History of How Pandemics End: Implications for Today’s COVID-19

With the COVID-19 pandemic on everyone’s mind, the natural question is:

How have pandemics ended in the past…

and what can we learn from these historical lessons?

As a follow-up to the article I wrote at the beginning of the COVID “lockdown” back in March, the History of Pandemics, here are how some of the great pandemics of the past ended and what the aftermaths were.

Pandemics History

1. Plague of Athens — Greece, 430 BC

Pericles Funeral Oration

During the Golden Age of Greece, what appears to have been typhus — or perhaps typhoid, or smallpox — hit the city-state of Athens and surrounding areas. Dozens of other diseases have been suggested as the cause, though it is suspected to have come from Ethiopia and then through North Africa.

It came at a bad time — as if there were a good time for a pandemic. Athens was involved in the 2nd Peloponnesian War against Sparta. Athenian city officials had enacted regulations for public safety when the disease hit.

But the populace didn’t fear prosecution for breaking the laws, as they didn’t think they’d survive.

There were two waves of the disease, the first being the more deadly. Our best source on the subject, the historian Thucydides, who caught the disease but survived, wrote in his History of the Peloponnesian War that it affected both strong and weak. He described the breakdown of traditional values and honor in Athens, giving way to self-indulgence:

”As for offenses against human law, no one expected to live long enough to be brought to trial and punished: instead everyone felt that a far heavier sentence had been passed on him.”

Though some Athenians blamed the disease on their enemy’s poisoning their water supply, Thucydides didn’t buy it.

The Athenian leader Pericles, who succumbed to the disease, had ordered his people to withdraw behind Athens’ newly-built walls and unintentionally created an ideal environment for the disease’s spread.

There was no known remedy at the time, though Thucydides hoped that future generations would learn from them, should it appear again.

“Through knowledge, patience, and science we can prevail.”

It did tip the Peloponnesian War in favor of their enemies, the Spartans. Athenian democracy would never be the same.

2. Antonine Plague — Rome, 165 AD

Antonine Plague

Named after the dynasty created by the Roman Emperor Antonius Pius and his two adopted sons, the second of whom, Marcus Aurelius, is most to be remembered. This plague was quite virulent and devastated Rome and its army. Quite likely an outbreak of smallpox or perhaps measles, it had a second outbreak 15 years later.

Marcus Aurelius persecuted Christians, believing that their refusal to pay homage to the Roman gods had brought divine wrath upon the populace. But it had an opposite effect among everyday Romans.

Christians’ faith compelled them to assist others in a time of great need, attended to basic food and water for the afflicted. Contrary to their neighbors who had fled the city to escape the plague, those Romans who survived found that their opinion of Christians improved. Christianity flourished despite the Imperial persecution.

Marcus Aurelius

Because so many things in Roman society hung on the reign of Marcus Aurelius, especially in art and literature, the plague had a potent impact. The Roman Peace, the Pax Romana, which had endured for the preceding four of the “Five Good Emperors,” ended with Marcus Aurelius’s death. He had written in his Meditations:

“To bear in mind constantly that all of this has happened before, and will happen again — the same plot from beginning to end, the identical staging. Produce them in your mind, as you know them from experience or from history: the court of Hadrian, of Antoninus. The courts of Philip, Alexander, Croesus. All just the same. Only the people different.”

The Antonine Plague had been the greatest since the Plague of Athens. Roman military strength, especially in the east and north edges of the Empire, was significantly weakened such that Germanic and Gallic tribes were able to push south toward Rome successfully.

Did this have an impact on the decline of Rome?

Edward Gibbon, in his seminal book, The History of the Decline and Fall of the Roman Empire, wrote:

“Pestilence and famine contributed to fill up the measure of the calamities of Rome”

There was no effective treatment for the disease, nor a cure. A vaccine would not come for another 1600 years.

3. Plague of Justinian — Constantinople, 541 AD

The plague that devastated the Eastern Roman Empire was likely the Bubonic Plague, caused by the Yersinia pestis bacterium. This was the same bacteria that caused the Black Death some 800 years later. Researchers have suggested that Justinian’s strain was related to but distinct from that of the Black Death. If this DNA research is correct, it means that persistent immunity did not stand in the way of a new strain of the deadly microbe.

During Justinian’s time, it killed 30 to 50 million people, about half the world’s population. Eight hundred years later, when the Black Death hit Europe, 50 million died between 1347 and 1351 alone.

This bacteria is still present in 200 species of rodents globally.

4. Black Death — Europe, 1347 AD

There was no treatment for the Bubonic Plague until antibiotics in the late 19th and early 20th-centuries. Even today, there is no single injection you can take that will knock it out. Still, in 2018 the World Health Organization created a Plague Vaccine Target Product Profile, which lists 17 possible candidates for vaccine approval, which are undergoing clinical trials and moving toward FDA approval.

However, as with earlier epidemics and pandemics before the emergence of germ theory, healthy people would avoid those who were sick. They used three methods to minimize the spread of the contagion:

• They would physically distance themselves from the infected.

