Pandemic – Then, Now and Future

Let us have a look on the pandemics that have threatened the world. 

As the years roll by, infectious diseases are becoming more diverse due to the increased number of humans and animals living in close vicinity with poor hygiene, increased global travel and misuse of the natural environment. This trend seems to be continuing and intensifying. The term 'globalization' also plays a major role in developing novel pandemics due to the interconnectedness of people, investment, and goods. This has produced many unquestionable effects worldwide. An infectious disease which develops in a local area is called an epidemic which crosses the border and spreads into other countries resulting in a global pandemic outbreak. This outbreak has a significant negative impact on health, the world economy, and security. Furthermore, it causes increased morbidity and mortality.

From plague to Covid-19, the world history has been facing many deadly pandemics that ravaged the humanity. Major pandemics such as plague, flu, SARS-CoV, Ebola, MERS- CoV and HIV have affected the mankind and brutally killed about millions of people. These infectious diseases are becoming the most important cause of death and disability widespread. For many ages, the control measures for pandemic spreading were restricted in interventions such as isolation, quarantine, use of soap/disinfectant, limited public meeting and good cleanliness. Transmission of the pandemics in human population can only be prevented by effective early detection methods, pharmaceutical and non-pharmaceutical control measures. In this, we discuss the major notable pandemics that have threatened the world and the changes have been faced.

Antonine Plague

This is one of the earliest pandemic outbreaks occurred in AD 165 lasted till AD 180 and this was documented by a physician Galen. So, it is also known as Plague of Galen. It was brought to Roman Empire by the troops coming back from Seleucia and by the time it had affected Asia, Egypt, Greece and Italy. Symptoms of plague included fever, sore throat and diarrhea. This killed about 5-10 million people and devastated the Roman Empire and led to social, health and economic crisis. This outbreak destroyed the Roman Empire and it also affected the roman traditions. Besides, it changed the spirituality and religiousness by spreading Christianity. 

Plague of Justinian

This outbreak was happened in the reign of Byzantine Emperor Justinian I in AD 541-542 caused by the bacteria Yersinia Pestis (Bubonic Plague) which was a ‘real plague’ pandemic and it is referred as first plague by historians. Turkey, Egypt, most of the Europe and Mediterranean were affected by this plague. The Byzantine historian Procopius recorded the outbreak of the plague. His record says, the symptoms included fever and fatigue. Many of the victims also experienced delusions and buboes in armpits and nearer to ears. Although, many people died right away after the start of symptoms, a few of the victims suffered for many days before death. 25-50 million lost their lives and their dead bodies were piled up in huge pits. Thus, Byzantine Empire were weakened in cultural, political, and economic ways. The destruction Empire led to the expansion of Islam by Arab tribes.

Black Death

This plague was first emerged in China and later occurred in Europe in 1347. This was known as bubonic plague outbreak caused by Yersinia Pestis, and this is referred as the second plague by historians. This was one of the much feared disease, but it occurs still can be treated with antibiotics.  It is believed that it was killed over 200 million people and ravaged the entire Europe in the period of 1347-1351. Fleas infected with this disease move to entire the Europe and cause widespread demolition wherever they went. In this modernized world, plague cases still pop up occasionally in US or China. It is no longer deadly as it used to be, due to the availability of proper treatment options.

Spanish Flu

This is one of the most severe pandemics in the 20^th century caused by Influenza A virus subtype H1N1 in 1918. It is first originated in United States, since some newspaper reports made wrong news saying Spain affected badly, it developed name Spanish Flu. Within months, the overcrowding and military movements led to spreading to all part of the world. Massive spread led to the terrible destruction in USA, Asia, Africa, and Pacific Islands. The virus mutated to more virulent form and came back to kill more people as second wave in august 1918. The virus affected many young healthy individuals of 20-40 old and also many World War I soldiers. Even the modern scientists cannot solve the mystery of why young people were being affected. The reason behind this virulence of 1918 flu is still unclear. Almost all influenza A pandemic outbreaks (1957, 1968 and 2009 pandemics) caused by the descendants of 1918 Influenza virus. Death toll

