 Now we're back, we're live, I'm Jay Fidel, this is Think Tech, it's a 12 o'clock block on a given Thursday, the 26th of August. We have Professor Robert Littman, he's here with us to discuss history is here to help, he is history helping us. We're talking about pandemics, we're talking about the fact that pandemics have been with the human race a long time, they were not born yesterday. And as an historian and an archeologist, Robert can help us understand that, at least from the moment that archeology can click into what happened in the classical world. Welcome to the show, Robert. Thanks very much. Well, this is the time of pandemics. Pandemics started as soon as there were human beings, as soon as you had enough people to become, to give a vector a place for diseases to exist. So let's start with the first slide. And one of the things that I work on is the history of pandemics and how they affected human civilization. Let's have the next slide. That first slide, by the way, had a COVID, a picture of COVID. One of the things that's very important is to learn lessons from history. Santayana said, those who cannot learn from the history are doomed to repeat it. Those who do not remember the past are condemned to repeat their mistakes. Now, here I have a few pictures of a few people. We have Boris Johnson, the Prime Minister of England. We have our governor, David E. Gay, and we have the president of the University of Hawaii, David Lassner. And I would like to also focus on DeSantis, the governor of Florida. These are all people who have, some of whom have learned a little from history and others haven't. First, Boris Johnson should be ashamed of himself. Boris Johnson, like me, studied classics, an ancient history at Oxford. And one of the things we all studied was Thucydides' Plague of Athens. And Thucydides says that he was describing the events, so if they should ever happen again, you'd be able to identify them and see how people behave. Well, Boris Johnson was first a denier of COVID when it struck. Oh no. Yes, and then he got COVID and he changed his tune. Now, if we look at David Lassner and E. Gay, they've done, I'd say, an okay job, not a great job in dealing with the pandemic, because they've taken some of the historical examples, but they haven't taken them fully. 400 colleges and universities required the students to be vaccinated. UH is allowing unvaccinated students to be on campus, albeit with tests. So that's a half-hearted measure. California has, San Francisco has made it a requirement to have a vaccination to go into restaurants. We know if you're not vaccinated, you're gonna get the disease, you're gonna spread COVID and we should be doing the same here. And if Sanchez in Florida is completely ignoring all the history and all the data, or maybe he knows it and has decided to make a political decision and is costing people their lives over it, the Sanchez clearly has blood on his hands. Now, if we don't learn from history, it's very difficult to deal with these things. We have had these pandemics before. We've had vaccinations before. Let me just throw out the idea of vaccinations from a smallpox, smallpox ravaged humanity for the last 5,000 years. In the 20th century alone, 500 million people died of smallpox. It makes COVID look like a blip. We developed a vaccine. We used the smallpox vaccination to vaccinate enough people. We couldn't vaccinate everyone in the world and the World Health Organization found a solution to this. What they did instead of trying to vaccinate the whole world, whenever an outbreak occurred, they would go into a village and they would vaccinate an area of a couple of miles around to make sure that there were no vectors for smallpox to spread. Now, it's really interesting that if you look and you go to primitive regions of Pakistan and other third world places, you find that health officials who go into the villages and give people vaccination get beaten up, they get driven away. It's magic, they're gonna put some foreign element into their bodies. I've seen this happen in Africa where I've worked and I thought America, our education is a little too good for this to happen here, but it is happening here. These people who are afraid of vaccinations, misinformation, it's just like the villages that permit the ignorant villages in Pakistan and other third world places. They're sure Bill Gates is planting a chip in you. Well, George Washington, I had two questions about this for you. George Washington inoculated his troops, which was really a tremendous thing and he probably saved his army that way because he was having an epidemic among his army. And what they would do is they would break the postural on somebody who was sick and slide a knife under the postural and then they would take that same knife and then cut a member of his army and slide that whatever the material was under the skin of this trooper. And that saved his army. But what, oh, and by the way, in the process, the Continental Congress, which was then apparently in existence, passed some bill to say you can't do that and he ignored