Here it is 2020, and we are still battling pandemics.  History records the first recognized pandemic in 165 AD, the Antonine Plague.  Marcus Aurelius Antonius was emperor and gets the credit as it occurred on his watch. It was a virus, probably measles or smallpox, nevertheless devastating. It killed one-third of the empire! 

We have had pandemics at regular intervals that decimated the population, but each time it seems that a smaller percentage of the people had to die. The plague of Justinian took 30 million. It was likely Pasteurella (now renamed Yersinia) Pestis, a gram-negative bacteria that was carried by fleas that infested rats. It occurred during Justinian’s reign, 541-540 AD, and is said to have thwarted Justinian’s efforts to reunite the Eastern and Western Roman Empire. From 1347 to 1351, the “Black Death” as the Plague was called, swept in from Central Asia on the backs of black rats that carried infected fleas.  It came in on the Silk Road, then transferring to merchant ships going to Genoa, Italy.  The world population had been 475 million but shrank down to 350 million.  1631 saw it for a return engagement in Italy, but later in 1665  in London, and yet again in 1885 in China and India with at least 12 million deaths. This was probably the most lethal of the pandemics so far. Europe lost half its population. It had three forms, bubonic, pneumonic, and septicemic.  The bubonic form was named for the enlarged lymph nodes that occurred in the axilla and groin called “Bubos.”  In the pneumonic form, the bacteria directly attack the lungs causing death sooner; therefore, the most lethal. The septicemic plague occurs in the bloodstream and is usually not infectious.

As a child growing up in Austria, I was always fascinated by the “Pest” (the German word for plague) columns. Most  European cities have a memorial erected to commemorate the plague depicting grotesquely posed dying humans often intermixed with devil and angel-like sculptings. Antibiotics were still far off then. Most of the first generation antibiotics, even Sulfa drugs, would have been effective against the “Black Death,” had they been available.

FJ6AKF Austria, Vienna, Graben, Pestsaule, Plague Column, 1693, detail.

In the late 1800s, the Yellow Fever virus decimated 150,000 French and Americans. This was related to the efforts to connect the Atlantic and Pacific Oceans by way of digging the Panama Canal. Yellow Fever is a viral disease transmitted, most often, by the female mosquito, Aedes aegypti. In 1793 there was an outbreak in Philadelphia, the then capital of the US. Nine percent of the population died, and the inhabitants of the city fled, including the President of the United States, George Washington.

Walter Reed, an army doctor, was the most instrumental in finally beating the disease, by control measures of the mosquito’s breeding in bodies of stagnant water and implementing extensive vaccinations. As an aside, it was Dr. Walter Reed, who gave us the procedure consent form.  When he was doing his experiments with yellow fever vaccinations in Cuba, he had the troops sign a paper that indicated there could be ill effects from what he was doing to them.

From 1889 to 1890, it was the Russian Flu that took 1 million people—followed by the Spanish Flu from 1918-1919, courtesy of the H1N1 swine flu, with 50 to 100 million deaths, the second worst pandemic. Later the 1957 H2N2 virus with 1.1 million people.  And then the Hong Kong Flu in 1968-1970 H3N2 virus took another 1,000,000. 

HIV Aids started in Africa, probably another zoonosis, a disease derived from animals. This one was transmitted from chimpanzees and began in 1981.  I remember listening to a lecture that mentioned this strange new disease that affected Haitians, Homosexuals, and Hemophiliacs.  It was something I thought would never have much to do with my career.  How wrong I was! It changed my entire approach to the surgical patient.  It has killed nearly 35 million people, including a physician acquaintance. I had an injury caring for a dying HIV  patient.  The ID doctor that cared for me, suggested I immediately cut off the finger where the injury occurred.  I didn’t follow his advice but did spend the next few anxious months checking my blood tests frequently. The newer antiviral drugs have finally made a dent in this disease, but HIV remains a formidable enemy. 

The more recent epidemics are far less lethal.  The 2009-2010 Swine Flu, another H1N1 virus, was only 200,000 deaths, SARS a mere 770, and MERS 850.  Ebola was more challenging to control and killed 11,000 people. It was named after a river, the Ebola River, which means “Black River,” sufficiently ominous-sounding, for a virus that looks like a worm under an electron microscope and has no known cure, with a mortality rate of 50 to 90%.

Our latest, now declared a pandemic, bat derived, Covid-19 has killed 11,921 as of 3/21/2020   8:43 AM EST. We have brought back an old response to epidemics, the quarantine. The process of isolating sick people was mentioned in Leviticus, and used in the Middle Ages to contain Leprosy.  In 1448 the Venetian bureaucracy imposed a 40 day waiting period before allowing ships to dock, to be sure no one on board had the plague.  The word “Quarantena” means “40 days” in the 15th-century Venetian language. 

There is good news, though.  Several drugs have shown some activity against the virus, including an old anti-malarial medicine, chloroquine. Several antiviral drugs are beneficial, and also serum from recovered Covid-19 patients contains antibodies that seem to help in very sick victims.  Based on that news, the market gained just 300 points, and then quickly plummeted by 900 points; so Wallstreet is not yet all that convinced.