by Karyn Pomerantz, 6-4-2022
Imagine this scenario:
- Disease outbreak blamed on Chinese
- Physicians coverup cases in white areas
- Business needs outweighed health protection
- Denial of healthcare to Chinese workers creates distrust of physicians and public health officers
- No cure existed
- It took years to find the zoonotic cause and control transmission
No, it’s not Covid. It is the bubonic plague that appeared in San Francisco in 1901. The Plague at the Golden Gate, a documentary produced by PBS, portrays the desperate search for the cause of the rapid deaths among Chinese residents crammed into a crowded neighborhood known as Chinatown. Out of 120 plague stricken people, 119 died. The handling of the outbreak holds lessons for public health workers, government officials, and the public today.
Public Health Under Attack: Denying Disease-Protecting Business
The Public Health Quarantine Chief, Joseph J. Kinyoun, raised the alarm that plague was the killer of those with the buboes, a tell-tale sign of bubonic plague. Later, he acquired laboratory evidence of the plague’s presence. He ordered a brief quarantine patrolled by aggressive police that blocked off the entire Chinatown area of 12 blocks where 25,000 to 35,000 lived. White mobs gathered outside to make sure nobody left. The city prohibited Chinese workers from leaving the city but allowed all others to travel; Kinyoun did not investigate any white neighborhoods, where white doctors attributed plague symptoms to pneumonia.
Kinyoun’s actions raised the ire of the state and city bosses who understood how business would suffer; they defamed his work and dragged him to court until the federal government replaced him. San Francisco had a large, profitable port used by many Asian businesses whose ships transported goods along with hundreds of rats that carried the fleas loaded with the killer bacteria. Despite verification of plague and rats as the causes of death, California Governor Henry Gage denied its existence to protect the railroad and business interests that enriched him.
Chinese Workers Protest the Quarantine: Individual Rights vs Community Safety?
While isolation of sick individuals makes sense, the public health officers handled this in an autocratic, repressive way (“policing the sick”) without considering the needs of the residents. In response, they hid their sick friends from quarantine and demanded rights to travel; the courts eventually ruled in their favor. Similar conflicts over the individual vs the public good occur today with Covid precautions and with HIV over naming names for contact tracing. Mistrust of public health drives these individual rights perspectives; many have good reasons and experiences for suspicion. With politics embedded in public health decisions today, we see the CDC bowing to business demands to open the economy and politicians relaxing mask mandates while new variants disable and kill seniors and others at risk.
Racism and Stigma Spread Disease
Marginalization, stigma, and racism drive resistance to healthcare and public health recommendations. Residents of Chinatown lived in crowded, segregated, deplorable housing without ventilation or repairs. Workers rotated beds according to their work schedules that entailed long hours in the laundries and restaurants. Government policies denied them employment elsewhere and excluded them from hospitals and healthcare. They, therefore, relied on indigenous remedies, increasing their distrust of “western” medicine.
Chinese workers, however, were not excluded from exploitation as workers. The robber barons building the transcontinental railroad at the end of the 19th Century employed 10,000 Chinese men at low wages ($26 per month) and long hours (from 5am to 7pm). It was brutal work as the workers had to blast their way through the mountains of the West. It left anywhere from 50 to 1200 dead from falls, explosions, and accidents (the RRs did not keep records). Once the RR opened for business, the Chinese workers moved to San Francisco where white workers saw them as competitors especially with the earlier discovery of gold. White men rioted and assaulted Chinese people, burning their businesses and cutting their long hair. No longer needing Chinese laborers, the government passed the Chinese Exclusion Act of 1882 that prohibited immigration from China until 1943, including the wives and families of the current residents. In 1875, the Page Act prohibited Chinese women from immigrating, separating families and making the Chinese population 90% male (see https://multiracialunity.org/2019/03/01/anti-asian-racism-another-american-tale/ for detailed history). These laws allow immigration when employers needed more low paid workers, such as the bracero program that used Mexican workers to harvest food.
Public health officer, Dr. Rupert Blue replaced Kenyoun in 1903 and changed the approach to epidemic control. He and his linguistic and cultural translator, Wong Chung, walked around Chinatown to develop relationships with the residents, and placed his lab and morgue there. He quarantined families of patients, not entire blocks. In contrast, Kenyoun only entered the neighborhoods with armed guards. This more humane outreach succeeded in meeting the sick people who required isolation and care.
Blue also implemented structural changes to attenuate transmission, such as cleaning out trash and disinfecting housing. Knowing that rats found nesting places in Chinatown’s wooden sidewalks, he ordered construction of cement sidewalks.
Nonetheless, the death rate among poor and immigrant people far exceeded that of white, higher income people, like the disproportionate death rates with Covid. These interventions did not change the disproportionate death rates of Chinese and other immigrants in San Francisco. Nor did it end the racism and marginalization of Chinese people. Media created propaganda that portrayed Asians as foreign, unclean, and threats to white job seekers. Decades later, Trump labeled Covid as the “Chinese flu” and accused Chinese scientists of creating Covid. These racist messages persist today and allow the US government to stigmatize China as an imperialist rival that requires US military operations in the South China Sea and eventually war.
The control of TB also echoes the problems of the plague and Covid outbreaks. While TB affected people of all backgrounds and social classes, the alleviation of symptoms only minimized the suffering of the wealthier. PBS’ The Forgotten Plague describes the scourge of the epidemic that killed one out of seven people who ever lived. No cause or cure existed for centuries. Books, movies, and operas starred people with TB, known as consumption, such as La Traviata based on the Dumas book, Camille.
TB and Covid Control: Public Health vs Business Needs
Once doctors identified fresh air as a cure before the discovery of antibiotics, states built sanitoriums to house people with TB. One out of 170 people lived in them, some for many years who described it as a “life of exile.” Crowded in large wards, segregated by race, patients spent hours outside and followed strict orders about food (6 raw eggs a day).
As with Covid and plague, individual preferences vs. disease control characterized the political environment. Today, people in the US dispute the need to wear masks and the number of days to isolate. Politics trump public health due to capitalism’s need to maintain the growth of the economy. As new, more contagious variants emerged, the CDC serves the needs of capitalism, reducing the number of days to quarantine while state and local governments reduce masking laws. Meanwhile, Covid attacks seniors, people with disabling conditions, and black and Latin families who suffer much higher rates of severe disease, hospitalizations, and death due to their medical histories and exploitation as essential workers. Immigrant patients also have disproportionate rates of disease, often due to crowded living conditions where quarantine is impossible and jobs that increase the risk of contact with Covid. The detention and deportation of undocumented workers increase the fear and reluctance of immigrants to seek care again.
These films offer lessons on disease control that are still ignored today. Implementing policies to control outbreaks must include equitable detection and care, compassion, mental health treatment, and economic support, such as payments and delivery of food and medications. Labeling people as disease vectors can induce trauma and encourage people to hide their health status, thus endangering their own lives and public welfare.
I highly recommend these films for public health students and practitioners as well as the public. Films on the transcontinental railroad and the Chinese Exclusion Act provide additional background to anti-Chinese racism that exploded in the murder of Asian women in Atlanta and attacks on Asian men, such as Vincent Jen Chin, killed in 1982 by 2 autoworkers who accused Asians of causing auto worker layoffs. As history shows, we can’t vote or organize ourselves out of the diseases often caused by and worsened by capitalist trade and production, but we can overcome the racism that divides us so we can strengthen our class and prepare to take over.
Quoting a well-loved chant: Asian, Latin, black, red, white; workers of the world unite!