Beyond Mortality

Abstract

Epidemics and pandemics are typically discussed in terms of morbidity and mortality, susceptibility and immunity, and social responses to and impacts of the immediate epidemic event. Much less attention is paid to the longer-term consequences for individuals and populations in terms of the sequelae of infections, such as blindness after smallpox, deafness due to congenital rubella, and paralysis after polio. This same tendency is observed in the COVID-19 pandemic, with counts of cases and deaths, questions of immunity, and economic impacts at the foreground and long-term or chronic health impairment of COVID-19 survivors receiving less attention. Much of the existing research on the effects of such disease sequelae has come from disability history; in addition, the bioarchaeology of impairment/disability is an emerging area of research that can contribute insight into experiences of disease consequences. In this article, we give an overview of published work on survivors of infectious disease using both bioarchaeology and disability history. Using the example of post-polio paralysis, we propose a theoretical approach to the bioarchaeological study of infectious disease that is inclusive of the history of impairment and disability, which we refer to as a survivor lens. We structure this discussion through scaffolded questions that move through multiple levels of analysis: from the individual and relational to the drivers of cultural change. We argue that bioarchaeological research on past epidemics and pandemics that attends to morbidity and lasting impairment and disability can contribute to wider conversations about infectious disease and disability in the past and present.
 
 En général, les épidémies et les pandémies sont considérées en termes de morbidité et de mortalité, de susceptibilité et d’immunité, et de réponses sociales et d’impacts immédiats de l’événement épidémique. Moins d’attention est accordée aux conséquences à long terme pour les individus et les populations en termes de séquelles d’infections, telles que la cécité après la variole, la surdité due à la rubéole congénitale et la paralysie après la polio. Cette même tendance est observée lors de la pandémie de COVID-19. Il y a moins d’attention accordée au nombre de cas et de décès, aux questions d’immunité et d’impacts économiques au premier plan, et aux problèmes de santé à long terme ou chroniques des survivants de COVID-19 reçoivent. Une grande partie de la recherche existante sur les effets de ces séquelles de la maladie provient de la recherche sur les déficiences/handicaps. De plus, la bioarchéologie de la déficience/handicap est un domaine de recherche émergent qui peut contribuer à mieux comprendre les expériences des conséquences de maladie. Dans cet article, nous donnons un aperçu des travaux publiés sur les survivants de maladies infectieuses en utilisant à la fois la bioarchéologie et l’histoire du handicap. En utilisant l’exemple de la paralysie post-polio, nous proposons une approche théorique de l’étude bioarchéologique des maladies infectieuses qui inclut l’histoire de la déficience/handicap, que nous appelons une lentille de survivant. Nous structurons cette discussion à travers des questions échafaudées qui traversent de multiples niveaux d’analyse: de l’individu au relationnel, jusqu’au aux changements culturels. Nous soutenons que la recherche bioarchéologique sur les épidémies et pandémies historiques qui examine la morbidité et le handicap peut contribuer à des conversations plus larges sur les maladies infectieuses et le handicap au passé ainsi qu’au présent.

Compounding vulnerabilities: Syndemics and the social determinants of disease in the past

“…While Battles and Gilmour (2022) and Franklin and Wilson (2020) do not explicitly take a syndemics approach in their studies on ancient disease, they include a multitude of socioeconomic and other biological factors impacting disease outcomes.…”

Two centuries of vaccination: historical and conceptual approach and future perspectives

“…In 1900, the average life expectancy at birth in the United States was ~47 years, and children under five accounted for 30.4% of all deaths ( 1 , 2 ). Survivors of these infections often suffered severe complications and disabilities such as paralytic poliomyelitis ( 3 ), osteomyelitis variolosa ( 4 ), and neurological and vision impairments, among others ( 5 , 6 ). However, there was a significant decline in the mortality rate from infectious diseases throughout the 20th century, from 797 deaths per 100,000 in 1900 to 59 deaths per 100,000 in 1996 ( 7 ).…”

Biocultural perspectives on bioarchaeological and paleopathological evidence of past pandemics

“…However, analyses which have overcome these challenges reveal that the biocultural approach creates unique possibilities for deeper understandings of past pandemics, as well as large‐scale epidemics, and their diverse sequelae, such as physical impairment (e.g., Battles & Gilmour, 2022; Cameron et al, 2015; Crespo & Lawrenz, 2015; DeWitte & Slavin, 2013; Kelmelis & Dangvard Pedersen, 2019; Kelmelis & DeWitte, 2021; Larsen & Crespo, 2022). Within this relatively small body of work, a range of pandemics have been assessed, including those involved in post‐contact Indigenous depopulation in the Americas, climate change, the Black Death, and the 1918 influenza pandemic.…”