COVID-19 end game: Lessons from other pandemics

With nearly 30 percent of the individuals around the globe fully vaccinated, nine identified variants of the SARS-CoV-2 still looming large, and countries going in and out of lockdowns, people everywhere are wondering – when will this end? And will it end at all?

 

We’re approaching the two year mark of the collective experience with COVID-19. More than 46 lakh people across the world lost their lives due to the coronavirus outbreak as of September 09, 2021.

With nearly 30 percent of the individuals around the globe fully vaccinated, nine identified variants of the SARS-CoV-2 still looming large, and countries going in and out of lockdowns, people everywhere are wondering – when will this end? And will it end at all?



Well, a quick look at three of the deadliest pandemic outbreaks from the past might give us some clues:

1. Bubonic plague

The earliest outbreak of the Bubonic plague was recorded around 60 generations ago in 540 AD. It was a dark age. The Mediterranean was experiencing an acute climate shift, parts of Italy was witnessing snow as well as frost bang in the middle of summer.


Patients discharged after suffering from bubonic plague.


There was no harvest or consumption of grains across many countries. With whatever little there was, the grains became infested with black rats carrying bacteria yersinia pestis. This bacteria was transmitted by fleas to rats via respiratory droplets from infected people. Since this caused swollen and inflamed lymph nodes called Buboes, the disease came to be known as bubonic plague. The disease lasted for as long as 2,000 years and killed millions of people.

The measure of loss


Nearly 200 million people died in the first 2,000 years of the Bubonic plague outbreak; even now, traces of it exist – one confirmed case came to light in Mongolia in July 2020. The black death, as it is commonly called, is the only known event in human history to have destroyed the human population at such a massive scale.


As documented by humankind, the plague lasted between 1346-1353. And, it is believed that it would take Europe another 200 years to replenish its population to pre-plague levels. The monumental loss was not just in terms of human lives, but also, labour, art, culture and the economy.


What’s the status now?


Although the plague has been controlled, the bacteria is still alive and the disease exists in small pockets of the world. The first plague vaccine was developed by bacteriologist Waldemar Haffkine in 1897. He tested the vaccine on himself to prove that it was safe. The disease is now fully treatable with antibiotics.


Lessons from the Bubonic plague


The plague ended with quarantining and improved sanitisation (sounds familiar?). The most popular theory is that the uninfected remained in their homes and left only when necessary. Those who could afford it used to leave and isolate themselves. Interestingly, this was also when cremations were carried out more frequently than burials due to the sheer number of bodies.


2. Smallpox


Fast forward another 100 years or so and we get to the age of the smallpox spectre. There is no known origin of the smallpox virus, however, according to the Centre for Disease Control and Prevention (CDC) - “The finding of smallpox-like rashes on Egyptian mummies suggests that it had existed for at least 3,000 years. The earliest written description of smallpox appeared in China in the 4th century CE (Common Era).”


The smallpox virus.


Induced by one of the deadliest viruses known to humans called the Variola Minor, it is known to spread through droplets while coughing or sneezing. Fluid-filled pustules are a common symptom in smallpox.


The measure of loss

Just like the plague, smallpox killed hundreds of millions of people - 300 million in the 20th century alone.


What’s the status now?


It took nearly two centuries to eradicate the virus. British doctor Edward Jenner developed a vaccine for it in 1796 and it remains the only antidote in human history to have fully worked.


Lessons from Smallpox


William “Bill” Foege, one of the architects of the smallpox eradication program believes the following four factors helped: A rigorous surveillance system to continuously deploy people to monitor and evaluate infected and vaccinated visitors. Ensuring data transparency and public trust is imperative. Scientists do not necessarily have all the answers. As pandemics evolve, the goalposts for approaches and answers keep shifting too. Constantly sharing and learning from others’ experiences is the key during these times.


3. Influenza


The world has seen a number of flu pandemic outbreaks. The biggest recorded outbreak was in the 20th century - the Spanish flu of 1918. The H1N1 virus caused the Spanish flu pandemic which is believed to have originated in the cramped and crowded army training camps of the Western Front during World War 1.


The measure of loss

The 1918 outbreak killed nearly 50-100 million people. After a couple of waves of the pandemic between 1918 to 1920, the flu exists as a benign version that affects millions of people every year. Presently, upto 650,000 are known to die from the seasonal flu every year. In 1968, the Hong Kong flu killed one million people and it continues to exist as a seasonal flu. According to the WHO, the influenza virus is unpredictable and continues to be a threat to humanity.


Lessons from Influenza


The upsurge of Influenza is one where we can draw close parallels with the current COVID-19 health crisis. Much like now, social distance, economic downturn, disinfection of surfaces, mask mandates were also prevalent during the Spanish flu pandemic. There was no cure. The only difference is advancement in science - it was only in the 1990s that the virus was identified.


The spanish flu broke out amidst army training camps during World War 1.


According to some experts, the Spanish flu outbreak of 1918 was contained because of herd immunity. It is worth noting here that despite all the advancement in technology and science, we are still having to rely on the 1918 way of doing things - good nursing care for victims, quarantining, social isolation, sanitation and mask mandates.”


So, how will the COVID-19 pandemic end?


The COVID-19 outbreak is one among the long line of pandemics caused by pathogens. After combining views from public health experts, scientists and diplomats, and taking into account all the knowledge about the virus, a good public health system, social distancing measures and increased vaccinations seem to be the only way out.


Immunologist Yonatan Grad speaking to the Harvard Gazette said “ The expectation that COVID-19 will become endemic essentially means that the pandemic will not end with the virus disappearing; instead, the optimistic view is that enough people will gain immune protection from vaccination and from natural infection such that there will be less transmission and much less COVID-19-related hospitalizations and deaths, even as the virus continues to circulate.”


 

Edited by Roshni Shroff

Written by Aparna Chandrashekar

Cover image by Pratyush Thaker

 

Some resources and links to help you know more about pandemics:

When will the COVID-19 pandemic end?

6 lessons we can learn from past pandemics