Historical Pandemics and Epidemics

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An epidemic is defined as “an outbreak of disease that spreads quickly and affects many individuals at the same time.” A pandemic is a type of epidemic (one with greater range and coverage), an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population. While a pandemic may be characterized as a type of epidemic, you would not say that an epidemic is a type of pandemic.

Epidemic:

An epidemic is the rapid spread of disease to a large number of people in a given population within a short period of time. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.

Epidemics of infectious disease are generally caused by several factors including a change in the ecology of the host population (e.g. increased stress or increase in the density of a vector species), a genetic change in the pathogen reservoir, or the introduction of an emerging pathogen to a host population (by the movement of pathogen or host).

Generally, an epidemic occurs when host immunity to either an established pathogen or a newly emerging novel pathogen is suddenly reduced below that found in the endemic equilibrium, and the transmission threshold is exceeded.

An epidemic may be restricted to one location; however, if it spreads to other countries or continents and affects a substantial number of people, it may be termed a pandemic. The declaration of an epidemic usually requires a good understanding of a baseline rate of incidence; epidemics for certain diseases, such as influenza, are defined as reaching some defined increase in incidence above this baseline. A few cases of a very rare disease may be classified as an epidemic, while many cases of a common disease (such as the common cold) would not.

Pandemic:

A pandemic is a disease epidemic that has spread across a large region, for instance, multiple continents, or worldwide. A widespread endemic disease with a stable number of infected people is not a pandemic. Further, flu pandemics generally exclude recurrences of seasonal flu.

Throughout history, there have been a number of pandemics of diseases such as smallpox and tuberculosis. One of the most devastating pandemics was the Black Death
(also known as The Plague), which killed an estimated 75–200 million
people in the 14th century. Other notable pandemics include the 1918 influenza pandemic (Spanish flu) and the 2009 flu pandemic (H1N1). Current pandemics include HIV/AIDS and the 2019 coronavirus disease, which was declared a pandemic on 11 March 2020 by the World Health Organization (WHO).

Historical Epidemics:

1. Prehistoric epidemic: Circa 3000 B.C.

About 5,000 years ago, an epidemic wiped out a prehistoric village in China. The bodies of the dead were stuffed inside a house that was later burned down. No age group was spared, as the skeletons of juveniles, young adults, and middle-aged people were found inside the house. The archaeological site is now called “Hamin Mangha” and is one of the best-preserved prehistoric sites in northeastern China.

Archaeological and anthropological study indicates that the epidemic happened quickly enough that there was no time for proper burial, and the site was not inhabited again. Before the discovery of Hamin Mangha, another prehistoric mass burial that dates to roughly the same time period was found at a site called Miaozigou, in northeastern China. Together, these discoveries suggest that an epidemic ravaged the entire region.

2. Plague of Athens: 430 B.C.

Describing these diseases how they started, how they ended, or if they are still among us, would end up being something like watching a three-hour movie. So I will list them as the earliest on record and be more descriptive in more of the recent epidemics.

3. Antonine Plague: A.D. 165-180

4. Plague of Cyprian: A.D. 250-271

5. Plague of Justinian: A.D. 541-542

6. The Black Death: 1346-1353

7. Cocoliztli epidemic: 1545-1548

8. American Plagues: 16th century

9. Great Plague of London: 1665-1666

10. Great Plague of Marseille: 1720-1723

11. Russian Plague: 1770-1772

12. Philadelphia Yellow Fever Epidemic: 1793

13. American polio epidemic: 1916

A polio epidemic that started in New York City caused 27,000 cases and 6,000 deaths in the United States. The disease mainly affects children and sometimes leaves survivors with permanent disabilities.

Polio epidemics occurred sporadically in the United States until the Salk vaccine was developed in 1954. As the vaccine became widely available, cases in the United States declined. The last polio case in the United States was reported in 1979. Worldwide vaccination efforts have greatly reduced the disease, although it is not yet completely eradicated.

14. Spanish Flu: 1918-1920

An estimated 500 million people from the South Seas to the North Pole fell victim to the Spanish Flu. One-fifth of those died, with some indigenous communities, pushed to the brink of extinction. The flu’s spread and lethality were enhanced by the cramped conditions of soldiers and poor wartime nutrition that many people were experiencing during World War I.

Despite the name Spanish Flu, the disease likely did not start in Spain. Spain was a neutral nation during the war and did not enforce strict censorship of its press, which could therefore freely publish early accounts of the illness. As a result, people falsely believed the illness was specific to Spain, and the name Spanish Flu stuck.

The Spanish flu pandemic of 1918, the deadliest in history, infected an estimated 500 million people worldwide—about one-third of the planet’s population—and killed an estimated 20 million to 50 million victims, including some 675,000 Americans. The 1918 flu was first observed in Europe, the United States, and parts of Asia before swiftly spreading around the world.

