Pandemics is covering a range of angles about pandemics of the past to help frame the COVID-19 crisis.

How World War I's Legacy Eclipsed the 1918 Pandemic

World War I came to an end on November 11, 1918—nine months after the first cases of what was referred to as the “Spanish Flu” were reported in the United States. Against the backdrop of the war, the 1918 influenza pandemic surged at a time when people were already experiencing more

The Deadliest Events in US History

It’s a grim but necessary calculation, counting those Americans who have died in service to their country, as targets of terrorist attacks, amid natural disasters or as victims of pandemic disease. Here are major events from history that have inflicted a devastating toll on more

When the Supreme Court Ruled a Vaccine Could Be Mandatory

In 1901 a deadly smallpox epidemic tore through the Northeast, prompting the Boston and Cambridge boards of health to order the vaccination of all residents. But some refused to get the shot, claiming the vaccine order violated their personal liberties under the Constitution. more

Why the 1918 Flu Pandemic Never Really Ended

An unthinkable 50 to 100 million people worldwide died from the 1918-1919 flu pandemic commonly known as the “Spanish Flu.” It was the deadliest global pandemic since the Black Death, and rare among flu viruses for striking down the young and healthy, often within days of more

How the Flu Pandemic Changed Halloween in 1918

“Witches Must Beware,” declared the Baltimore American on October 31, 1918. The Maryland city’s health commissioner had placed a ban on public Halloween events, instructing the police chief to prevent people from holding “carnivals and other forms of public celebrations.” The more

When the US Government Tried to Fast-Track a Flu Vaccine

After Private David Lewis collapsed and died during a basic training exercise at New Jersey’s Fort Dix on February 4, 1976, an investigation into the 19-year-old’s premature death identified a long-dormant, but notorious killer as the cause. Blood tests conducted at the Center more

5 Hard-Earned Lessons from Pandemics of the Past

Humankind is resilient. While global pandemics like the Bubonic Plague and 1918 pandemic wreaked havoc on populations through the centuries, societies honed critical survival strategies. Here are five ways people adapted to life amid disease outbreaks. 1. Quarantine The first more

When American Students Attended School—Outside

As the 20th century dawned, tuberculosis—otherwise known as consumption, “white plague” or “white death”—had become the leading cause of death in the United States. The dreaded lung disease killed an estimated 450 Americans a day, most of them between the ages of 15 and 44. At more

5 Advances That Followed Pandemics

Pandemics have ravaged human civilizations through history. But global health crises have also sparked progress in culture and society, changing lives for the better. Water and sanitation systems improved and revelations led to innovations in limiting disease spread, as well as more

The Post World War II Boom: How America Got Into Gear

In the summer of 1945, as World War II drew to a close, the U.S. economy was poised on the edge of an uncertain future. Since President Franklin D. Roosevelt’s call in late 1940 for the United States to serve as the “arsenal of democracy,” American industry had stepped up to meet more

Plagues and pandemics: when history repeats

When Professor of History Dyan Elliott began teaching a new class on pandemics in January, she had no idea that the course would segue into the headlines of today.

Elliott’s course, “The Black Death and Other Pandemics,” explored themes common to pandemics across time. From repeated episodes of the bubonic plague to the scourge of smallpox to the current outbreak of COVID-19, the lessons of history remain timely and relevant.

Here, Elliott, the Peter B. Ritzma Professor of the Humanities, shares some of those lessons, as well as her inspiration for the class, with the College’s associate director of content strategy, Rebecca Lindell.

Can you describe the class and what it covers?

I’m a medieval historian by training, and I was initially trying to get more people interested in medieval stuff, and death and disaster seem to sell. The Black Death , which hit Europe between 1347 and 1350, was the biggest pandemic on record. In fact, we still have outbreaks of the bubonic plague, which is the disease responsible for the Black Death. And then I thought that the course would be more appealing if it was transnational or maybe even transhistorical: let’s look at all different kinds of pandemics. So in addition to the Black Death, we examined smallpox, focusing mostly on the New World and the ways that European colonists killed off the First Nations with poison blankets and such. And then we studied cholera outbreaks in mid-19th-century London and 20th-century Venezuela and Haiti tuberculosis and the rise of the sanitorium in Europe and the U.S. malaria and mosquitos in India and Italy AIDS in Africa and the United States, and so on. We ended with the coronavirus, even though we obviously weren’t planning on it. The last class was originally going to be on Ebola.

So the class focused on both the scientific and social aspects of the pandemics.

I would always begin by describing the bacterium or the virus. But I’m not a doctor. I am more interested in the historical implications of what these pandemics do to people and how they respond, and in the successes and failures that we’ve had over time. In point of fact, the only thing that we’ve ever absolutely gotten rid of was smallpox, which was officially declared to be eliminated by the World Health Organization in 1980. That’s the only one we’ve ever beaten.

There are many other diseases that we will probably never be able to eliminate — like the bubonic plague, which has reservoirs in animal populations that we will never be able to get at. And then there are other things that remain challenging — like viruses that keep mutating.

What really fascinates me is the way that different bacteria and viruses work very hard to stay viable. In the 19th century, for example, cholera was so deadly that its human hosts died very quickly. But it mutated into a milder form in the 1960s, and many carriers were asymptomatic, as we now see with COVID-19. People who don’t know they have it can spread it. That’s also what happened with cholera in Haiti after the 2010 earthquake. It was spread by United Nations peacekeepers who may not have known they were sick, or at least did not know they had something as serious as cholera.

What got you interested in plagues and pandemics in the first place?

To be completely honest, my original concern was that nobody was paying attention to the distant past. I wanted to show students the ways in which the past is still with us and informs the present.

And we began at a very early point in time. The first real sighting of the bubonic plague was in the 7 th century during the Byzantine empire. The emperor, Justinian, was trying to conquer the western part of the Roman Empire, which had been overrun by Germanic barbarians. So this is one of those great “what if” questions — if Justinian’s armies hadn’t been decimated by the bubonic plague, would the Roman Empire have been reunited? Could it have continued?

Disease creates such interesting sorts of questions. Maybe this will be the fall of our empire. We don’t know.

With regard to the ways that people respond to a pandemic, what themes seem consistent throughout history?

The degree of denial and blame-shifting are pretty consistent.

