As of April 30, 2020, the novel coronavirus (SARS-CoV-2) had produced confirmed infections in more than 3,200,000 people and killed more than 231,000 around the world. In the US alone, the virus had infected more than 1 million and killed approximately 60,000.
On March 11, the World Health Organization officially designated the disease a pandemic. Since then, it has continued to sweep through country after country, upending daily life for most people as they have endured quarantines and lockdowns. The news is filled with heart-rending footage of ordinary people caught up in grief for loved ones and a fear of what will happen next.
This novel coronavirus is one of a family of respiratory viruses that includes the even more contagious and deadly SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) viruses, as well as the common cold and flu viruses.
The formal name SARS-CoV-2 refers to the virus itself, and COVID-19 (with the numerical designation referring to its detection in 2019) to the illness it causes. Symptoms and outcomes can range from mild or non-existent, to a bad flu-like illness, to pneumonia, organ failure, and death. Older adults and people with certain chronic conditions are particularly susceptible to the disease’s more severe effects.
But pandemics are nothing new to humanity, only to our current generation.
The “Spanish flu” of 1918-20
Even as new information about SARS-CoV-2 rolled over news feeds in early 2020, experts brought up the “Spanish influenza” of 1918 as a comparable lesson in history and epidemiology.
The first known cases of the 1918 flu emerged at the military base at Fort Riley, Kansas, and in nearby Haskell County. Soldiers and members of the general public began presenting with severe, flu-like symptoms. Inside of a week, hundreds of soldiers were in the hospital. In an eerie echo of present-day federal government inaction, no one at a higher level was sent to look into the matter after a local physician sent documentation to the Public Health Service.
The illness seemed to resolve itself in this population, but after those soldiers were shipped to fight in Europe in the waning days of World War I, they took it with them. The flu jumped into civilian European populations, mutated, and soon sickened and killed people around the world, even as far as the Arctic Ocean.
The 1918 flu—an H1N1 strain likely of avian origin—spread unusually rapidly from person to person. And, in contrast with today’s COVID-19, it largely affected healthy adults of prime working age, between 20 and 40 years old.
According to historians, the name “Spanish flu” only took hold because Spain was the only country at the time whose news censorship was loose enough to allow accurate reporting to emerge.
By late summer and early fall, the virus had infected and killed people in Massachusetts, Texas, and California, and spread to at least two dozen countries. Local and national governments issued stay-at-home orders to stem the spread, with individual cities subjected to lockdowns and citizens required or encouraged to wear masks in public.
The record specifically points to the United States as a leader in universal mask-wearing. Numerous historical photographs show Red Cross volunteers and everyday citizens on the streets wearing masks over the two years of the disease’s spread.
By the time health officials deemed that it had dissipated in late 1920 after several deadly waves, the 1918 flu had killed an estimated 16 million to 30 million people around the world. Some 675,000 people succumbed to it in the United States alone, a death toll more than double the number of American soldiers lost in World War I.
The plague of 1346-53
Europe’s “Black Death,” presenting as either pneumonic or bubonic plague, by many estimates killed about 50 million people between 1346 and 1353. That’s about two-thirds of the continent’s population. Believed to have been carried by fleas on rats and brought to Europe through trading vessels in Italian ports, the plague sowed widespread terror and civil unrest. Chronicles of the time provide harrowing descriptions of mass graves and shattering laments of loved ones lost.
One effective means of prevention emerged, with Italian cities ordering newly arrived sailors into 40-day isolation (“quarantino”). Scholars believe that the social upheavals in the plague’s wake were partially responsible for the break-up of the feudal system and the rise of modern nation-states.
It was only in the late 19th century that a researcher discovered the microbe that caused the medieval plague: Yersinia pestis. It is typically spread when infected rat fleas bite a human being or through inhalation of respiratory droplets or contact with body fluids of an infected person. The bacterium continues to circulate among wild rodent populations, although modern scientific and public health measures keep it at bay from most people in the developed world today. Early detection and antibiotic treatment can save the lives of most people who become infected.
The centuries-long scourge of smallpox
While the ultimate origin of smallpox remains unknown, the disease is at least thousands of years old. It is likely that, like the majority of other known pandemic agents, it is zoonotic, meaning that it jumped species after close human contact with animals. Caused by the variola virus, it is easily spread from person to person and is characterized by fever and a rash and pustules that spread progressively over the body.
Over the build-out of civilizations in the ancient, medieval, and modern worlds, smallpox spread along trade routes and other points of contact, bringing devastating consequences to people at every level of society. About 30 percent of all those infected died, and survivors were often left with life-long disfiguring scars.
In the 17th century, European colonists introduced the disease into the Americas. Since indigenous peoples had not built up immunity, it quickly spread and resulted in the deaths of as much as 95 percent of the original inhabitants of North and South America within a few generations.
But thanks to Edward Jenner’s 1796 vaccine and a concerted effort over succeeding generations, humanity was able to lessen the threat of smallpox. The World Health Organization declared the disease eradicated in 1980.
Although the types of disease involved in the numerous plagues and pandemics that have afflicted humankind differ, history continues to show us that solutions involve strong, widespread, and early preparedness and response on the part of governments and the public, coupled with a robust program to develop treatments and vaccines.