We all fall down

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CWA # 273, 27 April 2020
We all fall down
Epidemics through History

  Jenice Jean Goveas

Whether we have the grit and energy to deal with this pandemic which many compare to the fourth horseman of the apocalypse is for all to see in the coming days

"Ring a Ring o' Roses" one of the first nursery rhymes that each one of us naively sang as a child is believed to date back to the Great Plague of 1665. The rosy rash accompanied by Sneezing or coughing “A-tishoo! A-tishoo!” was a fatal symptom, therefore "all fall down" symbolised death. At a time when the entire world is talking about the New Covid-19 pandemic, it is apt to look back at some of the largest epidemics fought by humankind.  

Epidemic: From the Wrath of God to Vaccination to Social Distancing
Since times immemorial, humans have considered epidemics as the ‘Wrath of God’. The Bible mentions early Israelites receiving leprosy and plague as punishment for their sins. This unscientific perception often led to disastrous consequences.  Girolamo Fracastoro (1546) an Italian physician was among the first to explain the cause of disease by a concept of 'disease seeds'. The Father of Microbiology, Antoine Leewenhock (1674) was the first to see bacteria, yeast etc. under the microscope. 

John Snow (1854), the Father of Epidemiology used geography and statistical analysis to break the prevailing hypothesis that cholera was spread by miasmas and proved that it was indeed transmitted by tainted water or food consumption. Louis Pasteur in the late 1800s ascertained the significance of microbes and destroyed many myths regarding the spread of diseases. The Industrial Revolution and the later technological boom not only made the world a global village and brought people closer through trade but also simultaneously increased the risk of disease transmission, causing more epidemics blow into pandemics. 

In Homer’s “Odyssey” Zeus, says that humans always blame God for their suffering; “but they experience pain beyond their fate because of their own recklessness”. However, science and medicine also progressed exponentially enabling humans to battle various deadly diseases although we ourselves were responsible for many of them.

Epidemics: Down the History, from Plague to Corona
Going down mankind’s deadly memory lane of diseases, the first record is of the fourth century BC when Hippocrates described scarlet-fever-like symptoms. Another early epidemic was the Antonine Plague in AD 165 which is believed to have killed 6.5 million people. It was an outbreak of either smallpox or measles unknowingly carried by Roman soldiers. The bubonic Plague of Justinian that caused hand necrosis entered the Mediterranean region from China in 541 AD and killed 25 million people worldwide. The Black death or the plague of 1348-1350 is considered the most devastating pandemic in human history. The gangrene causing bacterium, Yersinia pestis wiped out 100 million people and is widely regarded as responsible for the European “Live for the moment” attitude. London's Great Plague killed 1,00,000 people in 1665-1666. Even though rats were the host of fleas which carried the disease, misinformation that pets were responsible for the plague along with misguided instructions to eradicate all cats and dogs in the cities skyrocketed the rat population, accelerating the plague.

However, accidents can prove to be blessings in disguise and the 1666 Great Fire that destroyed much of London assisted in putting an end to the epidemic.

It is interesting to note how Italy, today struggling to outwit the corona virus taught the world the practice of quarantine back in the 14th century while protecting coastal cities from plague epidemics. The term originates from the practice of anchoring ships for 40 days which translates to “quaranta giorni” in Italian. During1633-1634, Smallpox was brought by the European settlers to North America and it wiped out seventy per cent of the Native American population. It was only in 1770 that Edward Jenner developed a vaccine from cow pox and the last case of it was reported in 1949. In 1771, Bubonic plague struck Moscow. Quarantine measures imposed by officials infuriated and terrified the public resulting in widespread riots and destruction totalling a death of 2,00,000 people. 

Cholera pandemics have terrorised humanity since ages and the seventh pandemic is still ongoing causing 130,000 deaths a year. The third cholera pandemic of 1852 to 1859 that swept Asia, America, Africa and Russia was the deadliest cholera pandemic costing 10,00,000 lives. The 1918 Spanish flu was H1N1 and killed 75 million people most of whom were surprisingly young and healthy individuals. It later resurfaced in 1957 as the “Asian flu” and took away nearly 70,000 lives and again appeared in 2009 after which a vaccine was established. The deadly Ebola of 2014, affected the Central African counties of Congo and Sierra Leonne with over 11,000 deaths. Safe burial practices and strict quarantine helped contain the outbreaks. The rVSV-ZEBOV Ebola vaccine was employed for the first time to stop another outbreak in Congo in April 2018. The worst pandemic of this century is the ongoing Covid-19 which has affected more than one million people and killed about 65,000 individuals in 205 countries. Although an effective vaccine is yet to be discovered scientists have been pinning hopes on novel treatments like plasma therapy and nanoparticles to deal with the virus. 

The role of hygiene is highlighted in the Biblical story of an epidemic that struck the Philistines when they captured the Ark of the Covenant from the Israelites. The Philistines who took no sanitary precautions of the Levitical code became susceptible to the disease unlike Israelites who practiced disinfection techniques like burning the cart along with the dead oxen. In 1906, A cook nicknamed “Typhoid Mary” was a healthy carrier for typhoid virus and spread it to122 New Yorkers after which the epidemic escalated manifold until a vaccine was finally developed in 1911 and in 1948 antibiotic treatment was made available. In addition to vaccines, Modern sewage and water treatment facilities have helped control cholera but the virus is still present. 
Today, vaccines can greatly contain epidemics of diphtheria, measles and Polio. However, tuberculosis (TB) termed ‘White Plague’ is still a formidable killer. About 2 million people succumb to it each year, equivalent to seven Tsunamis annually. The increasing cases of multidrug and extreme drug resistant TB add to the scare. Influenza virus including coronavirus is another great threat as its strains easily mutate, making vaccinations ineffective.

After COVID-19
What is more horrifying is the belief that ancient epidemics like the black death are lying dormant in the third world animal population and could resurface anytime as massive outbreaks. A few prophesies like that of Nostredame also point to the same. The Biblical book of ‘Revelations’ mentioning “beasts of the earth” will have a part to play is considered as a reference to animal-borne diseases like the mad cow disease, the Bird Flu-H5N1, Nipah virus from pigs, and not to forget the New Covid-19 which broke out at an animal trade market in Wuhan. Predicting this outbreak did not require divine intervention. 

Even Bill Gates had in a TED talk in 2015 predicted that the biggest threat to mankind was not nuclear but microbial- something that we are not prepared for. This threat is real for now. For the first time in our lifetimes have we witnessed the entire world so helplessly holding hands like small children singing “Ring a Ring o' Roses”. Whether we have the grit and energy to deal with this pandemic which many compare to the fourth horseman of the apocalypse is for all to see in the coming days. 

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