For example, cholera was initially spread by fecal ingestion — at least, the classic or so-called “Asian” cholera was. But when the less-lethal form emerged, [University of Maryland microbiologist] Rita Colwell argued that it could subsist in a water supply without a human host, going dormant and then flaring up under certain conditions. People glommed onto that theory to explain the cholera outbreak in Haiti. But then there was all this investigative reporting that showed in fact that there was a United Nations base that had actually dumped feces directly into a river that was a main water source. There was a lot of back-and forth and blame, and eventually the UN did accept responsibility, but they never made any kind of repayment.

And so today, with COVID-19, we are hearing a lot of conspiracy theories. Some people in China are saying this might be an American invention, while President Trump has been calling it the “Chinese virus” and blaming runaway labs. There are always efforts to scapegoat certain segments of the population. During the Black Death, the Christian majority accused Jews of poisoning wells. When there was an outbreak of the plague in 19th-century India, they blamed the poor. During the AIDS crisis, evangelical Christians blamed the gay community, believing they were being punished for their sinful ways.

So people tend to want to assign blame for pandemics.

I think so. Or to push the blame away from self.

Another thing I find very interesting — and we saw this with the development of germ theory — is that you see people competing rather than collaborating with each other. For example, in the 1800s, Louis Pasteur and Robert Koch both tried to go after cholera at the same time. Some of Pasteur’s men got sick in Egypt in 1883, and when they finally returned home, they learned that Koch had moved on to India and made a breakthrough. What they didn’t do was collaborate. And we saw that same kind of competitive thing happen between the English and the Italians with malaria, between the Europeans and the Japanese with the discovery of Yersinia Pestis (the pathogen for the bubonic plague), and even between the Americans and the French during the AIDS epidemic.

So now, we’re talking about finding a vaccine for COVID-19. I hope the research community is moving forward in a spirit of collaboration, rather than in a bizarre nationalistic way of trying to get credit for scientific breakthroughs.

Is there anything positive we can glean from the past about our prospects right now?

I would say that in a lot of ways, human nature doesn’t change. People will always be trying to balance things like greed against safety or the economy against safety. We’re seeing efforts to close down boundaries and to quarantine, but keeping people out doesn’t usually keep the pandemic at bay, though there is a certain logic to it. Social distancing is, in fact, kind of a contained quarantine.

There’s so much fear and suspicion not only around disease, but around medicine as well. That also seems to be a recurring theme throughout these plagues and pandemics.

That’s right. That’s another thing that doesn’t change. There’s no evidence, for example, that some of the drugs that are being promoted, like hydroxychloroquine, are helpful, and they could potentially do a lot of harm. But people have always come up with these different kinds of nostrums. In the medieval sources, you can find recommendations to eat acidic things, because they thought that the acids could somehow kill whatever it was in the body that could harm you. Newspapers ran ads for inhalers promising to “cure” tuberculosis, using poisonous powders like mercury nitrate. Maybe some of those people were operating in good faith. But I also think there have always been people who, in times of disease, think “wow, I could really make a fortune here.”

And denial. There will always be a degree of denial, that this can’t hurt us, it can be contained, that sort of thing.

Is that common to pandemics? An initial feeling that we’re immune somehow?

Interestingly, not so much with the Black Death. It was so unprecedented and so quick that the population was in shock. The disease seemed to spare no one. It was seen as God’s punishment for humanity’s sinfulness. But historically, we see that wealthy people can isolate themselves from disease more effectively than the poor, so perhaps they can afford to be in denial. Even in the first rush of the Black Death, the records suggest that the members of the nobility and the higher clergy emerged more or less unscathed by comparison.

Smallpox was probably more egalitarian. But once the Europeans had an immunity, they could use it as a biological weapon against the First Nations, and they did. By and large, wealth does shield you from certain things. Cholera is caused by bad water supplies. And who has bad water supplies? The poor, right?

And now you can predict which people will get hardest hit by COVID-19 on the basis of their postal code. So the wealthy can often cushion themselves against these horrible social tragedies.

Do you see a pattern in how pandemics come to an end? How do they finally get under control?

The McKeown thesis suggests that the biggest improvements in healthcare have arisen not through medicine, but through improvements in public health and sanitation. There’s a lot of truth to that. Eliminating cholera, for example, is really about practicing good hygiene and ensuring that the water supply is clean. And to some extent, you could say COVID-19 emerged due to failures in public health — through the wet markets in China and in over-populated cities worldwide.

But COVID-19 does seem bizarrely contagious. It seems like the virus can “live” independently for a really long time. That’s not completely novel. After a medieval rat got infected with the bubonic plague, for example, a flea that infested it could survive in a cartload of hay for several days. But still, for a virus to be able to live so long on stainless steel or plastic, as the coronavirus apparently can — that’s amazing. It shows how “smart” viruses seem to be. They’re not really alive, but they do take on life. Once they invade a cell, they multiply and multiply.

It seems like we’ve essentially shut down our society and our economy in an effort to combat this pandemic. Did previous societies come to a screeching halt every time there was an outbreak of the bubonic plague?

The Black Death was spread by trade, and there was in fact a kind of a social breakdown for three or four years when things were really bad.

You can see this in Giovanni Boccaccio’s Decameron, which was completed in 1353 in the wake of the Black Death. It begins with a very graphic and horrific description of the Black Death in Florence. In order to escape the plague, a group of aristocrats (which in Italy was the merchant class) got on their horses and rode out to a deserted villa, where they sat around telling each other stories. So they certainly weren’t in town doing business as usual.

And the thing about the bubonic plague is that it’s endemic to an area, so it would recur for centuries, always creating economic havoc. When the bubonic plague recurred in 17th-century Barcelona, the city was quarantined and everything ground to a halt.

How did you incorporate the emergence of COVID-19 into the class?

We mostly stuck to the syllabus. When the course ended in early March, we didn’t know much about the virus: it had just been named COVID-19, and President Trump was still calling it a “hoax.” So I talked about the news coverage: the geographic spread of the virus, the plight of those huge cruise ships, the spread of the virus throughout that church in South Korea, etc. I showed them a series of news clips, and then we had some cake to celebrate the end of the quarter. It said “Pandemic 2020” and had a little red coronavirus on it. Now that things are so bad, it sounds like I have a very macabre sense of humor.

But nobody knew how bad things were going to get — though after teaching this course, maybe I should have known. I held a review class during reading week, but then we started getting notices saying that exams were optional, and soon we were told that spring quarter would be taught remotely.

