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Student Activities & Answer Guide:
WHAT YOU NEED TO KNOW
- Definition and difference of epidemic and pandemic.
- List of deadliest epidemics and pandemics in history.
- Nature and forms of plagues.
- Pandemic today: COVID-19
KEY FACTS AND INFORMATION
Let’s know more about epidemics and pandemics!
- According to the World Health Organization or WHO, an epidemic disease could be defined as one “affecting many persons at the same time, and spread from person to person in a locality where the disease is not permanently prevalent”, while a pandemic is “a worldwide spread of a new disease”. Due to the term ‘demic’, which comes from the Greek word ‘demos’, meaning ‘people of a district’, the words are used interchangeably.
- A pandemic is considered to be the highest possible level of disease according to the Centers for Disease Control and Prevention or CDC. Before a common illness reaches this level, it should exceed other levels.
Levels of common illness before reaching pandemic proportions
- SPORADIC. Characterised by infrequent and irregular occurrence of a disease.
- ENDEMIC. Usual prevalence of a disease in a given geographic area.
- EPIDEMIC. A sudden increase of infected people, more than the expected number within a population.
- PANDEMIC. An epidemic that spreads in and affects many countries or continents.
- Epidemiology is defined as a branch of medicine that studies the incidence, distribution, and control of diseases.
- The term ‘outbreak’ shares the same definition with epidemic, but is normally used for a more limited geographic area.
- Hyperendemic is used when the disease shows persistent and high levels of occurrence.
- According to WHO, infectious diseases are among the leading causes of death worldwide.
- Such diseases are caused by microorganisms such as bacteria, viruses, and fungi, collectively known as pathogens.
Causes of infectious diseases
- Infectious bacteria can grow, divide and spread in animals and the human body, and cause severe diseases.
- To treat bacterial infections, antibiotics are usually given.
- They are tiny infectious agents that can survive and replicate in active cells of other organisms.
- Viruses can infect plants, animals, and humans.
- Vaccines often prevent the spread of viruses.
- Antivirals can be used for some viruses.
- While most fungi are harmless and edible, others can be infectious and can cause diseases.
- Infectious fungi often affect the lungs, skin or nails and can penetrate specific organs.
- Viruses and bacteria can spread in a number of ways including:
- Animal-to-animal transfer through blood-sucking insects (viruses)
- Through airborne droplets like coughing and sneezing (viruses & bacteria)
- Exposure to infected blood or other body fluids (viruses & bacteria)
- Spread through surface and skin contact (bacteria)
- Through sexual contact (viruses & bacteria)
Deadliest epidemics and pandemics in history
- Plague of Justinian (AD 541-542), Byzantine Empire
- Black Death (1346-1353), Europe, mostly England
- Great Plague of London (1665-1666), London
- Smallpox (16th century), Mexico & Central America
- Flu pandemic (1889-1890), from St. Petersburg, Russia to Europe & the rest of the world
- Spanish flu (1918-1920), Western Front
- Asian flu (1957- 1958), China
- AIDS pandemic (1981-present day), West Africa
- West African Ebola epidemic (2014-2016), West Africa
Plague of Justinian
- Despite the long existence of the plague in human history, the Justinian plague is considered to be the first bubonic plague ever documented. During the reign of Emperor Justinian of the Byzantine Empire, historian Procopius recounted the ravages of the plague on Constantinople (now Istanbul).
- In the spring of 542, a few cases were recorded in Constantinople and were believed to have come from Mediterranean trading ships. Within four months, the plague had killed many in Constantinople and quickly spread
in Western Europe.
- Based on the accounts of Procopius, the plague killed about 10,000 people per day in Constantinople, which was questioned by contemporary historians.
- It is believed that the plague was caused by Yersinia pestis that was carried by the black rat (Rattus rattus) on trading ships from China and northeast India, until it reached Egypt and then Constantinople.
