Pandemics and epidemics have been with the human race since recorded history began, and mass casualties from infectious diseases are nothing new. Despite modern medicine and 21st-century scientific advances in public health, surveillance, pandemic response, and emergency preparedness, humans are still highly susceptible to contagion, illness, and death from such organisms. 

In the age of COVID-19, where a novel coronavirus never before seen by experts has encircled the earth, hobbled economies, and killed many thousands, great interest has been generated in the history of pandemics and epidemics, as well as public health and emergency response. We can learn from history if we choose to, and we can also repeat previous errors if we lose focus.  

Early History of Epidemics and Pandemics

Epidemics were recorded before the Common Era (BCE, previously, and sometimes still, referred to as BC). Over the course of the more than two thousand years of this Common Era (CE, previously, and sometimes still, referred to as AD), millions of deaths have been tallied in relation to pandemics. 

The so-called “Black Death”, caused by the bubonic plague, resulted in approximately 200 million deaths (one-third of the world’s population) in the 14th century. 

In the 15th century, Christopher Columbus and other explorers brought diseases to the “New World”, and the resulting epidemic of smallpox left as many as 56 million Native Americans dead. 

Around 1665, the bubonic plague surfaced again and killed approximately one-fifth of the citizens of London. Cholera, a feces-borne illness transmitted through food or water, has plagued humans for centuries, including significant outbreaks in the 20th and 21st centuries. 

While plenty of epidemics and pandemics occurred during the 19th century (e.g.: cholera, measles, bubonic plague, and the Russian Flu), one pandemic stands out in the early 20th century. 

The “Spanish Flu” of 1918

The so-called “Spanish Flu” of 1918 was an historic influenza pandemic to which many politicians, public health officials, epidemiologists, and media organizations frequently refer to in these days of COVID-19. 

According to the Centers for Disease Control and Prevention (CDC), “the 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919.  In the United States, it was first identified in military personnel in spring 1918.”

Approximately 500 million people (one-third of the world’s population) were infected with the virus, and around 50 million people died.  In terms of its virulence, the CDC states the following: 

“While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.”

As the most severe pandemic ever recorded, this outbreak remains a watershed moment in the history of public health and the awareness that mass death from a rapidly spreading disease is possible, even now. 

After 1918

The year 1957 saw an “Asian Flu” pandemic that killed 1.1 million people worldwide, including 116,00 Americans. And in 1968, the so-called “Hong Kong Flu” killed one million. 

In 2009, the H1N1 “swine flu” struck. describes it thus: 

According to the CDC, between April 12, 2009 and April 10, 2010, there were 60.8 million cases, 274,304 hospitalizations, and 12,469 deaths (range: 8868-18,306) in the US due to the virus. The CDC also estimated that up to 575,400 people died worldwide.”

It mostly affected “children and middle-aged adults (older adults had immunity, likely from a previous exposure to a similar H1N1 virus). And while the pandemic officially ended on August 10, 2010, the (H1N1)pdm09 virus continues to circulate as a seasonal flu virus, causing illness, hospitalization, and deaths worldwide every year.”

The early 1980s, of course, is when the world was introduced to the human immunodeficiency virus (HIV), which in turn causes acquired immunodeficiency syndrome (AIDS). states: 

Now, according to the most recent data from the CDC from 2006, it’s grown to pandemic proportions, with an estimated 65 million infections and 25 million deaths worldwide. New treatments, however, have allowed more people to live with HIV, and about 1.1 million Americans currently have the disease, according to government data. An estimated 38,000 new HIV infections still happen in the U.S. each year.”

SARS, MERS, Ebola, and other diseases (some of which are related to COVID-19) have also ravaged parts of the world in the late 20th and early 21st centuries. 

COVID-19 and Beyond

COVID-19 is the illness caused by a novel coronavirus (SARS-CoV2), which apparently emerged in China in late 2019 and may have appeared in the United States as early as January of 2020, if not possibly in the last months of 2019. It seems to have originated in bats, although the jump from animals to humans seems to have taken place in so-called “wet markets” in Wuhan, China, where animals are purchased live and butchered on the spot. It has long been known that these markets are vectors for disease. 

Many coronaviruses cause common cold symptoms. This particular “novel” coronavirus appears to be new as far as virologists can tell. Here in the United States, we reached the grim total of more than 100,000 known deaths in May of 2020, more than the number of Americans who’ve died in any single war since the Korean conflict. Many continue to fall ill around the world, with a fair percentage dying. 

While the main symptoms of COVID-19 are cough, fever, and acute respiratory distress that often require intubation and ventilation, we’ve also seen hemorrhagic strokes, diarrhea, and abdominal pain, as well as loss of the senses of taste of smell. Puzzlingly, some children develop an acute inflammatory condition that causes cardiac complications and a relatively low incidence of death, despite having exhibited no prior symptoms of the illness. 

As the world continues to struggle to come to grips with the deep impact of COVID-19 on our way of life, healthcare systems, and economies, we must also prepare for the next pandemic, which is said to be inevitable. Public health and science must be robustly funded, and we must continue to counter the falsehoods spread by cynical individuals and groups with nefarious or misguided goals. 

Pandemics are nothing new, and even in the 21st century we’re challenged to combat them, but fight on we must. These illnesses are not going away, thus we need to face the future with eyes, minds, and hearts wide open.