Will you teach the class again?

I will be on leave in 2020-21, but I will offer it the year after that. I’m sure there will be an ardent group ready to hear about pandemics. It did seem weirdly serendipitous that I taught the class this year, though, considering that I am a medieval historian who generally works on church history. But I wanted to teach a class that would show that the distant past is very interesting and pertinent. And I think this course did that.

Image: Rita Greer, The Great Plague 1665 (2009). Digitized image licensed by the Free Art License.

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The Pandemic and History

Four historians consider whether the experience of the pandemic has changed their views on the nature of historical crises.

‘The last year has underlined the interconnected nature of events’

Alex von Tunzelmann, Author of Blood and Sand: Suez, Hungary and the Crisis that Shook the World (Simon & Schuster, 2016)

Strictly, the answer to this question is no: the facts of this pandemic and the response have not changed the facts or natures of previous crises. More broadly, though, watching a global crisis unfold in real time has made me think about how I approach historical crises in three ways: focus, connections and diversity of experience.

The nature of crises is that they’re incredibly complicated. The ‘hot’ period of the Suez Crisis lasted around 16 days. It took me more than three years to research and write about it, because so many different powers and interests were involved all around the world: it coincided with the Hungarian Rebellion, threatening to draw the Soviet Union and the US into a Third World War. Future historians will have to reconstruct the pandemic from a global mountain of information, including social media as well as conventional media. My advice to them (and to myself) is to focus it’s better to tell one story well than to be overwhelmed by the material.

The experience of the last year has underlined the interconnected nature of events in a crisis. For instance, I’m interested in the phenomenon of conspiracy theories and denialism, which crop up in a lot of historical crises. It would be hard to tell the story of Covid deniers without rooting it in the last couple of decades of the ‘anti-vaxx’ movement, the expansion of conspiracy theories, the erosion of traditional media, the decline of trust in government and so on. The nature of crises and crisis responses is that they do not happen in a vacuum. Exploring these connections makes it even harder for a historian to maintain focus, but that is part of the challenge.

Finally, diversity of experience. The pandemic has brought suffering to many. Yet there are large numbers of people who are quite indifferent to this. There are those who have benefited materially from the pandemic and those who seek to deny or minimise its effects. For historians of past crises, this is a reminder that human stories are never simple we must never presume a single response. The nature of human experiences and opinions is always astonishingly varied.

‘It has deepened my understanding of the emotional response to such events’

Jessie Childs, Author of God’s Traitors: Terror and Faith in Elizabethan England (Vintage, 2014)

When the vestrymen of the burnt-out church of St Sepulchre’s gathered together after the Great Fire of London in 1666 they established several things very quickly: a new way of meeting, a list of the most vulnerable pensioners and a set of safety measures. They relit the streets, fixed the fire engines and recast the molten bell-metal into ‘sound and tuneable bells’.

Those impulses – to regroup, protect and come together as a community – have been iterated by the pandemic. From clapping on British doorsteps to singing from Italian balconies, a sense of campanilismo (loyalty to the bell tower) has been strong. The pandemic has also reinforced the view that most people, if faced with an existential threat, will prioritise security over liberty. Hobbes still matters.

It is no surprise either that the pandemic has exposed and deepened the cracks in society and caused further stresses to the economy, healthcare and education. It has not, therefore, changed my views on the nature of historical crises, which are in any case varied, contingent and hard to distil, but it has deepened my understanding of the emotional responses to such events.

Throughout the lockdowns, I’ve been writing about the British Civil Wars of the 1640s. A combination of natural and man-made factors made the 17th century a ‘global crisis’, in Geoffrey Parker’s phrase. Those who lived through it sometimes seem like iron men and women. It is easier now to appreciate their anger, confusion, envy, apparent apathy and extraordinary resilience. Having grappled with home-schooling, I’m more forgiving of lacunae in registers and diaries. Contemporaries spoke of their ‘distracted’ times. I’d always thought it was a euphemism, but now I realise that it is exactly the right word.

Past crises show that cities and states can rise from the ashes of catastrophe, but it takes inspired leadership and an awful lot of work. The British test and trace scheme was abysmal, the vaccine rollout magnificent. It may be that we can ‘build back better’, as the slogan goes, find a new equilibrium and perhaps even tread more lightly upon the earth. But at this point it is too soon to say.

‘It makes me think what is happening now is different’

Anthony Barnett, Author of The Lure of Greatness: England’s Brexit and America’s Trump (Unbound, 2017)

Yes and no. No: historic crises were as they were. Pandemics usually intensify but do not change existing forms of rule. With the exception of the Black Death, which appears to have transformed the value of labour because of the extent of the losses, natural disasters such as plagues do not alter the nature of a society. They are a challenge that amplifies existing problems but do not pose a systemic crisis.

Thus, in the 20th century, pandemics were still regarded as fate: the flu pandemic of 1919-22 killed more people than the First World War but left little lasting legacy. Similarly, the pandemics of 1957 and 1968. If you have not heard of them, that proves the point. AIDS and Ebola were lethal for the communities impacted, but did not become a ‘historic crisis’.

This pandemic is different. It has not led me to alter my view about what has happened in the past, but it makes me think what is happening now is different.

Until recently, all that could be done was slow infection rates: fatalism was unavoidable. As humanity became capable of genuine self organisation, a cult of fatalism was generated to protect rulers from popular agency. Called ‘market fundamentalism’ or ‘neoliberalism’, it insisted government was the problem and market forces had to be obeyed to achieve a better life.

Economically, its success ended with the financial meltdown of 2008-09. Now, politically and socially, the hegemonic theory of government has been overturned by a micro-organism. Tremendous advances in medical science and technology meant that Covid could be treated. In 1919 there were not intensive care units able to treat patients under 24-hour sedation. There was not, therefore, the danger of life-saving wards being overwhelmed in the same way. Governments had to act.

President Macron has said: ‘We are going to nationalise the wages and the profit and loss accounts of almost all our businesses . It’s against all the dogmas, but that’s the way it is.’ A huge effort will be made to rehabilitate the old order after its period in intensive-care, but it is unlikely to re-emerge unchanged – the pandemic has generated a historic crisis of its own.

