It seems that Europe is the epicentre of the COVID-19 virus.  Spain is in a lockdown and UK airlines have stopped flying to a number of international destinations.  The UK government has moved the UK from the Contain phase into Delay, hoping to prevent too many cases putting a strain on the NHS during its usual busy period.

People are right to be concerned but COVID-19 is not the first ever pandemic, there have been many in recorded history.  We first started to see epidemics about 10,000 years ago when the human lifestyle made contagion more likely.  Think tuberculosis, the ‘flu’ (in its many variants), Malaria, smallpox…. 

In simple terms, an epidemic (a disease that spreads rapidly throughout a population) becomes a pandemic when it becomes international, although there are experts who don’t wholly agree with this definition.  If we stick with the definition that I am using, Ebola virus, however dreadful, doesn’t fall into the pandemic category.  While looking at the major pandemics throughout history, remember that the medical advances we have today were not present, but a common theme persists… good sanitation and hygiene.

The Athens Pandemic/Peloponnesian War, 430 BC

Quick history lesson: Athens and Sparta were the most powerful city states in Ancient Greece.  They were at war with each other between 431 and 405 BC.  During this [Peloponnesian] war, a disease occurred that is believed to have started in Libya and spread across to what is now southern Greece.  At the time it hit, Athens was under siege by the Spartans.  As you might imagine, a city under siege would be suffering in more ways than one, and two-thirds of the population died.  

The symptoms of the disease were fever, red skin and lesions, a bloody throat and tongue and a severe thirst.  It is thus suspected to be typhoid fever, which is usually spread by contaminated food and water, which is entirely possible in the prevailing conditions.  This was the earliest recorded pandemic.

The Antonine Plague, 165 AD

No-one really knows how this started, or, indeed, exactly what it was, although it is believed to be either smallpox or measles.  The disease is believed to have persisted for about 15 years and to have killed over 5 million people, including the Roman Emperor Marcus Aurelius.  

The symptoms included fever, sore throat, diarrhoea and pus-filled sores if the individual survived long enough.  It was spread why Roman troops returning from war.  Hitting the Italian shores, they travelled across the country to their homes, explaining why the UK government is so keen on self-isolation with COVID-19.

The Cyprian Plague, 250 AD

This infection is believed to have started in Carthage (the capital city of what is now Tunisia).  It is named after the bishop of Carthage, Cyprian, who was the first known victim.  Its symptoms included diarrhoea, vomiting, throat ulcers, fever, and [this is nasty] gangrene in the feet and hands.  No-one is really sure what this disease was although some historians think it was smallpox, others Ebola.  

Unfortunately, those who lived in Carthage tried to escape the illness by going out into the country, but all they succeeded in doing was spreading the disease further afield.  The disease recurred intermittently over the following three centuries by which time it had spread to Britain, and we have no idea how many people were affected.

The Justinian Plague, 541 AD

This was perhaps the earliest appearance of bubonic plague, otherwise known as the Black Death, in the Byzantine Empire.  It is believed to have killed over half the population of Europe, about 50 million people.  The symptoms of bubonic plague (which is spread by fleas carried by rats) are swollen lymph nodes, fever AND chills, fatigue.  

This outbreak had a major impact on the economies of the countries affected, and quite probably changed the course of history.  Farmers were unable to deal with their crops, consequently, there were shortages and prices increased, although that was not the worst of it.  There were no bakers to make bread, and so on, so trade stopped and people starved. 

The Black Death, 1346 to 1353

This second occurrence of the bubonic plague is believed to have started in Asia, moving north-west via nomadic people, until it hit Sicily in 1347.  It spread throughout Europe rapidly, so rapidly, in fact that it was impossible to clear up all the dead bodies and many were left to rot on the ground where they dropped.  At the time, England and France were in full flow of the Hundred Years War, and agreed to call a temporary truce because of the outbreak.  It caused the breakdown of many societies as they were known at the time, including being instrumental in the collapse of the feudal system in England. 

The Columbian Exchange, 1492

“In 1492, Columbus sailed the Ocean Blue,” so we were taught at school.  Columbus was searching for India but instead he found the West Indies, the Caribbean.   The Caribbeans had never encountered diseases such as measles and smallpox before and had immunity.  And, of course, the bubonic plague which was also carried by the rats on board ship, completing the Hat Trick.  Thus Columbus and his crew wiped out around 90% of the population of the islands they visited.  Captain Cook caused similar problems when he visited the South Sea Islands centuries later, largely caused by the common cold.  

