Reader,

Ebola is back in the news and that, in turn, reminded me of one of my favorite books, The American Plague: The Untold Story of Yellow Fever, The Epidemic That Shaped Our History (2007) by Molly Caldwell Crosby. We don’t have Ebola but we had yellow fever.

One of the memorable parts of the book focused on the 1878 yellow fever epidemic that hit along the Mississippi River.

A bit of history

In 1878, yellow fever spread from New Orleans through the lower Mississippi Valley, affecting cities such as Memphis, Vicksburg, Grenada, and New Orleans. Estimates vary, but the region experienced roughly 120,000 cases and 13,000–20,000 deaths.

Memphis was devastated; more than 20,000 residents fled, and thousands died.

And that bit of history got me into a “conversation” with my intern, Chat GPT.

Here are three things I learned from my conversation:

Disease follows systems of movement.
​Yellow fever moved along the Mississippi River, through ports, steamboats, railroads, trade routes, and fleeing populations. Today, the equivalent is air travel, migration, global supply chains, interstate commerce, and dense urban networks.

Delayed recognition makes containment harder.
​Cities often hesitated to acknowledge outbreaks because admitting disease meant quarantine, economic loss, commercial disruption, and reputational harm. That delay cost lives. Today, governments and businesses face the same temptation: minimize early warnings to avoid panic or economic pain.

Public health infrastructure matters before the crisis.​
Memphis had poor drainage, sanitation, and living conditions, creating a highly vulnerable urban environment. Today’s parallel conditions include poor hospital surge capacity, inadequate disease surveillance, stressed local health departments, a vaccine infrastructure under attack, and not enough trained public health workers.

Epidemics expose inequality.​
Those with money fled. Those without resources stayed, became sick, cared for others, or died. Epidemics always reveal who has mobility, savings, housing security, healthcare access, and political voice. Today, the same pattern appears in COVID-19, measles outbreaks, heat emergencies, and vector-borne disease risk.

Climate and environment matter.​
Conditions in 1878, including a mild winter, long spring, and hot summer, favored mosquito breeding and yellow fever spread. Today, climate change, evident in the past few years, expands the range, season length, and intensity of many vector-borne disease threats. Yellow fever itself is unlikely to become a routine U.S. disease soon, but dengue, West Nile, chikungunya, Zika-like threats, Lyme disease, and other vector-borne risks are already here and are “moving north.”

Lessons for today

Keeping with my interest in learning from the past, dealing with the present, and intercepting the future, the 1878 epidemic gives us a useful hindsight – insight - foresight frame.

Hindsight: What should we remember?

The U.S. has repeatedly ignored weak signals until they became unavoidable: yellow fever, influenza, HIV/AIDS, COVID-19, mpox, measles resurgence, and now renewed concern about Ebola and other communicable diseases. The specific pathogen changes but the failure pattern often repeats: delay, denial, fragmented response, public confusion, and uneven burden.

Insight: What should we see now?

We are living in conditions that favor epidemic surprise: global travel, political distrust, misinformation, underfunded public health, climate change, urban density, healthcare workforce burnout, and fragile supply chains. The disease may be biological, but the vulnerability is systemic.

Foresight: What should we do before the next outbreak?

The U.S. should build a stronger disease warning and response system.

The lesson from 1878 is blunt: the pathogen starts the crisis, but the system determines the damage.

And I’m sorry to say, we do NOT have the best health system in the world. It’s good (and expensive), but it could be so much better.

So, get some mosquito repellent before you take that trek into the woods.

Happy summer,

Bill