As human civilisations have spread across the globe, so too have communicable diseases. From the bubonic plague and Spanish influenza to present-day COVID-19, pandemics have, and continue to, change the course of history.
[ Pan·dem·ic /pan’demik/ (of a disease) prevalent over a whole country or the world. ]
On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic, its first such designation since declaring Swine Flu (H1N1 influenza) a pandemic in 2009.
Infectious disease has plagued humanity throughout history. Here we take a look at some of the most notable diseases in history, including pandemics and epidemics, from earliest to most recent.
Plague Of Athens
430 BC
Death toll: estimates as high as 100,000
Disease: Unknown, possibly typhus, typhoid fever or viral hemorrhagic fever
The earliest recorded pandemic happened during the Peloponnesian War (431-404 BC). A plague struck Athens, which was under siege by the Spartans at the time. In the next 3 years, most of the population was infected, and some estimates put the death toll as high as 100,000 people – 25% of the city’s population.
Antonine Plague
165–180* AD
Death toll: 5-10 million
Disease: Unknown, possibly smallpox
The Antonine plague was possibly an early appearance of smallpox.
Many historians believe the epidemic was first b ought into the Roman Empire by soldiers returning home from a war against Parthia. The disease killed as much as one-third of the population in some areas and devastated the Roman Army – Emperors Marcus Aurelius and Lucius Verus were two of its victims.
*According to contemporary Roman historian Cassius Dio, the disease broke out again nine years later in 189 AD and caused up to 2,000 deaths a day in Rome.
What Causes Pandemics?
Many infectious diseases leading to pandemics are caused by zoonotic pathogens that were transmitted to humans due to increased contacts with animals through breeding, hunting and global trade activities.
Climate changes also influence the transmission of pathogens by expanding the habitats of various common zoonotic diseasecarrying vectors (eg, mosquitos and ticks). In recent years, there has also been concern about viruses linked to camels (MERSCoV), monkeys (Ebola) and bats (SARS-CoV-2).
Plague Of Justinian
541-543 AD
Death toll: 30-50 million
Disease: Bubonic plague
This is generally regarded as the first ecorded incident of the Bubonic Plague, at its height killing an estimated 5,000 people per day. While estimates do vary, some historians believe the death toll was as high as 100 million people, which was half the population at the time.
This plague was carried on the backs of rodents, whose fleas we e infected with the bacteria. These rats travelled all over the world on trading ships and helped spread the infection from China to North Africa and the Mediterranean.
The plague changed the course of the Byzantine Empire and marked its demise. It is also credited with creating an apocalyptic atmosphere, which fuelled the rise of Christianity.
The Black Death
1346-1353
Death toll: 75-200 million
Disease: Bubonic plague
The Black Death was responsible for the death of one-third of the world population. An outbreak of the plague devastated Europe, Africa and Asia, most likely stemming from Asia and spreading throughout continents via fleas on rats aboa d merchant ships.
The plague changed the course of history. England and France were so incapacitated by the plague that the countries called a truce to their war.
The Vikings’ exploration of North America was halted. As well, with so many dead, labour was hard to find, which led to better conditions and pay for workers and signalled the end of Europe’s system of serfdom.
Did You Know?
‘Quarantine’ was invented during the Black Plague.
Sailors would not leave their ships for 40 days to avoid spreading the illness onshore.
The word comes from the Italian word for 40, quaranta.
Cocoliztli Epidemic
1545-1548
Death toll: 5-15 million
Disease: Unknown, possibly Salmonella enterica
The infection that caused the Cocoliztli epidemic was a form of viral hemorrhagic fever, decimating as much as 80% of Mexico’s population. Recent DNA evidence from skeletons of victims demonstrated they were infected with a subspecies of Salmonella known as S. paratyphi C, which causes enteric fever, a category of fever that includes typhoid.
The Great Plague Of London
1665-1666
Death toll: 100,000
Disease: Bubonic plague
Throughout the 17th and 18th centuries, a series of “Great Plagues” routinely ravaged cities across Europe, collectively killing more than 3 million people. The Great Plagues consisted of around 40 resurgences of the bubonic plague, primarily in London.
The plague resurfaced roughly every 10 years in London, from 1348 to 1665. Its worst, and last, major outbreak was in 1665-1666, the Great Plague of London. Again, plague-infected rats were the main cause of transmission. By the time the plague ended, about 100,000 people, including 15% of the population of London, had died.
By the early 1500s, England imposed the first laws to separate and isolate the sick. Homes stricken by plague were marked with a bale of hay strung to a pole outside and victims were forced to stay inside their homes to prevent the spread of disease. If you had infected family members, you had to carry a white pole when you went out in public.
Sadly, the city had to endure more suffering shortly afte . On 2 September, 1966, the Great Fire of London began, which would last four days and destroy 436 acres, including 13,200 houses and 87 churches, including the old St Paul’s Cathedral.
