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Monday, October 3, 2022

The killer pandemics that are deadlier than CoviD-19.

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josef san jose
an ordinary man trying to do extraordinary things

World coronavirus cases continue to climb, approaching 23 million confirmed cases and more than 800 thousand deaths as we write this. It has only taken a few months to sweep the globe. Countries like the United States, India, Brazil, and the Philippines are having difficulty containing the coronavirus while some countries in East Asia and Europe seem to quell the outbreak, although there seems to be no assurance that it will not come back.

A disease must be infectious and crosses international boundaries, and not merely widespread or killed many people, to be classified as a pandemic. For instance, ischaemic heart disease is the leading cause of global death but is not a pandemic because it is neither infectious nor contagious.

Preliminary estimates by health care experts for the mortality rate of Covid-19 is around 1% or 10 times higher than the average for the seasonal flu. Middle Ages plague is estimated to have killed between 30% and 60% of the global population. Diseases like smallpox depopulated the indigenous people of the new world with “55 million death following the European conquest of the Americas beginning in 1492” or about 80-95% of native American Indians. The HIV/AIDS pandemic is one we’re still battling the longest. The Human Immuno Virus has infected 75 million people and 35 million have died since the start of the pandemic. It is in this number that one might find some morbid comfort in considering the historical context of pandemics like CoViD-19.

Pandemics have reshaped societies and remade the world in profound ways. Civilizations decimated, empires fell, governments unraveled and generations slaughtered. We may feel hopeless amidst the havoc brought by CoViD-19 but past pandemics offer lessons and a way out. It is therefore important to look back at the past as it provides a prologue to understanding the impact of present and future diseases.

The Spanish Flu (1918-1920)

CoViD-19 has inspired lots of parallelism to the 1918 flu pandemic. There is no universal consensus regarding where the virus originated, but an H1N1 (influenza type) virus caused it with genes of avian origin. It was first spotted in the US, Europe, and parts of Asia before it spread worldwide from 1918-1919. It affected about one-third of the world’s population at that time or about 500 million people and estimated to have killed 20 to 50 million people worldwide. That’s more than the combined numbers of soldiers and civilians killed during the First World War.

Many people believed and called it the Spanish flu since news sources from Spain were the only ones reporting on the flu. The Spanish media was the first to report and the only country being honest about the toll the pandemic took on their country while Allied countries and the Central Powers had covered up news of the flu to keep the morale of the troops high. The censorship and news blackout is the reason why this health crisis is often called the “forgotten pandemic”.

The first wave of the pandemic happened in the spring of 1918 and was like a normal mild flu with typical symptoms as chills, fever, and fatigue, with recovery after several days, but a second, highly infectious wave of influenza appeared with a vengeance in the fall of that aforesaid year. A mutated type of the Spanish flu virus had appeared that exhibited what’s called a “W curve”—high numbers of deaths among the young and old, but also a massive spike in the middle composed of otherwise healthy 25- to 35-year-olds in the prime of their life. The victims of the evolved Spanish flu, within 24 hours of manifesting the first signs of infection had their skin turning blue, nasal hemorrhaging, and their lungs filling with fluid that caused them to asphyxiate.

Public health officials were reluctant to impose quarantines because they wouldn’t want to endanger paralyzing the war effort by keeping munitions factory workers closed.  The absence of calm and steady leadership from the top worsened the global crisis, it was left to the local officials to step up and respond in varying ways.

The reason Spanish flu claimed so many lives was that science simply didn’t have the tools to develop a vaccine for the virus. Many of the world’s health care system then was primitive by modern standards. Only in the 1930s did microscopes able to see something as incredibly small as a virus. Flu vaccines only appeared in the 1940s. There was a shortage of physicians and other health workers because of the war effort and many of them have succumbed to the virus as well.

Many tried to profit from the chaos that ensued by selling fake remedies and relief from the virus. Borders were shut and public spaces like churches and theaters were closed. Medical students staffed homes, schools, and buildings were converted to makeshift medical clinics because regular hospitals are overloaded with patients. Wearing of masks were ordered, shaking of hands were avoided, and public spitting and sneezing are fined up to $100.00.

