Ebola in ancient Athens examination raises question: Is west Africa outbreak making history or repeating it?

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CID615The swift and brutal onset of the disease: fever followed by vomiting, diarrhea, bleeding, and for most, death within two weeks, made the outbreak terrifying, and seemingly inescapable. Even worse, it quickly became a disease of caregivers, with the greatest toll among physicians and family members who tended to the stricken. When the outbreak came to a crowded urban setting, widespread panic multiplied the ravages caused by the illness itself.

This could be a description of the current west Africa Ebola crisis, but an articlethucydides in June’s Clinical Infectious Diseases says it’s also a description of the epidemic that came to Athens in 430 BC, and over the next three years killed about quarter of the city’s population. Athens had never seen the like of that epidemic, which resurged three times over the five years following its arrival there from Africa, and while the outbreak was painstakingly described by the historian Thucydides, medical scholars have not had enough information to name the disease. Smallpox and typhus have been considered, and two decades after the outbreak in what was then Zaire gave Ebola its name, epidemiologist Patrick Olson examined the possibility that it caused the historic Athenian plague. The biggest problem with confirming that hypothesis then, a New York Times article noted, “is that modern doctors know so little about Ebola itself.”

They know more now, Powel Kazanjian, professor of infectious diseases and history at the University of Michigan, notes in his recently released article “Ebola in Antiquity?”. That includes recent molecular evidence that Ebola viruses are older than thought, with “an estimated lineage on the order of tens of millions of years.” It also includes data from a great many more paitents. Kazanjian compares the characteristics of Ebola to those of other illnesses that have been considered, and holds those against what is known of the Athenian outbreak described by Thucydides. The other diseases include epidemic typhus, anthrax, bubonic plague, smallpox and measles. In addition to the symptoms, features include survivors’ immunity, African origin, and involvement  of animals. Some illnesses, including bubonic plague, smallpox and measles, he shows, don’t fit either the course of disease or epidemic. Some, including typhus and anthrax, fit some, but not the spread to health workers noted by Thucydides (and, Kazanjian writes, the poet Ovid, who he quotes: “The nearer did any man approache[d] his diseased friend . . .the sooner did he catch his bane”).

If Ebola was responsible for the Athens epidemic in 430 BC, then what happened between then and 1976, when the virus was discovered in central Africa? Kazanjian offers that in the absence of a test to diagnose it until then, it may have gone unrecognized and broken out in environments and in forms in which its effect was less devastating.

He finds other similarities, the fear that led people to abandon the ill, and the resulting isolation that increased their misery. It is a pattern repeated in epidemics, he writes, describing the early years of the AIDS epidemic and the toll that stigma and discrimination continue to take on people living with HIV. He goes on to note how accounts of these tragedies — ancient and recent — have offered lessons on the cost of panic. They haven’t been heeded, he indicates, offering the example of the mandatory quarantines faced by asymptomatic volunteer health providers returning to the United States from Ebola-affected areas.

The five-year span of the Athenian epidemic, he notes is possible again, in light of the difficulties efforts to control the current Ebola outbreak have encountered. While much attention has been paid to unprecedented aspects of the current Ebola outbreak in west Africa, he concludes, exploring similarities to the past may be more useful.

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