Across the road from my house, there is a block of slightly taller buildings. The extra storey was for people living over the shops below: a butcher, a grocer, a hairdresser. But the house that directly faces me has an extra layer on top of that again. It now looks super-cool. The unit has been converted into expensive flats and this eyrie has a curved glass front giving on to a balcony with, I imagine, lovely views across the city to the mountains.
It wasn't just coughs and sneezes that spread diseases – it was poverty and squalor
When we moved in 30 years ago, this top floor was starker, less sophisticated. The glass panes formed a translucent wall through which the sun must have flooded. It could have been an artist’s studio. Except everyone knew it wasn’t. It was a TB room. When the block was built in the early 1930s, this was the best you could do for someone (a relatively privileged someone) with tuberculosis: isolate them so the rest of the family didn’t get the disease and expose them to the healing properties of sunlight. That family was gone and I never knew what happened to the patient. The curse of TB was long banished. But I still didn’t need to be told what that glass-fronted crow’s nest signified.
I grew up in a world alive with airborne contagion. The signs on the bus said “Please do not expectorate” and I can’t remember a time when I did not know that “expectorate” meant “spit”. We knew “coughs and sneezes spread diseases” as well as we knew the Hail Mary. Mobile X-ray vans where you could walk in and have your chest examined for TB were parked in the city centre. There were kids in callipers and you knew that meant they had contracted polio.
We all got measles and chicken pox, and mumps and rubella were common, but sometimes a kid would disappear from the classroom and you would hear dark mutterings of more serious illnesses: diphtheria, scarlet fever, whooping cough. We knew that there was always something in the air.
This was a grim kind of awareness but it did have one advantage. It was impossible, in such a world, not to understand health as a communal concern. Illness, in the way we thought about it, was primarily something you got from somebody else. It is one of the great paradoxes of the last 200 years that this awareness drove much of the social progress that transformed lives for the better. It forced the rich to pay attention to the lives of the poor.
Of course the well-off could to some extent protect themselves from contagion and get much better treatment if they did become ill. But they had to face the reality that, for bacteria and viruses, there was no impenetrable barrier between themselves and the fetid slums. It wasn’t just coughs and sneezes that spread diseases – it was poverty and squalor.
You can't protect yourself from Covid-19 by going to the gym – it may already be there before you
This recognition led to what historians call the "great sanitary awakening" of the 19th century. It led from sewage systems to clean water, from mass inoculation to universal national health services. It led, in social democracies, to sick leave. (One of the reasons the United States will be hit so terribly by Covid-19 is that this revolution never fully took hold there: 35 million workers have no entitlement to sick pay. They will go to work because they have to and they will spread the virus.) It is impossible to disentangle social justice from hygiene.
But this tide has been ebbing. The idea of health has been privatised and commodified. Hygiene, a public good, has been replaced by lifestyle, a personal choice. It is not about collective systems and behaviours – it is about my diet, my exercise regime, my body. These are, of course, good and proper concerns: not all killer diseases are communicable. But the irony is that this shift has been made possible only by the success of the communal systems. The very effectiveness of public health programmes – notably the virtual eradication of old killer infections in the developed world – has allowed us to take them for granted. The most bizarre symptom of this complacency is the anti-vaccination movement among the privileged – only those who have no memory of the devastation of ordinary lives by TB or polio or whooping cough can indulge this egotistical hysteria.
And now we have our rude awakening. The coronavirus is not personal. You can’t protect yourself from Covid-19 by going to the gym – it may already be there before you. The Alpine ski holiday that displays your rude good health may be the vector of the infection. We are back in the universe of contagion that every generation of humanity except the very recent ones in our privileged parts of the world has inhabited. And back with a vengeance – it is not just that the well-to-do cannot seal themselves off from the poor in their own cities, they cannot seal themselves off from the poor in cities 10,000 kilometres away. We will, as a result, have to do very fast what our societies learned to do gradually in the 19th and 20th centuries: understand that none of us is safe unless all of us are safe. Health just became public again.