The Manchurian Plague and COVID-19: China, the United States, and the "Sick Man," Then and Now

Am J Public Health. 2021 Mar;111(3):423-429. doi: 10.2105/AJPH.2020.305960. Epub 2021 Jan 21.


In this article, I explore the historical resonances between China's 1911 pneumonic plague and our current situation with COVID-19. At the turn of the 20th century, China was labeled "the Sick Man of the Far East": a once-powerful country that had become burdened by opium addiction, infectious disease, and an ineffective government. In 1911, this weakened China faced an outbreak of pneumonic plague in Manchuria that killed more than 60 000 people. After the 1911 plague, a revolutionized China radically restructured its approach to public health to eliminate the stigma of being "the Sick Man." Ironically, given the US mishandling of the COVID pandemic, observers in today's China are now calling the United States "the Sick Man of the West": a country burdened by opioid addiction, infectious disease, and an ineffective government. The historical significance of the phrase "Sick Man"-and its potential to now be associated with the United States-highlights the continued links between epidemic control and international status in a changing world. This historical comparison also reveals that plagues bring not only tragedy but also the opportunity for change.

Publication types

  • Historical Article

MeSH terms

  • COVID-19 / epidemiology*
  • COVID-19 / history*
  • COVID-19 / psychology
  • China / epidemiology
  • Communicable Disease Control / organization & administration
  • Epidemics
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Plague / epidemiology*
  • Plague / history*
  • Plague / psychology
  • Politics*
  • SARS-CoV-2
  • United States / epidemiology