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History of Pandemics – Lessons Learned from Covid-19

A sudden increase in the incidence of a disease that is typically confined to an area or group of people is called an ‘outbreak’. If this outbreak becomes more severe, and less localized, it may be then termed an ‘epidemic’. If it affects a significant portion of the population, all over the globe, and increases in geographical range, then the outbreak is categorized as a ‘pandemic’.

St. Louis Red Cross Motor Corps on duty during influenza epidemic (1918). Original from Library of Congress.

The word pandemic has a Greek origin; pan meaning all and demos meaning people. The Centers for Disease Control and Prevention (CDC) has a Pandemic Intervals Framework (PIF) for tracking phases of a pandemic. These phases are:

  1. Investigation Interval: The novel virus is investigated and identified, from animals or humans, anywhere in the world. It is believed to have a deleterious effect on humans.
  1. Recognition Interval: Clusters of cases are identified, along with an increased potential for person-to-person transmission.
  1. Initiation Interval: Now cases are confirmed with both efficient and sustained person-to-person transmission.
  1. Acceleration Interval: This novel virus affects vulnerable people. Health officials take measures like closing schools, encouraging social distancing, and offering anti-virals or vaccines, if available.
  1. Deceleration Interval: Now, there is a consistently decreasing rate of cases worldwide.
  1. Preparation Interval: Even after the pandemic has subsided, health officials continue monitoring and prepare to brace for another wave of illness.

History of Pandemics

Forget about the present, even history has not been kind to humanity. We have been ravaged by epidemics and pandemics that could’ve very well signalled the end of time. Most even ended huge civilizations. Let us know about pandemics from the past that devastated human species and left ugly scars as a remembrance.

  1. Circa: This epidemic occurred about 5000 years ago in a prehistoric village in China. No age group was spared. Skeletons were found stuffed inside a house that was later burned down. No one inhabited the place afterwards.
  1. Plague of Athens: Dating back to 430 B.C., during a war between Sparta and Athens, a disease spread. It is believed to have consumed about 100,000 lives. Many theorize the plague that spread was Ebola or typhoid fever, but historians are still unsure. The overcrowded outdoors due to the ongoing war exacerbated the epidemic even more.
  1. Plague of Cyprian: A bishop of Carthage, St. Cyprian, after whom the plague is named, described this epidemic as signalling the end of the world. Occrurring between A.D. 250-271, it killed an estimated 5000 people a day in Rome alone. Archeologists found mass burial sites of victims covered with a thick layer of lime, which was historically used as a disinfectant. The victims were burnt in a giant bonfire.
  1. The Black Death: From 1346-1353, the Black Death traveled from Asia to Europe and laid devastation in its wake. It is estimated to have wiped out about half of Europe’s population. Caused by a strain of bacterium Yersinia pestis, likely extinct today, it was spread by fleas on infected rodents. The victims were buried in mass graves.

Pandemics of the Last Century

Pandemics continued to thwart normal life in the 20th century as well. Introduction of new strains of virus and bacteria led to deaths of millions. Some of the major pandemics of the 20th century were:

  1. Spanish Flu: Although the flu did not start in Spain, due to relaxed censorship of press and free publishing of early flu accounts, the name stuck. Estimated to have infected about 500 million people all over the globe, the Spanish flu, which lasted from 1918-1920, pushed most indigenous communities to the brink of extinction. One-fifth of the infected people died. The lethality of the flu was enhanced because of cramped, poor nutrition conditions of soldiers and people. No vaccine was developed at that time due to confusion about the nature of micro-organism involved. The only effort to combat the disease was social distancing and treating secondary infections.
  1. Asian Flu: From 1957-58, the Asian flu pandemic, caused by H2N2 virus, was another global influenza outbreak. Originating from China, the disease killed more than 1 million people. The virus that caused this flu was a mixture of avian flu viruses. A vaccine was rapidly developed to combat the disease. Although it was found out that more than the usual quantity of vaccine was needed to produce immunity.
  1. Swine Flu: With its origin in Mexico, a new strain of H1N1 virus spread in 2009 to all parts of the globe. The virus infected about 1.4 billion people and killed between 151,700 and 575,400 according to CDC. The flu primarily affected children and young adults. About 80% deaths were recorded below 65 years. Vaccine for the H1N1 virus is now included in the annual flu vaccine.
  1. West African Ebola Epidemic: This disease ravaged West Africa between 2014-2016, with a reported 28,600 cases and 11,325 deaths. The first case was in Guinea and from there, it spread to Liberia and Sierra Leone. There is no cure for Ebola. Efforts at finding a vaccine are underway. The first known cases occurred in Sudan and the Democratic Republic of Congo in 1976. Bats may have been the vectors of Ebola.

