“Those who fail to learn from the mistakes of their predecessors are destined to repeat them.” – George Santayana
Throughout human history there have been a number of pandemics like the now eradicated smallpox and the continuing battle with HIV/AIDS and tuberculosis.
The most fatal pandemic in recorded history is the plague, also known as the Black Death which killed an estimated 75 to 200 million people in the 14th century.
A relatively recent plague-like event was the 1918 flu pandemic, better known as Spanish flu, which caused an estimated 50 million deaths worldwide (some say even 100 million). We are now in the midst of the newest one, the monster that is SARS-CoV-2.
For the unacquainted, pandemics are a term associated with infectious diseases on a global scale, diseases that are non-infectious such as cancer or heart failure – even though they do cause millions of deaths worldwide each year, are not considered pandemics.
The Enemy Within
The Age of Exploration generally refers to the period between the 15th and 17th centuries. During this time, technological advances in shipbuilding and navigation made it easier for nations to explore outside previous boundaries. Societies began to use these ships for war, trade and integration, and with them the emergent of an invisible enemy – infectious diseases. Slavery and animal trade was thought to be one of the ways these invisible enemies used to jump from one place, one species to another, paving the way for evolution and mutation to strengthen them up in the shadows while they wait to pounce.
In Alfred Crosby’s book “The Colombian Exchange” it details that diseases such as smallpox, measles and tuberculosis, among others, were spreading back and forth into Eurasian and African trade routes for centuries, becoming endemic to these continents. Generations within these societies acquired some kind of immunity so when the Colombian exchange happened, goods traded to the Caribbean natives (whom at the time, had no prior contact from the rest of the world) contained these bugs that subsequently burned through their population. Scholars have deduced that colonists conquered the Americas not by guns or steel, but by germs – specifically smallpox. Aptly named the “Red Plague”, smallpox was said to be responsible for decimating 80 -90 percent of the Native American population.
“bug” or “bugs” are an informal noun for harmful microorganism (bacteria or virus)/or an illness caused by such. Although formally, bugs (insects, arthropods etc.) carry these microbes, we will refer to them as vectors instead. – Definition from Oxford Dictionary
“Vaccine and Serum Evils” by Herbert M. Shelton records accounts of a smallpox-like disease has been found dating back to the 3rd Century BCE, in Egyptian mummies. Smallpox was the evil that reigned for centuries, its last 100 years of existence was said to have killed half a billion people worldwide (estimated to be more than the plague). It was not until 2 of the greatest contributors of medicine arose that finally lead to its downfall and eventual eradication. The Physician Edward Jenner managed to bottle up immunity by inventing the vaccine in 1796 and the Microbiologists Louis Pasteur built on Jenner’s work and convinced the world of the existence microbes with his “germ theory of diseases” in the 1800s. The Red Plague was ended in the 1980s. But the war with the enemies within is far from over.
The Pandemic Mother and her children
As technology progressed further, humans have engineered flight into their machines which was used for more warring, more trade and more transportation. With it were new ways bugs also travelled the world. In the book “The Impact of Globalization on Infectious Disease Emergence and Control” it reported that the West Nile Virus, discovered in Uganda in 1937, was transported to American soil in 1999 by planes that carried their vectors (mosquitos). Humans were able to travel and transport faster than ships now. Passengers infected with diseases would have travelled from one place to another before realizing they’re sick, unknowingly infecting the places and the people they came into contact with.
The world has endured two World Wars, and its consequences are not only felt by the deaths of those who faced guns and steel. Wars were always an avenue for the hidden enemy to mobilize. Frank Macfarlane Burnet, who won his Nobel Prize for immunology but who spent most of his life studying influenza, estimated the Spanish flu death toll as probably 50 million, and possibly as high as 100 million. A 2002 epidemiologic study by Johnson and Mueller also estimates the deaths at between 50 and 100 million. Mass troop movements and close quarter combat during World War I caused it to spread and mutate faster, and the soldiers who were malnourished, stressed and downed by chemical attacks were more susceptible to infection.
Spanish flu attacked in waves. It initially took the opportunity to spread in camps of soldiers gathered for war. A 2004 study by John Barry states that the first recorded person who got sick of the flu was a cook in one of the war camps and days later more than 500 soldiers got sick. Efforts for containment were least prioritized as war brewed on and soldiers were continually sent to Europe.
