Today their conversation seems darkly humorous. Kavita’s recommendation to get the flu shot held up. But as we all know now, SARS-CoV-2 rapidly became the most important pathogen of concern. The friend was absolutely right to have worried about it—a lot.

After two years of evolving science and persistent uncertainty, one thing has become clear: People increasingly mistrust public health agencies and the scientists who inform these policies because our information cycles fundamentally are mismatched to the way the scientific community develops recommendations and guidance.

The virus that unleashed COVID-19 did not arrive with an instruction manual, much less GoPro cameras to let us observe exactly how it affects individuals and populations. To learn how the virus behaves, scientists need to research and evaluate it, and to synthesize their findings—and to repeat the process every time a new variant emerges. Yes, the scientific community has mobilized to share information, lifting the paywalls that limit access to scholarly journals and innovating to ensure new studies are read broadly and quickly. But a significant gap remains between early research findings and implementable, science-based recommendations.

The time it takes to bridge that gap—occasionally days but more often weeks or months—is way too long for a world in which stories go viral in minutes, and content creators race for consumers’ eyes and ears.

A recent example is unfolding still. On November 26, 2021, the World Health Organization announced the identification of Omicron as a “variant of concern.” Scientists around the globe rapidly gathered, shared, and analyzed information, then began deliberating how this variant behaved among different groups (e.g., vaccinated versus unvaccinated, children versus adults, symptomatic versus asymptomatic, immunocompromised versus immunocompetent, in places where Delta still predominated versus in places where it had abated, etc.). Then, they had to synthesize those conclusions into guidance. The general public heard and saw very little of this process, instead experiencing co-narration by a thousand voices, predicting what Omicron might mean, from “…that’s the end of the pandemic!” to “…it defeats the vaccine!”

At a White House press conference during Omicron’s peak, President Biden was asked why he hadn’t changed leadership at the CDC. The question implied that since the CDC’s advice continues to evolve, CDC leadership must be confused. “The messages, to the extent they’ve been confusing—it’s because the scientists, they’re learning more,” the President responded, underscoring our point.

The public needs to remain aware that the messages we’re receiving through the media and others may reflect preliminary science. Having access to early information and competing points of view is part of being informed citizens. But what we do with such information matters. Here are a few ways we can gut check ourselves if (when) the next big sensational story happens: We can pause to acknowledge that headlines or social media posts, however definitively worded, may represent just one facet of early and incomplete findings. We can read further and seek other trusted sources—not to confirm our views, but to get more context to round out the picture. And we can try to remember that preliminary discoveries and varied interpretations are part of the process.

While it’s true that many public health agencies have struggled to communicate succinctly and clearly, their job (arguably, the most important one) is to control and prevent communicable diseases and health threats. These agencies focus on protecting current and future populations. Their successful public health efforts are not always emphasized, and are often taken for granted, remaining relatively invisible.

Consequentially, we’ve forgotten certain lessons from the past. After the 1918 and 1919 flu pandemic, public health’s pandemic and epidemic prevention efforts ramped up—only to decline in recent decades as we all settled into an optimistic sense that we would never face a years-long pandemic with over 900,000 national deaths and counting. Preventing disease has taken a back seat in the public consciousness. Instead of supporting and expanding public health infrastructure and personnel, congressional and state budgets have only temporarily increased. Our healthcare infrastructure runs really lean, forcing us to respond to dangers as they hit. We’ve faced our most dramatic healthcare staffing shortages yet during the Omicron surge, even though we’ve already experienced crisis-level shortages at least twice before in the pandemic.

Perhaps we also learned some wrong lessons from other recent, potentially pandemic-level pathogens. The rapid identification and successful control of coronaviruses SARS and MERS resulted in those epidemics going off the radar for most people in the U.S. in a matter of weeks to months. Public expectations of a quick resolution may have solidified around these successes.

They certainly affected public health officials’ expectations in late 2019 and early 2020. The successful strategies for containing SARS and MERS had relied on contract tracing and shutdowns—not masks. When SARS-CoV-2 emerged, epidemiologists applied the knowledge they had of these prior coronaviruses, while they worked to learn more. Unfortunately, this new virus turned out to be armed with an “invisibility cloak” of asymptomatic transmission, which called for different recommendations. Looking back now, we can see how expectations, early science, and public health messaging were out of sync from the start.