Asian flu

Asian flu is the second major influenza outbreak in 20^th century caused by Influenza A subtype H2N2. This Asian flu followed the 1918-19 flu and proceeded the 1968 flu. H2N2 virus is a mixed strain, it contains genes from both avian influenza and human influenza viruses. The first case of this outbreak was found in China in 1956, and it lasted till 1958. The symptoms of this include fever, body aches, and chills, loss of appetite, weakness, and cough. Also, young people suffered with nose bleeds. The death toll was 1.1 million worldwide. The rapid development of H2N2 vaccine by an American Biologist Maurice Hilleman and the availability of antibiotics decreased the mortality rate and transmission of disease to some extent. This H2N2 virus is believed to be gone extinct from the human population. Only the vials of the virus last in many laboratories across the world.

Hong Kong Flu

This pandemic was occurred in 1968-1969 and killed around 1 million humans worldwide. The causative agent of this flu was H3N2 virus, which was descendent of H2N2 virus, formed by a genetic process called antigenic shift. Though it originated in china in 1968, but it is not certain, it created a large epidemic outbreak in Hong Kong in July 1968. By the end of July 1968, Vietnam and Singapore witnessed for large-scale outbreak. And it disseminated to other countries such as India, north Australia, Philippines, Europe, and US by September 1968. In all countries except US, the death rate and effect of the flu were mild. Severity of this outbreak was less compared to other influenza pandemics due to reasons like, the immunity was retained in population who have been affected with H2N2 virus in 1957 pandemic, intensive medical care was given who were ill due to this flu and strong antibiotics were given to the affected people.  

HIV/AIDS

AIDS (Acquired Immune Deficiency Syndrome) is disease caused by Human immunodeficiency Virus types 1 and 2 (HIV-1 and HIV-2). Both these lentiviruses are formed by multiple cross species transmission of simian immunodeficiency viruses (SIVs) infecting African primates. Since first appeared in 1981, it has been killing approximately 1 million of people a year, and about 38 million people are still living with HIV. This HIV can be spread mainly from mother to child. Sexual contact and bodily fluids are also other transmission ways of HIV. 25-35 million people were killed due to these most infectious outbreaks. There is no effective vaccine has been developed yet for HIV. The vaccine development efforts are being hampered by the genetic diversity of the virus. Multitude of genetic variants are formed by the transmission of HIV from one person to other. The available treatment options like anti-retroviral therapies could be able to reduce the AIDS related deaths.

SARS

Severe Acute Respiratory Syndrome (SARS) is the primary outbreak occurred in 21^st century, caused by SARS Corona virus (SARS-CoV). Bats are the probable natural resource for SARS-CoV and palm civets could be the secondary host for the transmission of the disease.  This was commenced in china in 2002 and around 8000 cases were reported worldwide. During the period 2002-2003, it quickly spread to 29 countries. SARS-CoV is an airborne virus which can be spread through small droplets of saliva. It can also spread indirectly through surfaces that have been touched by an infected person. Incubation period is 2-7 days and may be up to 10 days. There is no vaccine for SARS and other control measures included isolation and quarantine of the infected person, washing hands with soap or disinfectants, and wearing masks. Death toll

Swine Flu/2009 H1N1

Swine flu is one of the major Influenza H1N1 viral infections. It was first found in Mexican pigs before infecting in humans, hence the name swine flu. Genetic studies shown that this virus is formed from animal influenza viruses, and it is different from the seasonal influenza H1N1 virus. Early pandemic outbreaks occurred in North America in April 2009. WHO declared this as pandemic in June 2009, and it transmitted to 74 countries at that time. 700 million – 1.4 billion people were affected by the flu, which is 11-20% of the global population. This H1N1 2009 flu continues to circulate as seasonal flu. Death toll

Ebola

2 simultaneous Ebola virus (EBOV) outbreaks happened in 1976 in South Sudan and democratic republic of Congo. The massive and complex Ebola outbreak the world has ever seen occurred in West Africa in 2014 and predominantly affected nations of Guinea, Liberia, and Sierra Leone. This also reached Nigeria and Mali. This virus spread from wild animals to human, then it widely disseminated among humans. The incubation period is 2-21 days, and the humans are not infectious until the symptoms develop. This flu like syndrome causes hemorrhagic fever followed by multiple organ failure and death.  The early treatment included rehydration with oral or intravenous fluids and treatment of specific symptoms improves survival rate. Monoclonal antibodies and vaccines were approved for the treatment of Zaire Ebola virus (it is one type of Ebola virus) infection. The initial treatment methods combined with pharmaceutical interventions helped to eliminate this public threat.

