Archaeology Shows How Ancient African Societies Managed Pandemics

Archaeology Shows How Ancient African Societies Managed Pandemics


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Every so often, a pandemic emerges that dramatically alters human society. The Black Death (1347 - 1351) was one; the Spanish flu of 1918 was another. Now there’s COVID-19.

Archaeologists have long studied diseases in past populations. To do so, they consider a wide array of evidence: settlement layout, burials, funerary remains, and human skeletons.

For example, because of archaeologists we know that the damaging impact of epidemics prompted extreme measures by ancient Africans, such as, the abandonment of settlements at Akrokrowa in Ghana during the early 14th century AD. About 76 infant burial sites at an abandoned settlement that now forms part of the Mapungubwe World Heritage site in the Limpopo Valley of South Africa suggest a pandemic hit the people living there after 1000 AD.

How Ancient Africans Managed Pandemics

Archaeological and historical insights also expose some of the strategies that societies adopted to deal with pandemics. These included burning settlements as a disinfectant and shifting settlements to new locations. Social distancing was practiced by dispersing settlements. Archaeologists’ findings at Mwenezi in southern Zimbabwe also show that it was a taboo to touch or interfere with remains of the dead, lest diseases be transmitted in this way.

Studying the societies of ancient Africans, like Great Zimbabwe (pictured), can reveal how communities dealt with disease and pandemics. ( evenfh / Adobe stock)

In the late 1960s, some members of an archaeological dig excavating 13th century house floors in Phalaborwa, South Africa , refused to keep working after encountering burials they believed were sacred. They also worried that the burials were related to a disease outbreak.

Social distancing and isolation have become watchwords during the COVID-19 pandemic. From archaeology, we know that the same practices formed a critical part of managing pandemics in historical African societies. In what is Zimbabwe today, the Shona people in the 17th and 18th centuries isolated those suffering from infectious diseases - such as leprosy - in temporary residential structures . This meant that very few people could come into contact with the sick. In some cases, corpses were burnt to avoid spreading the contagion.

Humans have a propensity to relax and shift priorities once calamities are over. Data collected by archaeologists, that show how indigenous knowledge systems helped ancient societies in Africa deal with the shock of illness and pandemics, can help remind policy makers of different ways to prepare modern societies for the same issues.

Social Distancing and Isolation

Research at the early urban settlement of K2, part of the Mapungubwe World Heritage site, has thrown significant light on ancient pandemics.

The Mapungubwe World Heritage site in South Africa. (JJ van Zyl / CC BY-SA 3.0 )

The inhabitants of K2 (which dates back to between AD1000 and AD1200) thrived on crop agriculture, cattle raising, metallurgy, hunting and collecting food from the forest. They had well developed local and regional economies that fed into international networks of exchange with the Indian Ocean rim. Swahili towns of East Africa acted as conduits.

Archaeological work at K2 uncovered an unusually high number of burials (94), 76 of which belonged to infants in the 0-4 age category. This translated into a mortality rate of 5% . The evidence from the site shows that the settlement was abruptly abandoned around the same time as these burials. That means a pandemic prompted the community’s decision to shift to another settlement.

Shifting to another region of Africa, archaeological work at early urban settlements in central and southern Ghana identified the impact of pandemics at places such Akrokrowa (AD950 – 1300) and Asikuma-Odoben-Brakwa in the central district of Ghana.

These settlements, like others in the Birim Valley of southern Ghana, were bounded by intricate systems of trenches and banks of earth. Evidence shows that after a couple of centuries of continuous and stable occupation, settlements were abruptly abandoned. The period of abandonment appears to coincide with the devastation of the Black Death in Europe.

Post-pandemic, houses were not rebuilt ; nor did any rubbish accumulate from daily activities. Instead, the disrupted communities went to live elsewhere. Because there are no signs of long-term effects – in the form of long periods of hardship, deaths or drastic socioeconomic or political changes – archaeologists believe that these communities were able to manage and adapt to the pandemic.

Analysis of archaeological evidence reveals that these ancient Africans adopted various strategies to manage pandemics. These include burning settlements as a disinfectant before either reoccupying them or shifting homesteads to new locations. African indigenous knowledge systems make it clear that burning settlements or forests was an established way of managing diseases.

The layout of settlements was also important. In areas such as Zimbabwe and parts of Mozambique , for instance, settlements were dispersed to house one or two families in a space. This allowed people to stay at a distance from each other – but not too far apart to engage in daily care, support and cooperation. While social coherence was the glue that held society together, social distancing was inbuilt, in a supportive way. Communities knew that outbreaks were unpredictable but possible, so they built their settlements in a dispersed fashion to plan ahead.

These behaviors were also augmented by diversified diets that included fruits, roots, and other things that provided nutrients and strengthened the immune system.

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Africa’s Past and the Future of Pandemics

There were multiple long-term implications of pandemics in these communities. Perhaps the most important was that people organized themselves in ways that made it easier to live with diseases, managing them and at the same time sticking to the basics such as good hygiene, sanitation and environmental control. Life did not stop because of pandemics: populations made decisions and choices to live with them.

Some of these lessons may be applied to COVID-19, guiding decisions and choices to buffer the vulnerable from the pandemic while allowing economic activity and other aspects of life to continue. As evidence from the past shows, social behavior is the first line of defense against pandemics: it’s essential this be considered when planning for the latest post-pandemic future.


Archaeology Shows How Ancient African Societies Managed Pandemics

Studying ancient African societies, like Great Zimbabwe, can reveal how communities dealt with disease and pandemics using social distancing and isolation. Great Zimbabwe. Photo: Yves Picq/Creative Commons Attribution-Share Alike 4.0 International

Every so often, a pandemic emerges that dramatically alters human society. The Black Death (1347 – 1351) was one the Spanish flu of 1918 was another. Now there’s COVID-19.

Archaeologists have long studied diseases in past populations. To do so, they consider a wide array of evidence: settlement layout, burials, funerary remains, and human skeletons.

For example, because of archaeologists we know that the damaging impact of epidemics prompted the abandonment of settlements at Akrokrowa in Ghana during the early 14th century AD. About 76 infant burial sites at an abandoned settlement that now forms part of the Mapungubwe World Heritage site in the Limpopo Valley of South Africa suggest a pandemic hit the people living there after 1000 AD.

