History of Pandemics: What Can They Teach Us About Coronavirus?

Our generation, at least in the U.S., has never seen anything like Coronavirus. But previous generations have.

Throughout most of recorded history, untreatable disease on either a local or global basis has been part of the human condition for every generation. But our generation has been spared from pandemics for the most part. So pandemics are not part of our collective cultural consciousness.

• If you’re under 65, you’ve not been faced with the curse of polio, because a vaccine became available in the 1950s.
• If you’re under 50, you would not have seen the devastation of mumps or measles. U.S. cases alone numbered in the hundreds of thousands until vaccines became available in the early 1960s. Rubella, sometimes known as German measles, was particularly dangerous to pregnant women and could cause congenital birth defects or neonatal deaths. Now, mumps, measles, and rubella are treatable with a single vaccination.
• If you’re under 40, Small Pox is a thing of the past, with vaccination campaigns eliminating it in 1979.

Definitions

First, let’s start with some general definitions about the Coronavirus:

SARS-COV-2 is the name of the virus.

COVID-19 the name of the disease caused by the virus. On March 11, the World Health Organization (WHO) identified this new disease as a pandemic.

Epidemic: The Greek roots epi+demos refers to “upon” “people” or a disease visited upon a people or population, typically in a region or local community. Informally, it means a disease that quickly and temporarily spreads.

Pandemic: Generally, a pandemic is an epidemic that is prevalent throughout an entire country, continent, or the globe. Pan+demos means “all” “people” or belonging to all the people. The WHO uses the term more specifically in a public health sense to refer to a disease that has increased and sustained infectious transmission across international borders to multiple continents that may have been carried initially by a traveler from the original community, but now has a secondary wave of infection from person to person in the new communities.

Pandemics come from epidemics, but not all epidemics become pandemics. There are widespread diseases, like Cancer, but it is not considered infectious, so it is not considered either epidemic or pandemic.

It has often been said that our inability to anticipate the impact of a crisis is based on a failure of imagination. Let me stir your imagination as we look at the more notable epidemics and pandemics of the last 2,500 years, using the following excellent infographic from VisualCapitalist as a guide.

Infographic: History of the Deadliest Pandemics

History

1. Plague of Athens:

• Date: 430-426 BC
• Disease: likely Typhoid fever
• Deaths: 75,000 to 100,000
• Source: Ethiopia
• Extent: Beyond the city of Athens to the eastern Mediterranean

At the hight of the Golden Age or Classical period of Greece, there was a war between armies representing the two leading city-states. During this Peloponnesian War, when the Athenian Delian League fought against the Spartan Peloponnesian League, a typhoid epidemic spread beyond the city-state of Athens.

It killed 25% of the city, including soldiers and sailors, extending to the eastern part of the Mediterranean. The Athenian General Pericles died from it, changing the outcome of the war. The historian Thucydides caught it, recovered, and reported on it:

“…the catastrophe was so overwhelming that men, not knowing what would happen next to them, became indifferent to every rule of religion or law.”

2. Antonine Plague:

• Date: 165-180 AD
• Disease: likely Small Pox
• Deaths: 5 million
• Source: Italian soldiers returning from the Near East
• Extent: The second outbreak in 251-266, called the Plague of Cyprian, killed 5,000/day in Rome. Possibly as many as 5 million died.

Also known as the Plague of Galen, for the physician who described the pandemic, its mortality rate was about 25% of those infected. The Antonine name is attributed to the co-regent of Emperor Lucius Verus, namely, Marcus Aurelius Antoninus (played by Richard Harris in the movie Gladiator). Verus was killed by the disease, along with one-third of the population in some places, and devastated the Roman army at the time.

Some towns on the Italian peninsula and European provinces lost all their inhabitants. A shortage of troops limited Marcus Aurelius’ ability to attack the Marcomanni German tribes across the Danube until 169 AD.

As Marcus Aurelius, the last of the philosopher-kings lay dying he said:

“Weep not for me; think rather of the pestilence and the deaths of so many others.” 

3. Plague of Justinian:

• Date: 541-750 AD
• Disease: Yersinia pestis, bacteria responsible for Bubonic Plague
• Source: Egypt, though possibly originally from Kyrgyzstan, Kazakhstan, and China
• Extent: Killed 50% of the population of Europe between 550-700 AD

The chronicler Procopius of Caesarea relates that this Constantinople outbreak killed 10,000 per day during its most virulent period in 541-542 AD and up to 40% of the city.

It passed beyond the city into the “known world” of the Neo-Persian Empire, the Byzantine Empire, and port cities of the Mediterranean Sea, killing a quarter to half the population. Justinian I was the Emperor of the Roman Empire in Constantinople at this time. Though he caught the disease, he survived. He had already spent enormous amounts on war and building projects, outstripping tax revenues from a population shrinking from the Plague.

