by Adwaith Hariharan and Annie Zhang
Epidemics and Pandemics
When we’re talking about diseases, the worst we’ll get is a pandemic, or an outbreak escaping the borders of a single country to infect the world at large. Often, pandemics are triggered by new viruses or diseases, ones the general population hasn’t yet been exposed to, or built immunity against. This means pandemics are notorious for producing large-scale death, and with it, cataclysmic paradigm shifts, including social disruption and economic loss [1].
An obvious example: the COVID-19 pandemic. A severe respiratory illness caused by the new SARS-CoV-2 virus (one of many strains of coronavirus), COVID-19 flared up in Wuhan, China in late 2019, and has since raged across the world, leaving over 2.5 million dead in its wake. Quarantine has (of course, necessarily) required depressive social barriers, an alien degree of self-isolation, and, in sum, the abrupt collapse of all familiar interpersonal routines. This, in turn, has exacerbated simultaneous supply, demand, and financial shocks, grinding the global economy to a slowdown, and leaving the world in a highly volatile limbo [2].
That’s the destruction of a pandemic. Second to that, in both geographic scale and mortality rate is an epidemic, a disease with a sudden, unexpected surge in cases. In contrast, the devastation caused by epidemics is relatively small. Still, these outbreaks are virulent and disruptive, and similar to pandemics, demand informed attention and education for their safe prevention, containment, and eradication. And what better teacher is there than the past? Let’s go WHACK-A-MOLE style through history, and see how the early civilizations and past societies handled (“whacked”) their epidemics and pandemics (“moles”).
Whack-a-Mole Through Pandemics
Mole No. 1: The Antonine Plague [3]
Just when Roman power was at its height throughout the Mediterranean World, the Antonine Plague erupted in 165 AD. The epidemic had originally begun in China, spreading westward along the Silk Road before reaching the Roman military stationed at Seleucia (a major city on the Tigris River). As legend has it, the Romans had taken siege on Selucia, and, to please the gods, had promised in an oath not to pillage the city. But, in a bout of avarice, the Roman general Lucius Verus ransacked Selucia, and in his violence, opened a closed tomb, a metaphorical Pandora’s box, and released the plague, a manifestation of the gods’ anger. When the troops returned home from the wars in the East, they brought the disease back to Rome.
As the Roman legions contracted the Antonine Plague, they fell ill and crumbled, leaving a vacuum of manpower in the Roman military and severely reducing Rome’s ability to defend its empire, especially along German frontiers. In a desperate attempt to man his army, Marcus Aurelius recruited a patchwork military of freed slaves, Germans, criminals, and gladiators, but this last resort was weak and disloyal, and soon, for the first time in more than 200 years, Germanic tribes crossed the Rhine River into the Roman heartland. Further successive external attacks, coupled with the continuous decline of the Roman military and subsequent economic and social disruptions, ultimately culminated in the decline and fall of the Roman Empire.
In this case, it looks like the mole broke the rules and whacked Rome, instead of vice versa. Still, what could we have expected in the very first showdown between plague and humanity? Marcus Aurelius did his best, but he was protecting a mammoth of an Empire from so-called “savages,” all while fighting an alien freak of a disease.
Mole No. 2: Leprosy [4]
It’s believed leprosy emerged from the ancient Indian subcontinent, where it was first referenced in a Sanskrit holy text known as the Athara Veda in 2,000 BC. Since then, leprosy (derived from the Greek lepra, or “scaly,” but ironically, referred to as elephantiasis graecorum by the Greeks themselves) has plagued the course of history, leaving its odious legacy in everything from ancient Chinese medical texts to the tzaraath of the Hebrew Bible and the lepra of the Greek New Testament. Legend has it that in an invasion of India in 4 BC, legions of Alexander the Great’s army contracted leprosy and carried it to the Middle East, eventually spreading it throughout the entire eastern Mediterranean on their trek home. Centuries later, the epidemic continued to proliferate via trade routes across Europe and into the Holy Land, where its most prominent victim was Baldwin IV, the “leper king” of Jerusalem.
