What Is A Pandemic?

The term pandemic has its origin in the Greek word "pandemos", which when translated to English, denotes "pertaining to all people". Separately speaking "pan" in Greek means "all", while the Greek word demos denotes "people". Therefore, when we use the term pandemic, we actually mean the spread of a disease affecting a large section of the global population. This usually occurs with the emergence of a new virus  among humans. The new virus not only results in grave ailment, but also spreads from one person to another (human transmissible) easily.

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In simple words, a pandemic covers a vast geographical region, usually across the globe. In fact, a pandemic affects much more people compared to an epidemic. An epidemic may be confined to a particular city, area or a country. On the other hand, a pandemic covers a greater region, crossing national borders.

An infectious disease reaches epidemic proportions when it affects many more people in any region or a country than what is usually expected. In other words, an epidemic occurs when a disease spreads quickly affecting a vast populace. On the other hand, when a contagious disease affects people in numerous countries simultaneously, it is said to assume pandemic proportions.

Usually, a new virus strain or a virus sub-type is responsible for a pandemic. It is a novel virus against which humans do not have any immunity or, even if they have, the level of immunity is negligible. When there is no immunity or the immunity is very poor, it is likely that the virus will rapidly spread across the globe, especially it transmits easily from one human to another.

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The seasonal outbreak of influenza is considered to be an epidemic because the virus subtype responsible for this condition is circulating among people from before. On the other hand, pandemics are usually caused by new virus subtypes which have never circulated among people earlier and, hence, they are not immunized against it. In addition, as in the case of influenza, pandemics may also be caused by viruses or virus subtypes, which are not in circulation among people for a prolonged period.

Compared to epidemics, many more people are affected by pandemics and even the casualties are much higher. In addition, pandemics are responsible for greater economic losses, social disruptions and general hardships than those caused by epidemics.

The six stages of a pandemic

The influenza program of the World Health Organization (WHO) has been categorized in six different stages:

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Stage 1
The first stage of the program states the condition when there are no reports of influenza virus already circulating in animals infecting humans.
Stage 2
In this stage, animal influenza virus found in wild or domesticated animals is reported to have infected humans. Such a situation is considered to be a potential threat of a pandemic.
Stage 3
This stage involves cases wherein animal or animal-human influenza reassortant virus has been found to be responsible for intermittent cases of disease or causing disease in small groups of people, but has not led to transmission of the disease from one person to another. However, this situation is considered to enough to result in community-level outbreaks of the disease.
Stage 4
This is the stage wherein it has been verified that human-to-human spread of a human-animal or animal influenza reassortant virus has the potential of a community-level outbreak.
Stage 5
This is the stage when a human-animal or animal influenza reassortant virus has already resulted in community-level outbreak of the disease in at least two or more countries in any particular WHO region.
Stage 6
This is the last stage wherein aside from the criteria mentioned in Stage 6, the above virus has led to community-level outbreaks of the disease in at least another country in a different WHO region.
Lost peak period
This refers to the various levels of pandemic outbreak of influenza in nearly all countries where the disease has plummeted from its peak levels owing to sufficient surveillance.
Post pandemic period
This refers to the stages of influenza activity, which have gone back to the levels usually witnessed for seasonal influenza in majority of the countries where there is sufficient surveillance.

Pandemics and noteworthy epidemics through history

Over the centuries, people have witnessed several major pandemics, which killed millions of humans across the globe. Especially zoonoses like influenza and tuberculosis, which was introduced following the domestication of animals, affected several millions. Human history has recorded several major epidemic outbreaks, which not only killed millions of people, but destroyed many cities over the centuries. Some of them are discussed briefly below.

