The Cholera epidemics in Hamburg and what to learn for COVID-19 (SARS-CoV-2)

When I was walking through the City of Hamburg last week, I passed the courtyard of the town hall with a fountain from the late 19th century. It was built in memory of the last outbreak of cholera in Hamburg, which was also the last cholera epidemic in Europe. The fountain is dedicated to Hygeia (Fig. 1), daughter of Asclepios and goddess of health. I took this picture for you to illustrate that epidemics are part of human civilization. Particularly interesting is that the cholera outbreak was foreseeable and partially man made. In the 19th century, the Government of Hamburg espoused the Miasma Theory, which claimed that the source of diseases was bad air and that diseases were transmitted by inhaling and not from person to person 1. A strong promoter of the Miasma Theory, also known as the anticontagion theory, was the famous chemist and inventor of practical and scientific hygiene von Pettenkofer (1818-1901) 2. Hamburg decided not to follow the germ theory of Robert Koch (1843-1910, 1905 Nobel Piece in Medicine) which claimed that microorganisms are the source of epidemics and disease 3 for good reasons. The consequences of accepting the germ theory would have meant substantial investments in the city's infrastructure, including water cleaning, sewage treatment, quarantine, and other measures. The memorial is well placed between the town hall and the stock market as a reminder of the responsibility that politics and finances had in that epidemic. During the epidemics in 1892, around 17,000 were infected, of whom more than 8,600 died 1. The numbers are not completely certain as, in the beginning, microbiological tests were not performed, and numbers were kept under lock and key not to jeopardize the economy and trade. The situation was resolved when, after the infections moved from the poor and unhygienic neighborhoods to those of the wealthy, Robert Koch was sent to Hamburg. He took all necessary precautions of modern disease control, and the epidemics finally stopped within a few months.