Pandemic Management through the Ages

Sarah Timbie for Health Empowerment Coalition

Although nowadays it seems like no one talks about anything but the COVID-19 pandemic, there have been other devastating diseases that have swept through humanity and there will likely be many more. The word “pandemic” refers to a disease that is widespread enough to infect people across multiple continents or worldwide, as opposed to an “endemic” which is usually contained to just one country or area. Although pandemics bring death and destruction, they also push humanity to learn and change their ways. Without pandemics of the past, science would never have evolved to where it is today.

Ever since humans made the shift from living in small hunter-gatherer groups to living in larger civilizations, practicing farming and keeping domesticated animals as food sources, diseases have been able to develop and spread. Most diseases in history stem from animals, often farm animals, that were passed on to the humans taking care of them, such as smallpox from camels, mumps from bats, MERS from camels, and Nipah virus from pigs.¹ Diseases also require a large enough population in order to effectively spread across areas/civilizations, which is why pandemics could not exist before populations increased and trade between communities started occurring on a large scale.

The worst pandemic in human history was that of the 14th-century Bubonic Plague, also known as the Black Death. Fleas infected with the bacteria Yersinia pestis spread the disease across Europe. They had an extremely easy time infiltrating the streets of Europe in the Middle Ages because they lived on rats, which were abundant in Europe’s dingy and unhygienic alleys. Estimates put the death toll between 75 to 200 million people, which at that time meant the demise of 17% - 45 % of the entire global population.² The name “Black Death '' comes from the common occurrence of body parts turning black due to infection in those who were infected.³

The Black Death was originally thought to have been brought about by supernatural causes, witchcraft, or “bad air” due to a lack of scientific knowledge at the time. People attempted to treat the sick with various potions, prayer, and bloodletting.⁴ It would be approximately another 500 years before scientists would learn that it was germs that cause disease and not bad smells. Europeans of the Middle Ages did attempt to implement social distancing and quarantine to help prevent the spread of disease, but because sickness was completely misunderstood in the 14th century, people did not follow the guidelines. Since one of the main ways of dealing with the plague was prayer, many people went to church instead of staying at home which helped the disease spread even faster.

The importance of washing hands and making an effort to not touch one’s face is well known - to prevent the spread of germs that could potentially cause harm. But it wasn’t until a major outbreak of cholera in the 19th century that led English physician John Snow to conclude that it was shared contact with sick people that would make other people sick and that miasma, the idea that disease was spread through bad air, was not the method by which diseases spread. Cholera is a diarrheal illness that is still prevalent today in countries without proper water sanitation systems. It is caused by the ingestion of food or water that has been contaminated with cholera-causing bacteria.⁵ John Snow noticed that people were getting sick when they used a certain water pump. After some research, he discovered that the water source was contaminated, as people using the same water pump were getting sick. Although Snow was not responsible for the idea of germ theory, he certainly paved the way for the scientific community after him. That would be established by French scientist Louis Pasteur later in the 19th century after studying the processes of fermentation. He would eventually go on to develop vaccines from weakened germs for cholera, anthrax, and rabies.⁶

Smallpox was another notable pandemic in history that spanned thousands of years. Although the origin of the disease is unknown, there is evidence that it dates back to ancient Egypt, as mummies have been discovered with smallpox-like scars.⁷ The mortality rate for smallpox was around 30%, and survivors were often left with scarring, loss of facial tissue, or blindness.⁸ Smallpox was common in Europe and there would be outbreaks every so often, but if someone survived the disease they would be immune to it for the rest of their life. Smallpox was one of the many diseases that Europeans introduced to Native Americans, along with influenza and the plague, starting in the 15th century onwards. Since the Native American population had never dealt with any disease like smallpox before, they had higher death rates, and much of the population was wiped out.⁹

Smallpox prompted the research that would eventually lead to the production of vaccines. As gross as it sounds, vaccines got their start during the Revolutionary War, when soldiers would insert infected material from one man’s smallpox bumps into the arm of a healthy man.¹⁰ It was an incredibly dangerous idea, but while some of the men died, the ones that didn’t develop an immunity to the disease. Today, vaccines are very different, usually consisting of parts of viruses that are dead and unable to infect people. As of 1980, smallpox was declared eradicated by the World Health Assembly.¹¹