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Athens Plague, 430 BC.
It is assumed that about a fourth of the Athenian troops and 25 percent of Athens' population succumbed to a typhoid fever over a period of four years. Aside from devastating the economy, this killer disease weakened Athens' dominance fatally. However, the extreme pathogenicity of the disease prevented its spread to newer regions. In other words, the disease killed its host at such a fast pace that it could not spread to new areas and other people. Interestingly enough, for several years no one was sure about the precise reason behind the plague. Very recently, scientists from the University of Athens examined the teeth they picked up from a mass grave beneath the historical city in 2006. Following their analysis, the researchers attributed the typhoid fever to bacteria.
Antonine Plague (165-180 AD).
Perhaps smallpox carried by soldiers returning home to the Italian peninsula from the Near East is responsible for the Antonine Plague. About a fourth of all the infected people, according to rough estimates as many as five million people, were killed by the disease. As many as 5,000 people were said to have died in Rome every day during the peak of the second outbreak of the disease known as the Plague of Cyprian (251-266), which is assumed to be the same disease.
Plague of Justinian (541-750).
This was the first ever recorded bubonic plague outbreak. The disease first started in Egypt and subsequently spread to Constantinople in the next spring. If the Byzantine chronicler Procopius is to be believed, at its peak the disease killed a whopping 10,000 people every day. In fact, it is estimated that the plague wiped out about 40 percent of the city's population.
Black Death (1347 - 1453).
This outbreak assumed pandemic proportions killing an estimated 75 million people across the globe. Worse still, the plaque revisited Europe about 800 years following its last outbreak. The disease first started in Asia and subsequently spread to the Mediterranean region and the western regions of Europe sometime in 1348. It is assumed that the disease was carried by Italian merchants who fleeing combat in Crimea. It is estimated that as many as 20 million to 30 million people succumbed to the plaque in just six years in Europe. This is about one-third of the continent's population at that time and almost 50 percent of the population in the urban areas worst affected by the disease. In fact, Black Death was the first plaque of a cycle of epidemics that struck Europe and lasted till the 18th century. During this period, people in Europe suffered over 100 plaque epidemics. In reality, this disease returned to Europe at intervals of two to five years between 1361 and 1480.

As many as 10 million people succumbed to the third plaque pandemic, which began in China in 1855 and subsequently reached India. The United States also suffered its first outbreak during this pandemic when the plaque afflicted residents of San Francisco between 1900 and 1904. Even today, isolated incidences of plague are reported from various western regions of the United States.

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Cholera

Cholera has claimed millions of human lives since its first pandemic outbreak in the 19th century.

First cholera pandemic (1816 - 1826)
In its initial stages, the first cholera pandemic was confined to the Indian subcontinent. This disease triggered in Bengal and by 1820 it subsequently spread all over India. Over 10,000 British soldiers and numerous Indians succumbed to this cholera pandemic. Gradually, the disease spread to distant areas including China, Japan and even the region around the Caspian Sea before it retreated. In Indonesia, over 100,000 people died due to the pandemic only in the Java Island. It is estimated that more than 15 million people died in India during this cholera pandemic between 1817 and 1860. An additional 23 million people died from 1865 to 1917. Deaths in Russia due to cholera pandemic surpassed 2 million during the same period.
Second cholera pandemic (1829 - 1851)
The second cholera pandemic afflicted several millions in Europe and the United States. The disease first struck Russia and Hungary, where it claimed an estimated 100,000 lives. The pandemic reached Germany in 1831 and London a year later. Over 55,000 people were killed in the United Kingdom alone. In 1832, the pandemic spread to France, Ontario in Canada and New York in the United States. By 1834, it spread to the Pacific Coast of North America. After sometime, England and Wales witnessed a two-year cholera outbreak in 1848. An estimated 52,000 people in the region lost their lives during this period. At the same time, it is thought that more than 150,000 people in America succumbed to cholera between 1832 and 1849.
Third cholera pandemic (1852 - 1860)
When the cholera pandemic occurred for the third time, it mainly afflicted people in Russia, which witnessed more than a million deaths due to the disease. The disease soon spread all over Spain claiming over 236,000 lives between the period 1854 and 1855. At the same time, a whopping 200,000 people were killed by cholera in Mexico.
Fourth cholera pandemic (1863 - 1875)
This time, most parts of Africa and Europe were affected by the cholera pandemic. Of the 90,000 pilgrims visiting Mecca, 30,000 were killed by the disease. North America also witnessed an outbreak of the disease in 1866, when an estimated 50,000 Americans lost their lives.
Fifth cholera pandemic (1881 - 1896)
The fifth cholera pandemic devastated Europe and the two Americas. It killed 250,000 people in Europe, while claiming a minimum of 50,000 lives in the Americas between 1883 and 1887. A few years later, the disease polluted the water supply in Hamburg in 1892 claiming 8,606 lives.
Sixth cholera pandemic (1899 - 1923)
When cholera broke out in a pandemic form for the sixth time, it did not have much impact on Europe, mainly because of advances made in the field of public health. However, it again devastated Russia.
Seventh cholera pandemic (1962 - 66)
The seventh cholera pandemic started in Indonesia and was dubbed El Tor, based on the name of the strain. In 1963, the pandemic spread to Bangladesh. Later, it reached India in 1964 and, in 1966, it again spread to the USSR.

