Covid-19 Outbreak: Are we in the cusp of another pandemic?
By Ahmed Manjang:
COVID-19, which stands for Coronavirus infectious diseases, 2019, is the term coined by the World Health Organisation to describe the disease causedby Coronavirus first isolated in Wuhan City in Central China in December 2019.
As I conclude writing this article, the Chinese foreign minister appeared on my TV giving live update about the current COVID-19 outbreak. As of today, February 15th, there are 67, 185 confirmed infected cases affecting 29 countries, 1,527 deaths, 8,510 recovered. Out of the 57,148 currently infected cases, 11,082(19%) are in critical condition and 46,066 (81%) in mild conditions. So far, there are 7 and 17,000 healthcare workers deaths and infections respectively as a result of nosocomial diseases. In the last 48 hours, there was a surge of new cases which force the WHO to declare Covid-19 as a global emergency and this could be the start of another major pandemic.
But what is a pandemic, a pandemic is an outbreak of global proportions. It happens when a novel infectious agent, for example, virus or a bacteria emerges among humans or jump from animal to humans-it cause severe illness and easily human transmissible (spreads quickly) from person-to-person). What is worrying about COVID-19 is the fact that virus shares similar mortality pattern with 1918-20 Influenza virus pandemic, virus infection normally kills babies with underdeveloped immune system and people with supressed immune system but COVID-19 seems to defy this trend and the virus is killing across all age groups.
Throughout history man had been afflicted by number of disease pandemics the latest of which is the HIV/AIDS which was first identified in 1981, AIDS destroys a person’s immune system, resulting in eventually death by diseases that the body would usually fight off. AIDS was first discovered in American gay communities, the disease, which spread through certain body fluids. Treatments have been developed that slow the progress of the disease, but 35 million people worldwide mainly from sub-Sharan Africa have died of AIDS since its discovery, and a cure is yet to be found.
In 1968 a category 2 Influenza pandemic, which was later to be known as “the Hong Kong Influenza”. The H3N2 strain of the Influenza A virus was the cause of the 1968 Influenza pandemic and was a genetic offshoot of the H2N2 subtype. The outbreak was first reported on the 13th of July, 1968, in Hong Kong, within 17 days, the outbreaks spread to Vietnam, Singapore, and in the space of three months, the virus had spread to India, The Philippines, Europe, Australia, and the United States. The 1968 pandemic Influenza strain had a comparatively low mortality rate (0.5%), it still killed over a million people, including half a million residents of Hong Kong, approximately 15% of its population at the time.
In 1956, Asian influenza, type A, of the H2N2 subtype pandemic broke out in China and lasted until 1958. In two years, the Asian influenza spread from the Chinese province of Guizhou to Hong Kong, Singapore, and the United States of America. The death toll of the Asian influenza, according to the World Health Organization estimate places the final tally to approximately 2 million deaths, 69,800 of those in the US alone.
Between 1918-1920 another deadly outbreaks of influenza tore across the world, infecting over a third of the world’s population and killing between 20 – 50 million people. Of the 500 million people affected in the 1918 pandemic, the mortality rate was estimated at 10-20%, with up to 25 million deaths in the first 25 weeks alone. What was peculiar about the 1918 Influenza pandemic from other influenza outbreaks was the victims' category; influenza had always previously only killed juveniles with the underdeveloped, and the elderly with the suppressed immune system, it had begun striking down healthy young adults while leaving children and those with weaker immune systems still alive.
Like its five previous cholera incarnations, the Sixth Cholera Pandemic originated in India, decimated the Indian population where it killed over 800,000, before spreading to North Africa, the Middle East, Russia and Eastern Europe. This Cholera Pandemic was also the source of the last American outbreak of Cholera (1910–1911).
Formerly the “Asiatic Influenza” or “Russian Influenza”, this strain, believed initially to be an outbreak of the Influenza A virus subtype H2N2; however, recent advances in laboratory sciences have instead established that the Influenza A virus was of the subtype H3N8. In May 1889, three cases were first observed in three separate distant locations, Athabasca in north-western Canada, Bukhara in Central Asia (Turkestan), and Greenland. Though it was the first real pandemic in the modern era of bacteriology and a lot more was learned from it. The 1889-1890 Flu Pandemic killed over a million people.
Between 1852-1860 there was another cholera pandemic, generally regarded the most deadly of the seven cholera pandemics in recorded history, and this outbreak was the third major outbreak of Cholera in the 19th century. This pandemic, like the first and second pandemics, also originated in Indian Ganges River Delta, before spreading through Asia, Europe, North America and Africa and killing over a million people. In 1854, John Snow, a British physician, while working in the inner city of London, succeeded in tracking contaminated water as the source of cholera and eventually identifying contaminated water as the means of transmission for the disease. In the same year, 23,000 people died in Great Britain as a result of cholera.
The great plague ravaged Europe, Africa, and Asia, between 1346 and 1353, killing an estimated 75-200 million people worldwide. Believed to have originated in Asia, the Plague most likely spread through continents via rat-infested merchant ships through fleas living on the rats. Ports being major urban centres those days, provided the perfect breeding conditions for the rats and fleas, and thus the deadly bacterium to flourish, devastating three continents in its wake.
The Justinian was an outbreak of the bubonic plague that afflicted the Mediterranean port cities and Byzantine Empire, killing up to 25 million people in its year-long reign of terror. The Justinian plague believed to have killed perhaps half the population of Europe. The Justinian plague is widely considered to be the first recorded pandemic of the Bubonic Plague, the Plague of Justinian left its mark on the world, killing up to a quarter of the population of the Eastern Mediterranean and devastating the city of Constantinople, where at its height it was killing an estimated 5,000 people per day and eventually resulting in the deaths of 40% of the city’s population.
The Antonine Plague, also known as the Plague of Galen, was an ancient pandemic that affected Asia Minor, Egypt, Greece, and Italy and is thought to have been either Smallpox or Measles, though the actual cause is still a mystery. This mystery disease was brought back to Rome by soldiers returning from Mesopotamia around 165AD; unknowingly, they had spread a bug which would end up killing over 5 million people and decimating the Roman army.
With all the advances in modern medicine, could the world suffer yet another major pandemic of biblical proportions? Unfortunately, yes, it is possible. The case of current Covid-19 outbreak should be given all the attention it deserves, there is no immediate cure for Covid-19 and couple that with the ease of global travel, the stakes could not be higher. We probably missed the bullet this time around, the outbreak started in China, which has a well-developed healthcare system and financial muscle they could put an entire city with a population of over 50 million people into complete lockdown. Had the outbreak began in a developing country with the poorly developed healthcare system, by the time the rest of the world know about it, we could have a pandemic.
Author: Ahmed Manjang
Editors note: Ahmed Manjang is a Senior Medical Technologist at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
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