The Fever Shed: COVID-19 and the Dominion of Presentism

Clinging to the coast of Kyushu, in western Japan’s Fukuoka Prefecture, is the charming city of Fukutsu, home to such curiosities as a gargantuan five-ton rope talisman lashed to the Miyajidake Shrine, and a crowd-pleasing statue of a wave-surfing rabbit situated on the grounds of the Namiori Shrine. The former is thought to ward off disease while separating the sacred from the profane, never a bad idea, while the latter, installed in 1866, evokes the Japanese myth of the Hare of Inaba. Following the travails of a god who took the form of a hare, only to be mauled by sharks while swimming from the Island of Oki to the Hakuto Coast, the tale is to be found in the Kojiki, Japan’s oldest extant literary document. After washing ashore in a pitiable state, it was said that the hare stumbled upon Ōnamuchi-no-kami and his eighty older brothers. While the senior siblings cruelly urged the hare to bathe in briny ocean water and dry itself in the coarse wind, Ōnamuchi took pity and bade the creature wash itself in the mouth of a river and roll amidst the spongy, pollen-laden cattails. This act of beneficence towards the disguised god earned Ōnamuchi the hand of Princess Yakami of Inaba, and in time he would come to be known as the Shinto deity Ōkuninushi, ruler of the unseen world and patron deity of farming, nation-building, medicine and business—quite a portfolio.

This essay appears in May’s Quadrant.
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It is generally understood that the story of the Hare of Inaba is that of an early clash between barbarism and civilisation, but it also speaks to a keen awareness of the diverse facets of the natural world. Sometimes a source of peril, and sometimes a salve, nature gives and takes in equal measure, according to the dictates of the kami (if you are of the Shinto persuasion), or of the laws of biology, thermodynamics, and so forth (should you be of an unimaginatively scientific bent). The Japanese, situated as they are on the Pacific Ring of Fire, have long understood this. In the city of Fukutsu, the all-pervading struggle against nature has not always been an existential one—at least when compared to the usual tsunamis, earthquakes and mudslides—but it has proven vexing all the same. Until 2007, the Kamisaigo River that runs through Fukutsu’s downtown proved an unceasing source of trouble for the townsfolk. Canalised, bound by ugly concrete banks, devoid of wildlife, and altogether prone to flooding, the Kamisaigo served as a textbook example of the challenges inherent in mankind’s quest to tame the waters and subjugate nature.

In a bid to put an end to endemic flooding from river overflows once and for all, the city undertook a restoration project in conjunction with a design team from Kyushu University, led by Yukihiro Shimatani of the Laboratory of Hydrosphere Sustainability Engineering. After consulting local residents, the team worked to return the Kamisaigo to its original state as a countryside stream, removing the unsightly concrete revetments, doubling the span of the river, removing dams, rehabilitating pool and riffle habitats, and adding rock weirs and logs to facilitate the formation of eddies and verges, thereby creating a habitat fit for the Hare of Inaba’s ablutions. The project was not finished until 2013, but the results were worth the wait. “Old designs,” as Shimatani put it, “focused on human intentions. This one was natural. You can’t control a river. But you can recreate a natural environment for wildlife.”

By accepting nature’s vagaries, the city found itself with a new source of civic pride, a lush park in which children can hike, play and catch loaches, and a downtown far less prone to flooding. And by replacing brutalist revetments with lovely stone embankments, narrow constraints with generous proportions, and a sterile environment with a verdant landscape, the people of Fukutsu exposed a great many of modernity’s flaws.

G.K. Chesterton, in his 1931 essay “Holding on to Romanticism”, lamented:

The modern world seems to have no notion of preserving different things side by side, of allowing its proper and proportionate place to each, of saving the whole varied heritage of culture. It has no notion except that of simplifying something by destroying nearly everything.

The “simplification” of the Kamisaigo River via canalisation, one notes with interest, served only to expose the city to the constant risk of destruction. “Old designs,” by which Yukihiro Shimatani actually meant modern designs, focused on “human intentions” without realising that nature itself has no interest whatsoever in human intentions and designs. It is this larger lesson that we are realising as we try to adapt and survive in the face of the plague which has emerged from China’s Hubei Province, and as we face what Nicolas Hulot has rightly called “une sorte d’ultimatum de la nature”.