Influenza

The World Health Organization (WHO) has several phases of influenza pandemic alerts.

Influenza was explained for the first time in 412 BC by Hippocrates, the renowned Greek physician who is often referred to as the "Father of Medicine".

The first ever influenza pandemic was reported in 1580. Since then there has been influenza pandemics once in every 10 years to 30 years.

The "Russian Flu" (1889 - 1890)
This influenza pandemic is also referred to as the Russian Flu. It was reported for the first time in Bukhara, Uzbekistan, in May 1889. By the time it was October, the disease spread to the Caucasus and Tomsk. The pandemic spread very rapidly westwards and inflicted North America by December 1889. Subsequently, the disease reached South America between February and April 1890. It rapidly spread to India by February - March in the same year and in March - April 1890, the pandemic reached Australia. Scientists suspect that the pandemic was a result of infections caused by H2N2 and H3N8 subtypes of the influenza A virus. Although the precise casualty figures are not available, there is no doubt that the pandemic was very severe and even the mortality rate was extremely high, resulting to an estimated one million deaths.
The "Spanish Flu" (1918 - 1919)
The "Spanish Flu" was reported for the first time at the United States troops training camp located at Camp Funston, Kansas, in March 1918. Very soon, the flu developed into a worldwide pandemic spreading to all the continents by October 1918. Ultimately, the disease inflicted about a third of the planet's population, about 500 million people! Though the pandemic was exceptionally deadly and dangerous, it receded almost as quickly as it started. The disease disappeared from the places it spread to within just 18 months. Very recently, scientists at the Centers for Disease Control and Prevention (CDC) reconstructed the virus. Currently, they are studying the remains of the virus that have been conserved by the Alaskan permafrost. In fact, the structure of the H1N1 virus is small, but is somewhat akin to that of the Spanish Flu.
The "Asian Flu" (1957 - 58)
This influenza pandemic is attributed to H2N2 virus and it claimed an estimated 70,000 lives in the United States alone. The disease first started in China towards the end of February 1957 and, hence, it is also referred to as the "Asian flu". By June 1957, the disease reached the United States. About 2 million people succumbed to the pandemic worldwide.
The "Hong Kong Flu" (1968 - 1969)
Caused by an H3N2 virus, this pandemic claimed an estimated 34,000 lives in the United States alone. Since the virus was identified for the first time in Hong Kong towards the beginning of 1968, it is often referred to as the "Hong Kong Flu". By the end of the same year, the disease reached the United States. This pandemic continued for two years (1968 - 1969) and claimed an estimated one million lives throughout the world. It is worth mentioning that Influenza A virus (also known as H3N2) continues to circulate in several regions of the world to this day.

Typhus

Often referred to as "camp fever", typhus emerged during the Crusades and in 1489 its first impact was felt in Spain, the first time in Europe. This disease is called "camp fever" because its outbreaks mostly occurred during strife. In addition, typhus is also referred to as "ship fever" and "gaol fever" as it spread wildly in the overcrowded quarters, for instance ships and jails. While only 3,000 Spanish people died in battles between the Muslims and Christian Spaniards in Granada, typhus claimed about 20,000 lives. Typhus is also said to be the reason behind the French losing 18,000 soldiers in 1528. As a result, France also lost its supremacy to the Spanish in Italy. In 1542, over 30,000 soldiers succumbed to typhus when they were fighting in the Balkans against the Ottomans.

An estimated 8 million Germans succumbed to typhus and bubonic plague throughout the Thirty Years' War, which lasted from 1618 to 1648. Moreover, in 1812, typhus was also responsible for devastating Napoleon's Grande Armée in Russia. On June 25, 1812, 450,000 French soldiers set out to conquer Russia crossing the Neman, but less than 40,000 could return home. Many more soldiers succumbed to typhus between 1500 and 1914 than those killed in fighting. Aside from this, more French troops succumbed to typhus compared to the personnel killed by the Russian soldiers when the former were retreating from Moscow. Towards the beginning of 1813, Napoleon replaced his losses in Russia by raising a new army of half a million troops. Another 219,000 men from Napoleon's army succumbed to typhus during their various campaigns that year. Typhus is also said to be largely responsible for the Irish Potato Famine. In addition, more than 150,000 people died due to typhus epidemics in Serbia during the World War I.

