# Black Death at the Golden Gate (book review)

Book review: Black Death at the Golden Gate: The Race to Save America
from the Bubonic Plague, by David K. Randall.

Imagine a story about an epidemic that reached San Francisco, after
devastating parts of China. A few cases are detected, there's
uncertainty about how long it's been spreading undetected, and a small
number of worried public health officials try to mobilize the city to
stop an imminent explosion of disease. Nobody knows how fast it's
spreading, and experts only have weak guesses about the mechanism of
transmission. News media and politicians react by trying to suppress
those nasty rumors which threaten the city's economy.

Sounds too familiar?

The story is about a [bubonic plague
outbreak](https://en.wikipedia.org/wiki/San_Francisco_plague_of_1900%E2%80%931904)
that started in 1900. It happens shortly after the dawn of the [Great
Sanitary Awakening](https://www.ncbi.nlm.nih.gov/books/NBK218224/), when
the germ theory of disease is fairly controversial. A few experts in the
new-fangled field of bacteriology have advanced the radical new claim
that rats have some sort of connection to the spread of the plague, and
one has proposed that the connection involves fleas transmitting the
infection through bites. But the evidence isn't yet strong enough to
widely displace the standard hypothesis that the disease is caused by
filth.

There was a
[vaccine](https://en.wikipedia.org/wiki/Waldemar_Haffkine#Anti-plague_vaccine)
for the bubonic plague, which maybe helped a bit. It was only 50%
effective, the benefits lasted about 6 months, and the side effects
sound like cruel and unusual punishment. It was controversial and often
resisted, much like the compulsory smallpox vaccinations of the time.

Yet the plague didn't seem to know that it was supposed to grow at
exponential rates. That left an eerie sense of mystery about how the
plague could linger for years, with people continuing to disagree about
whether it existed.

### 1.

I'm unsure whether to classify the book as history or as historical
fiction.

If I had been led to expect that this was a work of fiction, I would
only have noticed a few hints that it's based on actual events. The most
obvious hint is that the person who initially looks like the story's
hero gives up and drops out of sight about 40% of the way in, and is
replaced by a totally new character. Yet in spite of the fiction-like
style, [Wikipedia
confirms](https://en.wikipedia.org/wiki/San_Francisco_plague_of_1900%E2%80%931904)
many key claims, and doesn't appear to contradict any of it.

The story is simultaneously depressing and encouraging, because it
demonstrates that a society which is manifestly less competent than the
San Francisco (or New York, or Tulsa) of today can grow into an arguably
great society in a generation or so. Maybe even Brazil can recover from
being a disaster area.

Randall convinced me that Donald Trump is much less of an outlier than I
had previously thought (I'm talking mostly about Trump's personality,
and his management style, or lack thereof). However, I wonder if some of
Randall's portrayal of [Governor
Gage](https://en.wikipedia.org/wiki/Henry_Gage) is slanted so as to
emphasize the similarities between Trump and the thoroughly discredited
Gage.

### 2.

One large difference from today is that there was almost no controversy
about racism. There was a near-consensus in support of racism. The
experts who didn't hesitate to impose race-based quarantines seem more
sensible and less racist than their main opponents, who believed that
the white race is sufficiently superior that they needn't worry about
contracting the disease. Note that the quarantines weren't always as
polite as a Wuhan-style lockdown.

The book argues that the lone non-racist (or at least not blatantly
racist) person with any power saved many lives by treating the Chinese
with respect. There's likely some truth to that, but the situation was
messy enough to leave a fair amount of doubt - mostly, it took threats
of quarantines in order to accomplish much.

Randall neglects to mention a downside of the campaign for improved
sanitation. Many wood buildings were replaced with more rat-resistant
[brick
buildings](https://en.wikipedia.org/wiki/Unreinforced_masonry_building),
just in time to wreak havoc in the [1906
earthquake](https://en.wikipedia.org/wiki/1906_San_Francisco_earthquake)
(bricks fall more often, and farther from buildings, than wood, and
falling bricks kill).

The earthquake triggered conditions under which the plague thrived in
areas outside of Chinatown, while Chinatown retained some of the
benefits of the sanitation-oriented reconstruction. I presume it's just
a coincidence that officials became substantially more eager to combat
the plague when it hit wealthy neighborhoods, just as it's a coincidence
interest in COVID-19 declined when it faded from wealthier areas.

### 3.

Conspiracy theorists will be glad to point out the example of a massive
conspiracy of influential people that succeeded in mostly covering up
the epidemic for something like a year. However, it appears to have been
much less organized or centrally directed than conspiracy theorists want
to imagine.

Could such a conspiracy succeed today? It would be much harder. The
press in 1900 was mostly a cartel that was in the pocket of other
businesses. Today, the internet has succeeded in making the news media
much more democratic, so that there's much fiercer competition between
various ideological biases about which ideas to suppress. But it does
sound like there was a pretty widespread consensus among Californians
that any reports of the plague should be denied. So even if today's
press had existed in 1900, it seems somewhat plausible that most readers
would still have been unaware of the plague.

I can sort of imagine that we're currently experiencing situations where
both the left and the right unite enough to mostly hide something
important.

Could there currently be under-reporting of COVID-19 deaths in hopes of
reopening the country? In 1900, doctors had plenty of discretion about
how they listed causes of death, and were reportedly scared to list
plague as a cause, due to pressure from people who feared quarantines.

Could the same thing be happening this month? I don't see any evidence
that it has happened yet, but there are signs that plenty of people
would like it to happen. Before reading Black Death, I would have felt
confident that there were still enough people who cared about their
personal risk of getting the virus to prevent such a conspiracy. It
still seems far-fetched, but I'm now wondering how hard it would be to
detect by looking at excess death numbers.

### 4.

How does this book influence my forecast for the current pandemic?

I've updated slightly in the direction of society's response being
controlled by elites. I've updated more strongly in the direction of
responses depending on pressure from other states / countries.

There's a moderate chance that overflowing hospitals in July will cause
influential people in the sunbelt to react strongly, so that hospitals
will be safe for them to visit. That's a difference from 1900, since
back then influential people wouldn't stoop to being treated in a
hospital.

There will be a medium amount of pressure for more restrictions when the
elites notice that tourists from China, Mongolia, Senegal, etc., can
vacation in the EU, Thailand, and New Zealand, but US tourists are
unwelcome. I'm unclear whether that pressure will be sufficient to have
much effect.

Quarantines of US goods will also have some effect, but the shortage of
evidence implicating transmission via surfaces will keep those
quarantines fairly sporadic, so they probably won't be very effective.

Travel restrictions between US states might put pressure on the worst
states, but I'm unclear whether those will be enforced.

All of these factors will cause a moderate increase in elites scaring
voters into supporting more restrictions of some sort, plus better
testing and tracing, sometime during the next few months.

I'm unclear on whether further nursing home tragedies will cause much
outrage, even though I expect some more avoidable deaths there.

Trump will likely lose the election and be considered somewhat
disgraced, but it will likely be less of a landslide than pundits will
predict, and more quickly forgotten.

The world will continue to under-prepare for pandemics, in spite of the
general tendency to fight the last war. Invisible mindless enemies seem
not to generate much of a warlike response.

The pandemic won't prevent the world from prospering. As to how many it
will kill, that will be influenced more than I previously expected by
luck.

There will also be a good deal of luck involved in whether public health
officials get rewarded when they do things right.

Don't forget that the bubonic plague hasn't been fully eradicated in the
US. Have a nice day.