BY MIKE MAGEE

Epidemics don’t appear in isolation of geography, social status, race or economics.

In a recent Kaiser Family Foundation article, the authors reviewed case numbers and death rates organized by race/ethnicity. It will come as no surprise that the most vulnerable populations death rate is nearly three times greater than the least vulnerable. But what may surprise you is that the population at greatest risk was neither self-identified as Black or Hispanic, but Native American.

Sadly, this is not a new story, but in the analogs of American history, it has been papered over by a partially true, but incomplete, narrative. That storyline was largely popularized by the book, “Guns, Germs, and Steel.” Published in 1997, author Jared Diamond explained that European colonists, arriving in the Caribbean islands in the late 15th century, carried with them a variety of diseases like smallpox and measles, and transmitted them to indigenous people that had no prior exposure to these deadly microbes.

Two years ago, University of Oregon Professor of History Jeffrey Ostler recently challenged the “virgin-soil” hypothesis in an article in The Atlantic. In his words, “Although the virgin-soil-epidemic hypothesis may have been well-intentioned, its focus on the brief, if horrific, a moment of initial contact consigns disease safely to the distant past and provides colonizers with an alibi. Indigenous communities are fighting more than a virus.”

Students of American history are already more than familiar with the impact of infectious diseases on the natives of Saint-Dominique (now Haiti) in the late 18th century, but also the advance of disease northward that followed and eventually enveloped our own Native Americans. 

Best known among the documented tragedies of the 19th century is the Cherokee Trail of Tears. While immunologic susceptibility unquestionably played a role in the event, the forced expulsion of the Cherokees from Georgia, North Carolina, and Tennessee, in three phases was a complex and multi-faceted disaster.

It began with the U.S. Army destroying native homes and detaining our earliest Americans in concentration camps or holding pens for several months. Without decent shelter and sanitation, and limited food and water, disease thrived. Of the 16,000 contained, 2000 immediately perished primarily from dysentery, but also diseases like measles, whooping cough, and malaria.

Severely weakened, the forced march west that followed as a second phase, resulted in an additional 1500 deaths. Finally, the early months of relocation in Oklahoma, sacrificed an additional 500 souls. In all then, 4,000 of the original 16,000 died. 

This complex intermingling of disease and severely compromised and susceptible human hosts played out again and again in the years following the 1830 Indian Removal Act. That federal legislation directed the forced relocation of all Native peoples east of the Mississippi River to ‘Indian Territory’ – the future Oklahoma and Kansas.)

Forced migration, accompanied by exposure to the elements, malnutrition, and violent warfare attacks along the way, created a deadly brew – and that was before disease intervened. The Cherokees were not the only victims in the two decades between 1830 and 1850. A partial list of other tribes includes Creeks, Seminoles, Chickasaws, Choctaws, Senecas, Wyandots, Potawatomis, Sauks and Mesquakies, Ojibwes, Ottawas, Miamis, Kickapoos, Poncas, Modocs, Kalapuyas, and Takelmas.

The trial of the Sauks and Mesquakies from western Illinois to Oklahoma occurred in four segments, with a staggering 85% mortality rate. During their migration, dislocation, and for years after their relocation, fertility rates plummeted and maternal-infant mortality soared.

Professor Ostler does acknowledge the value of the “virgin-soil” hypothesis, but with caveats. As he wrote, “The virgin-soil-epidemic hypothesis was valuable in countering earlier theories that attributed Native American population decline to racial inferiority, but its singular emphasis on biological difference implied that population collapses were nothing more than historical accidents.” And, as is commonly claimed, “History repeats!”

Of native Americans, it has been fairly said: “They are contending with the ongoing legacy of centuries of violence and dispossession… Countering the invisibility of Native peoples, of course, means greater awareness of how COVID-19 is affecting them and enhanced efforts to provide resources to help them combat the current outbreak…”

On the broader issue of epidemics in America, past and present, it is useful to be reminded, it is as much about us as it is the about the microbes we are forced to encounter.

Mike Magee MD is a Medical Historian and the author of “CODE BLUE: Inside the Medical Industrial Complex.”