More about plagues…
- Affecting both humans and select mammals, the plague is a disease caused by Yersinia pestis. In human history, the plague was caused after being bitten by bacterium-carrying fleas that usually live on host rodents like rats. The most infamous epidemic was the Black Death or Bubonic Plague during the Medieval Period.
- Plague bacterium could be transmitted to humans through the bite of an infected flea, contact with contaminated fluid or tissue of a plague-infected animal/person, and infectious sputum droplets.
- Forms and symptoms
- Symptoms of the plague usually occur between 2 and 7 days after infection.
- Bubonic plague
- Symptoms include swollen lymph nodes, called buboes, high fever, fatigue, headache, chills, weakness, and vomiting.
- Septicemic plague
- Signs may include abdominal pain, chills, high fever, weakness, and shock.
- Dying tissues may appear black.
- Pneumonic plague
- Infected people suffer pneumonia, shortness of breath, cough, high fever, chills, nausea, diarrhoea, chest pain, and vomiting.
- The Black Death was a devastating pandemic of bubonic plague that arrived in Europe in October 1347 and killed millions of people. War, famine and weather contributed to its severity. Many historians believed that the plague was brought from northeastern China to Italy and then England.
- Through trading, the Black Death spread quickly in Europe, particularly in England. Like the Justinian plague, the Bubonic plague was caused by the bacterium Yersinia pestis.
- Due to poor knowledge in medicine and living conditions during the Medieval Period, the Black Death wiped out one-third of Europe’s population.
- Hasty mass graves in different parts of England are evidence of the devastating effect on the population.
- However, due to depopulation, better pay was given to workers. Moreover, feudalism and serfdom collapsed.
Smallpox epidemic or American plagues
- In 1519, conquistador Hernán Cortés colonised the Aztec Empire (now Mexico). Within two years, Cortés was able to penetrate the capital, Tenochtitlan, and kill its ruler, Moctezuma. Historians suggest that the fall of the empire was primarily because of epidemics of European diseases brought by the conquistadors.
- In addition to indigenous alliances and weaponry, the spread of a smallpox epidemic in the densely populated city of Tenochtitlan defeated the Aztecs.
- The epidemic reduced the native population by 40% each year. The native people of the Americas were especially vulnerable to smallpox because they had never been exposed to the virus and lacked immunity.
- In addition to the Aztecs, other Native American civilizations, such as the Mayan and Inca, were almost wiped out by smallpox epidemics.
- Moreover, other European diseases like measles and mumps also caused high death tolls among the native populations of the Americas.
- During the Second World War, smallpox was almost used by rival factions as a biological weapon.
Great Plague of London
- Following the 1348 Black Death, the Great Plague of London in 1665 is considered to be the worst plague in England. An estimated 100,000 deaths were recorded. In a week, about 7,000 Londoners died. The reason was the same as the previous Black Death.
- Those who had the means fled the city and went into retreat in their homes.
- The poorest population and those infected with the plague remained in London.
- At that time, many believed that the Bubonic plague was airborne. As a result, people began smoking tobacco and lit sea-coal fires to drive the pestilence away.
- In order to avoid the spread, public assemblies even funerals were banned, domestic pets, such as cats and dogs were killed (because they thought they might carry the plague).
- Houses of infected people were locked up and marked with a red cross for 40 days.
Flu Pandemic 1889
- Also known as the Russian flu, the outbreak of influenza between 1889 and 1890 was the first pandemic to be associated with the emergence of railroad transportation and steamships. The first urban case was recorded in St. Petersburg, Russia. After four to five months, the virus spread across the northern hemisphere and reached the United States.
- Cited as the first modern flu pandemic, Russian influenza was spread through human contact.
- Major cities such as Berlin, Brussels, Lisbon, London, Paris, Prague, and Vienna were affected.
- With the emergence of railroad transportation and steamships, Russian influenza crossed nations easily.
- As infected travellers used the vast network of railroads in the United States, the disease spread rapidly, and reports came in from major American cities including Los Angeles, Chicago, San Francisco, Detroit, Denver, and Kansas City.
