Fighting Covid-19: De novo Implementation of 19th Century Greek Measures

Keywords:Ioannis Kapodistrias, black death, plague of the poor, quarantine, coronavirus.

Today's society seems to become disillusioned and speechless in the face of a crisis. Yet, our ancestors lived intimately with epidemics, quarantines, and death. The plague – ð.ò + .ëëõìé (in ancient Greek), total + catastrophe (in English), or something that destroys everything – was more common and fatal during the late medieval period (1250-1500 AD). Yersinia pestis is a zoonotic infection that circulates among black rats and their fleas. The disease is transmitted by flea bites, contact with contaminated fluid, tissue, or droplets. Three forms of plague are known: bubonic (or the black death), pneumonic, and septicemic. Nowadays, antibio_tics can easily treat plague, and the use of standard precautions is advised (1). The Coronavirus disease 2019 (Covid-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and likely originated in bats. It is transmitted quite efficiently and is primarily spread via respiratory droplets (2).

In April 1828, an Egyptian captive army brought “the plague of the poor” back to the city of Methone in Messenia, Peloponnese, Greece. It spread quickly to Ibrahim's (1789-1848) army, killing 20 to 30 soldiers per day. Ibrahim was forced to confine himself to a ship to avoid infection. The plague then traveled to Hydra, and by April 17, 1828, the first outbreaks had occurred on the island (3). The governor of Greece, Ioannis Kapodistrias (1776-1831), having studied medicine at the University of Padua, did not underestimate the danger. He sent to the island the politician and physician Spyridon Kalogeropoulos (1790-1864) to take drastic measures to contain the epidemic. He enlisted specific persons to bury the dead, burn their clothes, and disinfect their homes. Moreover, he closed all churches and shops; also, for 50 days he quarantined those who were asymptomatic but suspected of being infected. Food vendors were excluded from this measure. Finally, on August 20, he issued a decree about the health measures to prevent the spreading of the disease (15/20.8.1828; article 285: paragraph 3). The decree forbade them from exiting their houses if outbreaks of plague occurred in the area (4, 5).

The inhabitants of Hydra complied with these instructions. Still, outbreaks increased in Hydra, Spetses, and the surrounding islands. As a result, Kapodistrias took stricter measures, putting the islands in quarantine for 40 days and mandating that no person or product could leave the affected islands. However, the epidemic soon traveled to the islands of Poros and Salamis, the cities of Chalkida, Megara, and Kalavryta, and the region of Argolida. Kapodistrias checked for new cases every day by sending representatives to the islands. He sent his brother Viaros (1774-1842) to Hydra, the swiss physician Louis-André Gosse (1791-1873) to Poros, and the politician Ioannis Kolettis (1773-1847) to Spetses. He also expanded the quarantine to include the coasts of Attica and Euboea. Infected citizens were moved to wooden huts one by one, in isolation. The governor did not allow any commercial activity until at least 40 consecutive days had passed without an outbreak. These measures contributed to the fight against the epidemic, which was eradicated in one year (4, 5).

In conclusion, in the 19th century the fledgling Greek state adopted a technique that has remained the dominant method of quarantine in modern epidemiology. The measures against plague and Covid-19 show how we can avoid similar pandemics in the future. Although we knew a pandemic was possible in the 21st century, it is safe to say that none of us expected it.

Conflict of interests: none declared.

Financial support: none declared.