Pandemics in America
When I was a boy growing up in Indiana, we played cowboys and Indians in the lawns around our neighborhood. On most days, those who were selected to be cowboys would wrap a bandana around their faces (like all good cowboys did to keep the dust out) and chase after those who were Indians for that day. If I was a cowboy, I always wanted to keep my bandana in place after the game ended but my mother said when I left the yard, I had to take it off. Fast forward 60-some years.
Things have turned upside down now that we are sheltered at home due to the corona virus pandemic. As a result, I spend most of my time in my own yard puttering around (adult playtime). Unlike my childhood days, my wife says if I leave our yard, I must be sure to put my mask ON in case I encounter a friend.
Our government leaders have enacted extraordinary rules about social interchange in response to the pandemic caused by the corona virus. The resulting disease is known as Covid 19, (19 to indicate the year the disease was first encountered). The disease is caused by the novel (a new virus) in the family of corona viruses. [Who decided to name it after a famous beer?] The deadly outbreak of this disease is easily the largest thing that has happened in my lifetime, eclipsing the horrors of both World War II, and Viet Nam in its ferocity of killing Americans. Monday’s news indicated that it was the deadliest day yet with the virus killing more than 3,000 Americans on one day. Twenty of our states have reported increases in the number of Covid 19 cases being reported with Michigan 3rd in the nation by reporting 4,000 new cases. In the same news, it was reported that most states are now ‘reopening’ their businesses despite recommendations from health officials that it is unwise.
How can it be that the calls to open our economy are occurring coincident with reaching new records in the number of deaths from this pandemic?
The passions concerning our economy are growing: In Michigan, armed men and women protested and entered the state house with swastikas, nooses, and military gear, demanding that the state re-open despite the certainty that more disease and more deaths will result. Several men among the protestors carried high-powered military guns and were dressed in make-believe military clothes, although there was not an honest-to-God military man among them. They reminded me of my boyhood playmates dressed in cowboy gear, strutting about for the cameras. “They are good people,” according to a government leader.
What are these people thinking?
The corona virus has taken over our nation and affected every American. Our President says that the rapid spread of the pandemic occurred in America because no one could see it coming. Such a poor excuse. The truth is that pandemics have occurred regularly in our history, both in the recent past and in the previous centuries and everyone involved in medicine and health knows this history with the apparent exception of those men and women appointed to high office by Donald Trump. Here is a thumb nail sketch of our history of pandemics that I discovered in a single afternoon.
EBOLA (1976 in Africa, 2014 in America)
The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976 in South Sudan near the Ebola River, and was caused by the Sudan virus (SUDV). The initial Sudan outbreak infected 284 people and killed 151. Since this outbreak, the virus has reappeared dozens of times in many countries, but primarily in Africa. The US has had only a few dozens of cases - primarily in 2014. The origin of the disease in America came from medical personnel who worked to help Ebola victims in Africa. Although the disease can be lethal, treatment for victims in America has been largely successful and the disease did not spread here because of successful mitigation efforts undertaken by former President Barack Obama.
Photo by Pablo Martinez Monsivais/AP
Nina Pham is hugged by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, as she leaves the NIH hospital in Bethesda. Pham was diagnosed with Ebola on Oct. 12. Another Dallas nurse, Amber Vinson, was treated at Emory University Hospital, and physicians reported Ebola is no longer in her blood.
SARS (2002)
SARS, which stands for severe acute respiratory syndrome, is caused by the SARS coronavirus. It first infected people in late 2002 in China, and within weeks spread to 37 countries including the US. The virus infected 8,000 people, killing about 800. SARS, a corona virus that caused pneumonia was ultimately defeated by health officials around the world including US medical experts who were instrumental in combating this disease.
HIV/AIDS (1980’s)
The HIV virus infected 60 million people and caused an estimated 30 million deaths around the world. This virus was transmitted from one person to another primarily through sexual activity. This virus is still active in many parts of the world but it is less severe than earlier because of successful treatments with a cocktail of medications that were developed in response to the pandemic.
SMALLPOX (discovered on Egyptian mummies from the 3rd century AD)
Before smallpox was eradicated, it was a serious infectious disease caused by the variola virus. It was contagious by person to person contact and by handling blankets and clothing worn by those who had the disease. People who had smallpox had a fever and a distinctive, progressive skin rash. Most people with smallpox recovered, but about 3 out of every 10 people with the disease died. Smallpox came to America with Europeans who immigrated here. American Indians were highly susceptible to this disease as they had no immunity and it was rapidly transmitted throughout their nations causing death to all who were exposed but for a fortunate few.
The smallpox (variola virus), no longer exists in nature thanks to the success of vaccinations. No cases of naturally occurring smallpox have happened since 1977 with the last natural outbreak of smallpox in the United States in 1949.