The lessons from the Kamisaigo restoration have only a tangential bearing on the current crisis, admittedly, but the notion of operating in conjunction with, rather than directly in opposition to, the forces of nature is rapidly becoming a matter of the utmost importance. I am in turn reminded of an extraordinary building erected by the University of Michigan back in 1914—the twenty-four-bed Contagious Hospital, which was of a design so clever that it could only have been produced in the past. After the smallpox epidemic of 1908 struck Ann Arbor, the city offered to provide funds with which to construct a hospital for the plague-stricken, so long as the university there provided the land and staff. As Dr Reuben Peterson observed in a May 1914 article for Transactions of the Clinical Society of the University of Michigan, the city “has found it a very expensive proposition to care for its contagious patients”, while:

the University has been in even a worse condition as regards contagious disease. House quarantining of students not only was ineffective but meant great loss to the student and the University. The University Hospital at times has suffered a great deal from different contagious epidemics which on a number of occasions has led to the quarantining for months of certain portions of the hospital.

Given the increasing awareness of the efficacy of the aseptic technique, and the novel realisation that, as Dr David Cowie wrote, “the very great majority of contagious and infectious diseases are communicated from one individual to another, or from one place to another, by means of direct or indirect contact. In other words, the infected person has come either in direct contact with the patient or with something that has, directly or indirectly, touched him,” the Contagious Hospital was designed accordingly. Resembling a pleasant bungalow, with each room given plenty of access to natural light and fresh air, the structure more importantly:

had an ingenious design, created entirely for infection prevention. Each room held two patients, and had two doors: one that opened into a central hallway, for doctors, nurses, cleaning staff and medical trainees to pass through, and one that opened onto a porch that wrapped around the entire building. The porch door allowed the patient’s bed to be wheeled through without passing other patients when they entered or left the hospital. It also allowed them to be taken out on the porch for some fresh air, which was considered to have healing properties. And large windows allowed medical students to stand on the porch as their professors discussed the care inside.

Upon the completion of the structure, Dr Peterson expressed confidence that “all patients, whether they be university students, city charges, or citizens of Ann Arbor, will be treated alike and that the administrative policy of this new pavilion will be satisfactory to all concerned”.

The proof of the pudding would be found in the eating, of course, and the facility was quickly tested by everything from measles and mumps to diphtheria and tuberculosis. The establishment was particularly well-timed, given that the Spanish flu arrived in Ann Arbor only a few years later, on September 23, 1918. A 1919 report to the University of Michigan Board of Regents testified to the value of the Contagious Hospital, finding as it did that only five students had perished of influenza, even though the disease, with its attendant cytokine storm, inflicted its highest rate of mortality on young adults. Thus did this early evidence-based facility, which differed so much in aesthetics and layout from the hospitals before its time and even of today, earn its place in the annals of Western medicine.

The landscapes of the past were once dotted with lazarettos, fever sheds, pesthouses, plague houses, and, unfortunately, plague pits and waste ponds for the rapid disposal of victims. These of course no longer exist, though the jury-rigged hospitals in China and the US Navy hospital ships dispatched to Los Angeles and New York City are now serving a similar function. Indeed we find ourselves unexpectedly in need of buildings “created entirely for infection prevention”, with the average modern hospital seldom fitting the bill. An important March 21 article written by clinicians in hard-hit Bergamo, Italy, “At the Epicenter of the COVID-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation”, argued that “Western health care systems have been built around the concept of patient-centered care, but an epidemic requires a change of perspective toward a concept of community-centered care.” The authors likewise observed:

hospitals might be the main COVID-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.

Given that COVID-19 appears to manifest itself differently depending on the level of viral load, and appears to be a disease that thrives inordinately on population density—though microbiologists and epidemiologists will naturally have the last word on the specifics of the virus and its spread—the importance of keeping hospitals from being overwhelmed for the sake of the infected, the uninfected, health workers, visiting priests and family members is obviously critical. Regrettably, the nature of our health system and even the physical layout of most hospitals make this a positively herculean task. Footage of, for instance, Spanish victims of the coronavirus lying in hospital hallways, coughing and groaning, and potentially infecting and re-infecting any and all who pass by, amply demonstrates the wisdom of Drs Cowie and Peterson, and all those responsible for the marvel that was the Contagious Hospital. Somewhere along the line, the hard-won wisdom of previous generations—hamstrung as they were by limited knowledge of infectious diseases and even more limited anti-bacterial and anti-viral resources—seems to have been lost.

