History of Pandemics
- Mahi Tewari
- May 26, 2020
- 14 min read
Research paper
Abstract
Humanity has faced several Pandemics that changed the course of history. Pandemics endanger the survival of humans and their containment is of dire importance. With each plague and epidemic, world has learned how a viral outbreak spreads, what can be a possible source and how to stop it from spreading further.
With time a clear dichotomy has been formed from, prayers to god for protection to vaccines.The contrast between the first plague of 541–542 AD to the current Corona pandemic becomes the core of human evolvement in fight against mortality.
The research focuses on leading reasons of a pandemic and it’s spread & impact on global scale.The paper’s underlying core is to analyse & defamiliarize the history and key features of each pandemics hitting humanity.
Keywords: Pandemics, containment, outbreak-spread, history, defamiliarization
Introduction
A pandemic (from Greek ‘pan-all’ & ‘demos-individuals’) is an epidemic of illness that is spread across a huge area, for example, multiple continents or globally, affecting a considerable number of individuals.
The research paper summarizes the deadliest Pandemics that have devasted humanity and were proved fatal.
Reason of the infection and the systematic spread of the infection are of prime importance. Focus is also on the circumstances that lead to the spread, initial reaction,treatments and consequences.
The paper discusses lethal outbreaks starting from the Bubonic Plague, to several Cholera outbreaks scattered across countries and different centuries and gradually towards 20th century pandemics of Spanish flu and HIV/AIDS Pandemic.
Research’s target is to defamiliarize the history of Pandemics and and create a contrast with the current Corona Pandemic and offer a window to learn from past pandemic responses.
The Bubonic Plague
Historical pandemics have gone down in history by the word ‘Plague’.
The root cause of these was the bacterium Yersinia pestis.
Rats have long been blamed for spreading the plague around Europe but new studies it would have been unlikely to spread as fast as it did if it was transmitted by only rats.The rodent model(rat-fleas to human) did not match the historical death rates. Current research show that human to human transmission of fleas and lice would also have needed to take place.
Though there have been three recorded instances of Plagues in history, the most infamous and deadly pandemics that world has ever faced were the ‘Bubonic Plagues’. Considered to be history’s most devasting pandemic, it claimed anywhere between 75 to 200 million people in Eurasia within four short years as it marched across Europe, Scandinavia, Northern Africa, the Middle East and Central Asia.
It arose at a time of emerging empires, greater exploration and new discoveries. Armies, colonisers and traders all imported and exported the disease in ships and overland.
This ruthless, unforgiving & pestilential pandemic got the name ‘Black Death’
The earliest accounts described it as emergence of tumors(buboes) in groin or armpits, some of them grew as large as a common apple, others as an egg. Later black spots would appear on arms and legs.These were followed by acute fever and vomiting blood. Victims usually died between two and seven days after being infected. The death rate was 60–90 per cent.
Historian and researches postulate that the Black Death originated in Central Asia, specifically in Mongolia and western China. Since the rodents that carry the plague diseases are indegenous to the central and western Asian areas of Kurdistan and Northern India. Graves found in Kyrgzstan from 1338-9 make written mention of the plague.
In 1347, Mongols attacked Crimea and this is how the infection travelled to Italy. Twelve Genoese ships that fled Kaffa(Crimea) arrived in Sicily with decks filled with dead bodies. The Italian authorities, being informed of the new disease started refusing docking. Due to lack of quick communication these were allowed to Marseilles, France. Thus marking the full-fleged commencement of the Black Death in Europe through ports.
Understanding of medicine and the spread of disease was extremely limited in medieval period. The concept of hygiene during this period was drastically different than we see it today. Human and animal waste were common inside the home and were disposed of in the streets, which more often than not weren’t drained or washed until it rained. These circumstances would have been the ideal breeding ground for diseases of all kinds.
As the plague claimed more lives, one of the most challenging, morbid and unseen dilemma was how to dispose of the dead. The best solution would have been to burn the bodies at a removed location. However, Catholic law prohibited this as burning bodies was considered desecration, as the Church believed the human soul would return to it’s body at the end of days.
Contemporary treatments were often religious or superstitious in nature, people were advised to hold flowers in or around their noses to ward off the bad air (medieval doctors thought the illness was caused by exposure to ‘bad air’) that surrounded them.
One of the most infamous figures to come out of the Black Death was the Plague Doctor. This person had no medical knowledge and were hired by a village, town or city to deal with the victims of the Plague. Common cures were bloodletting and attaching leeches to buboes.
In the end, the plague in general and the Black death in particular remains one of the history’s most lethal events, if not the deadliest. Not only did half the world’s population perished, but the entire economic system on which Europe was built was irrevocably damaged.