Archaeological and historical insights also expose some of the strategies that societies adopted to deal with pandemics. These included burning settlements as a disinfectant and shifting settlements to new locations. Social distancing was practised by dispersing settlements. Archaeologists’ findings at Mwenezi in southern Zimbabwe also show that it was a taboo to touch or interfere with remains of the dead, lest diseases be transmitted in this way. In the late 1960s, some members of an archaeological dig excavating 13th century house floors in Phalaborwa, South Africa, refused to keep working after encountering burials they believed were sacred. They also worried that the burials were related to a disease outbreak.

Social distancing and isolation have become watchwords during the COVID-19 pandemic. From archaeology, we know that the same practices formed a critical part of managing pandemics in historical African societies. In what is Zimbabwe today, the Shona people in the 17th and 18th centuries isolated those suffering from infectious diseases – such as leprosy – in temporary residential structures. This meant that very few people could come into contact with the sick. In some cases, corpses were burnt to avoid spreading the contagion.

Humans have a propensity to relax and shift priorities once calamities are over. Data collected by archaeologists, that show how indigenous knowledge systems helped ancient societies in Africa deal with the shock of illness and pandemics, can help remind policy makers of different ways to prepare modern societies for the same issues.


Archaeology offers clues to pandemic rebounds from the past

Credit: Pixabay

As the COVID-19 pandemic redefines what we think of as "normal," archaeology and ancient history can provide some consolation about the great adaptability of our species.

Flinders University archaeologist and ancient historian Dr. Ania Kotarba points to responses of extreme historical events that have threatened homo sapiens in the past as evidence that society—and the economy—can, and will, spring back again.

Dr. Kotarba researches global connectivity in the past through studying ancient international trade routes and human adaptation to extreme change.

She says the processes of urbanization, population growth and proto-globalization in the ancient world initially allowed outbreaks of infectious diseases and epidemics. These often surprisingly resulted in boosting the economy.

"The Black Death that we think killed a quarter or more of Europe and Near Eastern population in the 1300s, actually resulted, in longer term, in improvements to living and work conditions for the working classes, opened up markets and boosted the economy," says Dr. Kotarba.

Dr. Kotarba says archaeological evidence shows that ancient epidemics started with the foundations of urban life and intensified with the emergence of the ancient global economy.

Archaeologist Dr Ania Kotarba at work in an Oxford University laboratory. Credit: Flinders University

"The first time we recognize widespread of infectious diseases archaeologically is in the Neolithic period, when small hunter-gatherer groups moved towards a more sedentary life. The first permanent large settlements and the move towards urbanization increased the numbers of people living at close quarters with one another and with their newly domesticated animals, that fed on waste," says Dr. Kotarba.

"This allowed for the first large spreads of zoonotic (animal-borne) diseases, such as bubonic plagues—although the first zoonotic diseases can already be observed in skeletons from about 2.8 million years ago, in one of our oldest predecessors Australopitecus Africanus.

Archaeology is showing that this is something that humans, both modern and archaic, have dealt with for millions of years and exacerbated with the move towards more modern-like lifestyles."

The situation became more complex as far-distance trade flourished between fully urbanized cities, which developed in different parts of the world during the Bronze Age (approx. 3000–1200 BCE).

Already at this stage populations of many ancient cities reached over 100,000 people, with ancient Rome said to have reached well over 1 million people around 200 CE.

Dr Kotarba during an archaeological survey in Kuwait. Credit: Flinders University

"Trade routes, often connected with the demand for exotic and luxurious goods (such as spices), were responsible for widespread outbreaks of infectious diseases in the ancient world, and in the medieval and early modern periods.

"Since the dawn of a global economy, caravans and ships connected disparate peoples, cultures and ecosystems in unprecedented ways, and therefore served as key nodes in the spread of global diseases.

This is also because there was no passenger ships in the ancient world so all travel had to be on board of merchant vessels along the trade routes. The word 'quarantine' itself comes in fact from the seafaring terminology."

Dr. Kotarba says homo sapiens are one of the most adaptable species on Earth, having successfully emerged from events of extreme demographic and environmental stress. This includes the Toba super-volcanic eruption of 75,000 years ago, which created a genetic bottleneck with only an estimated 3,000-10,000 people surviving on the entire planet.

She also points to the Late Roman Justinian Plague (541–542 CE) that seems to have killed between 25-50 million people. "After this, we sprung back again as a species, with more adaptable traits favored in those who survived."

Dr Kotarba teaching a ‘First Aid to cultural heritage in conflict and natural disaster’ course for museum workers in the United Arab Emirates. Credit: Flinders University

This historical picture has become clearer thanks to biomolecular archaeology and pathogen genetics, which are now at the forefront of exploring ancient diseases, along with studying the connectivity of ancient trade routes.

The novel techniques are bringing new insights into the territorial extent and reach of various strains of viruses and bacteria—and point to the precedent of positive long-term outcomes from historical pandemics and other catastrophes.

"We are already seeing some small positive impacts of COVID-19-related lockdowns on, for example, climate change," says Dr. Kotarba.

"We are seeing people doing more gardening and striving to be closer to nature, while populist governments seem to be loosing their followers as voters are increasingly turning towards those leader who use empathy and evidence-based data to inform policies.

"Let's hope that, like our predecessors in Ancient Egypt, Rome and medieval Britain, we will re-surface from our isolation stronger and hopefully wiser."