them. What I find very interesting was that even then in a critical situation, there were people who opposed that vaccination. But the question I want to ask you about it is, you know, it was brilliant. It was brilliant to slide the knife under the postural and do another cut on someone else. Was that the first time or had there been historically others such brilliance before that? Okay, what George Washington did was called variolation. That is to actually infect a person with the disease. Now, this actually started earlier in the 18th century, about in the 1750s, 1760s. So Washington knew about it. The problem with variolation is that a lot of people died from it. So if an outbreak of smallpox that happened in Washington's army, based on our knowledge of how the mortality of disease, about 25% of the army would have died. Even 25, maybe even a higher percentage of the army. We did have smallpox outbreaks, historical outbreaks in cities. And we've seen that's the mortality rate. By using this variolation, you got the disease, but a much more mild version of the disease. And Washington lost under 10% of his army, maybe six to 10% of his army. So it wasn't the first time it was done. It had been done for 30 to 40 years. It was considered a chancey process. But Washington's smart. He knew that if he did this, he was gonna lose some of the army. If he didn't do this, he could lose a good deal of numbers of the army. But it's interesting, after Washington did this, within about a decade, a man called Edward Jenner saw that this was being done in about, I think it was 1796 or seven. And what he did, he noticed that there were milkmaids who got something that looked like smallpox and was actually cowpox. And this gave them an immunity. So then Jenner developed really the first vaccine at the end of the 18th century. And it, again, was used, and it had a tremendous actual effect on Europe because in the 18th century, you had a high rate of mortality among the nobility. Into the 19th century, they started using these smallpox vaccination and it reduced it greatly. But one of the things that, let me put up another slide. Can we have the next slide, please? And why we study ancient diseases. Okay, so the ancient diseases and the diseases of the past tell us how they function in human populations over generations. So for example, it shows us how people behave. We, if we read the Bible, if you read Thucydides from the 5th century BC, if you read Procopius from the 6th century AD, he tells us how people react in those pandemics. People react in the same sort of way. Now, the other thing that studying history does is that when we look at diseases in these pandemics, we see how they work over a generation. Now, one of the things that we do, the human generation is 40 years. So that's why we use rats for our experiments. The rats have a lifespan of about two years. So in 10 years, you have five generations. So you can see how diseases behave over generations. Let me give you an example with syphilis. Syphilis started probably around 1492. I remember when I first came to Hawaii, there was a Hawaiian, extremely educated Hawaiian noble called Sami Amalu. I don't know if any of you are older. He was in the newspaper a lot, wasn't he? That's right, exactly. And I remember him giving a talk saying, Captain Cook came to us, he gave us syphilis and in return, we ate him. Syphilis was brought by the British to this wonderful island. And if we look, syphilis started in about 1492. Certainly in Europe brought back, probably brought back from the New World by Columbus. But what do you say started though, Robert? You don't mean that it just emerged for the first time. There hadn't been predecessors, no? It had predecessors, yes. So what happened then with the syphilis is it was devastating to the European population starting in about 1492 or 1493. But over the years, it got attenuated. People were less, it was less virulent. And by the 19th century, people still got it and died from it, but not in the numbers. So one of the things that it teaches us by looking at the history of syphilis is how these pandemics develop over the centuries and what we have going forward. One of the things we have, it's really interesting. I wanna just jump to the last slide for a minute. Number 15, lessons from history. And I'll talk one of the things, these conclusions in this slide, first about smallpox and probably bubonic plague became much more deadly because of variants. So we've had the same thing with COVID. You can I just, what we have now with COVID is a virus, but smallpox is a bacteria, so is bubonic plague. And the variants and the mutations, it works differently with the bacteria, right? Yeah, but what we do have bacteria and bacteria and viral all have mutations of it. But what I'm saying is one of the things that we look about from human behavior is we always need to get ahead of the pandemic, not react in arrears. And we must rapidly vaccinate the world to prevent rises of new variants of COVID-19. They could be much more deadly, vaccine resistant and higher transmissibility rate. I