Worldwide Smallpox Epidemic
1877-1977
Death toll: 500 million
Disease: Smallpox
While smallpox is thought to have originated in India or Egypt at least 3,000 years ago, with devasting recurrences in Japan in 735- 737 and Mexico in 1519-1520, it resulted in the most casualties during the last 100 years of its existence. Between 1877 and 1977, smallpox in its various epidemics around the world was responsible for the deaths of an estimated 500 million people.
Naturally occurring smallpox was wiped out worldwide by the late 1970s after an unprecedented global immunisation campaign.
In 1980, the WHO declared smallpox eradicated – the only infectious disease to achieve this distinction.
Cholera Pandemics
1817- present
Death toll: 3 million+
Disease: Cholera
Though cholera has been around for many centuries, the disease came to prominence in the 19th century.
Since then, there have been six more cholera pandemics.
The first cholera pandemic originated in the Ganges River in India, stemming from contaminated rice and soon spreading throughout most of India, modern-day Myanmar and Sri Lanka and then to other parts of the world via trade routes.
During the third cholera pandemic, British physician John Snow, considered one of the founders of modern epidemiology, demonstrated that contaminated water, which he traced to a water pump in Soho, London, was the key source of the highly contagious bacterial disease.
The seventh cholera pandemic started in 1961, beginning in Indonesia and spreading to other countries in Asia, Europe, Africa and Latin America. While cholera has largely been eradicated in developed countries, it’s still a persistent killer in countries lacking adequate sewage treatment and access to clean drinking water.
The WHO has called cholera “the forgotten pandemic” and its seventh outbreak continues to this day. Cholera reportedly infects 1.3 to 4 million people every year, with annual fatalities ranging from 21,000 to 143,000.
Third Plague Pandemic
1855-1960
Death toll: 12 million
Disease: Bubonic plague
The bubonic plague re-emerged in the Chinese province of Yunnan in 1855. It continued to spread, reaching Hong Kong in 1894 and Mumbai (Bombay) in 1896. By 1900 it reached every continent, claiming the lives of more than 12 million people.
The third plague pandemic was the last, thanks to a series of achievements in the scientific understanding of the plague. One of these breakthroughs was in 1894, when the organism that causes plague was isolated independently by two bacteriologists, Alexandre Yersin and Kitasato Shibasaburo.
Yersin named the new bacillus Pasteurella pestis, after his mentor Louis Pasteur, but in 1970 the bacterium was renamed Yersinia pestis, in honour of Yersin himself. A few years later, epidemiologist Paul- Louis Simond discovered that bites from rat fleas we e the main way the infection spread to humans.
With these new discoveries, worldwide rat-proofing measu es were instituted, particularly in maritime vessels and port facilities.
Beginning in the 1930s, sulfa drugs and then antibiotics such as streptomycin gave doctors a very effective means of attacking the plague bacillus directly and numbers rapidly declined. The pandemic was considered active until 1960 when cases dropped below a couple hundred.
Spanish Flu (H1N1)
1918-1920
Death toll: 40-50 million
Disease: Influenza
A The 1918 influenza pandemic was an outbreak of an H1N1 influenza A virus that infected around 500 million people, or a third of the world’s population at the time. The avianborne flu esulted in as high as 50 million deaths worldwide, including young, healthy people, wiping out entire families and leaving countless widows and orphans in its wake.
It was first observed in Madrid (though this is up for debate), then other parts of Europe, the United States and parts of Asia before swiftly spreading around the world. At the time, there were no effective drugs or vaccines to t eat this flu strain.
The flu s spread and lethality were exacerbated by the cramped conditions of soldiers and poor nutrition many people were experiencing during World War I.
As well, with the war coming to an end, public health officials had fe official otocols to deal with such a contagious pandemic.
Although some cities did impose quarantines, masking and lockdowns of schools and businesses, it was too late to stop the disease’s spread. It finally came to an end in the Northern Hemisphere summer of 1919, as those who were infected either died or developed immunity.
Asian Flu (H2N2)
1957-1958
Death toll: 1.1 million
Disease: Influenza
A Caused by a blend of avian flu viruses, most likely from a mutation in wild ducks combined with a preexisting human strain, this new type of influenza (H2N2) sp ead rapidly.
It was first eported in Singapore in February 1957, Hong Kong in April 1957 and the coastal cities of the United States in their summer of 1957.
There was a second wave in 1958, and H2N2 went on to become part of the regular wave of seasonal flu. A vaccine for H2N2 was introduced and the pandemic slowed down and was eventually contained.
It is believed the H2N2 virus evolved and reemerged 10 years later into the “Hong Kong” flu of 1968-1969, which was caused by an H3N2 strain of influenza A and killed one million people.
HIV/AIDS
1981–present
Death toll: Estimated 35 million
Disease: human immunodeficiency virus (HIV)
Acquired Immune Deficiency Syndrome (AIDS) was first recognised in 1981 and the global HIV/AIDS epidemic continues to this day. It is one of the most devastating infectious diseases, with developing countries suffering the g eatest morbidity and mortality.
Today, about 38 million people are living with HIV, many of which do not have access to treatment. While there is still no cure, anti-retroviral therapy (ART) can dramatically slow the disease’s progress, prevent secondary infections and complications, and prolong life.