Past Webinar Recordings and Reports

  • May 13th - Shared Experiences with COVID-19 in African and African American Communities
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  • May 20th – Combating Racism and Xenophobia during COVID-19
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  • May 27th – Africa’s Healthcare Response to COVID-19
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  • June 3rd - COVID-19 and the African Economy
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  • June 10th - Race to a Vaccine
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  • June 17th - COVID-19 and the African Workforce
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  • June 24th -Implications of COVID-19 on Food and Nutrition Security
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  • July 1st - COVID-19’s Impact on Education in Africa
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  • July 8th -Future of Africa’s Health Systems
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  • September 23rd- The Role of Digital Health & Telemedicine
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  • September 30th - Current State and Priorities
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  • October 14th - Expression of Arts and Culture
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  • October 28th - Expanding Access to Mental Health
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  • November 18th - Meeting the Challenges of Higher Education in Africa
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  • December 2nd -The Impact for Women
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  • December 9th - Youth & Closing the Innovation Gap
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  • Get the most updated statistics on COVID-19 on the African continent via the Africa CDC website here.
  • July 16, 2020: Azad Essa, Harvard Neiman Fellow '18 published a children's book with Nathi Ngubane called “Duma says” which is about the adventures of Duma, his sister Zihle and their friends, as they try to find their way during the coronavirus pandemic in South Africa. This educational book series written and illustrated by Durban-born Nathi Ngubane and produced by the experimental Social Bandit Media, based between Johannesburg and New York. You can read more about "Duma Says" here. You can also download Duma Says in isiZulu, Kiswahili, and isiXhosa here.
  • June 26, 2020: CAS Executive Committee member, Professor Fernando Reimers, is publishing a series that documents some country initiatives that ensured education continuity for all using technology and provided support to teachers, students, and their families called Education continuity during the Coronavirus crisis:
    • Uganda: Popow’s Radio Response to Covid-19
    • Sierra Leone and Liberia: Rising Academy Network on air

    • Africa’s aim in navigating the COVID-19 crisis ought to be not merely preservation but amelioration not simply a return to normalcy but the improvement of standards of living. The unfolding crisis presents a unique opportunity to reshape the continent by bringing a large number of informal workers out of the shadows, something that has eluded policymakers on the continent for decades.
    • Most African countries have a narrow margin for error because of weak health systems operating at near capacity outside of a pandemic and the need to maintain control of other infectious diseases. Staggered periods of relaxed social distancing could avoid a large resurgence of cases while providing respite for economic activity. However, monitoring the effectiveness of non-pharmaceutical interventions and exercising flexibility in their implementation needs to be guided by continued surveillance through community testing. To meet this demand, testing capacity and implementation need to be scaled up substantially.
    • May 14, 2020: Read an article on how Archaeology shows how ancient African societies managed pandemics.
      • Social distancing and isolation have become watchwords during the COVID-19 pandemic. From archaeology, we know that the same practices formed a critical part of managing pandemics in historical African societies. In what is Zimbabwe today, the Shona people in the 17th and 18th centuries isolated those suffering from infectious diseases - such as leprosy - in temporary residential structures. This meant that very few people could come into contact with the sick. In some cases, corpses were burnt to avoid spreading the contagion.
      • May 11, 2020: David Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health and Professor of African and African American Studies at Harvard University, co-authored an article on COVID-19 and Health Equity—A New Kind of “Herd Immunity”.
        • COVID-19 is a magnifying glass that has highlighted the larger pandemic of racial/ethnic disparities in health. For more than 100 years research has documented that African American and Native American individuals have shorter life spans and more illness than white persons. Hispanic immigrants initially tend to have a relatively healthy profile but with increasing length of stay in the US, their health tends to decline. A black infant born in the US is more than twice as likely to die before his or her first birthday compared with a white infant. In adulthood, black individuals have higher death rates than white persons for most of the leading causes of death.

        April 23, 2020: The Harvard Center for African Studies and other Centers and Departments issued a joint statement on Xenophobic and Racist Actions in Response to COVID-19.