Cholera Pandemic
The word cholera means a bilious disease and is derived from the Greek term ‘chole’ or bile which is a nonspecific word that has been used in past centuries for various gastrointestinal diseases. It is caused by a bacterium, Vibrio Cholera, mostly found in salty & dirty water, it causes severe dehydration & diarrhea and death without treatment.
In the 18th century, British physician John Snow (1813-1858) explained the association of a terrible cholera outbreak in London in 1849 to contamination of the drinking water supply with human excreta. Despite his finding, the causative agent of this dreaded illness was unidentified until later in the 19th century.
In 1817 the first lethal outbreak occurred in Jessore, India, midway between Calcutta (Kolkata) and Dhaka (now in Bangladesh), and then spread throughout most of India, Burma (Myanmar), and Ceylon (Sri Lanka).By 1820 epidemics had been reported in Siam (Thailand), in Indonesia (where more than 100,000 people succumbed on the island of Java alone). At Basra, Iraq, as many as 18,000 people died during a three-week period in 1821. The pandemic spread through Turkey and reached the threshold of Europe.
Cholera kept spreading from this point, since then numerous outbreaks and seven global pandemics of cholera took place until 1923.
Drinking water was either dipped or pumped from shallow dug wells, rivers or lakes. Water sellers carried water drawn from wells or rivers. Sewage was deposited by individual households in streams or in cesspools which were allowed to overflow or seep into nearby sites. Water sources and sewage disposal were positioned for convenience, not safety - often so close together that the odor and taste of drinking water was a problem.
In general, cholera was blamed on miasmas, filthy living conditions, especially the poor blacks and Irish or the minority. Some blamed the sinful behavior of whole population groups and the just wrath of an angry God.
Orthodox cholera treatment in that period would have been recognized long ago by Galen (famous physician of the roman empire).
Bleeding, purging, and opium were used. Astringents such as lead acetate were often prescribed. Some advocated oral salt solutions-even intravenous solutions-but the idea was not accepted, though a few reported excellent results. There was no objective means of diagnosis.
Cholera did not spread widely again until 1961, the beginning of the seventh pandemic.The seventh pandemic started in Indonesia in 1961 and spread globally, currently infecting 3–5 million people annually.Cholera still effects developing economies like India where proper water sanitation is not followed.
Spanish Influenza
In the fall of 1918 World War-I was winding down and peace was on the horizon. . Deep within the trenches men lived through some of the most brutal conditions of life, which it seemed could not be any worse. Then, across the globe, something erupted that seemed as benign as the common cold.
The influenza ( a virus that attacks the respiratory system, highly contagious: When an infected person coughs, sneezes or talks, respiratory droplets are generated and transmitted into the air, and can then can be inhaled by anyone nearby)of that season, however, was far more than a cold.
In the two years that this scourge ravaged the earth, a fifth of the world's population was infected & 50 million died. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children.The virus infected as much as 40 percent of the global population over the next 18 months.
Spain was one of only a few major European countries to remain neutral during World War I. Unlike in the Allied and Central Powers nations, where wartime censors suppressed news of the flu to avoid affecting morale, the Spanish media was free to report on it in gory detail. Since nations undergoing a media blackout could only read in depth accounts from Spanish news sources, they naturally assumed that the country was the pandemic’s ground zero. This is one of the reasons why it is called the Spanish Flu even when it might have not even originated from this country.
The first wave of the 1918 pandemic occurred in the spring and was generally mild. The sick, who experienced such typical flu symptoms as chills, fever and fatigue, usually recovered after several days, and the number of reported deaths was low.
However, a second, highly contagious wave of influenza appeared with a vengeance in the fall of that same year. Victims died within hours or days of developing symptoms, their skin turning blue and their lungs filling with fluid that caused them to suffocate. In just one year, 1918, the average life expectancy in America plummeted by a dozen years.
Unlike most outbreaks this one did not spread due to transport and usual business between countries, reasons for it’s drastic spread was the period in which it had started spreading. Since 1918 was the year when the first world war was ending, soldiers from all countries were going back to their native land, it is believe infected soldiers spread the disease to other military camps across the country, then brought it overseas when the war ended.
One stark difference we see from past pandemics to this one is the acceptance of a medical explanation for the situation. Photographic evidence shows people using masks to cover their faces and even in makeshift hospitals measures were taken to quarantine sick people. The public health sector was extremely swift in some American cities, they immediately shut down schools, public spaces and restaurants. Newspapers were continuously publishing public health warnings and the severity of the Influenza.
But public health messages were confused too- and, just like today, fake news and conspiracy theories abounded, although the general level of ignorance about healthy lifestyles did not help. In some factories, no-smoking rules were relaxed, in the belief that cigarettes would help prevent infection.There was no centrally imposed lockdown to curb the spread of infection, although many theatres, dance halls, cinemas and churches were closed, in some cases for months.
