Topic Seven – The 20th and 21st Centuries and Disease
Introduction.
The 20th century has seen major advances in the fight against disease to the point where most epidemic diseases no longer pose a threat to society and in fact some are at the point of total elimination. Here I am speaking mostly of the developed world while in the undeveloped world most of the infectious diseases discussed in earlier topics are still viable and still infecting and killing people. For example, tuberculosis, a disease curable with antibiotics, has managed to kill some 1.3 million people in the world in 2012. Smallpox is an example of a disease eliminated in nature. It is thought that smallpox is alive only in two places, the first, the Center for disease control in Atlanta, and the second place a lab in Moscow.
I should mention that I wrote the above paragraph before the current pandemic of Covid 19 we are all living through now. We are now getting a taste of what many people in the past suffered through, especially the 1918 “Spanish Flu.” This transcript will end with a full discussion of today’s pandemic and I will try to be as up to date as possible.
In large part advances in isolation of germs causing infectious diseases made by the end of the 19th century have resulted in major gains in the battle against disease. By the 1940s we see the use of antibiotics as well as advances in the use of vaccinations, improvements in sanitation and public health, and increased personal health through better diets by populations in the developed world. The result is that today in the first world we face more of the risk from chronic illnesses such as heart disease and cancer than infectious epidemic diseases. AIDS is a recent example that the danger of infectious epidemic diseases has not gone away. Of course the Covid 19 epidemic is another.
Success is not complete and perhaps will never be as disease agents evolve to become resistant to modern drugs or brand new diseases pop up seemingly from out of now where or maybe artificially created in laboratories. Meanwhile old diseases continue to find sustenance in non-developed areas of the world. The current pandemic is an example of this. In this topic we will cover the following:
1-the return of plague (Yersinia pestis) in India and China
2-the influenza epidemic of 1918
3-tuberculosis and its comeback
4-the antibiotic revolution
5-the modern pandemic of AIDS, especially in Africa
6-new diseases such as SARS, Hanta virus, avian flu, and ebola
7-the current pandemic of Covid 19
8-where do we go from here?
The Return of Plague.
The third wave of plague broke out in India and China in the 1890s and lasted until 1930. The plague bacillus had been last seen in Europe in 1721 and then disappeared. The disease most likely remained endemic in China and South Asia afterwards. In 1894 a Swiss bacteriologist and physician named Alexander Yersin (1863-1945) was able to isolate the disease agent causing plague. He did this while studying disease in French Indochina and in Hong Kong where the discovery was made.
In 1896 an outbreak of plague occurred in Bombay India with the disease reaching that city from Hong Kong by steamship. At that time India was a British colony and British authorities wishing to show the superiority of Western medicine began to take strong action. The Epidemic Disease
Act of 1897 was passed giving the British powers to coerce the population to abide by quarantine laws, forcing them to move into isolation camps and even evacuating whole villages. India was an ideal place for plague as housing for the poor, mostly overcrowded mud and thatched dwellings with livestock living in the same abode was the norm for most of the population. Terror spread among the poor populace who feared being forced to go to plague hospitals which were seen as a place to die. The result was that less than half the plague victims reported themselves sick which meant the spread of this disease was almost impossible to stop. There was a failure to consult with local village leaders to help in controlling the spread of plague. An Indian civil service officer, Walter Charles Rand, was assassinated in 1896, a result of this opposition, . Local newspapers predicted bitter and widespread opposition to plague measures and portrayed British efforts as another example of oppression of natives by whites.
The plague outbreak lasted from 1896 to 1930 and it is estimated that 12 million plague deaths occurred in British India. In effect, British efforts to control this disease were almost futile. Why the outbreak ended in 1930 no one knows for sure.
While the plague was spreading in India there were two smaller epidemics in Manchuria. In 1910 the pneumonic form of the disease broke out killing 60,000 people in two years. The plague bacillus had existed in rodent populations including Russian marmots whose skins were major export items. The skins were apparently stored in underground dwellings where hunters lived who then were infected by the fleas living in the skins. The 1910 outbreak caught the Manchu dynasty at a weak stage and there was little significant effort to contain the spread of plague.
