Plague, Pandemic, and Human Nature

In the church of San Antonio in Milan in 1630 a frail elderly man who had been kneeling in prayer rose to sit on the pew behind him. Before he sat he used the edge of his cloak to wipe off the seat. Seeing this, a woman seated near him jumped up and pointing to the man cried out “Look, that old man is anointing the pews.” Despite the worship service in progress members of the congregation attacked the old man, grabbing him by the hair and dragging him outside the church where they beat and kicked him to death. The mob was acting under the influence of a bizarre, false conspiracy theory about how the plague was spreading through their city. When I read this in The Betrothed, a classic Italian novel by Alessandro Manzoni, I immediately thought of the way Americans of Asian descent were attacked in the street during the COVID pandemic. Just because the virus originated in China was no reason to blame or fear any individual Asian American, but the perpetrators of the violence were acting on an irrational conspiracy theory just like the mob in Milan four hundred years before.

The Betrothed (I Promessi Sposi in Italian) is on my list of favorite reading of 2022. Written in the early nineteenth century it is a story of star-crossed lovers set against the background of historical events in seventeenth century Lombardy; famine, war, and plague. The chapters that describe the Milan Plague of 1630 are famous and considered one of the best accounts of the plague ever written. Manzoni based his account on memoirs and histories, notably those of Giuseppe Ripamonti and Alessandro Tadino. Dr. Tadino was deputy to the Chief Medical Officer of Milan and a member of the Tribunal of Health during the plague. He personally witnessed the attack on the old man in the church of San Antonio; it is not fiction.

I confess that I thought many of the dysfunctional things that happened here during the COVID pandemic were peculiarly American. The initial denial and slow government response, the rejection of science, the susceptibility to conspiracy theories, the resistance to health measures, the scapegoating, the harassment and attacks on medical officials. But as I read Manzoni’s chapters on the plague I saw that all these things happened in Milan four hundred years ago. There is nothing that happened here that doesn’t find its parallel in Manzoni’s account of 1630 in Milan. Human nature, it seems, is a constant in every place and time. Manzoni is known as an astute observer and analyst of human nature so he is well placed to bring us this truth. In crisis some of his characters respond with heroism while others care only for themselves; some act rationally while others fall down the rabbit hole of absurd conspiracy theories; some change for the better while others learn nothing from their experience of an extreme disaster.

The plague was carried to northern Italy by invading German troops embroiled in the War of the Mantuan Succession. Taking a cue from Manzoni I won’t subject the reader to an explanation of that obscure and complicated dispute. As the foreign soldiers advanced through the countryside in late 1629 rumors of plague reached Milan. People were falling sick in outlying villages. Some in Milan, including the Chief Medical Officer Ludovico Settala, were old enough to remember the plague outbreak fifty-three years before and recognized the symptoms. But their warnings were ignored. The Governor was distracted by the war and the Tribunal of Health paralyzed with indecision. But Milan began to fill with villagers fleeing the sickness so on October 30th the Tribunal finally drafted an order to ban people from the affected villages from entering the city. With typical bureaucratic slowness the order was not implemented until November 29th. By then it was too late; the contagion had already spread through the city. Just as centuries later when President Trump banned flights from China it was too late; the coronavirus was already here.

Meanwhile, in another familiar scenario, large numbers of the public turned to denial. Manzoni writes:

In the public squares, in the workplace or at home, anyone who dared to hint at the danger, and who attributed the deaths to the plague, was treated to angry contempt and jeers of disbelief. The same disbelief, or rather the same blindness and obstinacy, prevailed in the Senate, the Council of Decurioni, and in every magistrate.

Even some doctors gave in to the prevailing mood. They:

trotted out the names of common illnesses to explain away every case of plague they were called upon to treat, regardless of the signs or symptoms.

Denial was such a strong feature of the American response to COVID that there were numerous accounts of patients denying they had it with their very last breath.

Then and now denial went hand in hand with anger and resistance to health measures, which in turn led to harassment and attacks on health officials. They were called “pro patriae hostibus,” enemies of the people, a phrase we are all too familiar with today. Doctors Settala and Tadino:

could not cross a public square without having obscenities or even stones hurled after them.