Most American cities that were placed under quick & efficient lockdown had visible decrease in death rates and those who did not comply faced dire consequences. One of the examples would be of city of San Francisco.
Thought the city had a lockdown they ended it too soon in November as they had low death rates and thought the contagion was over.Churches, public parks and gatherings started taking place without precaution. By December 1918 the deadly second wave of the Influenza hit America again & cases began to surge. Officials soon asked the public to wear masks again in January 1919. It was during this time that a protest took place of 45000 people to defy this order.February 1919 the city faced 3213 deaths, by the end of 1919, 45000 San Franciscans had gotten the flu making it one of the hardest hit cities in America.
After the lethal second wave struck in late 1918, new cases dropped abruptly – almost to nothing after the peak in the second wave, a theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. This is a common occurrence with influenza viruses: there is a tendency for pathogenic viruses to become less lethal with time, as the hosts of more dangerous strains tend to die out.
HIV AIDS PANDEMIC
Today, HIV (human immunodeficiency virus), remains one of the largest pandemics in the world. HIV is the virus that can lead to AIDS (acquired immunodeficiency syndrome). It doesn’t have a cure. There were approximately 37.9 million people across the globe with HIV/AIDS in 2018.
Over the decades, the virus spread through Africa, and to other parts of the world. It wasn’t until the early 1980s, when rare types of pneumonia, cancer, and other illnesses were being reported to doctors that the world became aware of a presence of a Virus. HIV was first identified in 1984.
The epidemic came into global light when it came to United States in the 1980s, increasing numbers of young homosexual men succumbed to unusual opportunistic infections and rare malignancies.Given the sociological parameters of known HIV patients in 1982, early scientists labeled the group of mystery illnesses as a gay-related immune deficiency, gay cancer or community-acquired immune dysfunction. Later research proved that females and heterosexual people were also susceptible to the virus.
The early months and years of HIV and AIDS research were marked by rapid change. Scientists not only grappled with a new killer illness that was poorly understood, but the virus itself exhibited new characteristics almost as fast as researchers could identify them.
In March 1989, 145 countries had reported 142,000 AIDS cases. However, the WHO estimated there were up to 400,000 cases worldwide.
In most of Africa though there was a steep increase in transmission of virus, public opinion was backed by the leadership of African politicians who refused to acknowledge the existence of sex between men, let alone a health crisis that affected a nation's homosexual population. In many countries, homosexuality was and still is a criminal act; it was not uncommon for early AIDS activists to end up in jail. In countries where the gay social network operated underground, reaching the population with lifesaving education and antiretrovirals (drug used to control HIV)was near impossible.
In 1999, researchers found a strain of SIV in a chimpanzee that was almost identical to HIV in humans.The researchers who discovered this connection concluded that it proved chimpanzees were the source of HIV-1, and that the virus had at some point crossed species from chimps to humans.
Created in 2003, PEPFAR is the U.S. government’s global effort to combat HIV. As an interagency initiative, PEPFAR involves multiple U.S. departments, agencies, and programs that address the global epidemic.
Although HIV testing capacity has increased over time, enabling more people to learn their HIV status, about one in five people with HIV (21%) are still unaware they are infected.Under Sustainable Development Goal 3, the global community has agreed to aim to end the AIDS epidemic by 2030, and under the UNAIDS “90-90-90” targets, countries work toward achieving, by 2020, “90% of people living with HIV knowing their HIV status; 90% of people who know their HIV-positive status on treatment; and 90% of people on treatment with suppressed viral loads.
Swine Flu Epidemic
The 2009 swine flu pandemic was an influenza pandemic that lasted for about 19 months, from January 2009 to August 2010, and the second of two pandemics involving H1N1 influenza virus (the first being the 1918–1919 Spanish flu pandemic which lasted about 15 months). First described in April 2009, the virus appeared to be a new strain of H1N1, which resulted from a previous triple reassortment of bird, swine, and human flu viruses further combined with a Eurasian pig flu virus, leading to the term "swine flu". The virus of the same H1N1 family as the pandemic flu had been circulating as ordinary seasonal flu since 1977.
The swine flu pandemic of 2009 killed an estimated 284,500 people, some 15 times the number confirmed by laboratory tests at the time, according to a new study by an international group of scientists.The flu infected from 700 milllion to 1.4 billion(estimate) people.