At the time, there were no effective drugs or vaccines to treat this killer flu strain. Citizens were ordered to wear masks, schools, theaters, and businesses were shuttered and bodies piled up in makeshift morgues before the virus ended its deadly global march.

Although the death toll attributed to the Spanish flu is often estimated at 20 million to 50 million victims worldwide, other estimates run as high as 100 million victims—around 3 percent of the world’s population. The exact numbers are impossible to know due to a lack of medical record-keeping in many places.

15. Asian Flu: 1957-1958

The Asian Flu pandemic was another global showing for influenza. With its roots in China, the disease claimed more than 1 million lives. The virus that caused the pandemic was a blend of avian flu viruses.

The Centers for Disease Control and Prevention notes that the disease spread rapidly and was reported in Singapore in February 1957, Hong Kong in April 1957, and the coastal cities of the United States in the summer of 1957. The total death toll was more than 1.1 million worldwide, with 116,000 deaths occurring in the United
States.

16. AIDS pandemic and epidemic: 1981-present day

AIDS has claimed an estimated 35 million lives since it was first identified. HIV, which is the virus that causes AIDS, likely developed from a chimpanzee virus that transferred to humans in West Africa in the 1920s. The virus made its way around the world, and AIDS was a pandemic by the late 20th century. Now, about 64% of the estimated 40 million living with human immunodeficiency virus (HIV) live in sub-Saharan Africa.

For decades, the disease had no known cure, but medication developed in the 1990s now allows people with the disease to experience a normal life span with regular treatment. Even more encouraging, two people have been cured of HIV as of early 2020.

17. West African Ebola epidemic: 2014-2016

Ebola ravaged West Africa between 2014 and 2016, with 28,600 reported cases and 11,325 deaths. The first case to be reported was in Guinea in December 2013, then the disease quickly spread to Liberia and Sierra Leone. The bulk of the cases and deaths occurred in those three countries. A smaller number of cases occurred in Nigeria, Mali, Senegal, the United States, and Europe, the Centers for Disease Control and Prevention reported.

There is no cure for Ebola, although efforts at finding a vaccine are ongoing. The first known cases of Ebola occurred in Sudan and the Democratic Republic of
Congo in 1976 and the virus may have originated in bats.

18. Zika Virus epidemic: 2015-present day

The impact of the recent Zika epidemic in South America and Central America won’t be known for several years. In the meantime, scientists face a race against time to bring the virus under control. The Zika virus is usually spread through mosquitoes of the Aedes genus, although it can also be sexually transmitted in humans.

While Zika is usually not harmful to adults or children, it can attack infants who are still in the womb and cause birth defects. The type of mosquitoes that carry Zika flourish best in warm, humid climates, making South America, Central America, and parts of the southern United States prime areas for the virus to flourish.

Now let us look at the pandemics:

The Black Death (1346-1353)

Black Death—The Invention of Quarantine

Social Distancing and Quarantine Were Used in Medieval Times to Fight the Black Death

Death Toll: 75 – 200 million
Cause: Bubonic Plague
From 1346 to 1353 an outbreak of the Plague ravaged Europe, Africa, and Asia, with an estimated death toll between 75 and 200 million people. Thought to have originated in Asia, the Plague most likely jumped continents via the fleas living on the rats that so frequently lived aboard merchant ships. Ports being major urban centers at the time, were the perfect breeding ground for the rats and fleas, and thus the insidious bacterium flourished, devastating three continents in its wake.

Third Cholera Pandemic (1852–1860)

Flu Pandemic (1889-1890)

Death Toll: 1 million
Cause: Influenza

Sixth Cholera Pandemic (1910-1911)

Death Toll: 800,000+
Cause: Cholera
Like its five previous incarnations, the Sixth Cholera Pandemic originated in India where it killed over 800,000, before spreading to the Middle East, North Africa, Eastern Europe, and Russia. The Sixth Cholera Pandemic was also the source of the last American outbreak of Cholera (1910–1911). American health authorities, having learned from the past, quickly sought to isolate the infected, and in the end, only 11 deaths occurred in the U.S. By 1923 Cholera cases had been cut down
dramatically, although it was still a constant in India.

Flu Pandemic (1918)

Death Toll: 20 -50 million
Cause: Influenza
Between 1918 and 1920 a disturbingly deadly outbreak of influenza tore across the globe, infecting over a third of the world’s population and ending the lives of 20 – 50 million people. Of the 500 million people infected in the 1918 pandemic, the mortality rate was estimated at 10% to 20%, with up to 25 million deaths in the first 25 weeks alone.