It is easy to point fingers at the health officials who told the public not to wear masks in March 2020. It is harder to live with today’s firehose of information, and decide to read beyond the headlines. Innovations and advancements have sped up the development of evidence-based guidance, but the process will never catch up to today’s information cycles. Perhaps one main lesson from the past 24 months is that the road goes both ways. As scientists are learning, the rest of us should be, too.

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Presidential sickness during a public health crisis can have lasting effects on the direction of the nation’s public policy. In the spring of 1919, for instance, Woodrow Wilson contracted the so-called “Spanish Flu” but covered up his sickness because he worried it would upend the stability of post-World War I Europe. Franklin D. Roosevelt’s polio, on the other hand, galvanized the nation into public health action. Roosevelt wasn’t always forthcoming about his wheelchair use—during the early 20th century, Americans notoriously looked down upon disabled individuals—but in his second term as president, with polio rates remaining staggeringly high across the nation, he helped create the most successful public health campaign in American history, the National Foundation for Infantile Paralysis, later known as the March of Dimes.

The most pertinent historical example to compare to Trump’s COVID-19 response comes from 19th-century Britain, when Queen Victoria’s son and heir, Prince Albert Edward, contracted typhoid fever, one of the deadliest infectious diseases of the period. After decades of ignoring or discounting one of the greatest health calamities of their age, a royal illness spurred British leaders, followed by the British public, to reframe the narrative around typhoid, characterizing it as a serious, preventable disease—and creating the first modern public health infrastructure, a system that still influences public health efforts today. Guided responsibly, Americans’ reactions to high profile COVID cases could have a similar impact.

Victorians always feared the next big outbreak of pandemic cholera, which arrived every few years and killed thousands during short bursts like the epidemic years of 1831-2, 1848-49, and 1853-54. But their everyday reality meant withstanding repeated domestic outbreaks of typhoid fever. Typhoid, which is caused by a strain of the Salmonella bacterium, is passed from person to person when tiny amounts of infected fecal matter contaminate food and water. In the 1800s, it was a fulminating, cluster disease, meaning that it erupted annually in cities, towns, and villages across Britain whose water supplies became contaminated. Typhoid killed up to 20,000 and sickened and debilitated up to 150,000 people each year.

The Prince of Wales caught the illness in the fall of 1871. Bertie, as he was affectionately known, spent two months in a feverish, delirious spell at the family’s retreat in Sandringham, looked after by two royal physicians, William Jenner and William Gull. All of Britain was absorbed with daily updates on the future king’s condition. When the prince began to recover in early 1872, there was massive jubilation, including a stunning public celebration in London in February marked by a royal procession from Buckingham Palace to St. Paul’s Cathedral.

The royal sickness that almost killed the Prince of Wales proved to be a turning point for Britain, which was at a political crossroads at the time. Queen Victoria had secluded herself in private mourning for a decade after the death of her husband, Prince Albert, in 1861, leaving the monarchy in shambles—and, as many republican critics believed—leaderless. In the way that only natural disasters like epidemics can do, though, the prince’s bout with typhoid brought the nation back together. On February 6th 1872, at the Opening of Parliament, a formal event that marks the first day of a new session, Queen Victoria returned to the public spotlight to give an energizing speech, where she thanked the entire nation for praying for her son “during the period of anxiety and trial” while sick with typhoid. The address restored the public’s faith in the monarchy. “Never before,” noted an editorial in the leading medical journal of the time, The Lancet, “has the bearing of all classes exhibited the strength of that common band of sorrowful sympathy which we are all bound together as a nation.”

That coming together was surprising because, up until Bertie’s prominent and public case of typhoid, most Victorians believed that the disease was the exclusive province of the urban-industrial poor—“the great unwashed”, to borrow the language of novelist Edward Bulwer-Lytton. Indeed, that metaphor of filth, fevers, and fever dens in urban spaces was so ubiquitous that it had become a kind of literary trope in contemporary novels, like Charles Dickens’ Bleak House, and drawings, such as those by cartoonist John Leech in the satirical magazine Punch. Because of how the deadly epidemic disease had previously been framed—as the repose of the poor—any effective nationwide response to typhoid had been obstructed. The wealthy simply blamed the poor and went about their business.