Between 11-13 AD, leprosy was considered viscerally contagious. The wealthy with leprosy lived alone in quiet mansions. The poor with leprosy wandered the streets, wearing signs and ringing bells to warn others of their approach. Depending on the direction of the wind, some lepers even walked on a particular side of the road, to prevent the passing of bad fumes. In churches, lepers drank from separate holy-water fonts and sat alone in secluded slots, or “lepers’ windows,” so as to view mass without contaminating the congregation. Often, leprosy was referred to as the “living death,” and its victims were treated as if they’d already died. Funerals were held to announce a leper’s diagnosis, after which, families rushed to claim their “dead” relative’s inheritance. As with most diseases in the Middle Ages, leprosy was considered a form of divine punishment, and disfigurement of the skin visible proof of the inner soul’s damnation.
Then, in around 13 AD for unknown reasons, the incidence of leprosy in Europe rapidly declined. It persisted in Scandinavia and Norway, before eventually crossing over to what is now Louisiana, the Southern United States, and Canada in the 1800s. On the American continent, the disease was controlled with segregatory “leper colonies,” large, stigmatized communities that forcibly relocated lepers to distant treatment centers; for example, most famously, the Kalaupapa treatment center on the island of Molokai, Hawaii. In the 1900s, when leprosy was finally becoming a treatable disease, officials’ first step to fighting outbreaks was to eradicate old social stigma. Public health authorities championed the slogan, “Leprosy is curable,” and to this day, leprosy patients who complete multi-drug therapy treatments can stop nerve damage, deformity, disability, and further transmission. WHACK-A-MOLE!
Mole No. 3: The Black Death [5]
Back Death was a bubonic plague pandemic that ran rampant through Europe between 1347 and 1351, leaving behind a ravaged trail of mythic proportion. Decimating one third of the world’s population, the Black Death raked in more deaths than any war or epidemic known at the time. Its frightening name was probably a mistranslation of the Latin word atra meaning both “terrible” and “black.” Transmitted from rodents to humans through the bite of infected flies, this deadly disease has transcended time, and variants of the plague’s DNA are still in circulation today. Talk about survival!
The Black Death is thought to have originated in China and spread west in caravans and trade ships. However, new research indicates that it began in the spring of 1346 in the Steppe region, where a plague reservoir stretches from the Northwestern shores of the Caspian Sea into southern Russia. The first outbreak of the Black Death is said to have originated in Kaffa on the Crimean Peninsula in 1346. The Mongol army which had already captured lands throughout Asia lay siege to this important trading post in Europe. When the Mongol soldiers were infected by the plague and died, the army catapulted their corpses over the city walls causing people inside the city to Kaffa to be infected. In a desperate attempt to halt the spread of the Black death from eastern Russia to Western Europe, the Mongols cut off the Silk road, the famous trade route central to the economic, cultural, political, and religious interactions between the east and the west.
The plague is hypothesized to have spread through ships, slipping in unnoticed on board and sailing unchecked across the world. The Black Death entered Europe through Sicily in 1347 on one of such plague ships. From there, it marched all across Europe, leaving behind an insurmountable trail of dead bodies. So much so that the disposal of all dead bodies was impossible, and the cities of Europe were drenched in the stench of the decaying dead in their streets!
Interestingly, the Black Death has a peculiar seasonal pattern. Given that the plague is transmitted through rats’ fleas, it strikes in summer, and its spread is checked in winter. Norway had over 30 waves of plague epidemic between 1348 to 1654, all in summer! WHACK-A-MOLE!
Mole No. 4: The Spanish Flu of 1918 [6]
As far as pandemics go, the Spanish flu of 1918 was considered the “Mother of all pandemics”. Considered the deadliest in history, this pandemic infected upward of 500 million people, killing an estimated 50 million worldwide in a brief period of time. Although the origins of the strain of Influenza that caused the Spanish flu of 1918 are unknown, it was first observed simultaneously in three distinct waves across Europe, the United States, and parts of Asia in a 12 month period in 1918-1919. The Spanish Flu did not originate in Spain, although its news coverage did. News services first reported an outbreak of this avian-born flu in Madrid, Spain in 1918. With World War I in full swing, wartime news blackouts blocked reportage to most European countries. Not subject to wartime news blackouts, Spain led the reporting on the flu and coined the misnomer, the “Spanish flu.” One peculiar aspect of the Spanish flu was that it killed a disproportionate number of previously hale and healthy young people —a group normally resistant to this type of infectious illness—including a number of World War I servicemen. In fact, the death count of the U.S. soldiers from the 1918 flu was more than World War I. With no cure for the flu, medical professionals advised patients to take up to 30 grams per day of Aspirin to alleviate the symptoms. This toxic dose caused symptoms that included hyperventilation and pulmonary edema, or the buildup of fluid in the lungs. It is now believed that many of the deaths during the Spanish flu were caused or hastened by aspirin poisoning.