SPANISH FLU (1918)
The influenza pandemic of 1918-1919 killed more people than those who died in World War I, somewhere between 20 and 40 million people. (Some estimates for the number of deaths from this outbreak are as high as 50 million.) It has been cited as the most devastating pandemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death/Bubonic Plague( see below). In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years.An estimated 675,000 Americans died of influenza during the pandemic. The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. In 1918 American children skipped rope to the rhyme:
I had a little bird,
Its name was Enza.
I opened the window,
And in-flu-enza.
Its name was Enza.
I opened the window,
And in-flu-enza.
This so-called Spanish Flu devasted all of America with the disease occurring everywhere in the US. Michigan was severely affected. Almost 15,000 Michigan residents died of flu or pneumonia between October 1918 and April 1919, and the age group with the highest mortality rate were young adults age 20 to 25.
People wearing cloth masks to protect themselves during this pandemic
During the 1918 flu pandemic, people wore masks but they provided limited protection against the virus. (Contributed by the Office of the Public Health Service Historian)
The uptick in April 1918 represents the first, less lethal, wave of the influenza pandemic. The second wave, in which the flu virus had morphed into a much more deadly strain, struck Michigan in late September and deaths skyrocketed in October. By mid-October, the governor and state health department ordered the closing of churches and "places of public amusement," from movie theaters to saloons. Many communities also closed schools. After those establishments were re-opened in November, deaths went up in December.” (Source: 1918-19 annual report from Michigan Commissioner of Health)
Another factor contributing to the rising death toll in December was how the disease spread in Michigan. The pandemic hit Michigan's urban centers first and the hardest. About three-quarters of all the deaths occurred in the southern third of the Lower Peninsula, and October was easily the worst month. In all, Michigan had four influenza outbreaks. The last large community outbreak occurred in 1920, more than two years after the initial introduction of the disease.
The central and northern Lower Peninsula and the Upper Peninsula -- including cities such as Grand Rapids and Saginaw -- were generally hit later, and the death toll in those counties peaked in November, December or even January 1919. Roscommon County with its 1918 population of 2998 souls saw a doubling of its death rate from 5.5 deaths per thousand residents in 1917 to 10.3 deaths per thousand in 1918.
BUBONIC PLAGUE OR BLACK DEATH (1347-1351)
Many nation states during the middle ages suffered through a contagious infection whose source was little understood and for which there were no known remedies. The infection was discovered not to result from a virus, but rather a bacterium. The pandemic spread rapidly through Asia, Europe, and Africa and killed an estimated 50 million people, perhaps one third of the entire population of Europe. The rate of death among untreated sufferers was 30 to 90 %. That the disease was known as the single most devastating tragedy the world had known accounts for the many tributes to its passing that are showcased in numerous town centers throughout Europe. Some of the large statues in town centers depict the suffering of hordes of people who were the ancestry of those towns and villages scattered throughout the urban areas.
The typical spread of the disease was from rats to fleas to people caused by the bacterium that became known as Yersinia pestis. The bacterium was spread in part by distribution of rats that accompanied trade from one nation to another including that which occurred as part of the ocean transport of goods with rats secreted amidst the bags and trunks used in international trade. The malady took its name from the blackening of victim’s skin as gangrene set in on parts of the body before death relieved the sufferer’s pain.
PLAGUE OF JUSTINIAN (541)
Another malady that occurred much earlier was the Plague of Justinian, a pandemic that originated during Roman times that was initially connected with capital city of Constantinople. This disease was initially recognized in 541 AD, with major recurrences until 750 AD. The disease is now easily cured by treatment with a variety of standard antibiotics. A vaccine for this malady has never been discovered, hence periodic breakouts have occurred in various locales until modern medicine is applied to interrupt the chain of transmission. It has been learned that The bacterium causing Black Death was the same that caused the Plague of Justinian and it continues to exist in nature today. Several cases of this plague have continued throughout the centuries with a recent outbreak in China in 2019 where four cases were recently confirmed.
So, what are we to learn from all these pandemics that have wreaked havoc on the world from the earliest times of human existence? I believe there are conclusions to be reached that are applicable to our current concerns with the novel corona virus and Covid 19.
1. Based on our past, serious health problems affecting large percentages of humans are inevitable; periodic outbreaks of diseases that defy available medications must be expected with regularity. Societies with rational leaders should be prepared for such emergencies.
2. Covid 19 will have recurrences over the next several months and perhaps years. It will not magically disappear without medical intervention that is not now available despite the happy talk of political leaders who are interested only in their personal well-being.
3. The only cure for the corona virus pandemic will be based on science and medical intervention. Until a treatment is available that cures the disease, and a vaccine becomes available that prevents its transmission, the disease will continue. The virus has no respect for a lack of economic activity or a surplus of same, only a citizenry dedicated to the defeat of the disease will win the battle.
Stay Safe, Bill