It became his “Waterloo,” weakening his Byzantine empire and signaling the “Fall of the Roman Empire.” Though he had reunited the Western and Eastern parts of the Roman Empire, it was short-lived, and the Lombards eventually successfully invaded northern Italy. (Lombardy, with its capital of Milan, has been the hardest hit by the Coronavirus in Italy.) This period of decline was followed by the early Medieval Period of history or the Dark Ages. As Procopius wrote about him:

“When pestilence swept through the whole known world and notably the Roman Empire, wiping out most of the farming community and of necessity leaving a trail of desolation in its wake, Justinian showed no mercy towards the ruined freeholders. Even then, he did not refrain from demanding the annual tax, not only the amount at which he assessed each individual, but also the amount for which his deceased neighbors were liable.” 

4. Black Death:

• Date: 1347-1353
• Disease: Yersinia pestis, responsible for the Plague from the time of Justinian to the Third Pandemic (Modern Plague) in 19th century China
• Source: China and Central Asia
• Extent: 75-200 million deaths across Eurasia. Recurrences include the half dozen outbreaks of the Great Plague of London sporadically between 1563 and 1665. Think: Shakespeare, Newton, etc. Outbreaks in Spain, Sweden, Prussia, Italy, and the Islamic world claimed between a third to two-thirds of their populations into the 1800s.

The “Bubonic Plague” is the most familiar pandemic to most people, having killed as many as 200 million across Europe and Asia. Its outbreak in Europe was swift and devastating and circled clockwise around Europe from Constantine south, west, north, then east within a short period of time between 1347 and 1353. Death estimates ranged from 30% to 60% or higher in Europe and took 200 years to recover the population to previous levels, parts of northern Italy not recovering until the 1800s. Recurrences of smaller outbreaks continued into the 1900s.

The European outbreak seems to have come along the Silk Road by armies and traders. The disease was carried on fleas riding on rats. Genoese (Italy) traders returning from the Mongol wars in Kaffa in the Crimea brought it home in 1347. From there, it was taken by Genoese galleys to Sicily, other ports in Italy, and north into Europe. It was in the seafaring town of Venice that quarantine (Italian: quarantino from quaranta giorni, 40 days) was effective, keeping sailors and crew on board for forty days before allowing them to disembark.

England experienced recurrences of a half dozen outbreaks of sporadically about every 20 years between 1563 and 1666. Think: Shakespeare, Newton, etc. The Great Plague of London lasted from 1665-1666. Though smaller in scope than the worldwide pandemic, it was the last major epidemic of the plague in Great Britain, killing 100,000, or 20% of the London population. London had been the largest city in the western world with half a million inhabitants.

Laws were put in place in England to identify those with the disease: a bale of straw attached to a pole hung outside one’s residence served as a way to isolate the sick. Those infected identified themselves with a white pole when they walked out in public to warn others to beware. Londoners initially blamed it on the French, though it likely entered the city through the Netherlands.

• Parish officials provided food to the poor.
• All public entertainment was banned.
• All trade was stopped between other plague towns and London. The death toll by the end of the summer was 7,000 per week.
• The dead were placed into mass graves and a plague bell was run for 45 minutes during each burial.
• Magistrates and aldermen enforced the orders of King Charles II in 1665 to lock those infected into their houses.

“The pague [is] making us cruel as dogs to one another.” – Samuel Pepys, from Daniel Defoe’s ‘Journal of the Plague Year’

It is difficult to overstate the social and economic impact of the Plague. With a significant and rapid reduction in the population, food prices fell as did land prices, while the value of laborers increased due to supply and demand. Inherited property contributed to a weakening of the Medieval feudal system. 

“India was depopulated, Tartary, Mesopotamia, Syria, Armenia were covered with dead bodies”.

5. Third Plague Pandemics:

• Date: 1855
• Disease: Yersinia pestis
• Source: China
• Extent: Worldwide, 12 million deaths

The bacteria Yersinia pestis showed up again between the mid-1800s and even into the 21st century in many parts of the world. In the mid-19th-century, starting in China and spreading to all continents, the Plague killed ten million in India alone. The prevalence of worldwide shipping quickly extended its reach. North America got its first glimpse in the 1900-1904 Plague of San Francisco, with a second wave occurring between 1907-1908. Outbreaks occurred in Africa as recently as 2017.

Treatment ranged from isolation into sanitariums, lime washing of homes, hospitalization and camp isolation, and travel restrictions. It was not until the late 1800s that early immunology was developed using a weakened form of Bubonic Plague. Vaccinations began in the Grant Medical College of Mumbai by Waldemar Mordechai Haffkine, a Russian bacteriologist. 