        • We strongly condemn xenophobic and racist acts arising from the global COVID-19 pandemic. International media outlets have reported on incidents worldwide targeting individuals and communities of Asian ancestry and the spread of racially targeted misinformation on social media platforms. Xenophobic and racist actions have also been reported against African and African American communities in Guangzhou, China. The reported actions are not only unjust and inhumane but serve to undermine the required global cooperation in response to COVID-19.
        • April 22, 2020: Professor Peter Huybers, member of the Center for African Studies Steering Committee and Executive Committee, co-authored research on Fever and mobility data indicate social distancing has reduced incidence of communicable disease in the United States.
          • "Estimating the effectiveness of these socialdistancing strategies is challenging because surveillance of COVID-19 has been limited, with tests generally being prioritized for high-risk or hospitalized cases according to temporally and regionally varying criteria. Here we show that reductions in mobility across U.S. counties with at least 100 confirmed cases of COVID-19 led to reductions in fever incidences, as captured by smart thermometers. "
          • April 22, 2020: Hippolyte Fofack,the Chief Economist and Director of Research and International Cooperation Department at the African Export-Import Bank authored an opinion on Shifting from reliance on commodities crucial for Africa.
            • Every crisis, though tragic, presents opportunities. The combination of the coronavirus downturn and oil price war has underscored the perennial risk of commodity dependency. It has also accentuated the need to expand industrial and manufacturing capabilities in Africa. Many countries on the continent are reliant on overseas imports for essential goods, including staple foods, while intraregional trade remains largely fragmentary. As the coronavirus circles the world, African leaders face a dire challenge. Closing their borders might shield their countries against the unchecked spread of the virus, but risks starving their populations and curtailing access to critical medical equipment that is in short supply in the region.
            • April 21, 2020: Euvin Naidoo, Senior Lecturer of Business Administration lists 7 Successful Battle Strategies to Beat COVID-19.
              • "The Agile methodology used to speed complex software development is also helpful for managing decision-making in today's crisis environment."
              • April 21, 2020: Shelby Carvalho, PhD student and Presidential Merit Fellow at Harvard University, co-authored a blog post on How Are International Donors Responding to Education Needs during the COVID Pandemic?
                • "The pandemic and its consequences are likely to continue for a long time and will inevitably have lasting impacts on education systems. Clarity on which donors are doing what, how, and why is key to helping education systems navigate the pandemic and to limiting growth of already wide finance gaps for education in developing countries."
                • April 20, 2020: Shelby Carvalho, PhD student and Presidential Merit Fellow at Harvard University, co-authored a blog on The Pandemic Reinforces Age-Old Urban Rural Divides in Access to Education in Ethiopia.
                  • "In the face of an uncertain global crisis and the potential for a prolonged time out of school, it makes sense to invest in developing remote learning strategies in Ethiopia. Yet, our interviews suggest that there is a need for more engagement with students, families, and teachers to communicate the importance of learning while schools are closed and to support the development of equitable and effective solutions for emergency learning and eventual recovery moving forward."
                  • April 16, 2020: Myriam Sidibe Senior Fellow, Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School, co-authored an article onAfricans can fight COVID-19 with stakeholder capitalism.
                    • With the COVID-19 pandemic threatening to overwhelm much of Africa, companies on the continent must broaden their perspective. Instead of focusing on short-term returns for owners and investors, they must consider the needs of a variety of stakeholders – employees, suppliers, customers, and the societies in which they operate. This stakeholder capitalism will help companies rewrite their rules of community engagement and rebuild their businesses faster post-COVID-19.
                    • April 16, 2020: CAS Faculty Affiliate, Professor Sarah Dryden-Peterson, offers her perspective on Learning and Community in a Time of Crisis.
                      • "In times of crisis, standardized and widely-accessible approaches are essential to help combat existing inequalities and avoid exacerbating them, even in typically decentralized education systems like the United States. During the Ebola crisis in West Africa in 2014, teachers recorded lessons on radio providing a trusted voice directly into the homes of millions of children."
                      • April 15, 2020: Professor Rema Hanna, Jeffrey Cheah Professor of South-East Asia Studies and Chair of the International Development Area at the Harvard Kennedy School, co-authored an article on Cushioning the Poor from the COVID-19 Shock.
                        • "Expanding social protection to reach vulnerable people quickly must be a pillar of every country’s COVID-19 strategy. To achieve this, resource-constrained governments must look to past experience and existing research to design the most effective and efficient programs possible."
                        • April 14, 2020: Nerissa Naidoo LLM’19, explores COVID-19 disinformation in South Africa in the article A Look at South Africa’s Covid-19 Disinformation Regulations.
                          • "But just because there’s no legal obligation to ensure the credibility of the information we share, doesn’t mean we don’t have a social one. The categories of false information enumerated in the regulations have the potential to result in physical harm, incite fear or discrimination, and derail public health efforts."
                          • April 15, 2020: Professor Rema Hanna, Jeffrey Cheah Professor of South-East Asia Studies and Chair of the International Development Area at the Harvard Kennedy School, co-authored an article on Cushioning the Poor from the COVID-19 Shock.
                            • "Expanding social protection to reach vulnerable people quickly must be a pillar of every country’s COVID-19 strategy. To achieve this, resource-constrained governments must look to past experience and existing research to design the most effective and efficient programs possible."
                            • April 15, 2020: A survey by GeoPoll on Coronavirus in Sub-Saharan Africa: How Africans in 12 nations are responding to the COVID-19 Outbreak.
                              • "Although many countries in Africa have only reported a small number of cases, there is a high level of fear surrounding the outbreak The level of concern is high across all countries, and a majority also believe that they themselves are at risk of contracting the disease. Food security and the economic impacts of the disease on economies that have already been struggling are at the top of mind for many people, aligning with warnings from experts that sub-Saharan Africa could experience high levels of food insecurity and an economic recession due to the virus."
                              • April 13, 2020: Free Harvard edX course begins on Lessons from Ebola: Preventing the Next Pandemic.
                                • This four-week course provides the context in which to understand the Ebola outbreak -- why now, and why did so many people suffer and die? The course lays out the global governance structure -- what was the global response supposed to look like, and where did it fail? The course will feature practitioners, experts, and scholars who will focus on cultivating a better understanding of the Ebola epidemic and implications for future health systems to ensure that the world is more effective in preventing the next pandemic.
                                • April 12, 2020: Chairperson of the African Union and President of the Republic of South Africa, His Excellency Cyril Ramaphosa appoints special envoys to mobilize international economic support for continental fight against COVID-19. Read press release here.
                                  • The Chairperson of the African Union, President of the Republic of South Africa His Excellency Cyril Ramaphosa has appointed Dr Ngozi Okonjo-Iweala, Dr Donald Kaberuka, Mr Tidjane Thiam and Mr Trevor Manuel as Special Envoys of the African Union to mobilise international support for Africa’s efforts to address the economic challenges African countries will face as a result of the COVID-19 pandemic.
                                  • April 9, 2020: Harvard Kennedy School Belfer Center for Science and International Affairs published a new case on COVID-19 & Security: Lessons From the Ebola Fight: “Managing a Security Response to the Ebola Epidemic in Liberia
                                    • In the rush to address COVID-19, policymakers are looking at recent outbreaks for guidance. Particularly relevant is the rise, spread, and containment of Ebola in West Africa in 2014. A new case from Harvard Kennedy School’s Case Program looks at the security lessons we can learn from that crisis. The case, developed by Margaret Bourdeaux and Juliette Kayyem of the Belfer Center’s Security and Global Health Project, looks at the various state and nonstate actors involved in containing a viral epidemic. It also explores how and whether security forces can be used to impose quarantines and the ramifications of such a decision.
                                    • April 8, 2020:CAS Executive Committee member, Professor Fernando Reimers, published a free, Open Access book, just published, explaining how to reform education systems so they educate all students as global citizens, with the necessary competencies to achieve the UN SDGs: Educating Students to Improve the World.
                                      • This open access book addresses how to help students find purpose in a rapidly changing world. In a probing and visionary analysis of the field of global education Fernando Reimers explains how to lead the transformation of schools and school systems in order to more effectively prepare students to address today’s’ most urgent challenges and to invent a better future. Offering a comprehensive and multidimensional framework for designing and implementing a global education program that combines cultural, psychological, professional, institutional and political perspectives the book integrates an extensive body of empirical literature on the practice of global education.
                                      • April 2, 2020: CAS Leadership Council member, Amandla Ooko-Ombaka co-authored this article: McKinsey: Tackling COVID-19 in Africa.
                                        • Across the continent, leaders in the public, private, and development sectors are already taking decisive action—both to save lives and to protect households, businesses, and national economies from the fallout of the pandemic. But several leaders have told us that they need a clearer picture of the potential economic impact of the crisis. At the same time, many African countries are still in the early stages of organizing their responses into focused, prioritized efforts that make the most of the limited time and resources available.
                                        • March 30, 2020:CAS Executive Committee member, Professor Fernando Reimers, co-authored this report to support the development of an education response to COVID-19: A framework to guide an education response to the COVID-19 Pandemic of 2020
                                          • This report aims at supporting education decision making to develop and implement effective education responses to the COVID-19 Pandemic. The report explains why the necessary social isolation measures will disrupt school-based education for several months in most countries around the world. Absent an intentional and effective strategy to protect opportunity to learn during this period, this disruption will cause severe learning losses for students.
                                          • March 29, 2020:Folorunso Alakija, CAS Africa Advisory Board member and Vice-Chairman of Famfa Oil Limited, donated N1 billion (US$ 2.6 million) to support the fight against COVID-19 in Nigeria.
                                            • “As the world rallies to deal with the health, security, economic and social implications of the coronavirus, it’s clear that we will feel the effects much more deeply than many of the developed world. Managing a crisis of this magnitude means that the strength of our response will determine our ability to weather the storm. Individually and collectively, we are rising to this unprecedented challenge in a way that symbolizes our resilience, our character and strength.” - Read more in this article.
                                            • March 29, 2020: Harvard Sociology Department Lecturer, Shai Dromi, shared his thoughts on Africa and philanthropy during COVID-19 with Inside Philanthropy: COVID-19 is Spreading in Africa. How Should Philanthropy Respond?
                                              • "Philanthropists wanting to make an effective intervention during COVID-19 should turn to one of the most commonly neglected aspects of epidemic interventions: continuing healthcare for all medical conditions and supporting the local healthcare systems in affected countries. Not only will this strategy help patients in need during the pandemic, it will also help the country sustain its independent healthcare sector in the long run. ​​​​​​"
                                              • March 25, 2020: Q&A on the economic impacts of COVID-19 on developing countrieswith Professor Rema Hanna, Jeffrey Cheah Professor of South-East Asia Studies and Chair of the International Development Area at the Harvard Kennedy School.
                                                • "The economic impact may be devastating as production, retail, trade, and almost everything comes to a standstill. For developing countries, it will be particularly devastating as they have fewer resources and lower borrowing ability to raise the funds needed to provide the kinds of health and economic support their citizens need, and providing the kind of support that citizens need right now could risk debt spiraling out of control."
                                                • March 24, 2020:Ricardo Hausmann, Director of the Growth Lab at Harvard's Center for International Development and the Rafik Hariri Professor of the Practice of International Political Economy at Harvard Kennedy School, authored an article on Flattening the COVID-19 Curve in Developing Countries.
                                                  • "The more contained you want the novel coronavirus to be, the more you will need to lock down your country – and the more fiscal space you will require to mitigate the deeper recession that will result. The problem for most of the Global South is that policymakers lack fiscal space even in the best of times."
                                                  • March 20, 2020: The Harvard Gazette covered how CAS Faculty Affiliate, Dr. Paul Farmer, the Harvard Medical School faculty members, and their colleagues at Partners In Health (PIH) are collaborating with local communities and national governments to help prepare some of the world’s most vulnerable people for the COVID-19 pandemic. Read the article 'Getting ready for the inevitable' on the Harvard Gazette website.
                                                  • March 5, 2020: Africa CDC: Africa Joint Continental Strategy for COVID-19 Outbreak
                                                    • In Africa, the primary strategy for COVID-19 will be to limit transmission and minimize harm. Given that transmission throughout the continent is inevitable, delaying and diminishing the peak of outbreaks can help health systems better manage the surge of patients and communities better adapt to the disruption of social, cultural, and economic activities. Tactics to achieve this include rapid diagnosis and isolation of infected persons, quarantine of people who had close contact with an infected person, and social distancing within the general population. Rigorous infection prevention and control practices will be needed in healthcare facilities and other high-risk congregate settings, including schools and prisons. Healthcare facilities will need to restrict hospital admission to infected persons who absolutely require a higher-level of care, such as intravenous antibiotics, oxygen, ventilatory or hemodynamic support, and/or management of complex co-morbid conditions.

