Dr. Arpan K Banerjee is the co-author of The History of Radiology. In this article, he describes a brief history of pandemics, from an outbreak of plague in Ancient Greece to the present-day worldwide spread of Covid-19.
We are currently in the midst of a pandemic caused by the COVID-19 virus (a coronavirus) and although much havoc is being caused to human health worldwide as well as to global economies it is important to remember that pandemics are not new and have been a part of life for centuries.
In ancient Greece, 5th century BCE, an outbreak of plague decimated the flourishing Greek civilisation in Athens which was then under the rule of Pericles: a brilliant statesman who encouraged the arts, championed democracy and had the Parthenon built on the Acropolis to celebrate the glory of his reign.
From the 14th century onwards and extending into the 16th and 17th centuries plague transmitted by rat borne fleas devastated almost a third of the population of Europe. This was the second plague pandemic. The outbreak in the 14th century was known colloquially as ‘the Black death’ and described by writers such as Chaucer in Britain and the Italian writer Bocaccio in his Decameron (which was made into a film by the Italian director Pasolini in 1971). Symptoms included fevers, malaise, and headaches. The bubonic form resulted in swelling of the lymph nodes whereas the pneumonic form caused respiratory symptoms. The outbreak in London in 1665 when around 70,000 people died in a population of less than half a million was well chronicled by the writer Samuel Pepys. European cities were also regularly affected by recurring plague outbreaks throughout the 17th century.
Today, although there have been no recent pandemics of plague, it is important to remember that outbreaks do occur from time to time and the disease is still endemic in several countries.
The third plague pandemic started in China in 1855 and spread to India. Today, although there have been no recent pandemics of plague, it is important to remember that outbreaks do occur from time to time and the disease is still endemic in several countries. In 1894 the cause of plague was found to be the bacterium Yersinia pestis (named after the discoverer Dr Yersin who was working at the Pasteur Institute) and thankfully today we have antibiotic treatments and also a vaccine against this disease.
More recently, in the 20th century, the 1918–20 Spanish flu pandemic, which came in two waves, infected an estimated 500 million people worldwide and caused up to 50 million deaths. It was highly infective with airborne transmission and the majority of deaths were due to a secondary bacterial infection in the lungs. The pandemic was caused by the H1N1 influenza virus which was incidentally also the cause of the swine flu pandemic almost a century later. One of the unusual complications included sleeping sickness or encephalitis lethargica (Von Economo’s disease). This was the subject of the late neurologist and writer Oliver Sacks’ 1973 book ‘Awakenings’ later made into a feature film in 1990 starring Robert de Niro and Robin Williams.
1957–1958 saw the Asian flu pandemic which originated in China and infected an estimated 500 million people with up to 4 million deaths. Another outbreak of flu was seen a decade later in 1968 originating in Hong Kong with similar numbers effected as during the 1957 outbreak. Again the figures are thought to be estimates.
In 2003 a SARS (severe acute respiratory syndrome) outbreak occurred in China and Hong Kong which was also caused by a type of coronavirus. The civet cats were the intermediaries who passed the SARS virus from bats to humans. The disease spread throughout China, to Singapore, the USA and Canada, but was relatively confined with less than 10,000 cases. Symptoms included fevers and a cough and non-specific flu like symptoms, much like the current COVID-19 outbreak. To date no vaccine has been produced in order to treat SARS.
The smaller epidemic of MERS (Middle Eastern Respiratory Syndrome), with non-specific symptoms of a high temperature and cough, similar to SARS, originated in Saudi Arabia in 2012 and spread throughout the Middle East and beyond including the UK and USA.
In a year’s time we will perhaps be looking back on this pandemic and the human and economic devastation it caused, but you can rest assured that in all likelihood there will be another pandemic in the foreseeable future.
More recently, in 2009 the world saw the swine flu pandemic with up to a 1 billion people infected and half a million deaths globally, though these figures are still estimates as it was not possible to serological test everyone. The causative agent was the H1N1 influenza virus, which was also the cause of Spanish Flu (1918–20) detailed earlier.
And so a decade later, we find ourselves in the middle of the COVID-19 pandemic, with cases of coronavirus first recorded in the city of Wuhan, capital of Hubei Province, China in December 2019 and subsequently spreading throughout the globe with accompanying lockdowns for containment, and political and economic implications.
In a year’s time we will perhaps be looking back on this pandemic and the human and economic devastation it caused, but you can rest assured that in all likelihood there will be another pandemic in the foreseeable future. MERS for example has been identified by WHO as a disease that could cause a potential global outbreak. Vital lessons will need to be learnt from all these outbreaks, with improvements required in general hygiene standards worldwide and prompt reporting of epidemics as they occur to central organisations such as WHO so that information can be shared between nations and potential epidemics and pandemics can hopefully be contained.
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R E McEwen, J E Scriven, C A Green, M S Bailey, and A K Banerjee Chest radiography findings in adults with pandemic H1N1 2009 influenza Br J Radiol 2010 83: 499–504
Dr. Arpan K. Banerjee qualified in medicine at St Thomas’s Hospital Medical School in London, UK and trained in Radiology at Westminster Hospital and Guys and St Thomas’s Hospital and worked as a consultant radiologist in Birmingham. From 2012–2017 he was Chairman of the British Society for the History of Radiology of which he is a founder member and current council member and trustee. From 2012–2016 he was on the scientific programme committee of the Royal College of Radiologists, London. He is Treasurer of the International Society of the History of Radiology (ISHRAD) and adviser to Radiopaedia. He is the author/co-author of seven books including The History of Radiology, 2013 (OUP). His research interests included imaging aspects of infectious diseases.