A second outbreak occurred in 1920 in the same area but the government was better prepared and deaths were limited to around 8500. As in India, plague hospitals appeared to be prison camps and there was much local resistance to being placed in them. These hospitals were surrounded by barbed wire fences and police guards had orders to shoot on sight anyone attempting to leave. As a kind of post script, in November of 2019 there was an outbreak of the Bubonic version of plague on the island of Madagascar that already killed 40 victims by the end of that month. Plague still remains endemic in parts of the world.
The First World War and the Influenza Pandemic of 1918
Several years ago I participated in a documentary and I was asked to describe the influenza outbreak of 1918 that may have killed up to 50 million people in the world and compare it to the Black Death in terms of the sheer number of dead in such a relatively short time as well as the fact that deaths occurred in every age group, including the young and healthy.
How many of you have had the flu? Today it is a rather unpleasant viral disease that virtually all of us have come down with at one time or another. Its symptoms include body aches and pains, fever, and sometimes general upper respiratory infection symptoms that might last up to a week or more. To an extent it is like blown up cold. The origin of influenza is in Asia largely because of the close proximity of ducks, pigs, and people All act as reservoirs passing the virus back and forth. Influenza generally does not kill people unless you are among the very old or young or there are other complications with other diseases. Unfortunately, it does not confer lifetime immunity as we can be struck down by slightly different strains each and every year.
Most of you may not be aware but earlier in the 20th century influenza suddenly became a major killer, starting during the last years of World War I. It swept around the world in 1918 and infected over 1 billion people and may have resulted in the deaths of 40,000,000 to 50,000,000. At the time it was called the Spanish flu but in reality it came from Asia. An important issue raised is why does a disease that normally debilitates becomes a killer? The answer is probably the same as other diseases as they evolve and change, humans lose their disease experience. What made this particular flu so deadly is that it affected individuals in the prime of their life. Traditionally influenza is most dangerous to the very young and very old. The 1918 flu was an exception. American soldiers who were training to be sent to Europe in World War I began to catch the disease in the United States at training camps and then helped spread it when they were sent overseas. Most of the deaths were not caused by the Spanish flu itself but that either viral or bacterial pneumonia often resulted and that was the real killer
.
Could this happen again? Some time ago I read a New York Times Magazine article from November 1992 on this very issue (influenza turns deadly). The gist of this article is that a repetition of the 1918 epidemic could well be repeated. The issue depends on how greatly the virus mutates from one year to the next. There is also evidence of some kind of influenza cycle every so many years with a more lethal strain developing. Researchers today conclude that the current version of the flu has not changed appreciably since 1968. This means when it does change, the world’s population may not be prepared for it, making it possible to have a repeat of what happened in 1918. I should also mention that a current dangerous flu, called avian influenza, is very similar in its makeup to the 1918 Spanish flu.
Tuberculosis.
Tuberculosis, as previously stated, is one of the most ancient diseases. It was found in ancient Egyptian mummies and was known to the ancient Greeks as Pthisis. It often attacks the lungs and body joints leaving lesions from the growth of tubercles that gives this disease its name. We already discussed the impact of this disease in overcrowded 19th-century cities and there was no cure. In the 1920s and 1930s the U.S. witnessed the rise of a sanitarium movement that resulted in tens of thousands of people going to treatment centers, often against their will, to recover from this disease. Usually, these sanitariums were set in isolated areas at higher elevations where rest and clean air allowed the body to defeat the disease.
TB is treatable with antibiotics and it appeared that this disease might well be on its way to extinction in the developed world but it has made a comeback in this country because it is still endemic in the less developed parts of the world and with easy movement of peoples from these areas to places like New York there is a resurgence. The resurgence is part of the phenomenon of homelessness in the 1980s and the rise of an undocumented immigrant population. Often a disease of poverty, TB is contracted by a homeless person or undocumented immigrant but because of their status they refuse to seek treatment. When treatment is sought it often is not followed up as the individual involved, once taking medication and feeling better, stop the treatment. It should also be mentioned that antibiotic treatment involves a series of injections for TB meaning that one shot is not enough. Further complicating the spread of TB is the spread of AIDS which results in the afflicted individual with this disease acutely at risk when they come into contact with the TB bacillus. I’ve heard it said that a person infected with AIDS should not ride the subways in New York.
