Journals On Topic

Plagues, Pestilence, and Pandemics: Here We Go Again

As the world continues to sort through the fear and uncertainty caused by COVID-19, it can feel like completely uncharted territory. But, in fact, this isn’t the first pandemic our world has seen and it likely won’t be the last. From the bubonic plaque to cholera to various strains of influenza, diseases have devastated world populations over the centuries. Just in the last 100 years, we’ve had to deal with a number of viral outbreaks. The difference today is we now have mass communications via the Internet and social media, which helps and hurts the situation. One the one hand, we now have a faster method of communicating new information. On the other, we are continually learning, leading to a feeling of uncertainty as “facts” change. Let’s take a look at five pandemics that occurred within the last 100 years to glean some insights that may help us today.

Before COVID-19 there was …

Spanish influenza (1918 — 1920). By far, the Spanish influenza was the worst pandemic in the last 100 years. It occurred during World War I, and global troop movements helped spread it quickly worldwide. It first appeared in the United States in March 1918 and killed more than 50 million people, with 650,000 in the U.S. Unlike, Covid-19, it killed young, healthy individuals more than the elderly. Other things sound oddly familiar:

  • There were no vaccines or effective treatments.
  • Schools and businesses were shut down and people were ordered to wear masks.
  • Patients were treated in temporary hospitals, set up in gymnasiums and auditoriums, and bodies piled up in makeshift morgues.

In Autumn 1918, there was a severe shortage of professional nurses because of the deployment of large numbers of nurses to military camps in the United States and abroad. Compounding the problem was the failure to use trained African American nurses.

By the end of 1918, the worst of the pandemic was over, though the virus resurfaced several times until it disappeared entirely in early 1920.

Asian influenza ­(1957 — 1958). A new influenza strain (H2N2) appeared in February 1957 in East Asia, triggering the Asian flu pandemic. American microbiologist Maurice Hilleman was concerned about a New York Times photo that showed sick patients being brought into Hong Kong hospitals by the thousands, and knew it would only be a matter of time before it arrived in the U.S. Unlike today, people couldn’t cross the globe in a day, so microbiologist and epidemiologists had more time to prepare for its arrival. Hilleman obtained a virus specimen from a Navy serviceman stationed in Japan. He then studied it and began working on a vaccine. Back then, he was able to bypass bureaucratic red tape and work with vaccine manufacturers directly. He asked them to immediately start making the vaccines, which they were able to do in May 1957.

Because it was a brand-new virus, there was no immunity in the population. It showed up in U.S. coastal cities in April 1957. Five months later it had travelled to all areas of the globe and was considered a global pandemic.

When U.S. schools and universities opened in fall of 1957, the number of flu outbreaks spiked, mostly infecting young children and teenagers. However, by that time, doctors were ready. Manufacturers had already produced 40 million doses of a vaccine. Hilleman later recalled, “that’s the only time we ever averted a pandemic with a vaccine.”

The overall number of deaths for the Asian flu pandemic was estimated at 1.1 million worldwide, with 116,000 in the United States.

Hong Kong influenza (1968 — 1970). The Hong Kong influenza pandemic began in China in 1968. It was caused by a virus known as influenza A, subtype H3N2. It’s widely thought that this virus evolved from the strain of influenza that caused the 1957 pandemic. 

The virus first appeared in the United States in September 1968 and killed an estimated 1 million people worldwide, with approximately 100,000 in the United States. Most of these deaths were people older than 65.

The H3N2 virus continues to circulate worldwide as a seasonal influenza A virus. Although these seasonal influenza viruses undergo small changes or mutations over time, the antibodies your immune system creates against one influenza virus can often recognize and respond to these similar influenza viruses, creating cross-protection.

Other recent pandemics. Since 1980, there have been three more major pandemics:

  • Human Immunodeficiency Virus (HIV), the virus responsible for acquired immunodeficiency syndrome (AIDS), appeared in 1981 and is still considered a pandemic. It has killed more than 25 million people worldwide.
  • Swine flu first appeared in 2009. It was caused by a novel influenza virus (H1N1), for which few young people had any immunity. It lasted for 1 year and caused more than 12,000 deaths in the United States.
  • The Ebola virus was first discovered in 1976 and has had several outbreaks since, mostly in Africa. The largest outbreak was in 2014-2016 in West Africa during which it killed 11,310 people. Because the outbreak areas are fairly isolated, the virus has never gained a foothold in the United States or most other countries.

Pandemics are nothing new. Although it’s difficult to predict the trajectory of the current COVID-19 virus, perhaps we can learn from past pandemics, as well as our current experiences with COVID-19, to better understand how to prepare for future pandemics because history will repeat.

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