- Symptoms included sudden chills, headaches, sore throat, laryngitis and bronchitis.
- “Persons with weak lungs and those suffering from heart disease or kidney troubles are most seriously affected, and in many cases the influenza leads quickly to pneumonia,” the New-York Tribune reported (1889).
- With a 10% fatality rate, a strain of influenza commonly known as Spanish flu, created another pandemic. According to estimates, the Spanish flu infected about ⅓ of the world’s population and killed about 50 million people.
- Despite bearing the name, the Spanish flu did not originate in Spain.
- According to National Geographic in 2014, the virus may have originated in China and was transported to the Western Front through the Chinese Labour Corps who built trenches and repaired damaged tanks during WWI.
- The strain was called the Spanish flu because it was Spain (then a neutral country during the war) that first published accounts of the illness. They did not impose strict censorship like other countries.
- Scholars suggest that soldiers on the Western Front became vulnerable to the flu because they lived in dirty and damp conditions. Moreover, most were malnourished and, thus, had weak immune systems.
- As soldiers returned to their home countries, towns and cities, they brought the undetected virus with them and infected civilians there.
- Unlike other infectious diseases, the virus hit young adults ages 20 to 30 who had previously been healthy the hardest.
- The city of Madrid in Spain was also struck by the virus. About 30 to 40 percent of people living in populated areas were infected. As a matter of fact, Alfonso XIII, the King of Spain contracted the disease.
- Symptoms of the Spanish flu included headache, tiredness, dry and hacking cough, loss of appetite, excessive sweating, and development of pneumonia.
- The virus reached mainland Europe, including Hungary, Germany, France, Britain, Sweden, South Africa, and the United States by late 1918, which made it a pandemic.
- In order to avoid infections, people were advised to do the following:
- Avoid crowded places
- Eat cinnamon
- Cover mouth and nose
- Avoid shaking hands
- Stay indoors
- Avoid touching library books
- Spitting in the streets of New York was made illegal
- According to Nancy Bristow’s American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic, about 500 million people around the world were infected by the flu. About 50 million people died, and 675,000 of them were Americans.
- With the effect of WWI and the Spanish flu, the worldwide population drastically decreased.
Asian flu 1957
- Also known as avian influenza, the category-2 flu pandemic was first identified in Guizhou, China. Unlike previous pandemics caused by viruses, the Asian flu was quickly identified by scientists. It was associated with the spread of the H2N2 virus.
- In February 1957, the flu reached Singapore, then Hong Kong the following month, and the United States in June.
- Infection rates were highest among children, young adults, the elderly and pregnant women.
- About three months after the outbreak in China, vaccines were produced and made available in September, while the United States was at the peak of the pandemic.
- In the United States, the Asian flu caused about 70,000 deaths and an estimated 2 million worldwide.
- Known as human immunodeficiency virus, HIV is a virus that specifically attacks and weakens an infected person’s T-cells and immunity to diseases and infections.
- If left untreated, HIV leads to AIDS or acquired immunodeficiency syndrome, for which there is no effective cure yet.
- It is believed that HIV originated from Kinshasa, in the Democratic Republic of Congo, in 1920. The virus was a product a species jump from chimpanzees to humans.
- While the origin of HIV is still subject to debate, according to the hunter theory, two types of monkeys infected with strains of SIV (Simian immunodeficiency virus) were eaten by chimpanzees, which were then hunted and eaten by humans (which developed the HIV strain).
- At the time of the spread, Kinshasa was filled with migrant workers building a railway network and an area of booming sex trade.
- By the 1960s, HIV reached Haiti and was believed to be carried by professional Haitians who worked in the Congo.
- By the 1980s, HIV was considered as a new health condition in the United States. It was in September 1982 that the disease was named AIDS. Initially, the illness was categorised as a gay-related immune deficiency or ‘gay cancer’, until the same cases occurred among heterosexuals in an outbreak in Haiti.
- In the 1990s, over 2.5 million cases of HIV/AIDS were recorded worldwide. High numbers of cases included the United States, Russia, Ukraine, Vietnam, Cambodia, and China.