6. Spanish Flu:

• Date: 1918-1920
• Disease: a subtype of avian or porcine H1N1 virus
• Source: China?, France?, Fort Riley, Kansas?
• Extent: Worldwide, 40-50 million

The Great Influenza of 1918-1920 infected over half a billion people across the world, about a third of the population at that time. During and because of World War I news of it was suppressed so as not to encourage enemies — indeed, the influenza was often discussed as the weapon of the enemy — but Spain did not suppress the news. This likely gave rise to the misconception that it was most severe there or had started there.

Unlike the current Coronavirus, where the elderly are most at risk of contracting the disease, the Spanish Flu took its toll on young adults. This may have been because older people had acquired some immunity from their parents following a flu outbreak in 1830. Older veterans of previous wars showed some resistance. But younger people had no such immunities.

The Spanish Flu moved quickly and widely. It killed people in a shorter period of time: in 25 weeks it killed more people than AIDS killed in 25 years. During the war years, it killed more people during the same period of time than died in battle. The crowding of military camps, the close quarters of “trench warfare” in Europe, the unsanitary conditions, and the use of chemical weapons all contributed to its spread. Bacterial pneumonia developed in lungs weakened by influenza. The death rate among those infected was about 20-28%.

Unlike today’s media coverage of Coronavirus, military leaders, public health officials, politicians, and law enforcement officials had various motivations to underplay the severity of influenza resulting in less press coverage. Nevertheless, at the height of the pandemic, during the second of three waves, quarantines were set up in many cities across America.

Whether or not the Great Influenza shortened the war since both sides found it difficult to field healthy armies, the war certainly created an ideal incubator for the more severe strains of the virus.

Inoculations against the virus were not available at the time, and it seems that the rapidly mutating virus developed into less lethal forms; the more lethal strains killed their hosts so quickly that it shortened their ability to spread it.

“The whole world seems up-side-down. So many people around here have died, and so many are sick.”

7. Small Pox:

• Date: 1520s-1979
• Disease: Variola virus
• Source: Cases reported in ancient Egypt, China, India?
• Extent: Worldwide, 56 million

An ancient disease, but only more recently eradicated, Small Pox is not to be confused with the milder Chicken Pox. Small Pox used to kill almost half a million Europeans during the 1700s and 1800s. Its mortality rate was 17%.

One well-known case in the U.S. involves the great theologian and preacher, Jonathan Edwards. He was a chronicler and participant in the Great Awakening (American First Great Awakening) religious revival of the 1740s. He’s most remembered for his uncharacteristic sermon “Sinners in the Hands of an Angry God.” He became president of Princeton (College of New Jersey) during an outbreak of Small Pox, but being an early adopter of scientific advances, participated in an early inoculation practice involving a weakened sample of the virus.

The participant was supposed to develop a mild case of the disease. However, unlike his contemporary sufferer George Washington, Edwards caught the disease but did not survive it. Edward’s daughter Ester and her husband Reverend Aaron Burr, Sr., prior president of Princeton, also succumbed to Small Pox.

Edwards wrote to his children before he died:

“It seems to me to be the will of God that I must shortly leave you; therefore give my kindest love to my dear wife, and tell her, that the uncommon union, which has so long subsisted between us, has been of such a nature, as I trust is spiritual, and therefore will continue forever… you are now like to be left fatherless, which I hope will be an inducement to you all to seek a Father, who will never fail you.”

In the 1900s, some 300-500 million deaths were attributed to the Small Pox virus, with a mortality rate of 30%. Even as recently as the 1950s outbreaks accounted for 50 million cases each year. But aggressive vaccination programs allowed the World Health Organization to declare that it had been eradicated in 1979.

8. Modern Pandemics:

Modern science has not eliminated all infectious diseases. There have been some epidemics and pandemics, though these have been much more limited in both scale (size) and scope (geography.) As the population grows — some 6 billion people have been added in the last century — and diets shift to higher levels of protein derived from meat, zoonotic diseases become more common.

• Asian Flu of the late 1950s and Hong Kong Flu of the late 1960s killed about 1 million each.
• Swine Flu killed about 200 thousand between 2009 and 2010.
• Ebola Virus, though highly virulent with a mortality rate of 25-90%, was mostly, though not exclusively, confined to tropical regions of Sub-Saharan Africa, Western Africa, and Southern Africa. It killed about 11 thousand people. Before a vaccine for the disease proved effective in 2019, isolation and quarantine were effective in slowing the spread of the disease.
• HIV/AIDS: This modern pandemic was identified in the early 1980s in America. Initially, it spread in Sub-Saharan Africa beginning in the late 19th and early 20th centuries. In 2010, 68% of all cases and 66% of deaths occurred in Africa across all ages, with a disproportionate 60% of the disease occurring in women.