One of the hallmarks of our modern civilisation is the self-soothing conceit that we somehow exist outside the broader course of nature and history, our society’s predilection for virtue-signalling in the form of ersatz environmentalism and historical grievance-mongering notwithstanding. Consider Francis Fukuyama’s 2006 afterword to his 1992 book The End of History and the Last Man, that book which notoriously identified “the end-point of mankind’s ideological evolution and the universalization of Western liberal democracy as the final form of human government”, a theory which is not exactly being borne out by the socio-political data furnished by our own era. Reflecting on subsequent developments, Fukuyama held that:

There is thus a twofold agenda that faces us. In the developed world, Europe faces a major crisis in its welfare state over the coming generations of declining population and unaffordable entitlements and regulation. But in the developing world, there is an absence of stateness that prevents economic development and that serves as a breeding ground for a host of problems such as refugees, disease, and terrorism. Consequently there are very different agendas in the two parts of the world: to cut back the scope of the state in the developed world, but to strengthen the state in many parts of the developing world.

None of his observations here are wholly misguided, at least from the bog-standard liberal perspective. But there is a suggestion that disease is a problem specific to the developing world, even though he was writing in the immediate aftermath of the SARS outbreak that originated in Foshan, China, but ominously spread internationally, albeit with a relatively small number of deaths (774 or so). There is also a lack of awareness that problems originating in the developing world invariably become those of the developed world, particularly when the states that comprise the latter similarly lack the “stateness” required to combat, or at the very least shield themselves from, global threats.

It is, in the end, rather more comforting to avert one’s gaze from the lessons of history than to heed them. One of the most important of these lessons, as expounded upon by the brilliant Hans Zinsser in Rats, Lice, and History (1934), is:

Swords and lances, arrows, machine guns, and even high explosives have had far less power over the fates of nations than the typhus louse, the plague flea, and the yellow-fever mosquito. Civilizations have retreated from the plasmodium of malaria, and armies have crumbled into rabbles under the onslaught of cholera spirilla, or of dysentery and typhoid bacilli. Huge areas have been devastated by the trypanosome that travels on the wings of the tsetse fly, and generations have been harassed by the syphilis of the courtier. War and conquest and that herd existence which is an accompaniment of what we call civilization have merely set the stage for these more powerful agents of human tragedy.

We have been thrown back into history, and must again consider the implications of epidemics on internal politics and geopolitics, from the Plague of Athens onwards. Recall Thucydides’s vivid description of the effect of the plague on the first democracy, during which:

among other things which they remembered in their distress was, very naturally, the following verse which the old men said had long ago been uttered: “A Dorian war shall come and with it death.” So a dispute arose as to whether dearth and not death had not been the word in the verse; but at the present juncture, it was of course decided in favour of the latter; for the people made their recollection fit in with their sufferings.

We are learning, of course, that “dearth” and “death” are not mutually exclusive.

More and more we are obliged to consider the relatively successful approaches to Spanish flu adopted in places as far-flung as American Samoa, St Louis, and Gunnison, Colorado, as well as the unsuccessful efforts in places like Western Samoa and Philadelphia. We are forced to look at Dr John Snow’s efforts to combat cholera in mid-nineteenth-century Soho, and the botched approach to that same disease in 1892 Hamburg. We must grapple with what Steven Johnson, in The Ghost Map, called our “conversion to a city-planet” and its implications for public health, given that “traditional bombs obviously grow more deadly as the populations they target increase in size, but the upward slope in that case is linear. With epidemics, the deadliness grows exponentially.” Historians and archaeologists have long known that cities are traditionally massive mortality sinks. Advances in modern medicine and hygiene gave those like Jane Jacobs, writing in The Death and Life of Great American Cities, cause to believe that, contrary to the historical record, cities might serve as “great disease conquerors”, but it is much more likely that the diseases were merely taking the age-old approach of reculer pour mieux sauter.