The Spanish flu of 1918-1919 was an influenza pandemic that killed approximately 33% of the world’s population with 675,000 deaths in the U.S.¹² The Spanish flu did not actually have anything to do with Spain and likely started in the U.S. or France. However, the virus began during World War I. Due to their neutrality, Spain did not censor their news sources and reported on the disease, making them the main reporter of the disease. Since the news was all coming from Spain, people started mistakenly referring to the flu outbreak as the Spanish flu. Part of the reason why the Spanish flu was so widespread was that it took place during World War I. Soldiers would be transported on boats in cramped quarters and in close contact with each other, so if one man had the flu he could very easily spread it to the entire rest of his ship. Eventually, enough people got and survived the virus that they became immune and life went back to normal in the 1920s.

Along with causing death and disrupting lives, pandemics across all of history have also brought with them various instances of prejudice and putting blame on groups of people who really have no connection to the disease at all. During the time of the Black Death, Jewish people were accused of poisoning people to spread the plague.¹³ The HIV/AIDS pandemic prompted an increase in homophobia.¹⁴ As we saw at the start of the COVID-19 pandemic, there was a lot of hatred and racism expressed towards Chinese people. Diseases make people scared, causing them to lash out at other groups and use them as scapegoats.

Diseases have been around as long as humans have, and they are not going anywhere. In today’s modern world filled with global travel and interaction, the conditions are perfect for pandemics to spread. Global illness is a terrifying thought, but at least there is better knowledge of sanitation, social distancing, and vaccination to combat such a scourge now, thanks to the lessons in public health and science learned over the course of history. With additional time and research, it is inevitable that our understanding and approach to disease treatment and management will continue to grow.

Resources:

1. Professor Cohan. (2021). A Journey Beyond Pandemics: Hope, Ethics, and Science. Biology 173 Global Change and Infectious Disease.

2. Public Health Online. (2021). History’s Worst Global Pandemics. https://www.publichealthonline.org/worst-global-pandemics-in-history/

3. Centers for Disease Control and Prevention. Traveler’s Health: Plague (Bubonic, Pneumonic, Septicemic).https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/plague-bubonic-pneumonic-septicemic

4. Mark, Joshua J. (2020). Medieval Cures for the Black Death. World History Encyclopedia. https://www.worldhistory.org/article/1540/medieval-cures-for-the-black-death/

5. World Health Organization. (2021). Cholera. https://www.who.int/news-room/fact-sheets/detail/cholera

6. Science History Institute. (2014). Louis Pasteur. https://www.sciencehistory.org/historical-profile/louis-pasteur

7. Centers for Disease Control and Prevention. History of Smallpox. https://www.cdc.gov/smallpox/history/history.html

8. The College of Physicians of Philadelphia. History of Smallpox. The History of Vaccines. https://www.historyofvaccines.org/timeline/smallpox

9. Heather Pringle. (2015). How Europeans brought sickness to the New World. American Association for the Advancement of Science. https://www.science.org/content/article/how-europeans-brought-sickness-new-world-rev2

10. https://www.colorado.edu/today/2020/04/08/6-lessons-we-can-learn-past-pandemics

11. Centers for Disease Control and Prevention. (2017). Smallpox Virus. https://www.cdc.gov/smallpox/index.html

12. Cleveland Clinic. Spanish Flu. https://my.clevelandclinic.org/health/diseases/21777-spanish-flu

13. Joanne Lu. (2021). Why Pandemics Give Birth to Hate: From Bubonic Plague to COVID-19. NPR. https://www.npr.org/sections/goatsandsoda/2021/03/26/980480882/why-pandemics-give-birth-to-hate-from-black-death-to-covid-19

14. Avert.org. Homophobia and HIV. https://www.avert.org/professionals/hiv-social-issues/homophobia

Author: Sarah Timbie

Edited by: Joy Jarnagin, Athena Wang, and Emily Lin

The Health Empowerment Coalition is a student-led organization that aims to empower individuals across the United States to improve their health literacy and take charge of their health. The views expressed in this article are the authors’ own and do not reflect the official opinions of the institutions at which they work and study. Additionally, the content in this article is not intended to provide medical advice.