In 1920, it was found that the key to flattening the curve was hygiene measures and social distancing. The main lesson from the past is that “any measure” before the pandemic that was described as “exaggerated [is] later considered insufficient.”

It’s believed that a third wave emerged in Australia in January 1919 and eventually worked its way back to the United States and Europe. The mortality rate of the third wave was just as high as the second wave.

A pandemic ends when there is no more uncontrolled community transmission and the 1918 Spanish flu ended after enough number of the population developed herd immunity, although the virus only disappeared in the late 1950s.

A decade of economic growth and widespread prosperity known as the roaring 20s ensued after the Spanish flu driven by deferred spending which leads to a boom in construction and rapid growth of consumer consumption.

It was a period of dramatic social and political change. Those who survived the war and the pandemic entered a phase of euphoria which typically appeared with people who experienced life and death crises. It is human nature to live like there’s no tomorrow after a horrifying battle with death.

This post-pandemic-optimism also gave rise to totalitarian/ultra-nationalists regimes espousing border control, xenophobic sentiment and veering away from internationalism.

The Triumph of Death by Bruegel the Elder inspired by the Plague

The Plague (541-542 CE, 1347 to 1352, 1885)

In July this year, a 15-year-old boy from western Mongolia died of bubonic plague that he contracted from an infected marmot. One would expect that death from the plague is a thing of the past, unfortunately, it is not. Are we still in danger of experiencing this horrifying pandemic?

The plague is caused by the bacterium Yersinia pestis which travels from person to person or through the bites of infected fleas or rats. Patients with the plague develop fever, weakness, coughing, chills with painful, swollen lymph nodes in the groin or armpits. The first recorded account of bubonic plague is told in the Old Testament in the story of the Philistines who stole the Ark of the Covenant from the Israelites and succumbed to “swellings.”

The Plague of Justinian

The first episode of the great bubonic plague in 541 CE was named after the Byzantine Emperor Justinian, which people believed to be either a devil or that the emperor was being punished by God for his evil ways. War and trade is said to be the culprit in the spread of the disease throughout the empire. It affected half of the population of Europe and likely arriving in the form of infected fleas hitching rides across the world on the backs of rodents.

The historian Procopius wrote that many thought the end of civilization was upon them. That apocalyptic atmosphere leads to the quick spread of Christianity as people take solace to the church for cure and hope. The near-collapse of the economic system did not dissuade Justinian from demanding the same level of taxes from his decimated population in his determination to recreate the Roman empire. The plague episode contributed to the decreased size, and the inability of the Byzantine army to resist Islamic forces, largely due to its inability to recruit and train new volunteers due to the spread of illness and death.

The outbreak lasted about four months in Constantinople, the capital of the empire, but would continue to persist for roughly the next three centuries, with the last outbreak reported in 750 CE. The devastation brought by the plague may have ushered in the period now known as the Dark Ages.

The Black Death

The Black Death of 1347-1352 CE is the most infamous bubonic plague outbreak of the medieval world estimated to have killed 200 million people.

In the early 1340s, the disease had struck China, India, Persia, Syria, and Egypt before it appeared in Europe when 12 ships from the Black Sea docked at the Sicilian port of Messina in October of 1347. A great number of sailors aboard the ships were dead, and those still alive were critically ill with blood and pus oozed out of strange swellings, which were followed by a sum of other unpleasant symptoms—fever, chills, vomiting, diarrhea, terrible aches and pains—and then, in short order, death.

The “Ship of Death” was ordered out by city officials but it was too late and the “Black Death” would wreak havoc in the next five years, killing 20 million people or one-third of Europe’s population.

It was highly infectious that people who were completely healthy when they went to bed at night could be dead by morning. Doctors count on crude and untested techniques such as bloodletting and boil-lancing.

Many thought it a supernatural phenomenon connected to the comet sighting of 1345 CE. Some believed that the Black Death [PxxxT] was a kind of heavenly punishment—compensation for sins of heresy, blasphemy, fornication, and greed against God.

