History of epidemics in China aids prevention and control
People of Northeast China wearing masks to prevent infection from an epidemic in the late Qing Dynasty (1644–1911) Photo: FILE
Epidemics have posed a continuous challenge throughout human history. Medical advances are to a large extent the result of our constant battle against outbreaks. China’s record of epidemics has a long history. “疫,” the Chinese character of “epidemic,” was found in the oracle bone inscriptions of the Shang Dynasty (c. 1600–1046 BCE). Around the Qin and Han dynasties (221 BCE–220), there appeared discussions on the relationship between epidemics and natural environmental factors, including flora and fauna and climate in The Classic of Mountains and Seas, the earliest surviving geographical work in China, and Huangdi Neijing, an ancient Chinese medical text that has been treated as the fundamental doctrinal source for traditional Chinese medicine.
Development process
As an agricultural country since ancient times with a high population density, China has been an easy target for epidemics. As they suffered from outbreaks of disease, ancient Chinese recorded their experiences in biographical history books, local chronicles, memoirs, archives, anthologies, medical cases, and newspapers and periodicals, all of which serve as rich resources and pertinent warnings for future generations. After more than 20 years of effort by my team, in December 2019 we published Collected Historical Documents of Epidemics in China Over Three Millennia, a project which comprises five volumes and over 2,800,000 characters.
According to our research, during the 2,720 years that ranged from the beginning of the Spring and Autumn Period in 770 BCE to the founding of the People’s Republic of China in 1949, at least 893 years saw epidemics, with an average occurrence rate of 32.8%. From the Spring and Autumn Period to the Han Dynasty that ranged from 771 BCE to 220, it had an occurrence rate of 5.7%. With an occurrence rate of 21%, the time spanning the Wei, Jin, Northern and Southern dynasties (220–581) was the first peak period for epidemics in Chinese history. The epidemic occurrence rate of 12.4% during the Sui, Tang and Five dynasties (581–960) represented a time of relatively low frequency. Furthermore, the Northern Song Dynasty (960–1127) witnessed an increase to 35.1%, the Southern Song Dynasty (1127–1279) 53.3%, the Yuan Dynasty (1279–1368) 57.8%, the Ming Dynasty (1368–1644) 78.3%, the Qing Dynasty (1644–1911) 98.5%, and the Republic era (1912–1949) a rate of 100%. It can be seen that since the Northern Song Dynasty, the occurrence rate of epidemics has kept rising and roaring. This long period was the second peak period of epidemics in Chinese history. Over the past three millennia, the overall trend of epidemics in China has shown increasing frequency.
Features
The occurrence of an epidemic is related not only to human activity but also to the natural environment, restricted by both social laws and natural laws. As such, the occurrence of an epidemic is both a socio-cultural and natural-ecological phenomenon.
From the perspective of social law, the scale of an epidemic is closely related to the demographic situation. An epidemic usually spreads in areas neighboring the epicenter through close contact, and the scale depends on the population density of the stricken area. As the population density rises and the population mobility increases, the frequency of epidemics has increased higher than ever before, and the typical duration has also extended each time. Second, the intensity of an epidemic is strongly linked to the degree of intensity of human interference with nature. In Chinese history, with human activity increasingly disturbing natural environments, both the species and pathogenicity of epidemics increased, such as a smallpox epidemic in the Eastern Jin Dynasty (317–420), the plague in the Southern Song Dynasty, and cholera in the Qing Dynasty.
From the perspective of natural law, large climatic variations and frequent natural disasters in cold periods lead to relatively frequent epidemics. Relatively stable climate and fewer natural disasters in warm periods lead to relatively fewer epidemics. Second, muggy weather helps aggravate the spread of some contagions, while cold and dry weather does the contrary. As such, there are usually more epidemics in summer and autumn but less epidemics in spring and winter. Third, the spatial distribution of epidemics is restricted by local ecological environments.
South China is relatively warm and humid, while North China is relatively cold and dry, so epidemics usually happen more in the South. A disease with a natural focus has an obvious endemicity, such as plague and schistosomiasis. Some pathogens survive only under relatively strict ecological environments, so epidemics caused by them also have certain endemicity, such as malaria, kala-azar and cholera. Lifestyles and customs are products of humanity’s long-term adjustment to natural ecology, and their impact on the spatial distribution of epidemics also reflects the forces of natural laws. For example, the lifestyles of people who lived in the Yangtze River Delta in the late Qing and Republic era encouraged outbreaks of cholera each year. Restricted by social and natural laws, epidemics in Chinese history have distinct features of spatial distribution: increased occurrence in densely-populated areas over sparsely-populated areas; increased occurrence in urban areas over rural areas; increased occurrence along traffic lines over remote regions; increased occurrence in areas with frequent natural disasters over those with fewer natural disasters; and increased occurrence in natural epidemic focuses.
Suggestions
The history of epidemics in China offers us useful experience in preventing and controlling contemporary public health emergencies. At present, it is suggested that the COVID-19 in China be prevented and controlled in the following ways.
First, special emphasis should be put on urban areas with high population density and great population mobility. If population density is known as the “starter” in an epidemic, population mobility could be regarded as the “fuel.” Considering this, we should gather up resources and intensify prevention and control in key cities.
Second, the regulation of population mobility should be strengthened across all transport lines to enhance the quarantine effect. It should be noted that the ultimate goal of traffic regulation is to control population mobility instead of the regulation of vehicles and transport lines themselves. The action of damaging roads arbitrarily in some places to obstruct traffic should be stopped.
Third, we should recognize epidemics such as the COVID-19 as a kind of major disaster; include it in the scope of the duties of the Ministry of Emergency Management and establish a material reserve for epidemic response. Just like building a material reserve to respond to unexpected earthquakes, medical materials such as masks, goggles and protective clothing should be reserved in advance to cope with potential epidemics. The SARS epidemic in 2003 helped improve the disease control and prevention system in China. It is hoped that after the cessation of the COVID-19, a long-term effective mechanism for possible epidemics will be established, allowing every infected person to receive treatment in time.
Fourth, we should accelerate the amending of the Law of the People’s Republic of China on the Protection of Wildlife and enact stricter regulations and punishments within the catering industry engaged in illegal wildlife trading. History proves once again that to protect wildlife is to protect ourselves.
Fifth, we should properly channel public sentiment. Also, we should ensure that the public has access to true and timely information on the epidemic situation.
Sixth, we should build large-scale health centers for special use to prevent general hospitals from becoming sources of transmission. As makeshift hospitals for COVID-19 patients, Wuhan’s Huoshenshan Hospital and Leishenshan Hospital play a critical role in preventing and controlling the disease. Given that they are not built for permanent use, it is suggested that after its cessation, the Wuhan government should renovate and preserve these two hospitals to meet potential unexpected future requirements. Meanwhile, each provincial capital city should also build a medical center with a capacity of one bed for every 10,000 residents, ensuring that every infected patient can receive timely treatment.
Gong Shengsheng is a professor from the College of Urban and Environmental Sciences at Central China Normal University.
edited by MA YUHONG
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