Mass gatherings to support the war continued to be staged in the US despite public health warnings. The succeeding waves were deadlier than the first one and those who survived the first were relatively immune, proving that the same bug was responsible and recurrent. There’s a debate that the Spanish flu virus evolved into a less lethal but more infectious strain since upgrading the infective ability would make the bug stay in populations longer than a more fatal but less infectious strain. Spanish flu ultimately claimed more lives the second time around and it didn’t help that containment measures were least prioritized when it was first felt.
According to CDC’s History of Influenza, Spanish flu continued to attack a third time in 1919, the virus had then spread throughout Europe. A fourth and least devastating wave happened in 1920. However, the impact of Spanish flu was not limited to 1918–1919.
Spanish flu was an Influenza virus (influenza A subtype H1N1). They are denoted by their antigenic type either A, B, C or D. Influenza A is the deadliest of the four, and is responsible for most of the flu outbreaks. The subtype names come from H and N antigens – numbered as they are discovered (H1N1, H2N2, H3N2, H5N1 etc) if it seems familiar it’s because we’ve met these names in our lifetimes – the swine flu pandemic of 2009 was a novel H1N1 strain and bird flu (H5N1) continues to have multiple outbreaks annually in various places worldwide.
Almost all influenza A cases/pandemics since 1918 (except human infections from avian viruses such as H5N1 and H7N7), have arguably been caused by descendants, in one way or another, of the Spanish flu virus. A 2006 study by Jeffery K. Taubenberger aptly names it “mother” of pandemics.
The Plague, there and back again
In human history, it is generally through zoonoses that constitute most of the widespread outbreaks, mainly from the domestication of animals. These outbreaks are further spread through war and trade. In the Peloponnesian War, the Plague of Athens was suggested to be a typhoid fever outbreak. The red plague, smallpox, was said to be responsible for the Antonine Plague in 165 to 180 AD, and subsequently the plague of Cyprian in 249 to 262 AD.
Perhaps the most famous pandemic in history is the Black Death, aka the Bubonic Plague, aka the Pestilence.
The Black Death was caused by an outbreak of the bacteria, Yersinia Pestis. But like virus-borne Spanish Flu, the plague’s havoc is not in one fell swoop but it came in waves – while Spanish flu’s time between its waves were shorter, the plague’s waves are centuries apart.
A 2018 study by Nicolas Rascovan and various authors have suggested that Yersinia pestis was responsible for the Neolithic decline some 3000 years ago, but that remains debated. What is definite is that the plague of Justinian in the 6th century was caused by Yersinia Pestis, only a different strain according to a genomic analysis by David Wagner and various authors in 2014. 800 years later the bacterium returned to infamously cause the most fatal pandemic in recorded history.
The Black Death’s migration followed land and sea trade routes of the medieval world. This migration has been studied for centuries as an example of how the spread of contagion is impacted by human society. According to historical compilations, scholars claim that the origins of the plague came from central Asia, carried by Mongol armies east and west of the Silk Road. A curious case of unintentional biological warfare, Mongolian armies attacked Caffa (Eastern Europe) in 1347 introducing the disease to traders who subsequently fled to Southern Europe, carrying the Plague with them. Black Death annihilated Europe from 1347-1350.
By the end of 1350 the Black Death had subsided, but it never really died out in England over the next few hundred years. It recurred throughout history, the plague of Venice in the 1500s, the outbreak in Munich in the 1600s, the Italian plague – which is also associated with troop movement as there was a war raging. The Great plague of Vienna, the Great Plague of London. The plague after the Great Northern War in Russia in the 1700s and the Epidemic in China which spread to India in the 1800s. At this time the cause of plague was investigated by a Swiss bacteriologists Alexander Yersin, and thus the bug was named. The plague continued to find places to hit as it did San Francisco in the 1900s.
Various advancements in medicine and sanitation (antibiotics, pesticides) halted the onslaught of Yersinia pestis. Yet various outbreaks still happen – the latest was a 2014 outbreak of plague in Madagascar which was investigated by WHO.