Medicosnext
Defined as ‘the worldwide spread of a new disease’, many deadly pandemics have occurred down the ages across many continents, killing millions upon millions. Among them, smallpox, cholera, bubonic plague, and influenza have been the deadliest. Smallpox, which has existed for 12,000 years, is estimated to have resulted in 300-500 million deaths.
Deadly Pandemics down the Ages
In 165 AD, five million people died due to the ‘Plague of Galen’ (a.k.a. Antoine Plague), its fatal effects seen across Egypt, Asia Minor, Italy, and Greece. The cause was unknown in that period of history, but today, experts assume it to have been either smallpox or measles, which was presumed to have been transmitted by Roman soldiers returning from Mesopotamia. Twenty-five million deaths were attributed to the infamous bubonic plague (a.k.a. the ‘Plague of Justinian’), which decimated half the population of Europe within a short span of just one year (541-542 AD), as also, almost a quarter of the population of the Eastern Mediterranean.
The most fearsome pandemic of the middle ages is indelibly etched in the history books as ‘The Black Death’ (due to the lethal disease, plague, caused by the bacterium Yersinia pestis), which is estimated to have killed 75-200 million between 1346 and 1353 AD in Europe, Asia, and Africa. The fatal disease is thought to have been carried from Asia by fleas living on the bodies of rats, which were ubiquitous on board commercial ships. In the period 1852-1860, one million people died due to the cholera pandemic, which originated in India and spread through Africa, Europe, and North America. This was the third such pandemic, and this was when John Snow, a British physician, first succeeded in establishing contaminated water as the means of disease transmission. In 1889-1890, another million deaths occurred worldwide due to the flu pandemic (a.k.a. ‘Asiatic Flu’), the cause of which was then believed to be Influenza A virus subtype H2N2, but later was determined to be Influenza A virus subtype H3N8.
In between 1910 and 1911, another cholera pandemic (the sixth), which again originated from India, spread over the globe. However, while it killed 800,000 plus in India, only 11 deaths were seen in the United States, which having learned from previous pandemics, was quick to isolate the infected patients. The flu pandemic of 1918 was much more deadly, infecting over one third of the world population and resulting in 20-25 million deaths. Unlike previous flu pandemics, where the young and the elderly were more vulnerable, this time around, even young and healthy adults were infected. The Asian Flu pandemic of 1956-1958 took a toll of two million, its cause attributed to Influenza A virus subtype H2N2, which originated in China, and killed 69,800 in the U.S. alone.
The flu pandemic of 1968, a.k.a. ‘Hong Kong Flu’, was due to Influenza A virus subtype H3N2. Although it killed one million people, the global mortality rate was relatively low, at just 0.5 percent, but much higher in Hong Kong, where it caused 500,000 fatalities (15% of the populace). The HIV/AIDS pandemic, which originated in the Congo in 1976, has resulted in 36 million deaths since 1981. Currently, some 21 million people (mostly in Sub-Saharan Africa) carry the disease, but with newer medical advances, the disease has become far more manageable now, with the annual death toll dropping from 2.2 million to 1.6 million between 2005 and 2012.
Preparing for a Pandemic
Scientific and medical advances have thankfully curtailed the deadly effects of pandemics to some extent, yet, as is so very evident today, they cause worldwide dismay and fear, where entire populations are affected. And, along with scientific advances, newer strains of viruses and bacteria continue to emerge, such as the Ebola virus, which fortunately is still confined to western Africa, making it an epidemic for the moment, as opposed to a pandemic. Plague, that killer of millions, while not being in the limelight, is still surviving today, with a few cases reported from even the U.S.A. every year. Better awareness about hygiene and cleanliness has made cholera largely a disease of underdeveloped countries, where much needs to be done in the area of hygiene and sanitation. At the same time, it is disappointing that influenza continues to kill hundreds of thousands worldwide every year, with new strains of the virus making their presence felt from time to time. Remember the H1N1 flu pandemic in 2009, infamously known as ‘swine flu’? The current pandemic isn’t the first one, either, due to coronavirus. Remember SARS (severe acute respiratory syndrome, 2002-2004) and MERS (Middle East respiratory syndrome, 2012), which were due to two strains of coronavirus, namely, SARS-CoV and MERS-CoV? .