Historical ignorance has allowed us the freedom to engage in pure folly, for example the inexcusable failure of the United States to substantially replenish its strategic stockpile of face masks after the H1N1 influenza pandemic of 2009, or the willingness to almost wholly outsource the manufacture of vital medicine and medical supplies to a strategic rival. At the same time, historical ignorance has created a citizenry with no frame of reference for the pandemics of the past, like the Spanish flu that infected as many as 500 million worldwide (killing roughly a tenth of that number), the 1957-58 H2N2 pandemic that took 1.1 million lives worldwide, the 1968 H3N2 pandemic that killed another million, and a myriad of other pandemics throughout time. Even the 2009 swine flu pandemic killed somewhere between 150,000 to 575,000, while an average flu year on its own produces 290,000 to 650,000 deaths globally. These numbers have hardly been mentioned during the coverage of COVID-19, though they would provide valuable context for policy-makers and those frightened members of the populace who have (by definition) lived through these grim events.

Archaeologists are fond of utilising the concept of systems collapse to explain civilisational catastrophes and anastrophes, and we are witnessing just such an event, one which has, according to the French journalist Renaud Girard, “mis en lumière la faillite de trois idéologies: le communisme, l’européisme, le mondialisme [brought to light the bankruptcy of three ideologies: communism, Europeanism, and globalism]”, amongst other public and private institutions. If this is the result of “the final form of human government” then I suspect a great many people will be looking to go back to the drawing board. Whether the world that emerges from the rubble is characterised by the sort of post-liberalism espoused by UnHerd’s Peter Franklin—with its short supply chains, radical localism and “deep optionality”—or whether it will be marked by an increased reliance on the dystopian Leviathan owing to mass panic and unemployment, time will tell. And all this because of that microscopic, crown-shaped, positive-sense single-stranded RNA virus we now call SARS-CoV-2. One begins to understand the original meaning of the Chinese word for crisis, wēijī, the “danger at a point of juncture”.

How did we arrive at such a momentous juncture? How could policy-makers have been so unprepared for nature’s ultimatum? The aforementioned twentieth-century pandemics, even the most fatal of them, did not produce such a profound societal bouleversement as the Wuhan coronavirus has managed in a matter of weeks. It is clear that the virus encountered a global system anything but anti-fragile in terms of political cohesion and institutional infrastructure, but there must be something more deep-seated at work, something inherent in modernity itself. The neo-Kantian sociologist Georg Simmel, in his treatment of fin de siècle civilisation, identified a phenomenon we can all recognise: “the temporal dissolution of everything substantial, absolute and eternal into the flow of things, into historical mutability, into merely psychological reality”. In his 1900 masterpiece The Philosophy of Money, Simmel further noted:

We are supposed to treat life as if each of its moments were a final purpose; every moment is supposed to be taken to be so important as if life existed for its sake. At the same time, we are supposed to live as if none of its moments were final, as if our sense of value did not stop with any moment and each should be a transitional point and a means to higher and higher stages.

Collective cognitive dissonance is only natural, particularly when we have been further subjected to “an extreme acceleration in the pace of life, a feverish commotion and compression of its fluctuations, in which the specific influence of money upon the course of psychological life becomes most clearly discernible”. And that was in 1900—imagine the effects of twelve more decades of progress. As Lawrence Scaff elaborated in his valuable 2005 article “The Mind of the Modernist: Simmel on Time”:

the dominion of presentism—erasure of the past, effacement of inherited connections, domination by the immediately visible sublime—is an integral part of modernity, an essential feature of “lived experience” under modern conditions.

Modernism is all about the eternal present, and a desperate adherence to whatever the latest form of enlightenment happens to be, as opposed to Chesterton’s proper and proportionate society dedicated to “a long historical view and a patient political experience”. Modernism has given us brutalist, canalised, flood-prone rivers, and brutalist hospitals with recycled air and recycled cross-infections. We have chosen the brine and the dusty wind, instead of fresh water and cattails. Is it any wonder our flesh has been flayed? As tens and even hundreds of millions of people languish in quarantine, in twenty-first-century fever sheds, it is just possible that we are gradually shedding the fever of modernism, that “feverish commotion and compression” that has left us unexpectedly vulnerable to the return of history, and to those eternal agents of human tragedy which dwell not in the gun barrel or the smokestack, but rather in the most minuscule fleck of sputum, just as they always have and always will.

Matthew Omolesky is a United States-based human rights lawyer. He wrote “Our Father Cain and the Rise and Fall of Human Rights” in the December issue.