The Antibiotic Revolution and Decline of Epidemic Disease.
The 20th century has seen major advances in all aspects of medicine, especially in the fight against epidemic disease. I should mention that most of these advances started in the 19th century with the discovery of the true sources of disease, the germ theory and the isolation of specific germs for specific diseases.
The use of vaccinations has resulted in the virtual elimination of diphtheria, smallpox, tetanus and many childhood diseases. As late as 1958 smallpox was killing 2 million people yearly but by 1975 with 250 million doses of vaccination a year it was announced that the last case of wild variola major in the world occurred (Bangladesh) and in 1977 the last case of variola minor in Somalia was uncovered and smallpox was formally declared eliminated in 1980 by the World Health Assembly.
With the attack on disease vectors such as the mosquito, malaria and yellow fever and other mosquito borne diseases were on their way to elimination in many areas of the world. Hook worm was eliminated in the American South through sanitation improvements and less poverty. With the use of the insecticide DDT the typhus louse was being eradicated meaning the elimination of typhus.
The most important advances occurred in the field of chemotherapy. Antibiotic drugs have become a multi-billion-dollar industry today and have been instrumental in saving millions of lives. In the past most drugs were useless or dangerous and even quinine, about the only drug used on a wide basis that was somewhat successful had very little that was known about it, especially how it worked. The real challenge was to find a drug that killed the disease agent, or at least prevented it from doing its worst until the body eliminated it without killing the host, meaning us. Probably the first major successful drug product in the 20th century was the work of Paul Ehrlich (1854-1915) who discovered Salvarsan in 1910 which was used against syphilis.
The next breakthrough came in the 1930s with the development of sulfa drugs which were derived from dyes by Gerhart Domagk (1895-1964) in 1935. He was awarded the Nobel Prize in 1939. Penicillin which was actually discovered by Alexander Fleming (1881-1955) in 1929 from molds but did not come into practical use until 1939. These drugs mentioned above were successful against most bacterial types of disease agents that cause such major diseases as plague and tuberculosis. It should be mentioned that antibiotics do not work against viral diseases and vaccination, which is preventative, is the main weapon.
In 1967 Surgeon General William H Stewart stated that the book could be closed on infectious diseases. As we will later discuss this belief was somewhat premature, especially when we take into account the fact that many diseases were becoming antibiotic resistant. At least in the developed world the advance against infectious epidemic diseases was so successful that leading causes of death were a result of such illnesses as heart disease, cancer, and complications from diabetes. These chronic illnesses are usually the result of a longer life, a sedentary lifestyle and environmental factors. Major exceptions to this trend are the advent of AIDS and Covid 19.
AIDS and Africa.
In 1980 Los Angeles physicians described a febrile (meaning feverish) mononucleosis type syndrome discovered in the homosexual community which appeared to be a new illness. The first patient died in March 1981. The Center for Disease Control issued a report finding that these first five cases had a common exposure that predisposed them to opportunistic infections. This was the birth certificate for AIDS or acquired immune deficiency syndrome.
In this section of the lecture, I will introduce you to AIDS, including a clinical description of the disease, the progress of AIDS in Africa and other parts of the world, and finally where we are heading with this disease.
What is AIDS? It is a disease caused by a virus known as HIV or human immunodeficiency virus which appears to exist in two major strains known as HIV-1 and HIV-2. HIV-1 is found mostly in the Americas and Western Europe while HIV-2 is found mostly in Africa and the Caribbean and the spread of this latter strain is mostly through heterosexual sex. There is a third strain among certain mammals, mostly monkeys, called simian AIDS.
Is AIDS a new disease? This is a difficult question as it seems to be without its own symptoms but rather is masked by opportunistic diseases such as pneumonia, tuberculosis, and Kaposi’s sarcoma (a kind of cancer of the skin) to take advantage of the compromised immune system weakened by AIDS. AIDS may be a brand-new disease or it simply existed but escaped medical attention. Some claim to see a similar disease in ancient Egypt in the Bible’s Book of Numbers which refers to a pestilence caused by sexual relations and called maggepha. In the late 1860s and early 1870s there appeared to be an outbreak of Kaposi’s Sarcoma in Vienna that may have been a sign of AIDS. In the 1930s and 1940s a similar skin cancer appeared in epidemic form in Nigeria and Zaire to which the natives called lubambo. All of these instances may have masked the outbreak of AIDS but without blood no one can tell.