Covid-19 and the World Now

An article in The Spectator (March 28, 2020 issue) written by Dr John Lee, a recently retired professor of Pathology and a former NHS consultant sheds elaborate light on the situation at present. It is a fact that this strain of coronavirus is new, unknown to scientists, and highly contagious. However in reality, rate and number of deaths reported vary with what is publicly broadcast. What Dr. Lee talks about in his article, specifically, is the manner in which we are treating this infection as opposed to the more common influenza.

Prevalence of most deaths in the elderly with pre-existing medical conditions proves that coronavirus is responsible for reducing the average life expectancy in a person with a weak immune system and/or heart disease, asthma, motor neuron disease, etc. What happened in Italy and America was a lot many deaths than any healthcare system would cope with, and it did affect us. Grim details from the countries added to the already brewing anxiety. But what we failed to notice is that the number of positive cases might really have been far more; merely because we considered the number of cases announced from the hospital and neglected those already existing in the population with no symptoms. It is proven that about 80% of the infected people don’t show any symptoms at all and may even recover without knowing they had the coronovirus. Therefore, the death rate might actually be 10 to 20 times less than what is documented and telecast.

Another important aspect that needs to be understood is that as per records from the United States Centres for Disease Control and Prevention, many people are killed by the common influenza virus in the US, however we don’t draft graphs for the seasonal flu like we did for Covid-19. If we did, the same exponential increase in deaths would be noticed. As per their estimate, since September last year, 23,000 Americans have been killed because of the flu, 390,000 hospitalized, and 38 million infected. Just because the flu is a known name does not make it any less dangerous.

Not just Dr Lee, but a number of medical practitioners and microbiologists agree that total lockdown and neglect of basic economic structure is an error committed by affected countries all over the world. Life, as we know it, has been thrown out of balance. The result of global lockdown is excessive pressure on the world economy, with global recession and increased unemployment in tow.

In a country like India, where most people earn on a daily-wage basis, unfortunate mass exodus of workers is observed from the place of work to the place of birth. Daily activities of vendors, businesspersons, media, transporters, and the lot have been curbed. Everyone is losing everything. People are confined to their houses with no other work than to look out for coronavirus related news. This has brought home anxiety disorders in, many otherwise, healthy individuals. Economic instability is about to bring about a pandemic corona never will.

On a Positive Note

Social distancing can prevent accelerated spread of this virus to the highly vulnerable group and reduce load of patients on hospitals, however, absolute captivity decreases the ability of a nation to survive on its own. More than the virus itself, what makes the situation worse is the panic epidemic. As Dr. Lee points out in his article, it is not a matter of lives vs money but lives vs lives. For now, without a vaccine in production, all we can hope for is achieving herd immunity.

However, along with the recent ease in lockdown, many success stories have come to limelight. The government has recognized apathy of its citizens and started initiatives to tackle the immense crunch Indians are facing. Relaxation provided to essential services, roadside vendors selling fruits and vegetables, government packages from Prime Minister’s Relief Fund, establishing online and offline sites for disease control, prevention and information, distribution of rations to migrants and labourers, is a huge step forward to support people. Centers for public grievance redressal and passes  given to the public for essentials is another way to combat economic and financial stress. Health care workers are being supported emotionally and certain hospitals are being designated as Covid-19 treatment centers to reduce work load on nurses, doctors, and paramedics.

Primary health centers are kept for treatment of other illnesses and online consultations are provided for ease of both, doctors and patients. Apart from this, better coronavirus management practices followed in states and UTs like Kerala and J&K, respectively, provide boost to other states to follow the same. Improved testing kits, safe glass chambers for sample collection, stringent social distancing, and catering to general public needs helped these regions contain the spread. Other states and union territories may learn from them.

This case of Covid-19, the coronavirus, that has brought our world to its knees, is just a little example of the threat other varieties of micro-organisms have in store for humans. With the infestation curve increasing in most countries, it’s time to think aloud and voice opinions about the fate of wet markets, the infamous hub, epicentre, headquarters of viruses harmful to humans. Now is the time to relinquish unhealthy quests, this insufferable need to dominate, and end pandemics, this and the forthcoming ones, once and for all.

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