wrote this in last March in a lecture that I gave at Mount Sinai Medical School for epidemiologists. I give an annual lecture on the history of pandemics for epidemiologists at Mount Sinai. And I called what was gonna happen with these COVID vaccinations six months ago because I looked at the history of these diseases and saw what was going on. Now, one of the things that we do learn from the history of medicine and the history of how people behave and react is everybody is always too slow. People react to the, people react to what's going on, to the epidemic in arrears, not in advance. And one of the things, we've had only two countries in the world who have reacted properly to get ahead of the curve to COVID. That's been New Zealand and Israel. And it's really, the United States has been much too slow. We've helped with the development of the vaccine and we've done well there, but we aren't working fast enough. Let me give you an example. In Israel, they have found that the COVID is occurring in vaccinated people. In fact, 60% of the hospitalized patients have been vaccinated. So what has Israel done is started the booster shot. And they find that giving the booster, your immunity goes up 10 fold. Okay, now- You're talking about the Pfizer booster? Pfizer booster. Pfizer booster and the Modena booster will be approved shortly. So Israel has now vaccinated everybody from 40 years old and older with the booster. This has immediately dropped their rate of infection and hospitalization. It works. So what do we do here? We wait. We're waiting too long. So Fauci, who is a wonderful scientist, but like all the others, is a little too conservative and gets behind the curve. We should be having the booster shots right now, not wait till this eight months, because by the time that happens, we will, the epidemic will be much worse. The other thing is that people don't realize how fast these epidemic curves work. There was a researcher from the University of Hawaii who did an estimate saying that the rate we're going, we will be at 3,700 cases a day in six weeks in Hawaii from our eight or not, 800, 700 a day now. And so what do people do? They're not moving fast. Part of the problem is think of it this way. If you have a dollar bill and your bank will give you interest and double it every three days, in 60 days you will have a million dollars from that one dollar. Think of that as a rate of how diseases, how fast diseases work. So let's go to as a slide. I'm thinking of the past where we may not have had a booster. You may not have had a vaccine. Thinking of the Spanish flu of 1918 and 1919 and so forth. I'm thinking of various times we've had pandemics in human history where we really didn't have a solution. And ultimately, as you said, they attenuate themselves. This is sort of a natural process in nature where they subside and then they sleep. And then they come back later. And of course, let me throw in one other thought is, and I'm sure you thought about this as an historian, history is told by the survivors. The ones who were dying, the ones who were in fear, they're dead. And so we don't learn from them, we learn from the observations of those who survived. So I guess my question, putting all that together, my question is in the past, these things have come and gone. Aren't they going to come and go naturally? Is it a rule of nature now? Absolutely, because diseases are efficient. They want to survive. It's natural selection, it's evolution. But the question is at what price? So let me give you some examples. The Black Death, the bubonic plague of the Middle Ages came starting in 1348 and moved into Europe. It killed between 40 and 50% of the entire population. We have very good population figures during the Black Death. In England, around 1350, the population of England was 4 million. By the year 1500, it dropped to 2.3 million. It had unbelievable effects on society, on economics, on religion. It took another 300 years till 1600 for the population to recover. Yes, our society will survive from this pandemic. And by the way, this pandemic is not a very bad one. Of course, it's terrible to be part of it. Our hearts go out to the 600,000 plus people who have died from it. But compared to some of the pandemics in the past, it's not that severe, because we're only losing under 1% of the population to it, compared to the outbreaks of the bubonic plague that have cost 40% of the population, outbreaks of typhus, 20 to 30% of the population, smallpox in the Roman Empire, which killed 10% of the population of the Roman Empire. But so when you think about it with things like the bubonic plague, there were, every other person died practically. Okay, now let's look at the Spanish flu. Spanish flu gives us a lot of parallels. Would you put on the slide that I have the Spanish flu? Okay, this is an interesting slide. This is about social distancing. Here I have a chart of an outbreak of the Spanish flu in Philadelphia and in St. Louis. Now, this is the death rate. Now, what happened is in the Philadelphia, the politicians refused to cancel the Mummer's Day