‘The pandemic has made more vivid the disaster that unfolded in the New World during the 16th century’

Camilla Townsend, Author of Fifth Sun: a New History of the Aztecs (Oxford University Press, 2019)

Living through the pandemic has made more vivid the disaster that unfolded in the New World during the 16th century. Following contact with Europe and its viruses, the indigenous population of the Americas dropped by at least 85 per cent over the course of the first century. By the 1580s, some Spaniards feared that literally all the Native Americans would die.

Because of this horrific context, there has been a tendency on many modern people’s part to speak of ‘die-offs’, to assert that around half the population would perish when an epidemic took place, or even to explain the conquest as a consequence of the fact that so many people were dying of disease that they couldn’t fight back militarily.

But the Aztec-language histories do not speak of events in this way. Instead, they convey an abiding sadness. Now, I understand better why.

This past year, though most of the world mitigated relatively successfully by keeping people at home, there were pockets that experienced Covid’s full two per cent mortality rate certain areas in New York City, for instance, or square-block areas in New Jersey, where I live. The sound of the sirens, the stories from my students’ families and my own fear for loved ones combined to leave me feeling traumatised. But, a few months later, life had continued for most of us and we were finding ways to laugh again. Our smiles were shaky, but genuine.

In the 16th century, smallpox could kill between 20 and 30 per cent of those that caught it. More common diseases, such as whooping cough or measles, had lower mortality rates. There was no die-off that left whole towns empty overnight. Instead, people went through something like unmitigated Covid, then a few years later, Covid but ten times worse, then the next year, a bad flu season, then in a decade, something twice as bad. After decades of this, they felt so vulnerable, their psyches didn’t know which way to turn. They focused on small victories. In a record in a small church in the 1620s, a man wrote: ‘Today no one’s child died.’ The survivors still laughed sometimes the following year, but by then, their sense of themselves in relation to the universe had changed forever.

1858-1859: Scarlet Fever

Scarlet fever killed 2,089 people, most of whom were 16 years old or younger, in Massachusetts between Dec. 1858 and Dec. 1859. Some of the children were employed, but the labor force exceeded 450,000 people so the effects of the epidemic were more emotional than economic. Those who were ill quarantined, but healthy people continued business as usual.

The Boston stock market was in bull mode throughout 1859. Most bank and some insurance stocks remained range-bound, but other insurers, including American, Boston, Boylston, City, and Commercial were up strongly. In addition, the Boston and Lowell Railroad increased from $89 to $98 per share over the year, and the Boston and Providence and Boston and Worcester railroads rose modestly.

The biggest gains of the year were in manufacturing. Amoskeag was up from $890 to $1,000 per share over the year, Appleton from $950 to $1,000, Bates from $85 to $106, Boott from $470 to $725, Boston and Roxbury Mill Dam from $29 to $50, and Boston Duck from $375 to $500.

Comparing COVID-19 with previous pandemics

In this article, we take a look back at some of the other pandemics that humans have endured. We investigate cholera, the Black Death, and the Spanish flu, among others. We will note any similarities and take lessons where we can.

Share on Pinterest Although COVID-19 is like nothing most of us have ever experienced before, pandemics are nothing new.

Pandemics have played a role in shaping human history throughout the ages. Few people reading this today will remember outbreaks on this scale, but history shows us that although it is devastating, what we are experiencing now is nothing unusual.

For clarity, it is worth explaining what “pandemic” means. The World Health Organization (WHO) define a pandemic as “the worldwide spread of a new disease.”

First, we will touch on the other pandemic that is ongoing.

With vast improvements in treatment, information, diagnostic capabilities, and surveillance in Western countries, it is easy to forget that experts still class HIV as a pandemic.

Since the early 1980s, HIV has claimed the lives of more than 32 million people. At the end of 2018, around 37.9 million people were living with HIV.

Although HIV is also caused by a virus, there are significant differences between the two current pandemics the most obvious being their means of transmission. Unlike SARS-CoV-2, which is the virus that causes COVID-19, HIV cannot be transmitted by coughs and sneezes.

Comparatively, COVID-19 spreads through communities much more easily. Within a matter of weeks, SARS-CoV-2 made it to every continent on Earth except Antarctica.

Another important difference is that there are currently no drugs that can treat or prevent COVID-19. Although there is no vaccine for HIV, thanks to antiretroviral medications, people who have access to care can now live long and healthy lives.

According to the Centers for Disease Control and Prevention (CDC), between April 2009 and April 2010, the swine flu pandemic affected an estimated 60.8 million people. There were an estimated 274,304 hospitalizations and 12,469 deaths.

Both swine flu and the novel coronavirus cause symptoms such as fever, chills, a cough, and headaches.

Like SARS-CoV-2, the (H1N1)pdm09 virus was also significantly different from other known strains. This meant that most people did not have any natural immunity.

Interestingly, however, some older adults did have immunity, suggesting that (H1N1)pdm09 or something similar might have infected large numbers of people a few decades before. Because of this immunity, 80% of fatalities occurred in people younger than 65.

This is not the case with SARS-CoV-2 all age groups seem to be equally likely to contract it, and older adults are most at risk of developing severe illness. It is possible that certain groups of people have a level of immunity against SARS-CoV-2, but researchers have not yet identified such a group.

The overall mortality rate of swine flu was around 0.02% . According to recent estimates, which are likely to change as the pandemic progresses, this is somewhat lower than that of COVID-19. Also, swine flu was less contagious than COVID-19.

The basic reproduction number (R0) of swine flu is 1.4 to 1.6 . This means that each individual with swine flu is likely to transmit the virus to an average of 1.4 to 1.6 people. In contrast, scientists believe that the R0 of COVID-19 is between 2 and 2.5 , or perhaps higher.

To further muddy the water, some experts have calculated that the R0 number may fluctuate depending on the size of the initial outbreak.

Over the past 200 years, cholera has reached pandemic proportions seven times. Experts class the cholera outbreak of 1961–1975 as the seventh pandemic.

Cholera is a bacterial infection of the small intestine by certain strains of Vibrio cholerae. It can be fatal within hours . The most common symptom is diarrhea, though muscle cramps and vomiting can also occur.

Although immediate rehydration treatment is successful in up to 80% of cases, the mortality rate of cholera can be up to 50% without treatment. This is many times higher than even the highest estimates for COVID-19. Cholera occurs when a person ingests contaminated food or water.