Officially the AIDS epidemic began in California in 1978 though it may have been around for years. There is one theory concerning the origin of AIDS using a process of investigating its DNA. According to this theory AIDS has an African origin where it began approximately 100 years ago in the Congo. The fact that certain species of African monkey carry a form of AIDS supports this theory. Green monkeys in Africa appear to carry a strain similar to HIV-2 and it is known that these monkeys are often eaten. One hypothesis sees AIDS as a biological weapon created by American virologists that had escaped out of the lab but the fact that this claim goes back to 1977 where no lab had the ability to create such a virus. By the mid-1980s a test was developed to detect antibodies in the blood that indicated contact with the virus.
More recent studies, especially through the use of DNA as an approach appear to more conclusively show the true origin of AIDS is in West Africa, more specifically the Congo. This study seems to support the earlier theory just mentioned. A book by Jacques Pepin, The Origin of AIDS (Cambridge, 2011), points to a subspecies of chimpanzee (Pan Troglodytes troglodytes) as the original source of the disease. Among the chimpanzees there was a form of AIDS caused by SIV (simian virus) that is equivalent to HIV-1 in humans. The author estimates that 6% of this subspecies of the Chimpanzee population had SIV and most likely transferred the disease to hunters who had killed and slaughtered the carcass, infecting themselves. Though this occurred at a very low rate, Pepin guesses that a small number of infected hunters moved to cities.
In West African cities HIV was then spread in two ways, through prostitutes and through the use of non-sterile needles. Pepin then goes on to say that the virus then spread from the Congo to Haiti via Haitian workers who had migrated to Africa for jobs then returned back to Haiti. In Haiti blood supplies were tainted further spreading the virus. The author conjectures that HIV then spread to the homosexual communities in San Francisco and New York. All of this took place in the early mid-1960’s.
The HIV virus, like most other viruses, invades a cell and then replicates itself as the cell divides or creates border cells. In the process original cells are destroyed, especially those that are part of the immune system. The virus itself was isolated by the Pasteur Institute in 1983 and December of the same year a hematologist in Cambridge England also isolated the virus. In May 1986 an international commission call this virus HIV.
How is AIDS transmitted? Humans are usually the vector and transmission of the virus requires a fluid to fluid contact. This can occur through semen and blood but not simple touch. There is no evidence that the virus can be transmitted through insects such as mosquitoes. There are three methods of transmission – sexual contact, direct injection, and through the placenta from mother to fetus. In the US and Western Europe AIDS is transmitted primarily through homosexual activity while in Africa mostly through heterosexual activity. The virus cannot penetrate normal skin. Sexual activities are the most frequent method of transmission. The spread of AIDS is often preceded by an outbreak of syphilis and gonorrhea which result in body sores providing an opening for the AIDS virus. It follows that the more unprotected sex individuals take part, the greater the chance of catching this disease. In the United States a Canadian airline steward was found to be carrying the HIV virus while having at least 250 sexual partners per year. This patient was dubbed patient zero who may have carried the disease and helped spread it from 1980 through March 1984 when he died.
There are other theories on how AIDS was spread. One, theory involves Cuban troops fighting in Angola in the 1960s and 1970s and in bringing the disease back to the New World.
Africa is the continent that is worst hit by this disease, especially sub-Saharan Africa. As of the year 2000 sub-Saharan Africa has suffered almost 20 million deaths and there may be over 30 million Africans who are HIV-positive. In some places such as South Africa half the teenage population is HIV-positive and the spread of the virus is aided by refusal of many African men to use condoms and practice safe sex. A rush to the cities in the 1960s resulted in many single men utilizing prostitutes in unhygienic situations. In 1987 it was estimated that almost 90% of the prostitutes of Nairobi were HIV-positive.