In 1981 five cases emerged in the U.S. among the male homosexual community and hypodermic drug users who showed signs of a rare form of pneumonia known to occur in people who had very compromised immune systems. The death of American actor Rock Hudson in 1985 and British musician Freddy Mercury of Queen in 1991 from AIDS brought it to media attention in a new way.

The initially limited scope of the disease in America and the western world moved beyond the preliminary infected groups to a larger population. The transmission vectors include unprotected sex, shared body tissues and fluids, including contaminated blood transfusions, infected hypodermic needles, and mother-to-child transmission during pregnancy, delivery, and through breastfeeding. More recently, it has moved into Latin America, Asia, and particularly Russia.

The disease is insidious in that its initial flu-like symptoms may disappear for years as the infection compromises the immune system. The progress of HIV/AIDS, in the western world at least, has been slow, but cumulatively large. In the 40 years since its 1981 identification, approximately 25-30 million people have died worldwide. There remains no vaccination for HIV/AIDS, though antiretroviral therapy can decrease the risk of transmission and slow the progression of the disease.

Various governments have suppressed information about the disease during the first part of the 21st century for political reasons, and conspiracy theories abound. Still, it is one of the very few pandemics of which our modern generation has awareness.

Coronavirus’ Uniqueness

Q: What are unique characteristics that make it different from other pandemics, and even from other influenza outbreaks?

• No one has any immunity. It is novel Coronavirus, meaning new.
• No vaccine. Early trials have begun this week, but it will likely take months to years for a successful vaccine to go into production.
• You’re contagious before you get sick. Infected individuals who have not presented any symptoms can still be contagious.
• Undocumented and asymptomatic cases are instrumental in spreading the new Coronavirus.

Q: What are some of the unique characteristics of our generation that have led to its rapid spread and a heightened sense of crisis?

• Geopolitically: the “world is flat” or globalization. Communication, cross-border travel, and extended supply chains throughout Asia have moved Coronavirus from Wuhan, China, where it was first identified into South Korea, Taiwan, Hong Kong, and Singapore before moving to Iran, Italy, and the rest of Europe.
• Urbanization: more people live in cities now than at any other time in history. High population concentrations make contagion easier.
• Aging Population: in America, Japan, and Italy means there is a more significant proportion of the population with more fragile health. Some elderly folks have risk factors that may have been built up over their long lifetime: smoking, obesity, heart disease, etc.
• Transportation: we know that before modern ground transportation, to move goods across land cost ten times what it costs to transport by water. Shipping since the Age of Discovery in the late 15th century spread disease from port to port, and via river from town to town. The advent of modern commercial air travel — which has doubled in the last decade — has made it easier to move goods, and people, farther and faster than ever before. What used to take days to months now takes hours.
• 24-hour media news cycle: where 15% of web traffic is going to content about Coronavirus, according to traffic analysis. Current big stories are travel restrictions, social distancing, and #FlattenTheCurve stories. It overshadows 2020 election coverage by 15 times. At the same time, Americans are 30% more engaged with content than last year.
• Online suppression: the Chinese social network TikTok directed its moderators to suppress posts from “users deemed too ugly, poor, or disabled for the platform,” according to internal documents seen by The Intercept.
• Online malware: we are witnessing not only a biological virus but online malware including credential phishing, malicious attachments, malicious links, business email compromise (BEC), fake landing pages, downloaders, spam, and malware, among others, all leveraging coronavirus lures.

Conclusion

While the infection numbers and death counts are low by historical standards, the current growth of the Coronavirus pandemic is exponential. See a real-time map here.

At some point, we will reach an “inflection point” in that exponential curve when the infection rate will drop, and the curve will flatten out and then turn down.

We do not yet have enough data to determine the mortality rate of Coronavirus. The numbers are all over the chart right now: it’s looking like it’s about 4% globally, but in Italy, it’s 8%, and among those over 80 years of age it’s 15%. The higher the mortality rate, the higher the percentage of infected people die. However, if an infected host dies, they are no longer able to spread the disease. The lower the mortality rate, the more successful the virus will be at surviving and becoming endemic or seasonal in its recurrence. At the writing of this article, it seems that Coronavirus is not as deadly as some diseases, though it is more infectious than traditional seasonal flu.

Viruses tend to have a “life” to them, which is influenced by temperature, climate, or time to mutate. Eventually, their infection rate slows. Today we’re looking at the first wave of the disease. If it’s like other pandemics in history, there will be a second wave and follow-on recurrences.

Bill Petro, your friendly neighborhood historian

www.billpetro.com

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