                                                    Watch & Listen

                                                    • April 22, 2020: The Harvard T.H. Chan School of Public Health hosted a seminar at 11:00AM EST on Addressing Mental Health During the Covid-19 Outbreak in Africa as Health Care Systems Brace for a Battering.
                                                      • When the WHO declared COVID-19 a pandemic, Africa was initially spared. However, this is changing rapidly, with over 12,000 cases and 600 fatalities. This online forum is for anyone interested in learning about how Africa’s health care system and mental health professionals are preparing for the looming threat and surge of COVID-19 cases in the continent. You can watch event recording here.
                                                      • April 13, 2020: The Harvard Center for African Studies hosted the African Studies Workshop featuring CAS Executive Committee member, Dr. Eugene Richardson, who presented two articles titled Pandemicity and On the Coloniality of Global Public Health. The discussant was CAS Faculty Affiliate, Dr. Paul Farmer.
                                                        • Eugene Richardson, MD, PhD, is a physician-anthropologist based at Harvard Medical School. He previously served as the clinical lead for Partners In Health’s (PIH) Ebola response in Kono District, Sierra Leone, where he continues to conduct research on the social epidemiology of Ebola virus disease.
                                                        • A recording of this workshop is available here:https://vimeo.com/408381902.
                                                        • April 17, 2020: Article published: Pandemicity, COVID-19 and the limits of public health ‘science’
                                                        • April 8, 2020:Margaret Anadu, CAS Africa Advisory Board member and head of Goldman Sachs’ Urban Investment Group, talks about COVID-19’s impact on US small businesses in this podcast.
                                                        • April 7, 2020: CAS Faculty Affiliate, Dr. Paul Farmer, and co-founder of Partners In Health, a global health non-profit, is featured on Reimagined Podcast's first episode of a new series Covid-19: the long view with Dr. Paul Farmer. He discusses what can lessons from Ebola teach us about how to effectively deal with Covid-19. Is this the moment to rebuild our human social architecture to ensure fatalities on this scale never happen again?
                                                          • “Shame on us if we cannot seize this moment to make some desperately needed improvements in our health systems.”
                                                          • March 27, 2020: She Leads Africa, co-founded by CAS Leadership Council member, Yasmin Belo-Osagie, is offering a free webinar "Are you an African woman who needs a supportive network through the Covid-19 crisis and beyond?" Join their community here to gain access.
                                                            • She Leads Africa is a community that helps young African women achieve their professional dreams. With engaging online content and pan-African events, our vision is to become the #1 destination for smart and ambitious young women.
                                                            • March 19, 2020: Mass General hosted its second Medical Grand Rounds lecture related to COVID-19. Members of the Greater Boston medical community, presented on the global effects of the pandemic. Watch the video here COVID-19 in Low-resourced Settings: Reaching for Global Health Equity.
                                                              • Speakers included Louise Ivers, the executive director of the Mass General Center for Global Health,David Walton, MD, MPH, of Build Health International and Brigham and Women’s Hospital Inobert Pierre, MD, of Health Equity International and St. Boniface Haiti Quarraisha Abdool Karim, PhD, of the Centre for the Programme of AIDS Research in South Africa, Columbia University and Paul Farmer, MD, PhD, of Partners In Health and Brigham and Women's Hospital.
                                                              • March 5, 2020: The Harvard Global Health Institute Director and K.T. Li Professor of Global Health, Dr. Ashish Jha asks Dr. John Nkengasong, Director, Africa Centres for Disease Control and Prevention on preparing for Coronavirus: How did he do it, what is the current capacity for testing, and what's next as the virus spreads around the world? You can watch this short video here: How Africa's CDC is Testing for Coronavirus.
                                                              • March 5, 2020: The Harvard Center for African Studies was hosted Dr. John Nkengasong (Director, Africa Centres for Disease Control and Prevention) in collaboration with the Harvard T.H. Chan School of Public Health as the keynote speaker for a lecture generously supported by the CAS Africa Advisory Board member, Dr. Joseph Agyepong, the Inaugural Joseph S. Agyepong Distinguished Lecture on Public Health in Africa.
                                                                • In collaboration with the Harvard Africa Policy Journal, we interviewed Dr. John Nkengasong at the cusp of this global health pandemic. You can watch the interview excerpt with Dr. John Nkengasong discussing COVID-19 and Africa on our vimeo channel.