What separated the 1918 flu pandemic from other influenza outbreaks was the victims; where influenza had always previously only killed juveniles and the elderly or already weakened patients, it had begun striking down hardy and completely healthy young adults while leaving children and those with weaker immune systems still alive.

Asian Flu (1956-1958)

Death Toll: 2 million
Cause: Influenza
Asian Flu was a pandemic outbreak of Influenza A of the H2N2 subtype, that originated in China in 1956 and lasted until 1958. In its two-year spree, Asian Flu traveled from the Chinese province of Guizhou to Singapore, Hong Kong, and the United States. Estimates for the death toll of the Asian Flu vary depending on the source, but the World Health Organization places the final tally at approximately 2 million deaths, 69,800 of those in the US alone.

Flu/Influenza transmission

Flu Pandemic (1968)

Death Toll: 1 million
Cause: Influenza
A category 2 Flu pandemic sometimes referred to as “the Hong Kong Flu,” the 1968 flu pandemic was caused by the H3N2 strain of the Influenza A virus, a genetic offshoot of the H2N2 subtype. From the first reported case on July 13, 1968, in Hong Kong, it took only 17 days before outbreaks of the virus were reported in Singapore and Vietnam, and within three months had spread to The Philippines, India, Australia, Europe, and the United States.

While the 1968 pandemic had a comparatively low mortality rate (.5%) it still resulted in the deaths of more than a million people, including 500,000 residents of Hong Kong, approximately 15% of its population at the time.

HIV/AIDS Pandemic (at its peak, 2005-2012)

Death Toll: 36 million
Cause: HIV/AIDS
First identified in the Democratic Republic of the Congo in 1976, HIV/AIDS has truly proven itself as a global pandemic, killing more than 36 million people since 1981. Currently, there are between 31 and 35 million people living with HIV, the vast majority of those are in Sub-Saharan Africa, where 5% of the population is infected, roughly 21 million people.

As awareness has grown, new treatments have been developed that make HIV far more manageable, and many of those infected go on to lead productive lives. Between 2005 and 2012 the annual global deaths from HIV/AIDS dropped from 2.2 million to 1.6 million.

What About Covid-19 (the Novel Coronavirus)?

Beginning in December 2019, in the region of Wuhan, China, a new (“novel”) coronavirus began appearing in human beings. It has been named Covid-19, a shortened form of “coronavirus disease of 2019.” This new virus spreads incredibly quickly between people, due to its newness – no one on earth has immunity to Covid-19, because no one had Covid-19 until 2019.

While it was initially seen to be an epidemic in China, the virus spread worldwide within months. The WHO declared COVID-19 a pandemic in March, and by the end of that month, the world saw more than a half-million people infected and nearly 30,000 deaths. The infection rate in the US and other nations was still spiking.

With the coronavirus pandemic, people all over the world have become more aware of the best practices during a pandemic, from careful hand-washing to social distancing. Countries across the world declared mandatory stay-at-home measures, closing schools, businesses, and public places. Dozens of companies and many more independent researchers began working on tests, treatments, and vaccines. The push for the human race to survive the pandemic became the primary concern in the world.

The outcome of the Covid-19 pandemic is impossible to predict, at the time of this writing. But we can learn from pandemics in history to determine our best courses. These are our teachers – the Spanish flu, the AIDS pandemic, and more.

Statics on Influenza/Flu

1819-1890  Approximately 1 million deaths.

1918-1990  Approximately 20 to 50 million deaths. An estimated 500 million were infected

1956-1958  Approximately 2 million deaths

1968- ???? 1 million deaths

Among the world’s deadliest diseases, Influenza still ranks in the top ten according to the World Health Organization.

Influenza:

While a healthy person can fight influenza on his/her own, immunocompromised people, especially children, old, pregnant women, and people with conditions like diabetes and hypertension are at increased risk of developing potentially fatal pneumonia.

Increased incidence and death toll due to swine flu (H1N1 virus) led the WHO to declare the first flu pandemic in 41 years on June 11, 2009. It affected all continents except Antarctica in the 2009-2010 season and has been a regular problem since then, though luckily mortality rate has been similar to the usual flu.

With complications like pneumonia, influenza poses a serious threat, especially to the above-mentioned risk groups. Preemptive vaccination is the most effective way to prevent disease while regular washing of hands, preventing unnecessary touching of nose and mouth, and wearing masks are also to be followed.

Respiratory diseases have been killing people for thousands of years. Yes, I do understand there are different strains of these diseases.

Now we have Covid-19 another respiratory disease. Is history repeating itself? We can send people to the moon and back. We can build weapons of mass destruction costing trillions of dollars, but we do not even know exactly how COVID-19 originated. Was it a fish market in Wuhan China, bats, snakes, or this animal called a Pangolin? We still are unable to find a vaccine.

Thank you for reading,

Michael.

Comments are welcome