Covid-19

        The year 2019 ended with an emergence of novel corona virus designated as 2019-nCoV in Wuhan, China. After SARS-CoV in 2002 and MERS-CoV in 2012, this is the third corona virus outbreak among human population in the past 2 decades. This pandemic is  continuing as a public threat and demolishing the world economy.   World faced ever toughest time during this pandemic. Many countries had to face shortage of necessary goods such as N95 Mask, Ventilators, hand sanitizers and ICU beds. Aged people are more vulnerable to the emerging Covid-19 infection. This virus attacks different people in different ways. Many of them develop mild to moderate symptoms and can be recovered without any treatment. Some will become very ill, that need medical attention especially old people who are having the conditions like cancer, diabetes, cardiovascular disease or chronic respiratory disease. Self-isolation, quarantine, N95 Mask, washing hands with soap or disinfectant and social distancing are the strategies to prevent the massive spread of this disease. And many biotechnology companies are in race to produce the vaccines for covid-19 that helps to put end to this most life threatening outbreak. Such developed vaccines and in use are Bharat Biotech’s Covaxin and AstraZenca’s Covishield. Around 247 million cases were registered worldwide. Though we have crossed 2 years with this turmoil, still we are facing 3^rd face of covid-19. But, due to the pharmaceutical and non-pharmaceutical interventions the covid-19 havoc has diminished to some extent.

Post-Covid world

           Where will the world be in next few years? How the world has been changing since the covid-19 pandemic? This unprecedented situation has heavily shaken the world in many domains and weakened the government. There is a huge list of changes the humanity has been facing now such as many people lost their jobs, many of them had to work for less income or no income, unemployment increased, globalization paused, people started working remotely and having virtual communications, e-commerce business increased, education system became online and affected the people’s mental illness. The travel prohibitions, closed boundaries, supply chain and export, import restrictions have impeded the globalization process making it difficult to rebound to the pre-pandemic world.

What we learnt from the past pandemics

How do human population overcome the pandemic? What are the solutions history taught us? Quarantine or isolation is first step of learning. The bubonic plague or Black Death has been slowed by isolating individuals. Quarantine also played a major role in controlling 1918 Spanish flu especially in American cities. History says the doctors who were treating the plague patients wore masks with bird like beaks. These beaks were filled with some herbs having strong scent to prohibit the illness. During the 1918 Spanish flu outbreak, masks were mandatory in San Francisco. Washing hands and surfaces using soap or disinfectant became inevitable to ward off the disease spreading. Covid-19 is the new series of pandemics, so hold all the lessons from the past and fight against this surge of covid-19.

Future of pandemics

“Expect the unexpected” – We should keep this in mind always when the term pandemic comes. Every pandemic has been unique since history. Varieties of infectious agents such as bacteria, viruses etc. are emerging and getting mutated to produce variant forms. So, the future of pandemic is unpredictable. The pandemic causing agent might disappear or it might continue as an endemic. Henceforth, we should learn to live in world of pandemic. We cannot completely wipe off the pandemic ever. Implementation of novel technologies for rapid diagnosing, drug repurposing and biomarker study for disease severity, moreover the development and manufacturing of new vaccines are needed to prevent the pandemic outbreak.