Taking all this into consideration, authoritative international health bodies like the World Health Organization, the Centers for Disease Control and Prevention, U.S.A. (CDC), and others have been tirelessly monitoring outbreaks and updating guidelines for emergency response and preparedness for the next pandemic to strike the globe—which it has, in the form of the current coronavirus pandemic, now named COVID-19. Yet, despite all that has been learned through many years of dire experience, one cannot say that the response has been as swift as expected, and despite so many advances in science and medicine, neither is the world as well prepared to come up swiftly with a cure to defeat new diseases. Although, as the National Institute of Allergy and Infectious Diseases, U.S, (NIAID) states, “Thanks to research investments into the SARS and MERS outbreaks, NIAID scientists and grantees are better prepared to develop diagnostics, therapeutics, and vaccines against 2019-nCoV. Included in those projects are basic research to understand how the virus infects cells and causes disease; adapting platforms used to develop diagnostic tests and vaccines; and evaluating treatments such as broad-spectrum antivirals and potentially monoclonal antibodies.”
Already, more than a thousand have died, and tens of thousands have been diagnosed with COVID-19, with tens of thousands more quarantined and under observation. At the time of writing this article, a cruise ship has been left stranded near the coast Yokohama, Japan, and the news is that more and more of the people on board are being diagnosed as infected with the virus. Some are of the opinion that the ship has become a breeding ground for infection, what with hundreds of staff and thousands of passengers living at close quarters day after day. It is a tragic drama in the making, and no one knows when it will end, or how. Till date, more than 200 cases have been confirmed as having COVID-19.
Talking about Nepal, plans are afoot to airlift about 180 Nepali students from Wuhan, China, the epicenter of the coronavirus pandemic, and put them under quarantine at some selected sites around the valley. Here, the question is, why has the government waited so long, and how long will they be quarantined for, since there are conflicting reports about the incubation period of the virus, with some saying 14 days, and others saying 24 days. Also, there’s much controversy about where the sites should be. Here, clear cut guidelines would be expected from the health ministry.
There have also been reports about the lackadaisical screening efforts at the Tribhuvan International Airport, which hopefully has been corrected now. Many neighboring countries have closed their borders with China for the time being, and others have stopped travel to and from the country. As far as is known, Nepal has done neither. Here, too, the question arises as to why the health ministry, or the government, does not seem to have clear guidelines in this matter. In addition, with at least one confirmed case in the country, one would also expect the health ministry to update the public about the situation on a daily basis, considering that China is a close neighbor (even though Wuhan is far away). Doubtless, there are other considerations, such as Visit Nepal Year 2020, which certainly could be having an effect on decisions being made. But no matter what the considerations, COVID-19 is in the limelight globally now, and perhaps the public’s health should take center stage now.
It looks like this pandemic is not going to end anytime soon. China has been lauded for taking extraordinary measures to contain the outbreak, although it has also received some criticism for not doing so sooner, and other countries around the world have taken strong steps, such as banning travellers from China into their countries for the immediate future, and closing off border points with the country. Efforts are ongoing around the globe to come up with a vaccine, but reportedly, that too will take quite some time (as long as 18 months, according to some). Questions, too, have arisen about the development of a vaccine that could well be useless once the pandemic is over (some say that the virus could disappear with the advent of warmer months), and perhaps some companies may not see much of a commercial viability in a venture that would undoubtedly be very costly.
A UN Crisis Management Team has been activated to address the issue, and WHO has brought out its strategic objectives, technical guidelines, recommendations for the general public, and so on, after gaining enhanced information and knowledge about the scope of this new pandemic. Understandably, no one wants to create a panic situation; a lesson learnt from past incidents, such as the H1NI pandemic, where the situation, while dangerous, was not as dire as initially thought to be. However, now that the pandemic is into its third month, with some 24 countries affected, and the death toll rising every day, the world is looking at the situation with a decidedly apprehensive eye.
Total and New Cases of COVID-2019 in last 24 Hours
(data as reported by Feb 22, 2020)
Globally
77,794 confirmed (599 new)
China
76,392 confirmed (397 new)
2348 deaths (109 new)
Outside of China
1402 confirmed (202 new)
28 countries (2 new)
11 deaths (3 new)
Reference: Coronavirus disease 2019 (COVID-19) Situation Report – 33
World Health Organization
Photo Credit: AP Photo/Kin Cheung