Another means of spreading AIDS in Africa may have occurred in the 1970s and 1980s with the use of dirty syringes for smallpox vaccinations. For example, from November 1986 to March 1987 five medical teams vaccinated 165,000 individuals with only a small handful of needles. In one case seven needles were used for 33,000 patients and there is evidence that the needles were not cleaned.
Does preventing the spread of AIDS in Africa appear to be hopeless? Not really and I will give an example of a success story in the African country of Uganda. Uganda in 1987 had a 24.1% infection rate of HIV positive for individuals in cities and 12.3% in the countryside. In 2003 this dropped to 4.1% for the adult population. How was this done? The answer is a change in sexual behavior. The use of condoms was promoted including providing them free of charge and the idea of monogamy or one partner was promoted both religiously and by the government. In a Darwinian sense those who refused to change caught AIDS and died off and those who did change survived.
Where are we today with the problem of AIDS? Though there is evidence of the spread of this disease into Asia, the number of newly infected individuals seem to be leveling off. In the United States the use of retroviral drugs has prolonged the life of many who would have died otherwise. Unfortunately, the creation of a preventative vaccine or some kind of cure appears to be far off and still the best approach appears to be preventative measures such as monogamy and the use of condoms-in other words to practice safe sex.
Ebola-A New Plague of the 21st Century?
Ebola, a hemorrhagic virus that has a mortality rate of up to 90%, has been much in the news but in fact the first known outbreaks began in 1976 in West Africa. Since that time there have been more than 20 outbreaks, all in Africa with the one 2017-18 the most serious. Earlier outbreaks were contained in rural areas but the 2017-18 managed to spread into urban areas in Sierra Leone, Guinea and Liberia. Well over 5000 people have died in Africa in this outbreak (2017-2018) and it is believed over 15,000 have been infected. To keep this in perspective, TB, a treatable disease, killed 1.3 million people around the world in 2012.
It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead. According to a Wildlife Conservation Society newsletter (winter 2014) the Ebola virus antibodies can now be found in great ape feces and a recent survey found that 10% of the guerrillas in several areas in the Congo were carrying the virus
Ebola is spread through direct contact with blood and body fluids of a person infected by and already showing symptoms of Ebola. Even after a person has died the body still can infect others. Ebola is not spread through the air, water, food, or mosquitoes. The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
The fear today is that fleeing Ebola victims will step on a plane and land anywhere in Europe or the United States and spread the disease to these places. Healthcare workers appear to be especially at risk and there have been several known cases of doctors and nurses leaving West Africa and eventually dying in Europe or the United States. One famous case occurred right in New York City when a physician returning from West Africa, where he contracted the disease, actually traveled on the A-Train subway from Manhattan to Brooklyn and back. I have taken this train myself and I have noticed many people wearing face masks while refusing to touch anything on the train. This was before the Covid outbreak.
The Ebola outbreak appears to be coming under control in West Africa but the Congo had begun going through a new outbreak in the Fall of 2018. In September of this year (2022) the BBC reported a new outbreak in Uganda (East Africa) with a death toll reportedly in the high 50’s as of November but this is likely an undercount and there is no knowing how far this will spread. Some nations are not allowing anyone out of West Africa to come across their borders. Should the United States follow suit?
The Current Pandemic (Spring 2020-Fall 2022) of the Coronavirus-Covid 19.
When I began this same course in late January 2020, who would have thought we would find ourselves in our own pandemic. The origin of this virus originally was thought to have been in Wuhan China starting in a “wet” market where wild animals are sold for food. It was believed to have originated in bats but unfortunately the Chinese government had not been very cooperative in allowing foreign researchers any involvement in looking for the true beginning. More recent reports, though sketchy, indicate the possibility that this disease is a created virus and a worker in the virology lab in Wuhan China may have accidentally started the pandemic. The time period when it began was late 2019, but again there is difficulty in pinpointing the exact time as Chinese government authorities, especially local ones, appeared to try to hide the true extent and lethality of this disease. The result of this lack of action was to allow perhaps 5 or 6 million local people living in the Wuhan region to leave the area, most likely to celebrate the Chinese New Year. The cat was out of the bag.