Parade. And as any of you know, the Mummer's Day Parade is wonderful gala in Philadelphia every year. In St. Louis, they started social distancing in masks very early. So the death rate in Philadelphia spiked and in St. Louis, it was minimal. So we look at the use of masks. DeSantis in Florida should look at this graph and see what social distancing and masks do. Now, in the pandemic of 1918, it was a flu. It was COVID. It was a variation of the same organism that we have, H1N1. So, and 50 million people probably died from COVID worldwide. Right now, we're up to a couple of million deaths so far from this COVID worldwide. We're gonna have another five million people die of this. Now, our population is much bigger. We're up to 7 billion than it was 100 years ago. So, percentage-wise, it's gonna be lower. Now, why are we gonna have a lot lower death rate? Because we have the vaccine. The miracle of our Western science is that we've been able in 11 months to develop, test and produce and manufacture a vaccine. Now, even though our former president Trump didn't pay much attention or whatever, one of the things you've got to give him credit for was to throw money at developing the vaccine. Because that was the one thing he did right. Everything else he did wrong in dealing with it. So it's clear that what we have here is that this will pass, but the question is at what price to our society? How many people will die? The other thing too is that lessons taken from history is that there will be deniers and there will be people who refuse. But that happened with smallpox and there was a Supreme Court case in 1906 where someone refused a smallpox vaccination and the Supreme Court ruled that in a public safety you were required to take the vaccination and the state could find him heftily in terms of money if this person refused the vaccine. Doesn't that absolutely apply now as a matter of law? We can do it. We can do it. We can require the vaccine, but we're too afraid to do it. Now, the other thing too, you talked about lessons from the history. California allowed religious and medical exemptions to vaccinations for the schools. And what happened? You started to get the spread outbreak of measles epidemics because there were too many unvaccinated people. We should require vaccinations that if you want to deal with the public sphere, if you wanna go to a store, if you wanna go into a movie house, if you wanna go to school, that you have to be vaccinated. Those who don't wanna be vaccinated for medical reasons or for conscientious reasons, that's fine, but they should not be allowed to infect the rest of us. They should not be allowed into school. They should not be allowed into a store. Vaccine passports work. We've had them for the equivalent of thousands of years. In the book of Leviticus, it says if you've got white spots, if you're infected, you gotta get out of the village. You gotta stay away from everyone until your rash goes away. So for thousands of years, we've done this. And it's clear that if we don't do it, if we aren't aggressive enough, our numbers are gonna double and double and double. And the other thing that we're facing too in terms of this vaccination, that we've seen with the rise of the Delta variation, if we don't get people vaccinated fast, we have a high chance of getting another variant that will result in the continuation of this epidemic. Oh, the question is, if you follow history, see these epidemics happen, you see people react, and as you point out, they're similar reaction behaviors over the decades and millennia. And you see anti-vaxxers, anti-science people surface. You see a kind of herd immunity that ultimately attenuates the virus or the bacteria. And you see this process like a sine curve over all of human history that we can study, even back to your archeological digs. So going forward from here, as you say, Robert, it will attenuate. The vaccine and the boosters will help when we finally realize that we have to do this as a matter of universal public health, but then it will come back. And people talk about endemics, where we'll have a sort of low rate of infection that will continue, and it'll be a sleeper virus, but it will be able to generate new and more potent viruses and variants going forward. So are you saying that the sine curve that you've been describing will continue? And can you give us a view based on history about how that will work even after we solve COVID? Well, the H1N1, the Spanish flu is still around. 