Pandemics in History

1. Pandemics in History

2. Pandemic Review • A pandemic is the spread of infectious disease across a large area. • It has occurred more frequently than normal and the effects are more dire than usual. • A disease is not a pandemic simply because it kills lots of people or occurs in a lot of places, it has to be infectious as well. • Cancer is not a pandemic disease, whereas AIDS is.

3. Terrible Pandemics in History And how we would treat them today…

4. Plague of Athens (430 B.C.E.) • Occurred during the Peloponnesian War between Sparta and Athens. • First recorded pandemic in history. • Killed over a quarter of Athens troops and up to 2/3 of Athens population. • The cause was unknown until 2006, where university researchers analyzed teeth of the dead and found typhoid bacteria.

5. Plague of Athens (430 B.C.E.) • Thucydides described the disease as such "People in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath. Next came coughing, diarrhea, spasms, and skin ulcers. A handful survived, but often without their fingers, sights, and even genitals!”

6. Plague of Athens (430 B.C.E.) • How we would treat it today: • Vaccine against the toxin produced by the typhoid bacteria. • Fluid replacement. • Antibiotics like tetracycline. • These would reduce the chance of death to close to zero.

7. The Antonine Plague (165-180 A.D.) • Roman troops returning from battles in the middle east brought back with the spoils of war, smallpox. • It decimated the population of Rome and is thought to be the single greatest cause of the weakening of the Roman Empire in Northern and Eastern Europe. • Killed the last great Roman Emperor, Marcus Aurelius Antoninius.

8. The Antonine Plague (165-180 A.D.) • At its height, it killed 5,000 people a day! • The famous Greek physician Galen described it as “a long, cruel disease that involved fever, diarrhea, and inflammation of the throat, as well as pustules on the skin”.

9. The Antonine Plague (165-180 A.D.) • How we would treat it today: • Smallpox vaccine • Antiviral drugs like Cidofovir. • Thankfully smallpox has been eradicated all over the world since 1979.

10. The Justinian Plague (541-542 A.D.) • The Byzantine Empire, which imported most of its grain from Egypt to feed its people, also imported the bubonic plague (caused by the bacteria Yserina pestis). • The plague killed between 5-10 thousand people a day.

11. The Justinian Plague (541-542 A.D.) • It eventually killed up to 40% of Constantinople’s population and by the year 700 A.D., killed up to 60% of Europe’s population.

12. The Justinian Plague (541-542 A.D.) • How we would treat it today: • Antibiotics like streptomycin and tetracycline. • 85% of today’s cases are curable.

13. The Black Death (1347-1351 A.D.) • The most famous and one of the most deadly pandemics in Earth’s history. • It wiped out between 30-60% of Europe’s population. • Lowered the world’s population by 75-200 million people!

14. The Black Death (1347-1351 A.D.) • Once arriving in western Europe via merchant ships, it spread rampantly from city to city creating widespread terror and panic. • Victims broke out in large, oozing pustules, vomited profusely, coughed up blood, and contracted other conditions such as necrosis and gangrene. • Four out of five victims died within eight days, and cities were quickly overtaken by piles of rotting corpses, vast cemeteries, shallow mass graves, and enormous funeral pyres.

15. The Black Death (1347-1351 A.D.) • How we would treat it today: • Antibiotics like streptomycin and tetracycline. • The plague still occurs in many underdeveloped countries today with 85% of the cases survived.

16. Native American Smallpox Epidemic (1500-1600 A.D.) • By the time European settlers began to move across North America, large numbers of the native populations had already been killed by the advance of European diseases, which had preceded the settlers’ presence. • That didn’t stop settlers, who saw Indians as vermin, from adding germ warfare to their methods of wiping them out. • Many deadly diseases were introduced either advertently or inadvertently among the Indians, effectively decimating their numbers as the natives had no previous exposure or resistance.

17. Native American Smallpox Epidemic (1500-1600 A.D.) • The worst of them was smallpox. This disease was made especially notorious because of an incident during the French and Indian War in which British commanders at Fort Pitt (now Pittsburg) discussed supplying the Indians with smallpox-infected blankets in an attempt to reduce their numbers. • Whether the plans were carried out is not confirmed, but it is known that Delaware Indians in the area soon began spreading smallpox rampantly. • By the late 1800s, it and other diseases had wiped out up to 90% of all Indians, making the Indian depopulation one of history’s greatest human catastrophes.

18. Native American Smallpox Epidemic (1500-1600 A.D.) • How we would cure this today: • Smallpox vaccine • Antiviral drugs like Cidofovir. • Thankfully smallpox has been eradicated all over the world since 1979. • Last case was in 1977 in Somalia.

19. Cholera Pandemics (1816-1994 A.D.) • There were seven cholera pandemics, the first six were very deadly. • The first six were the most deadly, killing huge numbers of people in Asia, India, Europe, Russia, the Americas, the Middle East, Egypt and Africa. • Untreated victims died within as little as 3 hours of the first symptoms, literally of fluid loss due to acute diarrhea, accompanied by vomiting, cramps and lowered blood pressure.

20. Cholera Pandemics (1816-1994 A.D.) • In Chicago in 1854, Cholera killed 5% of the city’s population. • One 1853 outbreak in London was only stopped when physician John Snow had the handle of the Broad Street water pump removed, proving the source of the outbreaks to be water contaminated by the feces of other cholera victims. • Still, it took over 50 years for word to get out, and cholera continued to be a scourge of urban areas until the 1920s, when most countries had updated their public health systems.

21. Cholera Pandemics (1816-1994 A.D.) • How we would treat it today: • Fluid replacement • Antibiotics like tetracycline. • Still pops up in underdeveloped nations with poor sanitation, however, when treated properly, mortality is below 1%.

22. Spanish Flu Pandemic (1918-1920 A.D.) • During the height of World War I, a shockingly virulent strain of Influenza-A swept the world, spreading quickly to regions as far apart as Asia, Australia, North America, Europe, the Pacific islands and even Arctic territories. • Whereas most flu epidemics affect weaker populations, such as infants or the elderly, this one involved a mutation that allowed the virus to overtake the immune system and turn it against the victim’s body.

23. Spanish Flu Pandemic (1918-1920 A.D.) • This resulted in a much higher mortality rate among the otherwise young and healthy, whose immune systems were stronger, as well as a devastating toll on social productivity. • Everyday life stopped, schools and shops closed, and even gravediggers were too sick to bury the dead. • In some cases, mass graves were dug using steam shovels, and bodies were buried without coffins. • The mass infection affected nearly one third of the world’s population, causing between 50 million and 100 million deaths – more than all the wars of the 20th century combined!

24. Spanish Flu Pandemic (1918-1920 A.D.) • How we would treat it today: • Antivirals like Tamiflu and Relenza. • Proper hygiene • This was the first Swine Flu pandemic in history.

25. Homework • Why did these diseases become pandemics? • What are some of the advances in medical technology that have prevented a reoccurrence of many of these diseases? • What are some diseases that have been pandemics in recent history (i.e. during your lifetime)? Why have they reached pandemic status?