They’ve Happened Before and They Will Happen Again
A pandemic is a disease outbreak that spreads to at least 3 countries and affects a significant proportion of the population. Millions are often affected, and millions die.
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It happened in 1918 with something called the Spanish Flu. 500 million people were infected around the world and 20 million died including 675,000 in the United States. Some historians believe the Spanish Flu to be the true reason World War I ended. But it gets worse.
A Brief Pandemic History
The Spanish Flu pales in comparison to past pandemics.
- 25 million people died in one year from the plague of Justinian in 541 A.D. It wiped out half the population of Europe at the time and was believed to be caused by the bubonic plague.
- The Black Plague raged across Asia to Europe from 1347 to 1353. More than 75 million people died.
- A cholera pandemic swept across India and spread to Indonesia and Russia from 1816 to 1824. More than 40 million died.
And it’s not just about the Dark Ages.
- In 1957 the Asian flu killed 2 million people.
- The Hong Kong flu of 1968 killed more than a million people.
And it gets worse. If it troubles you to worry about a coming pandemic, it may be very troubling to know that we’re living through one right now. In fact, we’re in the midst of two:
1. A tuberculosis pandemic is ongoing, killing over 1.5 million people every year. While there are effective treatments, the tuberculosis pathogen has developed a resistance to multiple drugs allowing the pandemic to progress. But there’s another factor.
2. The primary cause of the rise in deaths from tuberculosis is the result of the second pandemic affecting the world today: HIV/AIDS. HIV or Human Immunodeficiency Virus originated in west-central Africa during the late 19th to early 20th century. It was first identified by the Centers for Disease Control and Prevention (CDC) in 1981.
To date, more than 35 million people have died worldwide from HIV/AIDS. Treatments are proving effective and the CDC is considering recategorizing HIV/AIDS from pandemic to epidemic.
How Does a Disease Become a Pandemic?
The CDC and the World Health Organization (WHO) use a variety of measurements to classify a disease. This is based on the number of people infected, the geographic extent of the infection, and the duration.
Here are the basic classifications:
An outbreak is a localized occurrence of a disease. The locale can be as small as a school, village, city, or region. The response to an outbreak is proportional to the threat.
A mumps outbreak in a city, county, or state is contained and treated with routine methods and cautions. An Ebola outbreak even in the smallest village is treated with a serious and dedicated effort to stop or at least contain the spread of the disease.
An epidemic is declared when there is a widespread occurrence of a disease at a particular time, affecting a larger community up to an entire country. The continuing spread of the disease is the primary determining factor of an epidemic.
Local and federal resources are usually called into play to both treat and contain the disease. This is proving increasingly difficult given the high volume of international air-travel that occurs on a daily basis.
When a disease spreads to three or more countries, it is re-classified as a pandemic. There are some variables related to the rate of infection, the number of people infected, and deaths, but whenever a disease spreads from country to country, it is usually labeled a pandemic.
A classification that often appears is “endemic.” An endemic disease is native to a population or region and always present. This typically occurs in areas that are chronically exposed to a condition. In many parts of the world on the borders of the equator, malaria is endemic in the population of many countries, especially in Africa.
In fact, a genetic defense against malaria has evolved in people across many parts of Africa called sickle cell blood cells. They present a natural resistance to malaria but can also lead to a condition known as sickle cell anemia.
HIV/AIDS is also endemic in many parts of Africa, although no natural defense has evolved to offset the advance of the virus. The virus is so widespread in Africa it has been re-classified as hyperendemic.
Types of Disease Transmission and Virulence
The ability of any disease to spread is what ultimately takes it from outbreak to epidemic to pandemic. This ability is related to how easily the bacteria or virus can be transferred from one person to another.
There is also a factor referred to as virulence. This is the level of danger that a specific disease represents. The common cold is a virus which classifies it as a disease. Its symptoms are annoying but somewhat benign. Other diseases like Ebola, Cholera, and HIV/AIDS present severe, life-threatening symptoms.
Ease of transmission and high virulence are what make plagues and pandemics so devastating.
There are numerous levels and sublevels, but here are the basic ways that diseases are transmitted.
Direct, physical contact between an infected person and another person susceptible to the disease. Includes touching, kissing, sexual contact, contact with oral secretions, or contact with lesions.
Transmission as a result of contact with a contaminated surface including doorknobs, handrails, door handles, beds, tables, chairs, bathroom surfaces, dinnerware, medical instruments, musical instruments, computer keyboards, TV remotes, pens and pencils and other office supplies, and toys.
Transmission through the eyes, nose or mouth of droplets from an infected person’s cough, sneeze, or exhalation. Droplets are typically too large to be suspended in air for long periods.
When droplets evaporate, the droplet nuclei can remain in the air for longer periods of time. This allows transmission into upper and lower respiratory tracts.
The most common form of transmission for food and waterborne bacteria as a result of animal contamination, or inadequate handwashing; sewage treatment or water filtration and purification resulting in infection from both direct and indirect contact.
Transmission as a result of animals and insects. Bites are the most common method of transmission from mosquitoes, fleas, mites, ticks, rats, bats, and dogs. Transmission can also occur through feces of the vector coming in contact with food, water, or a surface.
The Perfect Pandemic Storm
It’s reassuring to believe that modern medical science could have effectively treated many of the pandemics of the past. That was certainly true in the case of smallpox, but there are some ominous factors related to virulence, transmission, and mutation that together could overwhelm contemporary medicine and result in a global, pandemic catastrophe.
Certain disease classes present symptoms and conditions that are so severe, they are fatal in the majority of cases. Ebola causes massive internal bleeding from all orifices and often ends with an infected person drowning in their own blood.
Anthrax has a vaccine but no cure and is fatal in almost all instances. Any occurrence of diseases in this class are immediately treated and every effort is made to isolate it.
Some transmissions can lead to rapid and widespread infection. Airborne transmission was the primary driver of past influenza pandemics. Vector transmission drove the bubonic plagues as a result of flea bites from infected rats. Indirect contact with contaminated surfaces led to the spread of smallpox.
Mutations are a primary driver of evolution and are typically the result of radioactive particles from the sun, space, or a nuclear incident affecting the DNA of cells.
In some instances, a bacterium or virus mutates to a more benign form. In other instances, the mutation makes the microbe more virulent or able to survive in additional or varied transmission environments.
Two Pandemic Possibilities That Could Have Disastrous Effects
Nature is relentless and the dynamic flux of evolution from mutation could lead to the natural occurrence of a disease that is highly virulent and easily spread. Smallpox was one of the most virulent and easily spread natural diseases we have known. Fortunately, smallpox has been essentially eradicated.
It’s possible to genetically modify an organism to change its characteristics. These GMO’s are showing up more and more in research on plants and animals. These experiments are not without controversy, but there’s one group of people unfazed by controversy: terrorists.
A terrorist group that is highly funded or backed by a rogue nation could develop a pathogen that combines extreme virulence with the ability to be transmitted across multiple pathways.
To make matters worse, the role of a suicide bomber could reemerge as a suicide-vector with a person intentionally infected and sent to spread the disease as rapidly and as widely as possible. The attack would be a Pyrrhic victory at best with no winner or loser as the entire world including the terrorists succumb to the disease.
No Easy Answers
Will we be struck by another global pandemic? If history is any guide, then it’s inevitable. If terrorist behavior continues as it has in the past, it may be sooner than we think.
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