The seventh pandemic was caused by a strain of V. cholerae called El Tor, which scientists first identified in 1905. The outbreak appears to have begun on the island of Sulawesi in Indonesia. From there, it spread to Bangladesh, India, and the Soviet Union, including Ukraine and Azerbaijan.

By 1973, the outbreak had also reached Japan, Italy, and the South Pacific. In the 1990s, though the pandemic had officially ended, the same strain reached Latin America, a region that had not experienced cholera for 100 years. There, there were at least 400,000 cases and 4,000 deaths.

As with COVID-19, hand-washing is essential for stopping the spread of cholera. However, to prevent cholera , access to safe water and good food hygiene are just as important.

In the spring of 1918, health professionals detected an H1N1 virus in United States military personnel.

From January 1918 to December 1920, this virus — which appears to have moved from birds to humans — infected an estimated 500 million people. This equates to 1 in 3 people on Earth. The virus killed around 675,000 people in the U.S. alone and approximately 50 million people worldwide.

This strain of influenza, like COVID-19, was transmitted through respiratory droplets.

As with COVID-19, older adults were most at risk of developing severe symptoms. However, in stark contrast to COVID-19, the Spanish flu also impacted children under the age of 5 and adults aged 20–40.

In fact, a 25-year-old was more likely to die from the Spanish flu than a 74-year-old. This is unusual for flu.

COVID-19, however, generally affects children in relatively minor ways, and adults aged 20–40 are significantly less likely to develop severe symptoms than older adults.

As with swine flu, it may be that older adults at this time had a preexisting immunity to a similar pathogen. Perhaps the 1889–1890 flu pandemic, which was referred to as the Russian flu, afforded some protection to those who survived it.

Additionally, some scientists believe that younger people’s vigorous immune responses might have led to more severe lung symptoms due to “ exuberant pulmonary exudation .” In other words, the strong immune responses of young people may produce excess fluid in the lungs, making breathing even more difficult.

At the time, there were no vaccines to prevent the disease and no antibiotics to treat the bacterial infections that sometimes developed alongside it. The virulent nature of this particular H1N1 strain and the lack of medication available made this the most severe pandemic in recent history.

The pandemic came in two waves, with the second being more deadly than the first. However, rather abruptly, the virus disappeared.

The Spanish flu had a mortality rate of around 2.5% . It is difficult to compare that with COVID-19 because estimates vary by region.

To understand why mortality rates are so difficult to calculate, Medical News Today recently published an article on the topic.

A different time

The Spanish flu’s high mortality rate was, in part, due to the virulence of the virus.

Social differences also played a role. In 1918, people tended to live in close quarters and perhaps did not value hygiene as much. These factors can influence how quickly a virus spreads and how lethal it can be.

Also, the world was at war, meaning that large numbers of troops were traveling to distant locations, which aided the spread.

During World War I, malnutrition was common for both those at home and those on the frontline. This is yet another factor that may have made people more susceptible to disease.

The Spanish flu and physical distancing

Although the Spanish flu pandemic has many differences to today’s COVID-19 pandemic, it teaches us a valuable lesson about the effectiveness of quickly implementing physical distancing measures, or social distancing measures.

In Philadelphia, PA, officials downplayed the significance of the first cases in the city. Mass gatherings continued and schools remained open. The city only implemented physical distancing and other measures around 14 days after the first cases appeared.

In contrast, within 2 days of its first reported cases, St. Louis, MI, moved quickly to implement physical distancing measures.

As one author writes, “The costs of [Philadelphia’s] delay appear to have been significant by the time Philadelphia responded, it faced an epidemic considerably larger than the epidemic St. Louis faced.”

Pandemics and the Shape of Human History

Outbreaks have sparked riots and propelled public-health innovations, prefigured revolutions and redrawn maps.

What’s often referred to as the first pandemic began in the city of Pelusium, near modern-day Port Said, in northeastern Egypt, in the year 541. According to the historian Procopius, who was alive at the time, the “pestilence” spread both west, toward Alexandria, and east, toward Palestine. Then it kept on going. In his view, it seemed to move almost consciously, “as if fearing lest some corner of the earth might escape it.”

The earliest symptom of the pestilence was fever. Often, Procopius observed, this was so mild that it did not “afford any suspicion of danger.” But, within a few days, victims developed the classic symptoms of bubonic plague—lumps, or buboes, in their groin and under their arms. The suffering at that point was terrible some people went into a coma, others into violent delirium. Many vomited blood. Those who attended to the sick “were in a state of constant exhaustion,” Procopius noted. “For this reason everybody pitied them no less than the sufferers.” No one could predict who was going to perish and who would pull through.

In early 542, the plague struck Constantinople. At that time, the city was the capital of the Eastern Roman Empire, which was led by the Emperor Justinian. A recent assessment calls Justinian “one of the greatest statesmen who ever lived.” Another historian describes the first part of his reign—he ruled for almost forty years—as “a flurry of action virtually unparalleled in Roman history.” In the fifteen years before the pestilence reached the capital, Justinian codified Roman law, made peace with the Persians, overhauled the Eastern Empire’s fiscal administration, and built the Hagia Sophia.

As the plague raged, it fell to Justinian, in Procopius’ words, to “make provision for the trouble.” The Emperor paid for the bodies of the abandoned and the destitute to be buried. Even so, it was impossible to keep up the death toll was too high. (Procopius thought it reached more than ten thousand a day, though no one is sure if this is accurate.) John of Ephesus, another contemporary of Justinian’s, wrote that “nobody would go out of doors without a tag upon which his name was written,” in case he was suddenly stricken. Eventually, bodies were just tossed into fortifications at the edge of the city.

The plague hit the powerless and the powerful alike. Justinian himself contracted it. Among the lucky, he survived. His rule, however, never really recovered. In the years leading up to 542, Justinian’s generals had reconquered much of the western part of the Roman Empire from the Goths, the Vandals, and other assorted barbarians. After 542, the Emperor struggled to recruit soldiers and to pay them. The territories that his generals had subdued began to revolt. The plague reached the city of Rome in 543, and seems to have made it all the way to Britain by 544. It broke out again in Constantinople in 558, a third time in 573, and yet again in 586.

The Justinianic plague, as it became known, didn’t burn itself out until 750. By that point, there was a new world order. A powerful new religion, Islam, had arisen, and its followers ruled territory that included a great deal of what had been Justinian’s empire, along with the Arabian Peninsula. Much of Western Europe, meanwhile, had come under the control of the Franks. Rome had been reduced to about thirty thousand people, roughly the population of present-day Mamaroneck. Was the pestilence partly responsible? If so, history is written not only by men but also by microbes.