 References

• Huremović D. (2019). Brief History of Pandemics (Pandemics Throughout History). Psychiatry of Pandemics: A Mental Health Response to Infection Outbreak, 7–35. https://doi.org/10.1007/978-3-030-15346-5_2
• Piret, J., & Boivin, G. (2021). Pandemics Throughout History. Frontiers in microbiology, 11, 631736. https://doi.org/10.3389/fmicb.2020.631736
• MyBioSource (n.d.), History Of Pandemics, https://www.mybiosource.com/learn/history-of-pandemics/
• History.com Editors. (2020, December 21). Pandemics That Changed History. HISTORY. https://www.history.com/topics/middle-ages/pandemics-timeline
• LePan, N. (2021, October 5). Visualizing the History of Pandemics. Visual Capitalist. https://www.visualcapitalist.com/history-of-pandemics-deadliest/
• Sabbatani, S., & Fiorino, S. (2009). La peste antonina e il declino dell'Impero Romano. Ruolo della guerra partica e della guerra marcomannica tra il 164 e il 182 d.c. nella diffusione del contagio [The Antonine Plague and the decline of the Roman Empire]. Le infezioni in medicina, 17(4), 261–275.
• John Horgan (2014, December 26), Justinian’s Plague (541-542 CE), World History Encyclopedia, https://www.worldhistory.org/article/782/justinians-plague-541-542-ce/
• Sharp, P. M., & Hahn, B. H. (2011). Origins of HIV and the AIDS pandemic. Cold Spring Harbor perspectives in medicine, 1(1), a006841. https://doi.org/10.1101/cshperspect.a006841
• Kilbourne E. D. (2006). Influenza pandemics of the 20th century. Emerging infectious diseases, 12(1), 9–14. https://doi.org/10.3201/eid1201.051254
• Kalra, S., Kelkar, D., Galwankar, S. C., Papadimos, T. J., Stawicki, S. P., Arquilla, B., Hoey, B. A., Sharpe, R. P., Sabol, D., & Jahre, J. A. (2014). The emergence of ebola as a global health security threat: from 'lessons learned' to coordinated multilateral containment efforts. Journal of global infectious diseases, 6(4), 164–177. https://doi.org/10.4103/0974-777X.145247
• Rogers, K. (2020, March 25). 1968 flu pandemic. Encyclopedia Britannica. https://www.britannica.com/event/1968-flu-pandemic
• Rogers, K. (2020, March 26). 1957 flu pandemic. Encyclopedia Britannica. https://www.britannica.com/event/1957-flu-pandemic
• Centers for Disease Control and Prevention (n.d.), 1957-1958 Pandemic (H2N2 Virus), https://www.cdc.gov/flu/pandemic-resources/1957-1958-pandemic.html
• NHS website. (2019, October 30). SARS (severe acute respiratory syndrome). Nhs.Uk. https://www.nhs.uk/conditions/sars/
• James Myhre & Dennis Sifris, MD (2021, August 02), Why it is So Hard to Make an HIV Vaccine, Verywellhealth, https://www.verywellhealth.com/hiv-vaccine-development-4057071
• SinoBiological (n.d.), Hong Kong Flu (1968 Influenza Pandemic), https://www.sinobiological.com/research/virus/1968-influenza-pandemic-hong-kong-flu
• SinoBiological (n.d.), Asian Flu (1957 Influenza Pandemic), https://www.sinobiological.com/research/virus/1957-influenza-pandemic-asian-flu
• Centers for Disease Control and Prevention (n.d.), History of 1918 Flu Pandemic, https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm
• Severe Acute Respiratory Syndrome (SARS). (2019, November 1). World Health Organization. https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1
• Koff, W., & Williams, M. (2020). Covid-19 and Immunity in Aging Populations — A New Research Agenda. New England Journal of Medicine, 383(9), 804-805. doi: 10.1056/nejmp2006761
• Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, X., Huang, B., Shi, W., Lu, R., Niu, P., Zhan, F., Ma, X., Wang, D., Xu, W., Wu, G., Gao, G. F., & Tan, W. (2020). A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine, 382(8), 727–733. https://doi.org/10.1056/nejmoa2001017
• Munster, V.J., Koopmans, M., van Doremalen, N., van Riel, D., & de Wit, E. (2020). A Novel Coronavirus Emerging in China - Key Questions for Impact Assessment. The New England journal of medicine, 382(8), 692-4.
• Lurie, N., Saville, M., Hatchett, R., & Halton, J. (2020). Developing Covid-19 Vaccines at Pandemic Speed. New England Journal of Medicine, 382(21), 1969-73.
• How Will the World Be Different After COVID-19 - IMF F&D. (2020)? International Monetary Fund. https://www.imf.org/external/pubs/ft/fandd/2020/06/how-will-the-world-be-different-after-COVID-19.htm