Ludovico Settala was a revered figure in his eighties with a distinguished career as a doctor and scientist and a reputation for charity. But as Manzoni reports:

It could not shield him from the animosity and the insults of those members of the public who leap more easily from judgments to demonstrations to action… Such was his reward for predicting the plague, identifying it , and wanting to save thousands of people from its ravages.

In one incident a mob surrounded his sedan chair accusing him of terrorizing the city to create business for doctors. He was able to escape into the nearby home of a friend. The modern parallel is the harassment of Dr. Anthony Fauci, a man who like Settala has devoted his career to saving people from disease. The public square in our time is the internet where insults and death threats reach millions in an instant. Dr. Fauci has even been threatened by elected officials and requires round the clock security for himself and his family. The accusation that health officials were out to make money was also a feature of our pandemic. A conspiracy theory spread on social media that hospitals were recording deaths from COVID when they were actually from some other cause in order to make more money. This led to harassment of hospital doctors and nurses whose jobs were already stressful enough. I remember an interview with an exhausted doctor who described verbal abuse and accusations of murder from one family. He said he had to put that aside and do all he could to save the patient, but it was emotionally draining and led to burnout in many health professionals.

At some point it became impossible for the people of Milan to deny the existence of the plague. At the height of the outbreak 1500 people a day were dying out of a population of 250,000; an estimated 64,000 people died over a period of less than a year. No one could ignore the carts that trundled through the streets every day collecting the bodies of the dead. Here, if you didn’t trust any news media you could remain in denial. I saw one woman interviewed who said there was no pandemic because she had never seen any bodies of victims who dropped dead in the streets. Well in Milan the people saw the bodies. Then they turned from denial to conspiracy theories and blaming scapegoats.

Foreigners of course, then and now, made the perfect scapegoats.

Foreigners, easily identified by their unusual dress, were suspected simply because they were foreign and subjected to citizen’s arrests.

In one instance three young Frenchmen visiting Italy to study the antiquities were exploring the Duomo. Manzoni tells us they were easily identified as French by their hairstyles, clothing, and shoulder bags. Something in their behavior aroused suspicion, they were foreign after all, and a mob soon surrounded them, beating and dragging them to the courthouse. The trio were luckier than the old man in the church; they survived the attack and were released from custody. One imagines they hightailed it back to France. During our pandemic certain politicians, grabbing an opportunity to further hysteria about illegal immigration, made accusations that asylum seekers at the southern border were carrying the virus to infect Americans. Illogical, since the virus was already here, but nevertheless effective in drumming up suspicion of Hispanic people, whether illegal or citizens themselves.

Conspiracy theories spread into what Manzoni describes as “collective delirium.” It was the dark arts, diabolic rituals, black magic, contagious poisons, or even a trick by French Cardinal Richelieu to depopulate Milan in order to capture it without a fight. But the most bizarre conspiracy theory, the one that led to the old man’s death, was that a secret group of malign individuals were “anointing” surfaces in the city with an “unguent” that spread the contagion. It began on May 17th 1630 when a group of people claimed they saw some-one dabbing a greasy substance on a wooden screen in the Duomo. Dr. Tadino was brought in to investigate. He examined the screen and surrounding pews but found nothing suspicious. Perhaps people had seen a cleaner going about his duty. Nevertheless, “out of an abundance of caution,” and hoping to calm the hysteria, Tadino ordered a cleaning of the screen. But next morning the people of Milan awoke to find walls throughout the city daubed with yellowish stripes.

Here and there were uneven splotches, as if someone with a sponge dipped into a purulent substance had smeared the walls.

Something was on the walls; there are numerous eyewitness accounts including from Dr. Tadino himself. He collected samples of the substance and tested it on dogs who suffered no harmful effects. Perhaps it was a prank; the origin was never found. But it was enough to provoke a complete hysterical uproar in Milan. People saw anointers everywhere, denouncing, attacking, and as we have seen, killing anyone suspected on the flimsiest of evidence like making a wiping motion with a cloak. With his astute understanding of human psychology Manzoni writes:

The fervent belief in anointers made their discovery inevitable. All eyes were alert, any act could prove suspicious. And suspicion led easily to certainty, and certainty to fury.

