. If you lived near the Broad Street well, you were in grave danger. If you didn't, you were likely to be unaffected.
Compare this pattern of information flow to the way news spreads now. On Thursday, Craig Spencer, a New York doctor, was given a diagnosis of Ebola after presenting a high fever, and the entire world learned of the test result within hours of the patient himself learning it. News spread with similar velocity several weeks ago with the Dallas Ebola victim, Thomas Duncan. In a sense, it took news of the cholera outbreak a week to travel the 20 blocks from Soho to Fleet Street in 1854; today, the news travels at nearly the speed of light, as data traverses fibre-optic cables. Thanks to that technology, the news channels have been on permanent Ebola watch for weeks now, despite the fact that, as the joke went on Twitter, more Americans have been married to Kim Kardashian than have died in the United States from Ebola.
As societies and technologies evolve, the velocities vary with which disease and information can spread. The tremendous population density of London in the 19th century enabled the cholera bacterium to spread through a neighbourhood with terrifying speed, while the information about that terror moved more slowly. This was good news for the mental well-being of England's wider population, which was spared the anxiety of following the death count as if it were a stock ticker. But it was terrible from a public health standpoint; the epidemic had largely faded before the official institutions of public health even realised the magnitude of the outbreak.
We hear it said constantly that modern society is uniquely vulnerable to the threat of a pandemic because of the global connectedness of air travel. Yet we rarely pause to consider the other side of our global connectedness: the speed of information, which has been increasing at a much faster rate over the past few decades than the speed of airplanes has. With the H1N1 pandemic of 2009, for instance, a virulent new strain of the flu was identified in a rural Mexican community, and within a matter of days health organisations around the world had been notified, and were trained to identify the new virus.
Thanks both to technology and to the essential work of institutions like the World Health Organisation and the Centers for Disease Control and Prevention, we can alert the world to potential threats from a single smartphone. This is particularly true in countries, like the United States, with mature public health institutions, but it is also true in countries like Nigeria that were able to act quickly on early information about Ebola victims and contain the outbreak within weeks.
So this is the strange paradox of the modern epidemic: The speed of information is both our greatest defence against a true epidemic in a city like New York, and it is the source of constant, nagging anxiety that creates the - entirely incorrect - sense that we live in unusually perilous times. A New Yorker or Londoner is far less likely to perish from an epidemic disease than he or she would have been 150 years ago. We are vastly less at risk and at the same time we are more worried - for the same reason.
Information travels faster than viruses do now. This is why we are afraid. But this is also why we are safe.
©2014 The New York Times News Service
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