The symptoms of coronavirus are rather flu like with fever, dry cough, headache, muscle ache, and difficulty breathing (in more severe cases). Loss of taste and smell is another tell-tale sign. Covid 19 is spread like the flu with nasal droplets expelled by the sufferer (called shedding the virus) through coughing and sneezing and or touching surfaces infected by the virus (hands to nose or mouth). That is why we must cover our coughing and sneezing and wash our hands so often. The closest virus type illness is SARS (Sudden Acute Respiratory Syndrome) which also broke out in China in 2002. In terms of morbidity Covid 19 appears to be several times as lethal as influenza but there is not enough factual and statistical information at present to come to this conclusion. More recent strains of covid appear to be less lethal, with mortality rates dipping. There may be as many people carrying this disease with light or no symptoms as compared to those who have been hospitalized and tested. The higher the number of the total population who have or had the disease with little or no symptoms, the lower the morbidity rate.
Coronavirus’ similarity with SARS goes beyond symptoms in terms of a similar lack of information coming out of China that helped its spread but it was contained in Asia by prompt action of nations such as Vietnam, South Korea and Taiwan. Unfortunately, the failure to spread much beyond Asia fooled many including the World Health Organization and western governments, including the US government, in thinking that Covid 19 would be similarly contained like SARS. A question is why did Covid 19 spread so far and wide in 2020 unlike SARS in 2002-2003. Part of the answer lies in China’s economic success in that so many more Chinese citizens have attained middle class status and are able to travel. With globalization, China’s business interests have grown world-wide and much of this success happened in the last twenty years. The result is large numbers of Chinese citizens traveling to other parts of the world for tourism and business.
Why has this pandemic spread so rapidly to Europe and the US and why was NYC and its suburbs almost the epicenter of the world during the initial breakout in 2020? The answer in part, as mentioned above, is globalization and increasing wealthy citizens of China who fly to the US and Europe for tourism and business. Europe was slower to cut flights to China (the US did so by the end of January 2020) and, in effect, flights from Europe helped infect the US eastern states, especially NYC as Americans returned from abroad. Another factor, especially when compared to annual influenza pandemics is the “newness” of the coronavirus making it to be so easily catchable with more severe symptoms. Influenza has been around a long time and most of us, at one time or another, have had the “flu” meaning that our immune systems have some experience with it and, in effect, we are disease-experienced. This was not the case for covid 19, though by the spring of 2022, the US, between vaccinations and those experiencing covid, a majority of the population are resistant. Covid itself appears to be changing with new variants less lethal.
As of the updating of this Topic (late November 2022) the U.S. had a total of 100.2 million cases (likely an under count) and 1.1 million deaths. The world stands at around 6.62 million deaths and rising.
Why did NYC and its suburbs (New Jersey and Connecticut) lead the US in infections and death during the first year of the covid epidemic (parts of the rest of the country have since caught up)? I will express MY opinion as to why and then where we are going (first NYC and suburbs and then the US).
One of the most important factors involve population density. NYC probably has the highest population density of any region in the US (Europe’s population density is also very high). NYC has roughly ten times the population density of Los Angeles. You can add the factor of the public transportation system (think of packed subways and buses during rush hour) as a means of spreading disease. NYC is also a regional transportation and business hub where many people come to the US through its airports. Tourism is also a major industry. Lack of preparedness on both the city and the state for such a pandemic also adversely affected by a slow federal response are factors. For the last fifteen or so years the city and state have been closing hospitals, cutting down Medicare/Medicaid reimbursements to hospitals and the like-all to save money despite recommendations to do the opposite. Lockdowns in a free society are hard to maintain and we are seeing reaction in terms of “lockdown fatigue.” This is especially true as we see the virus surging across the country especially among younger people who are less likely to cooperate. The existence of new variants have also come to light with some of them more easily spread (fortunately less lethal).
A factor that has finally had a positive influence in slowing the spread is growing numbers of citizens vaccinated. The US has been fortunate in that very large amounts of money were made available to a number of drug companies in 2020 and in record time a number of vaccines developed by the end of that same year. In November 2020 Pfizer announced the results of their final drug trials with their new vaccine over 90% effective while Modena announced an effectiveness rate of 95%. This is better than the “flu” shot which has an effective prevention rate of 50-60%. Availability began late December 2020 and by the spring we began to see availability to the general population. Rates of vaccination vary state by state and New York has been conspicuous with a slow rollout.