There has rarely been a better description of mob mentality. And in a further twist, anyone who denied the existence of anointers must be an anointer himself. It reminds me of Senator Joseph McCarthy’s hunt for communists in the 1950’s. If you denied the existence of communists in the government you must be one yourself. The same twisted logic can be seen in the contemporary hysteria over “groomers.” If a librarian refuses to remove a targeted book from the library shelves, then she herself must be a groomer.

Although medical officials in Milan knew that the plague was spread by human contact and could be mitigated with quarantine and social distancing measures, they were helpless to stop super-spreader events. In the early days of the epidemic the Governor, more concerned about the war and his standing with his patron Philip IV of Spain, insisted the city hold a lavish public festival to celebrate the birth of Prince Carlos, Philip’s first son. Despite the protests of the Tribunal of Health the event went ahead with crowds thronging the streets, no doubt doing more to spread the contagion than any imaginary team of anointers.

As the deaths mounted and people turned to their faith for solace, Cardinal Federico Borromeo came under pressure to hold a religious procession with the relics of San Carlos, a hero of the earlier Milan plague. Siding with the Tribunal of Health, Federico at first refused but he was eventually forced to relent. The Tribunal of Health tried to minimize the risk by closing the city gates on the appointed day and nailing shut the doors on about 500 infected houses. Manzoni’s description of this procession, based on eyewitness accounts, sounds like something as elaborate as a royal coronation or funeral. Officials of Church and State, civic organizations, priests and monks, all followed the crystal casket of San Carlos, his corpse visible within dressed in splendid robes. The procession passed through Milan’s crowded streets stopping at each crossroads for prayer. The faithful believed that honoring and praying to San Carlos would end the plague. But the inevitable happened:

the death toll went up the next day, in every social class and in every part of the city so suddenly and steeply that the cause was unmistakable.

Rumor, however, blamed anointers who were said to have sprinkled a white powder along the procession route that stuck to people’s clothing. During the pandemic many Americans stuck to outright denial when President Trump’s 2020 campaign rallies, held against medical advice from his own administration, became super-spreader events. The rally in Tulsa even caused the death of Trump supporter and former presidential candidate Herman Cain. When 462,000 people gathered for the Sturgis Motorcycle Rally in South Dakota in August 2020 they caused a spike in COVID cases in that state. And when they carried the contagion home with them spikes occurred all over the country. As in Milan, “the cause was unmistakable.”

One of the most heartbreaking features of the COVID epidemic was the strain on hospitals and their staff as they struggled to manage the overwhelming numbers of the sick. Milan, with just one hospital, had a similar problem. Outside the city gates stood the Lazaretto, a large partly open air hospital with a central chapel. Officials called monatti were responsible for collecting the dead and for transporting the sick to the Lazaretto. There was no treatment other than palliative care; the goal was to sequester the sick to help halt the spread. At first the place was a chaotic scene of unimaginable suffering. Few were willing to risk their lives by working there. In desperation the Tribunal of Health asked the Capuchin monks to take over the running of the hospital. Over seven months 50,000 patients were admitted; 1500 a day dying at the peak of the epidemic. The Capuchins worked tirelessly and selflessly, many dying of the plague themselves as a result. In America an estimated 3,600 healthcare workers died of COVID in the first year of the pandemic.

Cardinal Federico followed the example of his cousin San Carlos by visiting the sick in the Lazaretto. Although his entire household died of the plague he refused to seek refuge in the country. Manzoni reports that “he sought out the pestilence and lived in its midst.”

The learned borrowed whatever delusions of the common people suited their own ideas. And the common people borrowed whatever they could understand from the hallucinations of the learned. And from the combination of the two an enormous tangle of public insanity was formed.

And he remarks ruefully:

Most of this long and twisted course could have been avoided, however, if the tried and true methods of observing, listening, comparing, and thinking before speaking had been adopted.

Most chillingly, in one short line that could easily be overlooked, Manzoni reveals the danger in how conspiracies, misinformation, and incitement work upon different personalities:

… those members of the public who leap more easily from judgments to demonstrations to action.

Some sit in front of their screens and fume, some join demonstrations shouting abuse and threats, while others leap more easily to action. I think of a more recent attack on an elderly man, Paul Pelosi, perpetrated by an individual who was urged to action by conspiracy theories just like the mob in the church of San Antonio centuries ago.