April 2, 2020

Back to the Pump~Dr.John Snow, Cholera, COVID-19, & Why This Matters


Medical Health Officer for British Columbia Dr. Bonnie Henry provides daily briefings on  the Covid-19 pandemic, its impact on British Columbia and what we can do to “flatten the curve” of infection.

In looking at lessening the  pandemic, Dr. Henry is “getting back to the pump” which is an expression used in public health to describe the work of Dr. John Snow.  Dr. Snow is  often called the father of epidemiology, which is the  study of disease incidence and control.

In 1854 Dr. Snow who was a London physician used geographical co-ordinates to figure out where cholera, which was infecting and killing people in the Broad Street area of  Soho London, was coming from. He traced the disease to  a public water pump on the street. By removing the handle of the pump, and asking patients to wash hands and practice good hygiene the infected water was not consumed and the cholera cases diminished.

Dr. Snow had plotted the domiciles of the people who were infected and were dying looking for patterns and connections. What he found is that all the cholera infected had been drinking water from this one well, which was not very deep and which had been contaminated.

The action of removing the handle of the pump was controversial at the time when it was assumed that disease was airborne, and found in bad scents. By using meticulous locational analysis and a “simple and direct” action, Dr. Snow stopped the deaths and saved lives.

It was this same methodical approach that made the difference in the 1918 Spanish Flu epidemic that infected 27 percent of the world’s population.I have written about  how New York City had lower death rates than other cities by instituting four important principles. The City had a “robust” and organized public health infrastructure, the healthy were distanced from the infected, a  citywide public health campaign was launched, and disease surveillance was implemented.

One hundred and two years later  with a pandemic of a virus where there is no vaccine the advice is similar.  Physical distancing,  isolation, hand washing, a robust public health campaign and tracking of disease is paramount.

Dr. Snow had recommended handwashing and hygiene almost 170 years ago to prevent cholera. Even today epidemiologists have estimated that handwashing with soap can reduce diarrhoea by 47 percent and save one million lives in third world countries.

But you can look to the first world too about the need for better handwashing. In a study done in the United Kingdom in gas stations, sensors indicated that only 64 percent of women and 32 percent of men were washing hands with soap. That  indicates  that even with the knowledge of what to do, that failed in practice.

You can view this HarvardX YouTube video below that details London’s 1854 Cholera Outbreak and how Dr. John Snow’s epidemiological work saved the lives of many.



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