President Trump has a bad case of Semmelweis Reflex. Here’s what that means

It was nice when we looked back at pandemics and thought science had put them in the past. American California was born during a 14-year cholera pandemic, as the disease spread through Europe, New York, the Midwest, back to New York and Europe, then out West with the Forty-Niners. It came to San Luis Obispo, leaving “scattered graves in many directions” (as Walter Murray first saw our town). It came back in 1852 and wiped out almost all the Chumash.

What science has put in the past is wild guesses about cause and prevention. For most of the last 2,000 years, people thought diseases like cholera were spread by miasmas. Avoid miasmas — bad air (mal aria in Italian) — and you’d be OK. Fortunately, that encouraged people to avoid sewage, swamps and spoilage. But viruses, bacteria and parasites pass in ways you can’t smell or see.

Two years after SLO’s second cholera epidemic, John Snow, a London surgeon who thought a diarrheal disease more likely to be spread by water than miasma, mapped a cholera outbreak, tracing it to a water pump next to a cesspool, thus founding modern epidemiology. Officials removed the pump handle. As soon as the outbreak diminished they put it back, thus founding political denial in the face of epidemiology.

That’s called the Semmelweis Reflex — a refusal to believe new scientific data that contradict old routines. Ignaz Semmelweis, an obstetrician, stumbled on randomized clinical trials in 1846 by overseeing two clinics in Vienna admitting on alternate days. One had a high mortality rate, the other a low one. The healthy clinic trained midwives; the unhealthy one, doctors, who came straight from autopsies. Semmelweis had the doctors sterilize their hands; the death rate plummeted. But other doctors refused to believe they’d been doing anything wrong. Semmelweis got so exasperated, his colleagues locked him in a mental institution. He died two weeks later of blood poisoning.

Neither Snow nor Semmelweis knew why cholera or puerperal fever made people sick, just how to stop them spreading. It took 300 years from Antonie van Leeuwenhoek seeing microorganisms with a microscope to Louis Pasteur figuring out what microorganisms were up to. At last it was clear the problem wasn’t smell but germs. Not mal aria in swamps but malaria parasite in mosquitoes.

One problem solved. The other is the Semmelweis Reflex. Right now the biggest Semmelweis reflex is coming from the president of the United States. Huge.

A coronavirus with an exponential infection rate and startling mortality has disrupted our social, political and economic routines. But the notion that fighting a pandemic and saving the economy are contradictions is nonsense. They’re the same thing. Dead people don’t shop.

Neither do fearful people. Coronavirus has killed, as I write, 0.02% of Italians, rising 10% each day, even with universal medical care and a nationwide lockdown — neither of which the U.S. has. The 200,000 deaths floated by the White House “if we do things perfectly” is 0.06%. But the White House isn’t doing things perfectly, with no national or international planning or coordination and the president floating one attention-grabber after another. “King Cholera” scarred the psyche, not to mention economy, of the 19th century with 0.2% deaths of total population, two per thousand — what epidemiologists estimate for unchecked COVID-19.

You can look at SLO County’s small number of confirmed coronavirus cases and think we’re one of Trump’s “not so affected” areas. For weeks people told me (as I refused shaking hands) “it’s not here.” Testing wasn’t here; the virus was. Confirmed cases are rising exponentially, 20-30% per day. Compared to population, our known infections put us among Bay Area rates, dramatically worse than L.A. Look at infections per population and exponential increase, and every spot’s a hotspot.

We distanced late but quickly in San Luis. Business people — and their employees — with vast financial pressure have still done the right thing. But with presidential dithering, dishonesty and denial, inconsistent lockdowns will keep coronavirus caroming from one community, state and nation to another — like cholera in the 19th century. We can think locally; we have to act globally.

Tribune columnist James Papp is an architectural historian, co-owner of heritage tourism company SLO Walkabout, and a member and former chair of the city of San Luis Obispo’s Cultural Heritage Committee.