The events of late 1871 and early 1872 changed the public narrative around typhoid fever. If the future king of England could get typhoid, so could anyone. Increasingly, well-placed Britons began to consider the epidemic “a national disgrace,” as one prominent doctor, Alfred Haviland, put it. Queen Victoria herself publicly declared that typhoid needed a national solution. Parliament responded swiftly, passing the first comprehensive sanitary legislation, the Public Health Act of 1872, followed by subsequent improvements in another act of 1875. Together, these acts compelled local authorities to provide municipal sanitation systems and hire permanent Medical Officers of Health, local public health officials to conduct disease surveillance and outbreak investigation. The acts also established a national disease surveillance system, centralized at the Medical Department of the Local Government Board, whose team of inspectors were charged with keeping track of and investigating infectious disease outbreaks throughout the country.

The United Kingdom had created the nucleus of the first modern public health system in the world and was the first to systematize the practices of state-sponsored epidemiology and allow it to thrive as the chief science of public health. In the period from 1872 to 1900, no other infectious disease was studied more closely than typhoid fever. When the central Medical Department was notified of a local outbreak, it would send an inspection epidemiologist, who interviewed local patients and doctors and performed case-tracing to ferret out the routes of disease communication. These early epidemiologists analyzed sickness and death rates in local communities where an outbreak was occurring, creating maps, diagrams, charts, and photographs in order to see, trace, and understand the spread of an epidemic disease. There were hundreds of local outbreaks to study, with each presenting another illuminating angle on how contaminated surface wells, leaking privy pipes, breakdowns in public water systems, and contaminated milk supplies contributed to widespread community outbreaks.

Everyday practices and methods of epidemiology still relied upon today coalesced and became routinized during this period. Through these investigations, Victorian health officials also realized that for widespread change in preventive public health to occur, epidemiological knowledge had to be communicated to various publics: local officials, business owners, lawmakers, and even everyday people. They relied on new rhetorical strategies, such as attending local town council meetings, writing in popular newspapers, and creating health promotional campaigns through handbills and other visual media—what today we call health communication.

By the first decades of the 20th century, typhoid rates declined sharply in the U.S. and western Europe, in large part because the typhoid problem had been treated as a systemic problem, with officials mandating and encouraging healthy, science-based improvements to the built and the natural environment, and successfully convincing citizens to change their personal habits. Apart from a few scattered outbreaks in the 1920s and 1930s, typhoid largely disappeared in the West, where today it is a long-forgotten memory, save for the infamous story of “Typhoid Mary,” the early 20th-century Irish immigrant cook in New York who infected dozens with the disease and was quarantined for decades against her will. However, typhoid remains a global health problem in the Global South, where it strikes 20 million and kills about 200,000 each year. A 2019 Lancet study called the disease an “invisible burden,” and recommended “global solutions: better data and better surveillance”—just the sort of innovations British epidemiologists introduced 150 years ago.

Smack in the middle of our own pandemic, we might rightly look back at typhoid as we consider how epidemiological knowledge is produced, defended, and debated, and how our leaders discuss the seriousness of the disease. It’s pertinent to note that typhoid policy bred skeptics, too. Epidemiologists in the 19th century frequently ran up against complaints that they were “meddlesome,” and “troublesome,” and had no “right” to tell local folks what to do about home and hearth—not unlike the backlash building against leading public health experts like Dr. Anthony Fauci and local officials like Michigan governor Gretchen Whitmer.

Reckoning with the history of epidemics and epidemiology provides a salient reminder of how inextricably bound diseases are with politics and how personalities can clash with public health. Victorian health workers ultimately broke through the pushback by convincing everyday people—business owners, farmers, and politicians—that investing in removing structural causes of disease through the reduction of environmental pollution and the safeguarding of food and water supplies was both a public good and an economic good. Epidemiologists and political leaders today might mull what kind of rhetorical and communicative strategies will best help them discuss the cause and prevention of COVID-19 with everyday Americans and to reinvigorate those who are simply “over” the pandemic and the daily death counts.

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