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COVID 19 – Neither the First Pandemic nor the Last.

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A rapid spread of a disease to a large number of people in a given population is called an epidemic. When an epidemic spreads beyond a country’s borders, its called a pandemic. As human beings became more connected by trade and wars, pandemics became more common. In the 21st century when travel across continents on opposite sides of the globe takes less than a day, one can say that this pandemic we are witnessing now, Covid 19, was inevitable.

The earliest recorded pandemic happened from 430-426 BC across Libya, Ethiopia, Egypt and Athens. The Greek historian Thucydides recorded the outbreak which took the lives of at least one-third of the population of Athens. Perfectly healthy people started falling sick with symptoms such as redness of eyes, difficulty in breathing, violent coughing and high fever. Many of the sufferers died within 7-9 days from the onset of symptoms. For nearly 2500 years since then, historians and scholars have attempted to identify exactly what disease swept Athens. Modern day guesses include typhus, measles, smallpox or maybe even Ebola.

There have been several pandemics recorded in history since then. Cyprian Plague between 249 AD and 262 AD nearly ended the Roman empire, killing 5000 people a day in Rome. Justinian Plague which started in 541 AD created an apocalyptic atmosphere that spurred the rapid spread of Christianity.

Black Death, which struck Europe between 1347 and 1353 AD maybe the deadliest pandemic in recorded history. It is speculated to have originated in Asia, and was brought to Europe through merchant ships. Black Death wiped off 1/3rd of Europe’s population in just 6 years. Death toll is estimated to be between 7.5 crore and 20 crore.

You may ask - why couldn’t anyone treat these outbreaks? Or at least help to contain the spread of the disease?

The plague of Florence in 1348. Black death took the lives of 1/3rd of Europeans.

The plague of Florence in 1348. Black death took the lives of 1/3rd of Europeans.

Medieval medicine at its best - discovering 'quarantine'

The method of science – proving theories with evidence, was in its infancy during the time of black death. Most people relied on superstitions, even the doctors of those times. For example, a popular theory during the black death was that ‘spirits’ left the dead ones to infect the ones alive. As intriguing as the theory sounds, it was useless as it gave no prescriptions on how to treat the disease. It also had no evidence to support it. Another theory was based on an ancient belief that to be healthy one’s body has to have a right balance of blood, bile and phlegm. Black death was alleged to be due to an excess of blood, and it had to be let out by cutting veins or arteries. An ancient misguided practice – called ‘bloodletting’, that not only did not cure any, but killed many.

Though there was no treatment for any of these pandemics when they struck, one method was discovered during the times of black death which helped in containing the spread – quarantine. A document from 1377 states that before entering the city-state of Ragusa (in modern day Croatia) newcomers to had to spend 30 days (a trentine) in a restricted place (originally nearby islands) waiting to watch out for symptoms of black death. In 1448 the Venetian Senate prolonged the waiting period to 40 days, giving birth to the term ‘quarantine’. The forty-day quarantine proved to be an effective formula for handling outbreaks of the plague. The practice of isolating people who have symptoms was there even before this, but the practice of ‘quarantining’ people before they develop symptoms was something new, and effective. Quarantining and social distancing is considered by medical historians to be one of the highest achievements of medieval medicine.

Discovery of microorganisms in 17th -19th centuries

If we ask anyone in the contemporary world on why people fall sick with cough, cold or fever, we are likely to get the answer that it must be a virus or bacteria. We often take for granted the existence of these tiny organisms ten thousand times smaller than our finger-tips, that can potentially make us sick. We should pause and ask, when were these ‘microorganisms’ discovered?

Bacteria was discovered in 1676 by the Antonie Van Leeuwenhoek, using a microscope of his own design. The bacteria were just at the limit of what his simple microscope could be used to see. The progress of science is often limited by technology. Microscope can be said to be the one technology medical science was waiting for. Plant cells, red blood cells, microscopic algae, yeast, several types of bacteria were all discovered using microscope.

The bacteria responsible for black death (yersinia pestis) was discovered in 1895, more 500 years after the black death. The medieval doctors had no choice, really.

The bacteria causing bubonic plague under microscope, discovered 500+ years after black death

The bacteria causing bubonic plague under microscope, discovered 500+ years after black death

Pandemics from modern history, and the progress of modern medicine

There were still more pandemics in the late modern history – especially as the world became even more connected with trade, wars and colonialism.