In 2021 2 to 3 million Americans were being vaccinated daily and as of late November 2022 over 68% of our population are fully vaccinated. Other parts of the world (Israel and England exceptions) have not been doing so well with the European Union dragging behind. Asian countries, which initially have been doing well in curbing Covid but have not been doing well in vaccinating their populations. Curiously, a relatively large percentage in the US indicate they do not want to be vaccinated (25-30%). The issue is when will the US and the world reach “herd” immunity when the spread begins to shrink. We may be approaching that in the US.
Finally, the impact of the current pandemic has been almost catastrophic. The closest experience in the US has been the 1918 “Spanish Flu” in terms of daily life. Fortunately, the morbidity has been quite low compared to the 1918 flu for both the US and the world (the 1918-20 flu may have killed 50 million out of 1.5 billion while the covid virus is projected to kill 7 million out of more than 8 billion. I’ll let you do the math. This is due in large part to our advanced state of medicine. I also marvel at the sheer vitality of the American people in coming up with new testing methods, possible drug treatments and cures, and vaccines. We are getting better and better at treating the virus and this attested to by a falling morbidity rate (also more recent patients are younger with better immune systems). At present, infections rates appear to be rising, because of new sub-variants, but the death rate is falling to under 400, Perhaps we are seeing the typical course of epidemics where they are the most severe when initially spreading, but as time goes on, new variants, though easily spread, are becoming less virulent.
The economic impact, on the other hand, may have been closer to the great Depression of the 1930’s though time will tell. As vaccinations advance it appears the US economy has begun a recovery. A few words about China which is now going through a dramatic upsurge of covid infections, while its “zero-tolerance” policy where whole cities are shut down (October-November 2022). China had developed its own vaccine, Sinovac, which has proved much less effective than western vaccines, especially against the newer variants. Probably for reasons of nationalism, the Chinese government has refused to use these western vaccines to the detriment of its own citizens. Meanwhile its strict lockdown and quarantine policies has crippled its economy. There has also been widespread resistance in China by local citizenry to these quarantines. A number of states in the U.S. had attempted to also impose strong close-down and quarantine policies that were also destructive of the economy and to education of school children.
I am by nature an optimist and feel we will get through this pandemic as there is light at the end of the tunnel with vaccinations advancing. I wonder what this section of my lecture will look like when I teach this same course next semester (Spring 2023)?
Future Directions.
Despite the birth of the modern hospital and major advances in medicine, including the antibiotic and vaccination revolutions, infectious epidemic diseases still remain a threat. New diseases are being discovered all the time and examples include Hanta virus, the aforementioned Ebola, SARS, avian influenza, Zika Virus, Covid 19 and others which are all killers (see Laurie Garrett’s The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Elinor Levy and Mark Fischetti.s The New Killer Diseases: Why SARS, West Nile, Ebola, and Mad Cow Disease Are Only the Beginning for more information on our near future concerning infectious epidemic diseases). The spread of resistant germs to anti-biotics is a growing problem. Overpopulation, environmental pollution, and poverty provide ideal grounds for the birth of new diseases and the reappearance of old ones. Warming of the earth also will have an impact. Germs and viruses like warm weather.
Individuals living in underdeveloped countries of the world in Africa, Latin America, and Asia are particularly at risk from these new and old diseases in large part because of the absence of a public healthcare infrastructure. I’ve seen some figures where healthcare expenditures add up to
around $1-$2 a year per person per year in these under developed areas of the world. Of course inefficiency, incompetence and outright corruption plays a role in the lack of public health. I read in a book by Paul Collier called The Bottom Billion that for every hundred dollars donated for healthcare purposes to sub-Saharan Africa only one dollar’s worth of services reaches the people.
Sometimes when I am doing the reading and research on infectious diseases and deadly parasites or watching some of the many documentaries on the subject (such as “What’s Eating You” or “the Animals Inside,”) I feel the best course of action is to never go to a hot and damp place and stay home living in a bubble. We can’t, however, live like that and we should certainly count ourselves lucky living today much longer and healthier lives than just about all the people who ever lived before us. Just keep washing your hands.
Jfrangos/November 2022.