The Great Plague, 1665

Perhaps I should say, ‘the return of the plague.’  It killed off about 20% of the population and was only stopped but the Great Fire of London in 1666.  We can still see evidence of the Great Plague in the City of London, where the church yards are much higher than the entrances to the churches, because there are so many bodies buried there.  At the time, the cause of the disease was still unknown, and thought to have been spread by cats and dogs rather than rats, thus they were slaughtered in their masses.  It’s also worth remembering that London was incredibly unhygienic at the time, with sewage running in the streets and being thrown into the Thames.  

Cholera Pandemics, 1817 – 1919

The first of seven cholera pandemics started in 1817 and continued for about 150 years or so.  A million people died in the first one.  Cholera is caused by bacteria, spread through contaminated water and food.  It infects the small intestine causing diarrhoea, and, in extreme cases, death.  There is some debate about where this pandemic originated, some scholars say Russia, others say India.  Regardless, it lasted for six years when a severe winter is believed to have killed it off.

A second cholera pandemic began in 1829, reaching the UK in late 1831.  Local health boards were established here and areas quarantined, but fear spread throughout the public, and there was a widespread distrust of doctors.  Press reports led people to think that more people died in hospitals than in their own homes, leading to fears that the medics were intentional killing off people so they could use the bodies for anatomical research.  Remember this was only a few years after the murders committed by the notorious Burke and Hare, and shortly after, a Liverpool based surgeon called William Gill was found guilty of grave-robbing.  Subsequently so-called cholera riots took place in Liverpool.  

Between 1852 and 1860, killing 1 million people.  1854 was the worst year for the cholera epidemic in London, which was when a British Physician John Snow tracked the cases throughout London’s Soho and traced the source to a public well pump.  (You can see where the pump was located to this day.)  When Snow convinced the authorities to remove the pump the number of cases dropped immediately.  

In the same year, an Italian microbiologist, Fillipo Pacini, identified the bacterium responsible and by 1885 a vaccine had been developed, however, outbreaks continued, largely because the sources hadn’t been eliminated.  However, by this time, the UK and USA were largely unaffected because they had improved water supplies and sanitation.  

Cholera still breaks out from time to time: in 1991, it appeared in Peru where it wiped out 3000 people in the first year, then more recently in Zimbabwe in 2008/9.  In 2017, there was an outbreak in Somalia and the Yemen, which affected 500,000.  According the WHO it was the largest cholera epidemic in the modern world.

The Third Plague Pandemic, 1855

This time it started in China and moved to India and Hong Kong.  It was most severe in India and was only considered to have stopped being active in 1960 when the number of cases dropped to below a couple of hundred.  

Russian Flu, 1889

Again, there is some dispute as to where exactly this originated, with some reports saying somewhere in Siberia, others saying concurrently in Turkestan, Canada and Greenland (which seems unlikely).  In any event, although the pandemic lasted less than two years, it killed around a million people.  

Spanish Flu, 1918

Although it’s known as Spanish flu, it is believed to have originated in China, and spread rapidly when Chinese labourers were taken by rail across Canada on their way to Europe.  The outbreak hit Europe by the spring.  It is estimated that there were 25 million deaths in the first 25 weeks alone, and a total of somewhere between 20 and 50 million people worldwide.  

What was most interesting about this flu outbreak is that normally the flu is worse in the very young, the very old and those with weakened immune systems.  This flu was different, it hit healthy adults, killing more Americans than American soldiers died in the First World War.  

Spanish flu died out in the summer of 1919, presumably because most of the remaining population had developed an immunity.

Asian Flu, 1956 – 1958

This flu started in Hong Kong, spread throughout China and then into the United States.  It travelled from there to Europe and the UK, where 14,000 people died in the space of six months.  A second wave of the flu started in 1958 causing an estimated 1.1 million people to die across the globe.  A vaccine was subsequently developed.

Flu, 1968

Also known as Hong Kong flu, where it was first reported, it took only 17 days before cases were reported in Singapore and Vietnam.  Within three months, it had spread across Asia into Australia, America and Europe.  One million people died worldwide, making this outbreak one of the lowest mortality rates at 0.5%.  

HIV/AIDS, 1981, peaking 2005-2012

This was first identified in the Congo in 1976, it’s a retrovirus that disrupts the immune system.  Death is caused because the body can no longer fight off diseases that would usually be dealt with by the immune system.  It is passed by bodily fluids.  It has killed 36 million people worldwide.  In the Western world, at least, it is now treatable and the treatments can stop transmission to others.  

And so, pandemics vary in their duration, morbidly and virulence.  We will have to wait to see how COVID-19 plays out, and whether a vaccine can be found soon enough.

© Susan Shirley 2020