1918 epidemic is still around, but it doesn't kill like it did in 1918 because it's attenuated. And also we've developed flu vaccines, but despite that, we still lose about 30 to 40,000 people a year, that's a flu. And that's gonna happen to COVID. The question is at what price? Now, our science is unbelievable. There is a guy named Peter Palais at Mount Sonne Hospital in New York who is working on a new flu vaccine that will work for every type of flu and lasts for 25 years. He's, if he perfects that, it's I think stage one trials now, that will finally eliminate most of these flu vaccines. But these microorganisms have been with us. We carry them in ourselves. We carry, they're everywhere. They will always be with us. We live together with microorganisms. And when they get out of control, they mutate, we can get these pandemics. So they're not going away, but our ability to deal with these pandemics, our ability to know, to create vaccines is getting better and better. And so we can face this in the future, but we now have 20 or 30 or 40 vaccines. We all get us. I grew up, I never had the measles or mumps or flu measles, mumps vaccine, because I had mumps, I had measles, I had whipping cough, but now we have the development of vaccines that can continue in public health. And that's why, thanks to vaccines and modern medicine, our life expectancy has gone from 35 in 1800 to close to 80 in the West today. So Robert, you know, one of the things comes to mind we should cover before we close. And that is what we've learned about collaboration. It seems to me that one strain of response to these various diseases and pandemics has been that, you know, different places, towns, villages, counties, states, countries, you know, have learned at least on some occasions that it pays to collaborate. It pays to compare notes. It pays to share the technology you're talking about. It pays to pass the word. And, you know, watching the experience that humanity has had with COVID over the past 18 months, it's not clear that it's not, we have not had a perfect experience in collaboration. And frequently geopolitical obstacles arise and, you know, and they distract us and stop us from collaborating. So, Querie, have we learned about that? What else can we learn about that? And will that be a salient factor in how we can deal with this in future pandemics? Well, one of the things that's clear about COVID and the way these pandemics move throughout the whole world, and we can see that in the history of the bubonic plague in the 19th century, the only way we're gonna get out of this epidemic is to vaccinate most of the world. We're not in this alone, because if we don't, if we just take care of ourselves, if we don't vaccinate everyone in India, we will get new variants. The Lambda variants is already out there. There'll be new variants that'll come back and will defeat the present vaccine. But the only way out of this is a global reaction, and we need the World Health Organization who is largely responsible for eliminating smallpox. So, the lessons from history is that borders don't keep out diseases. State borders don't keep out. So, unfortunately, what's going on in Florida is gonna affect the rest of the country as well. Yeah, and maybe that's one of the great lessons is you can't allow a Florida phenomenon to happen again, nor a Texas phenomenon, that those jurisdictions have to be brought into the fold. Well, Robert, we've covered a lot of ground here, but at the same time, there's a lot of ground to be covered. I'm sure we haven't covered all the issues that you have thought about and spoke about and written about. So, I would like to set up another show where we could continue this discussion, and I'm sure it will continue to be relevant in the weeks going forward. But before we close today, I'd like you to try to summarize from the four corners of this discussion, what advice, what comment, what summary point or points you would leave with our audience about how history has helped, could help, will help, might help in dealing with pandemics of this nature in the future. Well, one of the things that we learned from history is that they're always, you're always gonna have a segment of people who don't react to the facts. Another thing that we're gonna, and we have to figure out how to deal with that, which is education and persuasion. The other thing that we are gonna find is that people are always behind in these epidemic curves, and we need to get out ahead of it. So I urge, I'd like to start in terms of Hawaii, urge Governor E. Gay to put in passport vaccinations. Don't let anyone go to a restaurant without being vaccinated. I'd like to urge that we start getting the booster shots sooner rather than later. I would like to urge social distancing. And also this is gonna get a lot worse. It's clear from all the evidence that Hawaii and then the United States, we're working into a storm in the next four to six weeks. People don't realize it. And so go out, get vaccinated, go out and get your booster shot. And what is your advice to the anti-vaxxers who are hardcore refusing, protesting against vaccines? I think to the hardcore, they should be not allowed to infect other people. That means they shouldn't be allowed into grocery stores, into movie theaters, into schools. They should be kept away from the rest of us because they're endangering us. Thank you. Professor Robert Littman of History of Archeology at UH Manoa for many, many years. It's great to have you on the show. You're a, what shall I say? May I say this? You're an historic treasure, Robert. Thank you very much for coming around. Thank you, very welcome. I look forward to coming again. Aloha. Aloha.