Just as there are many ways for microbes to infect a body, there are many ways for epidemics to play out in the body politic. Epidemics can be short-lived or protracted, or, like the Justinianic plague, recurrent. Often, they partner with war sometimes the pairing favors the aggressor, sometimes the aggressed. Epidemic diseases can become endemic, which is to say constantly present, only to become epidemic again when they’re carried to a new region or when conditions change.

To this last category belongs smallpox, dubbed the speckled monster, which may have killed more than a billion people before it was eradicated, in the mid-twentieth century. No one knows exactly where smallpox originated the virus—part of the genus that includes cowpox, camelpox, and monkeypox—is believed to have first infected humans around the time that people began domesticating animals. Signs of smallpox have been found in Egyptian mummies, including Ramses V, who died in 1157 B.C. The Romans seem to have picked up the pox near present-day Baghdad, when they went to fight one of their many enemies, the Parthians, in 162. The Roman physician Galen reported that those who came down with the new disease suffered a rash that was “ulcerated in most cases and totally dry.” (The epidemic is sometimes referred to as the Plague of Galen.) Marcus Aurelius, the last of the so-called Five Good Emperors, who died in 180, may also have been a smallpox victim.

By the fifteenth century, as Joshua S. Loomis reports in “Epidemics: The Impact of Germs and Their Power Over Humanity” (Praeger), smallpox had become endemic throughout Europe and Asia, meaning that most people were probably exposed to it at some point in their lives. Over all, the fatality rate was a terrifying thirty per cent, but among young children it was much higher—more than ninety per cent in some places. Loomis, a professor of biology at East Stroudsburg University, writes that the danger was so grave that “parents would commonly wait to name their children until after they had survived smallpox.” Anyone who made it through acquired permanent immunity (though many were left blind or horribly scarred). This dynamic meant that every generation or so there was a major outbreak, as the number of people who had managed to avoid getting infected as children slowly rose. It also meant, as Loomis rather cavalierly observes, that Europeans enjoyed a major advantage as they “began exploring distant lands and interacting with native populations.”

Alfred W. Crosby, the historian who coined the phrase “the Columbian Exchange,” also coined the term “virgin soil epidemic,” defined as one in which “the populations at risk have had no previous contact with the diseases that strike them and are therefore immunologically almost defenseless.” The first “virgin soil epidemic” in the Americas—or, to use another one of Crosby’s formulations, “the first New World pandemic”—began toward the end of 1518. That year, someone, presumably from Spain, carried smallpox to Hispaniola. This was a quarter of a century after Columbus ran aground on the island, and the native Taíno population had already been much reduced. The speckled monster laid waste to those who remained. Two friars, writing to the King of Spain, Charles I, in early 1519, reported that a third of the island’s inhabitants were stricken: “It has pleased Our Lord to bestow a pestilence of smallpox among the said Indians, and it does not cease.” From Hispaniola, smallpox spread to Puerto Rico. Within two years, it had reached the Aztec capital of Tenochtitlán, in what’s now Mexico City, a development that allowed Hernán Cortés to conquer the capital, in 1521. A Spanish priest wrote, “In many places it happened that everyone in a house died, and, as it was impossible to bury the great number of dead, they pulled down the houses over them.” Smallpox seems to have reached the Incan Empire before the Spaniards did the infection raced from one settlement to the next faster than the conquistadores could travel.

It’s impossible to say how many people died in the first New World pandemic, both because the records are sketchy and because Europeans also brought with them so many other “virgin soil” diseases, including measles, typhoid, and diphtheria. In all, the imported microbes probably killed tens of millions of people. “The discovery of America was followed by possibly the greatest demographic disaster in the history of the world,” William M. Denevan, a professor emeritus at the University of Wisconsin-Madison, has written. This disaster changed the course of history not just in Europe and the Americas but also in Africa: faced with a labor shortage, the Spanish increasingly turned to the slave trade.

The word “quarantine” comes from the Italian quaranta, meaning “forty.” As Frank M. Snowden explains in “Epidemics and Society: From the Black Death to the Present” (Yale), the practice of quarantine originated long before people understood what, exactly, they were trying to contain, and the period of forty days was chosen not for medical reasons but for scriptural ones, “as both the Old and New Testaments make multiple references to the number forty in the context of purification: the forty days and forty nights of the flood in Genesis, the forty years of the Israelites wandering in the wilderness . . . and the forty days of Lent.”

The earliest formal quarantines were a response to the Black Death, which, between 1347 and 1351, killed something like a third of Europe and ushered in what’s become known as the “second plague pandemic.” As with the first, the second pandemic worked its havoc fitfully. Plague would spread, then abate, only to flare up again.

During one such flareup, in the fifteenth century, the Venetians erected lazarettos—or isolation wards—on outlying islands, where they forced arriving ships to dock. The Venetians believed that by airing out the ships they were dissipating plague-causing vapors. If the theory was off base, the results were still salubrious forty days gave the plague time enough to kill infected rats and sailors. Snowden, a professor emeritus at Yale, calls such measures one of the first forms of “institutionalized public health” and argues that they helped legitimatize the “accretion of power” by the modern state.

There’s a good deal of debate about why the second pandemic finally ended one of the last major outbreaks in Europe occurred in Marseille in 1720. But, whether efforts at control were effective or not, they often provoked, as Snowden puts it, “evasion, resistance, and riot.” Public-health measures ran up against religion and tradition, as, of course, they still do. The fear of being separated from loved ones prompted many families to conceal cases. And, in fact, those charged with enforcing the rules often had little interest in protecting the public.

Consider the case of cholera. In the ranks of dread diseases, cholera might come in third, after the plague and smallpox. Cholera is caused by a comma-shaped bacterium, Vibrio cholerae, and for most of human history it was restricted to the Ganges Delta. Then, in the eighteen-hundreds, steamships and colonialism sent Vibrio cholerae travelling. The first cholera pandemic broke out in 1817 near Calcutta. It moved overland to modern-day Thailand and by ship to Oman, whence it was carried down to Zanzibar. The second cholera pandemic began in 1829, once again in India. It wound its way through Russia into Europe and from there to the United States.