                                                                Initiatives & Opportunities

                                                                The UNDP is calling on Hackster's global community to support developing countries through the sharing and transfer of open source technology. This challenge has three priority actions:


                                                                Social distancing and isolation

                                                                Research at the early urban settlement of K2, part of the Mapungubwe World Heritage site, has thrown significant light on ancient pandemics.

                                                                The inhabitants of K2 (which dates back to between AD1000 and AD1200) thrived on crop agriculture, cattle raising, metallurgy, hunting and collecting food from the forest. They had well developed local and regional economies that fed into international networks of exchange with the Indian Ocean rim. Swahili towns of East Africa acted as conduits.

                                                                Archaeological work at K2 uncovered an unusually high number of burials (94), 76 of which belonged to infants in the 0-4 age category. This translated into a mortality rate of 5%. The evidence from the site shows that the settlement was abruptly abandoned around the same time as these burials. That means a pandemic prompted the community’s decision to shift to another settlement.

                                                                Shifting to another region of Africa, archaeological work at early urban settlements in central and southern Ghana identified the impact of pandemics at places such Akrokrowa (AD950 – 1300) and Asikuma-Odoben-Brakwa in the central district of Ghana.

                                                                These settlements, like others in the Birim Valley of southern Ghana, were bounded by intricate systems of trenches and banks of earth. Evidence shows that after a couple of centuries of continuous and stable occupation, settlements were abruptly abandoned. The period of abandonment appears to coincide with the devastation of the Black Death in Europe.

                                                                Post-pandemic, houses were not rebuilt nor did any rubbish accumulate from daily activities. Instead, the disrupted communities went to live elsewhere. Because there are no signs of long term effects – in the form of long periods of hardship, deaths or drastic socioeconomic or political changes – archaeologists believe that these communities were able to manage and adapt to the pandemic.

                                                                Analysis of archaeological evidence reveals that these ancient African communities adopted various strategies to manage pandemics. These include burning settlements as a disinfectant before either reoccupying them or shifting homesteads to new locations. African indigenous knowledge systems make it clear that burning settlements or forests was an established way of managing diseases.

                                                                The layout of settlements was also important. In areas such as Zimbabwe and parts of Mozambique, for instance, settlements were dispersed to house one or two families in a space. This allowed people to stay at a distance from each other – but not too far apart to engage in daily care, support and cooperation. While social coherence was the glue that held society together, social distancing was inbuilt, in a supportive way. Communities knew that outbreaks were unpredictable but possible, so they built their settlements in a dispersed fashion to plan ahead.

                                                                These behaviours were also augmented by diversified diets that included fruits, roots, and other things that provided nutrients and strengthened the immune system.


                                                                Archaeological Record Reveals Epidemics and Responses Throughout History

                                                                Bioarchaeologists analyze skeletons to reveal more about how infectious diseases originated and spread in ancient times.

                                                                The previous pandemics to which people often compare COVID-19 – the influenza pandemic of 1918, the Black Death bubonic plague (1342-1353), the Justinian plague (541-542) – don’t seem that long ago to archaeologists. We’re used to thinking about people who lived many centuries or even millennia ago. Evidence found directly on skeletons shows that infectious diseases have been with us since our beginnings as a species.

                                                                Bioarchaeologists like us analyze skeletons to reveal more about how infectious diseases originated and spread in ancient times.

                                                                How did aspects of early people’s social behavior allow diseases to flourish? How did people try to care for the sick? How did individuals and entire societies modify behaviors to protect themselves and others?

                                                                Knowing these things might help scientists understand why COVID-19 has wreaked such global devastation and what needs to be put in place before the next pandemic.

                                                                Clues about illnesses long ago

                                                                How can bioarchaeologists possibly know these things, especially for early cultures that left no written record? Even in literate societies, poorer and marginalized segments were rarely written about.

                                                                In most archaeological settings, all that remains of our ancestors is the skeleton.

                                                                For some infectious diseases, like syphilis, tuberculosis and leprosy, the location, characteristics and distribution of marks on a skeleton’s bones can serve as distinctive “pathognomonic” indicators of the infection.