- As of today, HIV could be transmitted from person to person through body fluids, such as blood, semen and pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk.
- To clear common misconceptions about this condition, HIV/AIDS cannot be not spread by air or water, insect bites, saliva, and physical contact like touching and shaking hands. Princess Diana played a significant role in destigmatising touching infected people.
West African Ebola pandemic 2014
- According to the WHO, the 2014 Ebola outbreak in West Africa was the most complex Ebola epidemic in existence. By 2016, about 11,000 of 28,000 infected people died of the disease.
- Formerly known as Ebola hemorrhagic fever, the Ebola virus disease is a rare but deadly disease caused by either one of the several Ebola virus strains – Zaire, Sudan, Tai Forest, and Bundibugyo. Two other strains – Reston and Bombali – are known for causing disease in primates, pigs, and bats.
- The first Ebola outbreak occurred in the Congo in 1976, while in 2014, the second outbreak was recorded in southeastern Guinea.
- Based on a number of studies, scientists suggest that the Ebola virus is animal-borne, probably in bats, and primates like apes, chimpanzees, etc.
- High death tolls were recorded in Liberia and Sierra Leone, while smaller counts occurred in Nigeria, Mali, Senegal, the United States, and Europe.
- Ebola virus could be transmitted through the following:
- Animal-to-animal transmission
- Animal-to-human transmission
- Through hunting and eating infected animal meat
- Human -to-human transmission
- Traditional funeral practices, such as washing, in which a person had contact with the infected person’s blood and body fluids.
- Unprotected healthcare workers.
- Unprotected contact with infected body fluids, like blood.
- The main symptoms of the Ebola virus include fever, severe headache, muscle and joint pain, abdominal pain, weakness, fatigue, diarrhoea, vomiting, and unexplained bleeding and bruising.
- Late-stage symptoms can include red eyes, skin rash, and hiccups. Almost the same symptoms as illnesses like influenza, malaria, or typhoid fever.
Pandemic Today: COVID-19
- On March 12, 2020, the WHO officially categorised COVID-19, caused by a strain of Coronavirus, a pandemic. According to WHO’s Director-General Tedros Adhanom Ghebreyesus, COVID-19 is the first pandemic caused by a coronavirus to reach at least 195 countries (25/03/2020).
- The epicentreof the outbreak began in Wuhan, Hubei Province, China in late 2019. In March 2020, Italy became the epicentre of the European outbreak.
- The term ‘coronavirus’ is derived from the Latin word ‘corona’, which means wreath or crown. Coronaviruses are most common in mammalian species like cattle, camels, cats, and bats. There are rare strains that can infect people, such as MERS-COV, SARS-CoV and now novel SAR-CoV-2. All three have their origins in bats.
- Based on existing investigations, the outbreak began in a large seafood and live animal market in Wuhan, China, which most likely suggests that the spread was an animal-to-person case before person-to-person transmission.
- According to the Centers for Disease Control and Prevention, common symptoms like fever, dry, persistent cough, and shortness of breath may appear between 2 to 14 days after exposure. Severe symptoms may include persistent chest pain, bluish lips and face, and trouble breathing.
- Spread and transmission
- Based on existing studies, the virus spreads when an infected person coughs or sneezes, producing droplets.
- Coronavirus could also be acquired from touching surfaces contaminated with the virus, then touching the mouth, nose or eyes.
- Groups at higher risk
- Older adults
- People with respiratory concerns and existing health conditions like cardiovascular disease and diabetes
- Pregnant women
- HIV-positive and immunocompromised people
- Prevention and response
- Impose self-quarantine when sick
- Cover the mouth and nose with a tissue when sneezing or coughing. Dispose of used tissues right away. Alternatively, sneeze or cough into your elbow
Wash hands thoroughly with soap and water for at least 20 seconds
Clean and disinfect surfaces and objects frequently touched including smartphones
- Avoid large crowds or communal activities