In contrast to plague and smallpox, which made few class distinctions, cholera, which is spread via contaminated food or water, is primarily a disease of urban slums. When the second pandemic struck Russia, Tsar Nicholas I established strict quarantines. These may have slowed the spiral of spread, but they did nothing to help those already infected. The situation, according to Loomis, was exacerbated by health officials who indiscriminately threw together cholera victims and people suffering from other ailments. It was rumored that doctors were purposefully trying to kill off the sick. In the spring of 1831, riots broke out in St. Petersburg. One demonstrator returning from a melee reported that a doctor had “got a coupl’ve rocks in the neck he sure won’t forget us for a long time.” The following spring, cholera riots broke out in Liverpool. Once again, doctors were the main targets they were accused of poisoning cholera victims and turning them blue. (Cholera has been called the “blue death” because those suffering from the disease can get so dehydrated that their skin becomes slate-colored.) Similar riots broke out in Aberdeen, Glasgow, and Dublin.

In 1883, during the fifth cholera pandemic, the German physician Robert Koch established the cause of the disease by isolating the Vibrio cholerae bacterium. The following year, the pandemic hit Naples. The city dispatched inspectors to confiscate suspect produce. It also sent out disinfection squads, which arrived at the city’s tenements with guns drawn. Neapolitans were, understandably, skeptical of both the inspectors and the squads. They responded with an impressive sense of humor, if not necessarily a keen understanding of epidemiology. Demonstrators showed up at city hall with baskets of overripe figs and melons. They proceeded, Snowden writes, “to consume the forbidden fruit in enormous quantities while those who watched applauded and bet on which binger would eat the most.”

Eight years later, while the fifth pandemic raged on, one of the most violent cholera riots broke out in what’s now the Ukrainian city of Donetsk. Scores of shops were looted, and homes and businesses were burned. The authorities in St. Petersburg responded to the violence by cracking down on workers accused of promoting “lawlessness.” According to Loomis, the crackdown prompted more civil unrest, which in turn prompted more repression, and, thus, in a roundabout sort of way, cholera helped “set the stage” for the Russian Revolution.

The seventh cholera pandemic began in 1961, on the Indonesian island of Sulawesi. During the next decade, it spread to India, the Soviet Union, and several nations in Africa. There were no mass outbreaks for the next quarter century, but then one hit Peru in 1991, claiming thirty-five hundred lives another outbreak, in what is now the Democratic Republic of the Congo, in 1994, claimed twelve thousand.

By most accounts, the seventh pandemic is ongoing. In October, 2010, cholera broke out in rural Haiti, then quickly spread to Port-au-Prince and other major cities. This was nine months after a magnitude-7.0 earthquake had devastated the country. Rumors began to circulate that the source of the outbreak was a base that housed United Nations peacekeeping troops from Nepal. Riots occurred in the city of Cap-Haïtien at least two people were killed, and flights carrying aid to the country were suspended. For years, the U.N. denied that its troops had brought cholera to Haiti, but it eventually admitted that the rumors were true. Since the outbreak began, eight hundred thousand Haitians have been sickened and nearly ten thousand have died.

Epidemics are, by their very nature, divisive. The neighbor you might, in better times, turn to for help becomes a possible source of infection. The rituals of daily life become opportunities for transmission the authorities enforcing quarantine become agents of oppression. Time and time again throughout history, people have blamed outsiders for outbreaks. (On occasion, as in the case of the U.N. peacekeeping troops, they’ve been right.) Snowden recounts the story of what happened to the Jews of Strasbourg during the Black Death. Local officials decided that they were responsible for the pestilence—they had, it was said, poisoned the wells—and offered them a choice: convert or die. Half opted for the former. On February 14, 1349, the rest “were rounded up, taken to the Jewish cemetery, and burned alive.” Pope Clement VI issued papal bulls pointing out that Jews, too, were dying from the plague, and that it wouldn’t make sense for them to poison themselves, but this doesn’t seem to have made much difference. In 1349, Jewish communities in Frankfurt, Mainz, and Cologne were wiped out. To escape the violence, Jews migrated en masse to Poland and Russia, permanently altering the demography of Europe.

Whenever disaster strikes, like right about now, it’s tempting to look to the past for guidance on what to do or, alternatively, what not to do. It has been almost fifteen hundred years since the Justinianic plague, and, what with plague, smallpox, cholera, influenza, polio, measles, malaria, and typhus, there are an epidemic number of epidemics to reflect on.


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Pandemic, outbreak of infectious disease that occurs over a wide geographical area and that is of high prevalence, generally affecting a significant proportion of the world’s population, usually over the course of several months. Pandemics arise from epidemics, which are outbreaks of disease confined to one part of the world, such as a single country. Pandemics, especially those involving influenza, sometimes occur in waves, so that a postpandemic phase, marked by decreased disease activity, may be followed by another period of high disease prevalence.

What is a pandemic?

A pandemic is an outbreak of infectious disease that occurs over a wide geographical area and that is of high prevalence. A pandemic generally affects a significant proportion of the world’s population, usually over the course of several months.

What have been some of the world’s deadliest pandemics?

Throughout history, there have been many deadly pandemics, but the Black Death and the influenza pandemic of 1918–19 rank among the most lethal. The Black Death, which ravaged Europe between 1347 and 1351 and likely was caused by plague, killed roughly 25 million people. The influenza pandemic of 1918–19, or “Spanish flu,” claimed an estimated 20–40 million lives.

What causes a pandemic?

Pandemics can be caused by several factors. For example, in some cases, a new strain or subtype of virus that first emerged in animals jumps to humans and then becomes readily transmissible between humans. In other instances, an existing disease-causing agent mutates, increasing its infectiousness.

How do pandemics end?

Pandemics typically slow and come to an end on their own, though the process may be accelerated through effective preventive strategies, such as improved personal hygiene or the development of a vaccine. Some pandemics, however, occur in waves, such that decreased disease activity may be followed by another period of high disease prevalence, thereby prolonging the outbreak.

Infectious diseases such as influenza can spread rapidly—sometimes in a matter of days—among humans living in different areas of the world. The spread of a disease is facilitated by several factors, including an increased degree of infectiousness of the disease-causing agent, human-to-human transmission of the disease, and modern means of transportation, such as air travel. The majority of highly infectious illnesses that occur in humans are caused by diseases that first arise in animals. Thus, when a new infectious agent or disease emerges in animals, surveillance organizations located within affected areas are responsible for alerting the World Health Organization (WHO) and for closely monitoring the behaviour of the infectious agent and the activity and spread of the disease. WHO constantly monitors disease activity on a global scale through a network of surveillance centres located in countries worldwide.