                                                                Most skeletal signs of disease are non-specific, though, meaning bioarchaeologists today can tell an individual was sick, but not with what disease. Some diseases never affect the skeleton at all, including plague and viral infections like HIV and COVID-19. And diseases that kill quickly don’t have enough time to leave a mark on victims’ bones.

                                                                To uncover evidence of specific diseases beyond obvious bone changes, bioarchaeologists use a variety of methods, often with the help of other specialists, like geneticists or parasitologists. For instance, analyzing soil collected in a grave from around a person’s pelvis can reveal the remains of intestinal parasites, such as tapeworms and round worms. Genetic analyses can also identify the DNA of infectious pathogens still clinging to ancient bones and teeth.

                                                                Bioarchaeologists can also estimate age at death based on how developed a youngster’s teeth and bones are, or how much an adult’s skeleton has degenerated over its lifespan. Then demographers help us draw age profiles for populations that died in epidemics. Most infectious diseases disproportionately affect those with the weakest immune systems, usually the very young and very old.

                                                                For instance, the Black Death was indiscriminate 14th-century burial pits contain the typical age distributions found in cemeteries we know were not for Black Death victims. In contrast, the 1918 flu pandemic was unusual in that it hit hardest those with the most robust immune systems, that is, healthy young adults. COVID-19 today is also leaving a recognizable profile of those most likely to die from the disease, targeting older and vulnerable people and particular ethnic groups.

                                                                We can find out what infections were around in the past through our ancestors’ remains, but what does this tell us about the bigger picture of the origin and evolution of infections? Archaeological clues can help researchers reconstruct aspects of socioeconomic organization, environment and technology. And we can study how variations in these risk factors caused diseases to vary across time, in different areas of the world and even among people living in the same societies.

                                                                How infectious disease got its first foothold

                                                                Human biology affects culture in complex ways. Culture influences biology, too, although it can be hard for our bodies to keep up with rapid cultural changes. For example, in the 20th century, highly processed fast food replaced a more balanced and healthy diet for many. Because the human body evolved and was designed for a different world, this dietary switch resulted in a rise in diseases like diabetes, heart disease and obesity.

                                                                From a paleoepidemiological perspective, the most significant event in our species’ history was the adoption of farming. Agriculture arose independently in several places around the world beginning around 12,000 years ago.

                                                                Prior to this change, people lived as hunter-gatherers, with dogs as their only animal companions. They were very active and had a well balanced, varied diet that was high in protein and fiber and low in calories and fat. These small groups experienced parasites, bacterial infections and injuries while hunting wild animals and occasionally fighting with one another. They also had to deal with dental problems, including extreme wear, plaque and periodontal disease.

                                                                One thing hunter-gatherers didn’t need to worry much about, however, was virulent infectious diseases that could move quickly from person to person throughout a large geographic region. Pathogens like the influenza virus were not able to effectively spread or even be maintained by small, mobile, and socially isolated populations.

                                                                The advent of agriculture resulted in larger, sedentary populations of people living in close proximity. New diseases could flourish in this new environment. The transition to agriculture was characterized by high childhood mortality, in which approximately 30% or more of children died before the age of 5.

                                                                And for the first time in an evolutionary history spanning millions of years, different species of mammals and birds became intimate neighbors. Once people began to live with newly domesticated animals, they were brought into the life cycle of a new group of diseases – called zoonoses – that previously had been limited to wild animals but could now jump into human beings.

                                                                Add to all this the stresses of poor sanitation and a deficient diet, as well as increased connections between distant communities through migration and trade especially between urban communities, and epidemics of infectious disease were able to take hold for the first time.

                                                                Globalization of disease

                                                                Later events in human history also resulted in major epidemiological transitions related to disease.

                                                                For more than 10,000 years, the people of Europe, the Middle East and Asia evolved along with particular zoonoses in their local environments. The animals people were in contact with varied from place to place. As people lived alongside particular animal species over long periods of time, a symbiosis could develop – as well as immune resistance to local zoonoses.

                                                                At the beginning of modern history, people from European empires also began traveling across the globe, taking with them a suite of “Old World” diseases that were devastating for groups who hadn’t evolved alongside them. Indigenous populations in Australia, the Pacific and the Americas had no biological familiarity with these new pathogens. Without immunity, one epidemic after another ravaged these groups. Mortality estimates range between 60-90%.

                                                                The study of disease in skeletons, mummies and other remains of past people has played a critical role in reconstructing the origin and evolution of pandemics, but this work also provides evidence of compassion and care, including medical interventions such as trepanation, dentistry, amputation and prostheses, herbal remedies and surgical instruments.

                                                                Other evidence shows that people have often done their best to protect others, as well as themselves, from disease. Perhaps one of the most famous examples is the English village of Eyam, which made a self-sacrificing decision to isolate itself to prevent further spread of a plague from London in 1665.

                                                                In other eras, people with tuberculosis were placed in sanatoria, people with leprosy were admitted to specialized hospitals or segregated on islands or into remote areas, and urban dwellers fled cities when plagues came.

                                                                As the world faces yet another pandemic, the archaeological and historical record are reminders that people have lived with infectious disease for millennia. Pathogens have helped shape civilization, and humans have been resilient in the face of such crises.

                                                                Michael Westaway, Australian Research Council Future Fellow, Archaeology, School of Social Science, The University of Queensland

                                                                This article is republished from The Conversation under a Creative Commons license. Read the original article.


                                                                The Introduction of Paper as a Wipe

                                                                Although paper originated in China in the second century B.C., the first recorded use of paper for cleansing is from the 6th century in medieval China, discovered in the texts of scholar Yen Chih-Thui. In 589 A.D, he wrote, “Paper on which there are quotations or commentaries from the Five Classics or the names of sages, I dare not use for toilet purposes.”

                                                                By the early 14th century, the Chinese were manufacturing toilet paper at the rate of 10 million packages of 1,000 to 10,000 sheets annually. In 1393, thousands of perfumed paper sheets were also produced for the Hongwu Emperor’s imperial family.

                                                                Paper became widely available in the 15th century, but in the Western world, modern commercially available toilet paper didn’t originate until 1857, when Joseph Gayetty of New York marketed a "Medicated Paper, for the Water-Closet,” sold in packages of 500 sheets for 50 cents. Before his product hit the market, Americans improvised in clever ways.