SARS-CoV
2002-2003
Death toll: 770
Disease: coronavirus
SARS, or severe acute respiratory syndrome, is an illness caused by one of the 7 coronaviruses that can infect humans. First identified in 2003 after several months of cases, SARS is believed to have spread from an animal reservoir, possibly bats, to civet cats, and first infected humans in Guangdong province in China in 2002, before travelling to 26 other countries.
Public health response by global authorities, including quarantining areas and isolating infected individuals, proved effective and the consequences of the virus were largely limited due to this quick response.
Swine Flu
2009-2010
Death toll: Between 150,000 and 575,000
Disease: Influenza
A This novel influenza virus was firs detected in the United States, spreading quickly to the rest of the world. The 2009 swine flu pandemic was caused by a new strain of H1N1 that originated in Mexico before spreading to the rest of the world. In one year, the virus infected as many as 1.4 billion people across the globe and killed between 151,700 and 575,400 people, according to the Centers for Disease Control and Prevention (CDC).
The virus was diffe ent from other H1N1 viruses circulating, as few young people had existing immunity, while many people over 60 years of age had antibodies. It is estimated that 80 percent of deaths occurred among patients under 65 years of age. It is thought, in the case of the swine flu, older people seemed to have already built up enough immunity to the group of viruses that H1N1 belongs to, so weren’t affected as much. A vaccine for the H1N1 virus that caused the swine flu is now included in the annual flu vaccine.
COVID-19 (SARS-CoV-2)
2019-present
Death toll: 4.45 million (as at 25 August, 2021)
Disease: coronavirus
On December 31, 2019, the WHO China Country Office was informe of pneumonia of unknown cause, detected in the city of Wuhan. The disease was determined to be the result of a novel coronavirus, later named COVID-19. On March 11, 2020, the WHO declared COVID-19 a pandemic. By then, it had barrelled through 114 countries in three months and infected over 118,000 people. The pandemic reached Australia on 25 January, 2020, with the first confirmed cas reported in Melbourne.
Since 2021, variants of the virus have emerged and become dominant in many countries, with the Delta variant being the most virulent. As of 25 August 2021, more than 213 million cases and 4.45 million deaths have been confirmed, making it one of the deadliest pandemics in history.
Since January 2020, vaccine development has been expedited via unprecedented collaboration in the pharmaceutical industry and between governments. As of 25 August 2021, more than 5 billion doses of COVID 19 vaccine have been administered worldwide based on official eports from national public health agencies.
Experts estimate that herd immunity would require around 80-90% of the population to have COVID-19 immunity, either through prior infection or vaccination.
AMP Sources: Wikipedia – List of Epidemics, LiveScience, History.com, Britannica, The Conversation, https://www.history.com/news/pandemicsend-plague-cholera-black-death-smallpox https://www.businessinsider.com/pandemics-that-changed-the-course-of-human-history-coronavirus-flu-aidsplague# cholera-1817-1823-4 https://www.sciencedaily.com/ releases/2016/06/160627160935.htm https://www.medicalnewstoday.com/ articles/148945#history
How Do Pandemics End?
History suggests diseases fade but are almost never truly eradicated. ‘Whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them,’ says Nukhert Varlik, Assoc Prof of History at the University of South Carolina.
The only disease that has been eradicated is smallpox, achieved via successful mass vaccination campaigns led by WHO in the 1960s and 1970s.
‘Success stories like smallpox are exceptional,’ she says. ‘Even with successful vaccines and effective t eatment, COVID-19 may never go away.
Even if the pandemic is curbed in one part of the world, it will likely continue in other places, causing infections elsewhere. And even if it is no longer an immediate pandemic-level threat, the coronavirus will likely become endemic – meaning slow, sustained transmission will persist… much like seasonal flu ‘Today, in an age of global air travel, climate change and ecological disturbances, we are constantly exposed to the threat of emerging infectious diseases while continuing to suffer f om much older diseases that remain alive and well. Once added to the repertoire of pathogens that affect human societies, most infectious diseases are here to stay. Research on the global burden of disease finds that annual mortality caused by infectious diseases – most of which occurs in the developing world – is nearly onethird of all deaths globally.’
We can only hope that COVID-19 and its variants will prove to be a tractable and eradicable pathogen.
But, as Varlik notes, the history of pandemics teaches us to expect otherwise.
Source: The Conversation
NUMBER OF COVID-19 CASES WORLDWIDE AS OF AUGUST 25, 2021
213,347,574
NUMBER OF DEATHS FROM COVID-19 WORLDWIDE AS OF AUGUST 25, 2021
4,455,551
NUMBER OF COVID-19 VACCINATIONS ADMINISTERED WORLDWIDE AS OF AUGUST 25, 2021
5,039,979,248
NUMBER OF PEOPLE WORLDWIDE FULLY VACCINATED AS OF AUGUST 25, 2021
1,929,563,338
(24.8% OF THE WORLD’S POPULATION)
Sources: Wikipedia, The New York Times, Johns Hopkins University