• They would separate apparently healthy but suspected infected people from the known healthy. Quarantine, first successfully developed in Venice, was a way of sequestering arriving travelers for forty days, quaranta giorni, (Italian for 40 days,) to ensure they were not infected.
• They would isolate the known infected away from those who were healthy. During the later English bout of the Bubonic plague, The Great Plague of London in 1665, the sick would be sent out of London to the countryside… where they were left to fend for themselves.

What was the aftermath of the Black Death?

Whole books have been written on the economic impact in the wake of the Black Death. But a few facts can illustrate the profound economic “sea change.”

It took 200 years for the population to be restored in Europe after the Black Death. With land being a fixed resource but a population that had been reduced, the ratio of labor changed. This meant laborers were suddenly in higher demand and could command higher pay.

Meanwhile, economically, there was abrupt and extreme inflation. Since it was both difficult and dangerous to procure goods through trade and to produce them, the prices of both goods produced locally and those imported from afar skyrocketed.

How did the Black Death end?

Several things contributed to minimizing its impact.

The wealthy, like King Charles II of England, could afford to move their families to Oxford or other locations, far from London.

“Lord have mercy on this house.”

Because incubation of the disease took only 4-6 days, when it appeared in a household, the entire house was sealed, with a red cross on the door along with the words

“Lord have mercy on us”

The dead bodies were carried away by cart with the call

“Bring out your dead”

(really) and taken to the plague pits. The disease’s fast progression and rapid removal of corpses moved the disease away from the healthy population.

The late Autumn turn in the weather, with its colder temperatures, killed off the rat-borne fleas which were the real carriers of the disease.

The Great Fire of London in 1666 destroyed much of the center of London, killing off many of the black rats who transported the disease. Bubonic plague is rare today but has been found in Africa, Asia, South America, and a few American states.

Some courageous pastors encouraged their parishioners not to flee the towns by preaching to them in the open air. The story is told of the Derbyshire village rector William Mompesson who preached from a rock in a dell now called Cucklett Church. Money donated for the afflicted was dipped in vinegar, or placed in well water, to minimize contagion from the disease.

5. Small Pox — Worldwide, 1520 AD

Smallpox vaccine

The smallpox virus, Variolae, I’ve discussed previously in detail in an article here. Indeed, the remedy to this disease, a vaccine, gets its name from the Latin phrase Variolae vaccine, meaning the “smallpox of the cow,” and referred to as cowpox. While cowpox is different, it’s the same family of diseases as smallpox.

Having killed tens of millions of people worldwide at this time, in addition to some ancient outbreaks, it was treated first with variolation — transferring material to a healthy person from an infected one — which had a risk of contagion to others.

Vaccination developed in the late 18th-century proved more effective, using a weakened version of the virus to develop immunities in healthy people.

6. Spanish Flu — Worldwide, 1918 AD

Spanish Flu

The pandemic most often compared to COVID-19 is the so-called “Spanish Flu” or the Great Influenza, a subtype of the avian or porcine H1N1 virus.

During World War I, the disease moved quickly through the troops in Europe and the U.S. Between 1918 and 1920; there were at least three waves of the disease, the second wave being the deadliest. No inoculation was available at the time.

Starting in the 1930s, it took decades of research to understand the complexities of the influenza virus. Indeed, it wasn’t until 1945 that a vaccine was approved for use in America. Still, two years later, scientists realized that seasonal changes in strains and mutations of the virus made a single vaccine ineffective. Each year the vaccine needs to change.

Because the Spanish Flu was a rapidly mutating virus, it developed into less lethal forms; the more lethal strains killed their hosts so quickly that it shortened their ability to spread it.

Today’s Pandemic

In some ways, COVID-19 has been less deadly than previous pandemics:

• Bubonic Plague killed 25-50 million people in just a few months in the sixth century during the Plague of Justinian, with 10,000 deaths daily during its most virulent period.
• Smallpox consistently killed 400,000 people every single year of the 18th-century, not counting its other outbreaks in the 16th through 20th centuries. In the last 100 years alone, it killed 300-500 million people.
• Measles killed 200 million people in the nineteenth and twentieth centuries until a vaccine became available.
• Spanish Flu claimed 50 million lives between 1918 and 1920.
• COVID-19 has killed fewer than 2 million worldwide as of this writing.

But in other ways, COVID-19 has been more insidious:

The disease is particularly contagious because it doesn’t quickly debilitate and kill most of its victims as some previous pandemics did. This means with modern air travel, presymptomatic or asymptomatic people can be contagious and spread the disease far and wide before they even know they have the disease. No one with an active case of Bubonic Plague was sailing on a cruise ship or skiing in Aspen. They were suffering until death, which happened within hours.

Pfizer-BioNTech COVID-19 vaccine

This COVID-19 pandemic that has captured the world’s attention — the first of its kind in this generation — is currently surging in several places across the globe. Interest in vaccines and treatments for those hospitalized are at a fever pitch, no pun intended.

Now that the U.S. FDA has approved the first vaccination for emergency use, in my next article, I’ll describe where we are with the Coronavirus vaccines and what additional steps are necessary to see COVID end.

Bill Petro, your friendly neighborhood historian

www.billpetro.com

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