There were seven cholera pandemics between 1817 and 1975. Cholera originated in Indian subcontinent, and is believed to have killed 1.5 crore people in British India between 1817 and 1860. The third cholera pandemic (1852-1860) is said to be the deadliest, but it was during this pandemic that the puzzle of the origin of the disease were solved. In 1854 in London, physician John Snow identified a pump in Broad Street neighborhood as contaminated. Identifying the source helped to end the outbreak, and established cholera as a germ-contaminated water-borne disease. Until this discovery, the popular conception was that cholera spread through ‘miasma’, or ‘bad air’.

It was between 1850 and 1900, that different bacteria causing different diseases such as cholera, tuberculosis, anthrax were discovered. A vaccine for cholera was developed by Waldemar Haffkine in 1892 made with an attenuated form of the cholera bacterium. Haffkine tested the vaccine on himself first, and reported the findings. From 1893-1896 the vaccine was tested in Calcutta where thousands were dying from ongoing epidemics. The subsequent cholera pandemics were much less deadlier worldwide.

More pandemics followed nevertheless. For example the modern bubonic plague pandemic which killed about 10 lakh people in India alone between 1896-1905, or the Spanish flu of 1918 which killed more than 5 crore people worldwide.

But in the 20th century, the medical science and technology has made even more progress, and modern medicine have also become accessible to the general public. With the discovery of antibiotics, and global vaccination programs with the collaborative efforts of WHO, the life expectancy increased from 45 years in 1950 to 71 years at present. The eradication of the deadly smallpox virus, which was behind several pandemics since ancient times is considered one of the biggest triumphs of humanity.

At the turn of 20th century, viruses were a mere speculation – germs too small to be seen under a light microscope. Here we are, looking the the photograph of the coronavirus behind Covid-19 taken with an electron microscope!

SARS-CoV-2 virions under electron microscope

SARS-CoV-2 virions under electron microscope

The progress medical science made in the 20th century will need several pages to even summarize. Many of the critical discoveries in 17th-19th century itself has been overlooked in this article - for example the discovery of genetic material - RNA in 1868 and DNA in 1869. It is sometimes easier to understand the concepts of science through the history of it. For example, how was vaccination discovered? How were viruses discovered? How was antibiotic discovered? Search the web for answers!

The entire ‘RNA genome’ of the virus causing Covid 19 was sequenced in just a few weeks after the virus outbreak happened in Wuhan. Several different vaccines developed are now under clinical trials. As we wait for the vaccines to be available, let us stay safe, slow down the spread of the virus, and keep our elders safe.

References and Further Readings

1. Pandemics That Changed History

https://www.history.com/topics/middle-ages/pandemics-timeline

2. Outbreak: 10 of the Worst Pandemics in History

https://www.mphonline.org/worst-pandemics-in-history/

3. The Plague at Athens, 430-427 BCE

https://www.ancient.eu/article/939/the-plague-at-athens-430-427-bce/

4. Black Death – Causes, Symptoms & Impact – History

https://www.history.com/topics/middle-ages/black-death

5. Was the Black Death in India and China?

https://pubmed.ncbi.nlm.nih.gov/22080795/

6. Did India and China Escape the Black Death?

https://contagions.wordpress.com/2011/11/26/did-india-and-china-escape-the-black-death/

7. Social Distancing and Quarantine Were Used in Medieval Times to Fight the Black Death

https://www.history.com/news/quarantine-black-death-medieval

8. The 1832 Cholera Epidemic in New York State | 19th Century Responses to Cholerae Vibrio

https://web.archive.org/web/20100502025213/http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html

9. Infectious and Epidemic Disease in History, Department of History, University of California, Irvine, Instructor: Dr. Barbara J. Becker

https://web.archive.org/web/20120306060712/https://eee.uci.edu/clients/bjbecker/PlaguesandPeople/week8a.html

10. WALDEMAR MORDECAI HAFFKINE | Haffkine Institute

http://www.haffkineinstitute.org/waldemar.htm

11. Cholera - HISTORY

https://www.history.com/topics/inventions/history-of-cholera

12. 1918 Pandemic (H1N1 Virus) | CDC

https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html

13. Differences in life expectancy across the world

https://ourworldindata.org/life-expectancy

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

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