                                                                "The greatest necessity of the age! Gayetty&aposs medicated paper for the water-closet."

                                                                Barry Kudrowitz, associate professor and director of product design at the University of Minnesota, has studied the history and use of toilet paper. Through the 1700s, corncobs were a common toilet paper alternative. Then, newspapers and magazines arrived in the early 18th century. “The ‘legend’ goes that people were primarily using the Sears catalog in outhouses, but when the catalog began to be printed in glossy paper people needed to find a replacement,” says Kudrowitz. Americans also nailed the Farmer’s Almanac onto outhouse walls, leading the company to pre-drill the legendary “hole” into their publication in 1919.

                                                                The first perforated toilet paper rolls were introduced in 1890, and by 1930 toilet paper was finally manufactured “splinter free.” Today, softer, stronger and more absorbent describe the toilet paper found in American homes.


                                                                2. Black Death—The Invention of Quarantine

                                                                A couple suffering from the blisters of the Black Death, the bubonic plague that swept through Europe in the Middle Ages. From the Swiss manuscript the Toggenburg Bible, 1411. 

                                                                VCG Wilson/Corbis/Getty Images

                                                                The plague never really went away, and when it returned 800 years later, it killed with reckless abandon. The Black Death, which hit Europe in 1347, claimed an astonishing 200 million lives in just four years.

                                                                As for how to stop the disease, people still had no scientific understanding of contagion, says Mockaitis, but they knew that it had something to do with proximity. That’s why forward-thinking officials in Venetian-controlled port city of Ragusa decided to keep newly arrived sailors in isolation until they could prove they weren’t sick.

                                                                At first, sailors were held on their ships for 30 days, which became known in Venetian law as a trentino. As time went on, the Venetians increased the forced isolation to 40 days or a quarantino, the origin of the word quarantine and the start of its practice in the Western world.

                                                                “That definitely had an effect,” says Mockaitis.


                                                                The Black Death

                                                                “The Plague” was a global outbreak of bubonic plague that originated in China in 1334, arrived in Europe in 1347, following the Silk Road. Within 50 years of its reign, by 1400, [24] it reduced the global population from 450 million to below 350 million, possibly below 300 million, with the pandemic killing as many as 150 million. Some estimates claim that the Black Death claimed up to 60% of lives in Europe at that time [25].

                                                                Starting in China, it spread through central Asia and northern India following the established trading route known as the Silk Road. The plague reached Europe in Sicily in 1347. Within 5 years, it had spread to the virtually entire continent, moving onto Russia and the Middle East. In its first wave, it claimed 25 million lives [24].

                                                                The course and symptoms of the bubonic plague were dramatic and terrifying. Boccaccio, one of the many artistic contemporaries of the plague, described it as follows:

                                                                In men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg. From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. As the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves [26].

                                                                Indeed, the mortality of untreated bubonic plague is close to 70%, usually within 8ꃚys, while the mortality of untreated pneumonic plague approaches 95%. Treated with antibiotics, mortality drops to around 11% [27].

                                                                At the time, scientific authorities were at a loss regarding the cause of the affliction. The first official report blamed an alignment of three planets from 1345 for causing a “great pestilence in the air” [28]. It was followed by a more generally accepted miasma theory, an interpretation that blamed bad air. It was not until the late XIX century that the Black Death was understood for what it was – a massive Yersinia Pestis pandemic [29].

                                                                This strain of Yersinia tends to infect and overflow the guts of oriental rat fleas (Xenopsylla cheopis) forcing them to regurgitate concentrated bacteria into the host while feeding. Such infected hosts then transmit the disease further and can infect humans – bubonic plague [30]. Humans can transmit the disease by droplets, leading to pneumonic plague.

                                                                The mortality of the Black Death varied between regions, sometimes skipping sparsely populated rural areas, but then exacting its toll from the densely populated urban areas, where population perished in excess of 50, sometimes 60% [31].

                                                                In the vacuum of a reasonable explanation for a catastrophe of such proportions, people turned to religion, invoking patron saints, the Virgin Mary, or joining the processions of flagellants whipping themselves with nail embedded scourges and incanting hymns and prayers as they passed from town to town [32]. The general interpretation in predominantly Catholic Europe, as in the case of Justinian plague, centered on the divine “punishment for sins.” It then sought to identify those individuals and groups who were the “gravest sinners against God,” frequently singling out minorities or women. Jews in Europe were commonly targeted, accused of “poisoning the wells” and entire communities persecuted and killed. Non-Catholic Christians (e.g., Cathars) were also blamed as “heretics” and experienced a similar fate [33]. In other, non-Christian parts of the world affected by the plague, a similar sentiment prevailed. In Cairo, the sultan put in place a law prohibiting women from making public appearances as they may tempt men into sin [34].

                                                                For bewildered and terrified societies, the only remedies were inhalation of aromatic vapors from flowers or camphor. Soon, there was a shortage of doctors which led to a proliferation of quacks selling useless cures and amulets and other adornments that claimed to offer magical protection [35].

                                                                Entire neighborhoods, sometimes entire towns, were wiped out or settlements abandoned. Crops could not be harvested, traveling and trade became curtailed, and food and manufactured goods became short. The plague broke down the normal divisions between the upper and lower classes and led to the emergence of a new middle class. The shortage of labor in the long run encouraged innovation of labor-saving technologies, leading to higher productivity [2].

                                                                The effects of such a large-scale shared experience on the population of Europe influenced all forms of art throughout the period, as evidenced by works by renowned artists, such as Chaucer, Boccaccio, or Petrarch. The deep, lingering wake of the plague is evidenced in the rise of Danse Macabre (Dance of the death) in visual arts and religious scripts [36], its horrors perhaps most chillingly depicted by paintings titled the Triumph of Death (Fig. 2.2 ) [37].

                                                                The Triumph of Death (Trionfo Della Morte), fresco, author unknown, cca. 1446, on display at Palazzo Abatellis, Palermo, Italy


                                                                Watch the video: An African Urban Farmscape: An archaeology and chronology of successful terrace farming in Bokoni


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