In the case of influenza, which is the disease that poses the greatest pandemic threat to humans, WHO has organized a pandemic preparedness plan that consists of six phases of pandemic alert, outlined as follows:

Phase 1: the lowest level of pandemic alert indicates that an influenza virus, either newly emerged or previously existing, is circulating among animals. The risk of transmission to humans is low.

Phase 2: isolated incidences of animal-to-human transmission of the virus are observed, indicating that the virus has pandemic potential.

Phase 3: characterized by small outbreaks of disease, generally resulting from multiple cases of animal-to-human transmission, though limited capacity for human-to-human transmission may be present.

Phase 4: confirmed human-to-human viral transmission that causes sustained disease in human communities. At this stage, containment of the virus is deemed impossible but a pandemic is not necessarily inevitable. The implementation of control methods to prevent further viral spread is emphasized in affected parts of the world.

Phase 5: marked by human-to-human disease transmission in two countries, indicating that a pandemic is imminent and that distribution of stockpiled drugs and execution of strategies to control the disease must be carried out with a sense of urgency.

Phase 6: characterized by widespread and sustained disease transmission among humans.

When WHO upgrades the level of a pandemic alert, such as from level 4 to level 5, it serves as a signal to countries worldwide to implement the appropriate predetermined disease-control strategies.

Throughout history, pandemics of diseases such as cholera, plague, and influenza have played a major role in shaping human civilizations. Examples of significant historical pandemics include the plague pandemic of the Byzantine Empire in the 6th century ce the Black Death, which originated in China and spread across Europe in the 14th century and the influenza pandemic of 1918–19, which originated in the U.S. state of Kansas and spread to Europe, Asia, and islands in the South Pacific. Although pandemics are typically characterized by their occurrence over a short span of time, today several infectious diseases persist at a high level of incidence, occur on a global scale, and can be transmitted between humans either directly or indirectly. Such diseases represented in modern pandemics include AIDS, caused by HIV (human immunodeficiency virus), which is transmitted directly between humans and malaria, caused by parasites in the genus Plasmodium, which are transmitted from one human to another by mosquitoes that feed on the blood of infected humans.

Influenza pandemics are estimated to occur roughly once every 50 years, though the actual pandemic interval has in some instances been shorter than this. For example, following the 1918–19 pandemic, there were two other 20th-century influenza pandemics: the 1957 Asian flu pandemic and the 1968 Hong Kong flu pandemic. The virus that caused the 1957 pandemic, which lasted until about the middle of 1958, was also responsible for a series of epidemics that emerged annually until 1968, when the Hong Kong flu appeared. The Hong Kong flu pandemic, which lasted until 1969–70, caused between one million and four million deaths. The next influenza pandemic occurred in 2009, when a subtype of H1N1 virus spread across multiple regions of the world. Between March 2009 and mid-January 2010, more than 14,140 laboratory-confirmed H1N1 deaths had been reported worldwide.

In March 2020 an ongoing outbreak of a novel coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) was declared a pandemic by WHO officials. Infection with SARS-CoV2 produced an illness known as coronavirus disease 2019 ( COVID-19) the illness was characterized primarily by fever, cough, and shortness of breath. The outbreak began in late 2019 in Wuhan, China, when a patient with pneumonia of unknown cause was admitted to a local hospital. In the following weeks, the number of people infected with the novel virus grew rapidly in Wuhan, and the disease spread to other regions of China. By early 2020 COVID-19 had reached Europe and the United States, carried there by travelers coming from affected regions. By the time the outbreak was declared a pandemic, cases of COVID-19 had been detected in numerous countries worldwide, with about 130,000 confirmed cases and close to 5,000 deaths.

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Pandemics of Biblical Times

Classical Corner: The Antonine Plague and the Spread of Christianity

The Antonine Plague, described as similar to smallpox, may have killed as much as ten percent of the Roman population over a 23-year period in the late second century C.E. Aside from practical consequences of the outbreak, the destabilization of the Roman military and economy, the psychological impact must have been substantial. Ancient Romans must have felt fear and helplessness in the face of such a ruthless, and frequently fatal disease. It is not difficult to understand, then, the apparent shifts in religious practices that came about as a result of the Antonine Plague.

Justinian Plague Linked to the Black Death

The Justinian Plague, linked via bacterial research to the Black Death, claimed the lives of tens of millions of people in the 540s, and shaped world history for centuries to come. When Justinian’s troops had conquered nearly all of Italy and the Mediterranean coast, they were struck by plague and could not continue the conquest through Europe, ultimately losing much of the conquered territory after Justinian’s death. The Justinian Plague halved the European population and weakened the Byzantine Empire, making it vulnerable to the Arab conquests of the seventh century.

The Cyprian Plague

Between about 250 and 271 C.E., a plague—now known as the Cyprian Plague—swept across Egypt and the rest of the Roman Empire, reportedly claiming more than 5,000 victims a day in Rome alone. Researchers believe they have uncovered the burial site of the Theban plague victims.

Ancient Medicine

Medicine in the Ancient World

Entire cults and professions dedicated to health dotted the spiritual, physical, and professional landscapes of the ancient world. So what exactly did ancient cultures do to combat disease and injury, and did these methods have any real basis in science as we know it today? A survey of medical practices and how they interacted with religious practices in various ancient cultures.

Doctors, Diseases and Deities: Epidemic Crises and Medicine in Ancient Rome

In this lecture presented at The Explorers Club in New York, Sarah Yeomans examines a recently excavated archaeological site that has substantially contributed to our understanding of what ancient Romans did to combat disease and injury. This is a 48-minute video.

The Ten Plagues of Exodus

Exodus in the Bible and the Egyptian Plagues

The Book of Exodus describes ten Egyptian plagues that bring suffering to the land of pharaoh. Are these Biblical plagues plausible on any level?

The Bible in the News

In his column The Bible in the News, Leonard J. Greenspoon looks at the various ways the famous Biblical story of the ten plagues of Egypt is used by today’s media.

Watch the video: Hvordan mestre medisinstudiet under pandemien? (January 2022).