Smallpox

An extremely infectious disease, smallpox is attributed to the variola virus. Towards the end of the 18th century, this killer disease claimed about 400,000 lives in Europe every year. According to rough estimates, smallpox killed anything between 300 million and 400 million people as recently as the 20th century. More recently, in the beginning of the 1950s, there were an estimated 50 million incidences of smallpox throughout the world each year. This led to widespread vaccination campaigns during the 19th and 20th centuries across the world. The success of these campaigns led the World Health Organization (WHO) to certify in December 1979 that smallpox has been eradicated from the planet. As of now, smallpox is the sole human contagious disease that has been eradicated completely. In fact, this is one of the two contagious viruses that have been successfully wiped out from the face of the globe.

Measles

In the olden days, measles was widespread all over the world since this is an extremely infectious disease. The National Immunization Program reports that 90 percent people are infected by this disease by the time they are 15 years old. Prior to the introduction of the measles vaccination in 1963, an estimated 3 million to 4 million people were infected by this disease every year in the United States alone. During the last 150 years, about 200 million people succumbed to measles across the globe. It is shocking to note that in 2000 itself, measles claimed about 777,000 lives worldwide.

Measles is considered to be an endemic disease. In other words, this disease has always existed in a community and over the years numerous people have developed resistance against it. However, in places where people are yet to be exposed to this disease, it may be devastating when they are exposed to a new disease. In fact, a measles outbreak in Cuba in 1529 wiped out about two thirds of the native population, though they have successfully endured a smallpox outbreak earlier. Aside from Cuba, measles has also devastated Central America, Mexico and the Inca civilization at different times.

Tuberculosis

It may seem to be incredible, but about a third of the world's population is currently infected with the bacteria called Mycobacterium tuberculosis. The rate of infection too is also alarming - one person every second. What is even worse is that about 5 to 10 percent of all such latent infections eventually develop into active tuberculosis (TB). If the disease is not treated or treated timely, it may result in the death of 50 percent victims. According to available records, an estimated 25 percent of the population in Europe was succumbed to tuberculosis during the 19th century. In fact, one in every six persons died in France due to tuberculosis by the year 1918. In the 20th century, a whopping 100 million people succumbed to tuberculosis. Even today, tuberculosis is a major health issue worldwide, especially in the developing nations.

Leprosy

Also known as Hansen's or Wopat's disease, leprosy is attributed to a bacillus called Mycobacterium leprae. Leprosy is a chronic health condition that has an incubation period of a maximum of five years. The good news is that more than 15 million leprosy patients worldwide have been cured since 1985.

From the historic point of view, people have been afflicted by this disease since way back in 600 BC. However, leprosy outbreaks were first seen in the western regions of Europe sometime around 1000 AD. During the Middle Ages, many leprosy hospitals called leprosaria came into existence. According to Matthew Paris, a Benedictine monk and English chronicler, there were about 19,000 leprosy hospitals all over Europe during the beginning of the 13th century.

Malaria

Malaria (Plasmodium falciparum) is prevalent in the tropical as well as sub-tropical regions of the world, which includes several parts of Africa, Asia and the two Americas. Every year, about 350 to 500 million cases of malaria are reported from across the globe. Treatment of malaria has become difficult during the 21st century owing to drug resistance. In fact, malaria has become resistant to all types of anti-malarial medications, save for artemisinins.

There was a time when malaria was widespread in most of the regions of Europe as well as North America. However, currently this disease is non-existent in these regions. It is assumed that malaria may have been responsible for the downfall of the mighty Roman Empire. This is perhaps the reason why malaria was also called "Roman fever". In fact, Plasmodium falciparum or malaria had turned out to be a real menace for colonists as well as the indigenous people, when the disease reached the Americas via slave trade. For instance, malaria was responsible for the devastation of Jamestown colony and the disease continued to ravage the Midwest and South regularly. Malaria had arrived in the Pacific Northwest by 1830. More than 1.2 million soldiers on both sides of the American Civil War were affected by malaria. Millions of people were afflicted by malaria in the southern United States and this continued until 1930s.

Yellow Fever

Yellow fever (also referred to as yellow jack) has been responsible for numerous ravaging epidemics. In fact, yellow fever epidemics have devastated several cities in the north, including Boston, Philadelphia and New York. A major, perhaps the largest in America's history, yellow fever epidemic appeared in the United Sates in 1793 claiming about 5,000 people just in Philadelphia, roughly 10 percent of the region's population then. The devastation was so severe that nearly 50 percent of the residents of the region, including President George Washington, had fled the region. During the days of colonization, the devastation caused by malaria and yellow fever led to West Africa being referred to as "the white man's grave".

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