The scene over a hundred years ago was identical to what we see in our COVID-ridden world with a pandemic on a deadly global march. As the Spanish flu spread and deaths piled up, the absence of drugs and vaccines to fight the disease exacerbated the situation. Much like this past year, citizens were asked to wear masks; schools, places of worship, recreation, and businesses were put in lockdown; and quarantine measures were announced. Economy came to a grinding halt. The flu took a heavy toll on society in general, wiping out entire families at a time. By the summer of 1919, the flu pandemic came to an end, as those infected either died or developed immunity. WHACK-A-MOLE! Pandemic Fun Facts Did you know that the origin of modern plague epidemics lies in the medieval period. That’s right! In fact, modern genetic analysis indicates that the strain of Y. pestis introduced during the Black Death is ancestral to all surviving circulating Y. pestis strains known to cause disease in humans. Often referred to as the “forgotten pandemic,” the impact of the Spanish Flu’s spread was overshadowed by the deadliness of WWI and covered up by news blackouts and poor record-keeping. In 1518, there was a Dancing Plague in France. It started with Frau Troffea dancing in the streets in July, and her husband screaming at her from the top of his lungs to stop. Troffea only stopped dancing when she collapsed half-way into the night. The next morning, she started dancing again. Hundreds soon joined, and they’d dance in hordes through the streets, their feet bleeding, their faces spasming, their bones ripping through muscle and skin. Doctors chimed in claiming the cure was to dance the disease away, so carpenters built stages, and around these, fiddlers played neverending music. Then, the doctors came back and changed their minds: these dancers couldn’t be cured naturally, they were spiritual sinners! So, the dancers were grabbed off stages and stacked, still dancing, into carts and hauled to the shrine of Saint Vitus, where they were spackled by priests with holy water and incense. To this day, it’s unclear what actually caused the Dancing Plague [7]. Can We Really Whack All the Moles? History suggests diseases fade away into oblivion but are almost never truly gone. Pandemics end in various ways; however, these ends are neither quick nor neat. Although most pandemics appear out of nowhere, they seldom just vanish into thin air. They linger on as outbreaks that are diluted into endemics. While some do go away, only to come back later, mankind is constantly in a game of Whack-a-Mole with Mother Nature. As you try to whack a mole in North America, another pops up in Asia. As you go about whacking the mole in Asia, another pops up in Africa, yet another in Australia. History is replete with examples. Remnants of genetic materials of the bubonic plague from centuries ago are still in circulation today, the mole ready to raise its ugly head anywhere, anytime! Historians predict that the current coronavirus pandemic could end socially before it ends medically. It is expected that people may grow so tired of the restrictions that they are bound to declare the pandemic over, even as the virus continues to smolder in the population and before an effective treatment is found. As the new normal becomes the next normal, an end to the current coronavirus pandemic can occur not because a disease has been vanquished but because people grow tired of panic mode and learn to live with a disease. Sources 1. What’s The Difference Between An Epidemic And A Pandemic? (n.d.). MPH Online. Retrieved from https://www.mphonline.org/epidemic-vs-pandemic/ 2. Bauer, L., Broady, K., Edelberg, W. & O’Donnell J. (2020, September 17). Ten facts about Covid-19 and the U.S. economy. Brookings. Retrieved from https://www.brookings.edu/research/ten-facts-about-covid-19-and-the-u-s-economy/ 3. Horgan, J. (2019 May 2). Antonine Plague. Ancient.eu. Retrieved from https://www.ancient.eu/Antonine_Plague/ 4. Leprosy. (n.d.) Britannica. Retrieved from https://www.britannica.com/science/leprosy/History 5. Black Death. (n.d.) Britannica. Retrieved from https://www.britannica.com/event/Black-Death 6. Spanish Flu. (2010 Oct 12). History.com. Retrieved from https://www.history.com/topics/world-war-i/1918-flu-pandemic 7. Dancing Plague of 1518. (n.d.) Britannica. Retrieved from https://www.britannica.com/event/dancing-plague-of-1518