By this reasoning, the only way to defeat the plague was to win God’s absolution by purging their communities with heretics and troublemakers leading to attacks on, and even massacres of, specific groups, notably the Jews, thousands of whom fled.

The plague never really ended and it returned with a vengeance years later. But officials in the Venetian-controlled port city of Ragusa were able to slow its spread by keeping arriving sailors in quarantino or 40 days in the sea until it was clear they were not carrying the disease—creating social distancing that relied on isolation to slow the spread of the disease.

Its legacy, particularly in Europe, was traumatic and deep, reshaping the continent’s social and economic landscape. The institution of feudalism where a laborer paid rent and homage to a landlord on was doomed because of the limited labor force which started to demand wages. Social tension and rebellions ensued when the aristocracy tried to fight these new demands. Women, who had lost their husbands and men in the family, gained some rights of property ownership which originally reserved for men before the plague. 

The Third Plague

Before the third and last great plague pandemic, Italy was struck with the bubonic plague in 1629 killing a million Italians and London in 1665 killing 100 thousand people.

Yunnan province of China was the setting of the last attack of the plague pandemic. The infectious disease wreaked havoc on its citizens, killing tens of thousands, and by the late 19th century it reached Hong Kong and Guangzhou, major coastal shipping hubs and from there the disease spread around the world to the subcontinent of India, Africa and in the Americas killing more than 12 million people.

Luckily, it occurred at a time when the scientific understanding of diseases was way better compared to previous plagues. In 1894, in Hong Kong, Swiss-born French bacteriologist Alexandre Yersin isolated the bacterium behind the plague (Yersinia pestis, named after Yersin) and determined the common mode of transmission. His findings led to modern treatment methods, including insecticides, the use of antibiotics, and ultimately plague vaccines. The French researcher Paul-Louis Simond showed the role of fleas as a vector giving doctors and scientists a perfect empirical test case for germ theory and new medicines.

All of these discoveries has been a large part of why we haven’t seen a fourth plague pandemic.

The post-CoVid-19 world

The economic impact of CoViD-19 is a certainty, we are now in a recession and it will last for a long time. This pandemic has been a brutal x-ray of the weaknesses of our social safety net in dealing with national emergencies. Social protection systems have to be put in place since they act as stabilizers. This is a great time for health and education advocates to lobby our policymakers not just to invest but to push for a health care system that looks after everyone not just the rich and to an education system that embarks on bold and futuristic technology of learning.

The shocks it will leave the business sector is a silver lining and will be good in the long term. Businesses will try to adapt and prepare better for the next crisis whether it’s a pandemic, war, or an extinction-level event. We need to accept that there will be industries that would be hit hard and might not survive the pandemic but it could also lead to a paradigm shift and innovation in doing business as well.

“In a crisis, be aware of the danger–but recognize the opportunity.” – JFK

It is too early to say the long-lasting political and social impact of CoViD-19 to our society but each historical experience has such unique characteristics and dimensions that the saying that history is lived first as a tragedy and then as a farce is probably true. We know for certain that the poor are disproportionately impacted by this health crisis and if not addressed properly would create more inequality that could lead to unrest. We have also seen the psychological toll to our people of this pandemic, some have attempted suicide while some are beguiled to conspiracy theories and cult ideas.

There is no question that politicians, media pundits, and many others have seized on the opportunity to exploit the pandemic for political gain. Populists politicians may have been revealed as incompetent fools but beware that they also know how to exploit every crisis. For authoritarian pretenders, the pandemic presents an opportunity to install containment rules that becomes a convenient tool to stifle inconvenient dissent.

Anti-globalists, ultra-nationalists, and xenophobic sentiments would be used to further divide the world yet the more politicians try to create division and border, the more the world will realize that we are all a thread in the same cloth and that inter-cooperation is the only way forward.

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  1. Much better if there’s experts interview/short clips video. Graphs and tables between diseases to see the difference and impact on health and mortality rate.


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