Swine flu, caused by the H1N1 influenza virus, infected its first known victim in central Mexico in March 2009.By April it had reached California, infecting a 10-year-old, and then quickly spread around the world, triggering fears and even panic.On 27 April, with 900 cases of suspected swine flu reported in Mexico, the World Health Organization (WHO) upgrades the pandemic warning level from 3 to 4 on a six-point scale. Intensive efforts to understand the virus and develop a vaccine begin immediately. Pandemic’s impact varied widely by region, with 51 percent of swine flu deaths occurring in Africa and southeast Asia, which account for only 38 percent of the world’s population.
Even though the elderly were more likely to die once infected, so few caught the virus that 80 percent of swine flu deaths were of people younger than 65.
The swine flu lead individuals differ in the way they react to viruses. A virus that binds deep in the lung can trigger potentially fatal pneumonia if the person infected mounts a strong inflammation in response to it.
Although swine flu seemed to be spreading slowly, it was still progressing quickly enough to justify preparing for a pandemic. However, the WHO delayed declaring a pandemic, partly because there was not enough evidence that the virus was spreading in the general population outside the Americas, where it originated.
Researchers discover that the swine flu virus binds far deeper in the lungs than ordinary flu, possibly explaining why it is sometimes fatal. However, the majority of cases were still mild, and it appeared that many of the people with severe cases have an underlying health problem – although some of these “problems” were no more remarkable than being overweight, pregnant or unborn. By September 2009 a vaccine was formed which worked similar to a seasonal flu shot. By 19 November 2009, doses of vaccine had been administered in over 16 countries.
Current Pandemic and Conclusion
The Corona outbreak came from the wet markets of China in 2019 and has since become a Pandemic.The corona pandemic isn’t the first pandemic that arose from China in the 21st century. In 2003 the SARS outbreak was traced to a wet market in Foushan, China. Chinese officials were quick to shut these markets and banned wildlife farming. But they tried to hide the outbreak first. A few months after the outbreak, the Chinese government declared 54 species of wildlife animals legal to farm again.
That SARS outbreak was a relative to the current virus, the past pandemic took almost 800 lives. But due to global efforts it was stopped from spreading like the current contagion.
The first SARS outbreak of China had a 10% rate of fatality but its spread from human to human wasn’t as strong as the current SARS COVID-19 plus the symptoms were so extreme most people immediately went to the hospitals.
If lessons were learned from this outbreak and earlier outbreaks & precautions were taken maybe this pandemic could have been avoided.
Both of the virus arose from contact between a sick animal and a human; conditions adequate in a wet market. China knew of the dangers but didn’t pay heed.
Testimonials from Wuhan doctors and citizen journalist provide adequate proof that the officials tried to hide this outbreak. They did not impose restrictions on meetings during the Chinese New Year which acted as a breeding ground for a massive infection strain.
The viral outbreak wasn’t called the Chinese flu or the Wuhan virus because WHO has identified best practices for the naming of new human diseases, with the aim to minimize unnecessary negative impact of disease names on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups. These practices have taken place considering the stigma that happened during the Spanish Influenza.
Similarities we see in this pandemic with the past ones are of panic and a general atmosphere of doubt. As the information about the virus spread, people in large numbers started migrating to their native lands and this spread the Corona virus further.
During Bubonic plaque misinformation played a big role in false treatments and misconceptions of the disease. Just like the belief that the smell of roses could ward off the plague, many believed in false news of corona being cured by alcohol.
From the example of San Fransico it can be understood that opening a lockdown too quickly or not abiding to social-distancing norms can lead to massive infections and deaths of thousands.
During Cholera particular communities were blamed for the pandemic just like the Chinese community is being ostracized now.
AIDS pandemics shows how certain government tries to hide outbreaks due to social stigma and how they rather let the situation go untreated than let the world know of a deadly infectious virus.
In both the Swine flu & Current pandemic situation inadequacy of WHO leadership can be noticed.
My research portrays the adverse effects of a pandemic, how it spreads when officials fail to contain it or understand its seriousness, and areas which a pandemic strikes hard.In all the pandemics finding the source land of the pandemics and the patient zero has been deemed essential. Spread of a virus can help us understand how it was created and which places need to be locked-down to stop it’s spread. Example- London Cholera outbreak was traced to the source infected water tank & stopped.
Given the effects of globalization, the intense mobility of human populations, and the relentless urbanization, it is likely that the next emerging virus will also spread fast and far. It is impossible to predict the nature of this virus or where it will start spreading.
Through the history we learn the marvelous thing about humanity,is its capacity to survive, and to record its own history. And through that desire we keep track and tell tales of hardship & woe. Today we understand the devastation that a disease can wreck. Because of this desire to avoid pain & suffering we have modern medicines & to avoid global pandemics, we need to make sure such outbreaks never happen again & that can only be done through worldwide containment efforts across all countries.
BIBLIOGRAPHY
The Black Death: A History from Beginning to End
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