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2000 Years of Pandemics Past, Present, and Future Claudia Ferreira Marie-Françoise J. Doursout Joselito S. Balingit 123 2000 Years of Pandemics Claudia Ferreira • Marie- Françoise J. Doursout Joselito S. Balingit 2000 Years of Pandemics Past, Present, and Future Claudia Ferreira Marie-Françoise J. Doursout Private Practice Department of Anaesthesiology Marnes la Coquette, France The University of Texas Health Science C Houston, TX, USA Joselito S. Balingit Paris, France ISBN 978-3-031-10034-5 ISBN 978-3-031-10035-2 (eBook) https://doi.org/10.1007/978-3-031-10035-2 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland In loving memory of Prof. Hans Hoekstra, Prof. Don Cameron, Prof. Ward Casscells and Prof. Thomas F. Burks II Preface Never has our modern civilization experienced such an impactful event as the SARS-CoV-2/COVID-19 pandemic. At least half of the Earth’s inhabitants have been directly affected by SARS-CoV-2/COVID-19 in their daily life, requiring major adjustments caused by confinements, travel restrictions, and trade route reorganizations and necessitating new forms of communication and education. These profound changes in our lives have been driven by the threat of sickness and death caused by this pandemic. Had we done nothing, it is likely that 70–100 million people could have died, and health systems could have collapsed under the pressure of hundreds of thousands of very sick people brought to the hospitals. Since January 2020, the COVID-19 pandemic has made worldwide headlines. Through a combination of healthcare management and vaccines, the pandemic is considered to be controlled in most countries at the present time (mid-2022). The lifting of mask mandates and the easing of travel restrictions herald a possible return to normalcy for a majority of the world’s countries. However, the pandemic is still far from over. This situation, however, is not new to humanity. Pandemics have always been present, as long as contagious diseases could propagate through travel, trade, and wars. They have brought more casualties than all wars combined and have impacted the course of history. In most cases, the causes of these pandemics remain unknown, previously considered as acts of God against sinners or more frequently as a result of the other culture’s weakness. For over 2000 years, pandemics have been documented by historians, described as rare but dramatic events, such as the various plagues that have virtually destroyed cities and seriously jeopardized an empire’s or kingdom’s stability. Beginning with the European colonization of North America 500 years ago, and to a greater extent with the start of globalization 200 years ago, epidemics spread farther and faster, with some propagating over continents and some spreading globally. Since then, pandemics have occurred with increasing frequency: a few prior to 1000 CE and then increasing every century until the 1800s and almost every decade since then. At the same time, advances in medical science led to treatments which partially controlled the adverse consequences of the population growth. This was sufficient to ensure the survival of our civilization but fell short in preventing contagious disease outbreaks or effectively curing such diseases. vii viii Preface The etiologies of infectious diseases have been discovered over the last 150 years: bacteria, viruses, and other microorganisms taking advantage of the human biology to reproduce and attack the different bodily systems. In the vast majority of cases, humans have been minimally affected by viruses and bacteria. But ultimately, along comes a microorganism that is capable of causing suffering and death and is easily transmitted among humans. Where do they come from? What enabled these microorganisms to reach humans, infect them, and lead to severe illness and even death? There is strong evidence that human behaviors are often responsible for the emer- gence of these microorganisms that cause pandemic viruses and bacteria to flourish. This history and the questions raised here lead us to view the pandemics of the last 2000 years through a wider lens—not only as diseases with microbiological origins, but also as consequences of humans’ impact on the environment, such as eating habits, travel, and trade. In this book, we illustrate the paths of disease propagation and some of their dire consequences, through individual pandemic histories. We have developed numerous ways to deal with these diseases, from simple but effective isolation measures to complex endeavors, such as global vaccination programs. Ultimately, our objective is to bring awareness of the consequences of human activity on global health and to contribute to informed decisions when choices need to be made for the health of our children and the future of the human race. Marnes la Coquette, France Claudia Ferreira Houston, TX, USA Marie-Françoise J. Doursout Paris, France Joselito S. Balingit Introduction Keywords Pandemics; Human development; Changes in natural ecosystems; Migration; Travel; Zoonoses A pandemic is considered as an outbreak of a disease occurring over a wide geo- graphic area, crossing national borders, and affecting a high proportion of the world’s population. Throughout human history, pandemics have caused more deaths than even the most powerful army combat. Through the past 2000 years, pandemics have led to discrimination, confrontations, demographic pressure, starvation, and forced massive immigration. Pandemics occur because of human development, changes in natural ecosystems, migrations, and travels. These factors enable viruses from wildlife to infect humans and facilitate their spread to the general population. Consequently, we must address these harsh conditions by mitigating the effects of zoonoses, preventing future pandemics. In this book, we have analyzed the factors that initiated pandemics over the past 2000 years. During the 1st millennium AD, three main pandemics emerged. The Antonine plague (165–190 ad) [1], caused by the hemorrhagic smallpox, killed 5 million people and contributed to the downfall of the Roman Empire [2]. Four hundred years later, the Justinian plague [3] caused by Yersinia pestis decimated the Byzantine Empire [4], killing 50 million people [5, 6]. Between 1346 and 1353, the Black Death, also caused by the Yersinia pestis bacteria, took 200 million lives [7–9]. With the American colonization, Europeans brought several infectious diseases to the New World including Yersinia pestis, smallpox, influenza, and enteric salmonella, among others [10], subsequently devastating 90% of the local Native American population and bringing down the Mayan and Aztec civilizations [11]. Since 1497, several outbreaks of cholera have been reported worldwide with a mortality of 54–68% in the absence of treatment [12]. From 1629 to 1667, outbreaks of Yersinia pestis were reported mostly in Europe, killing about 1/3 of the population [13]. During the late nineteenth century and through the mid-twentieth century, several influenza outbreaks emerged. Combined, the Russian flu (H2N2), Spanish flu (H1N1), Asian flu (H2N2), and Hong Kong flu (H3N2) killed around two billion people worldwide [14]. Previously unknown viruses, such as Marburg, Ebola, and HIV, came into public awareness in the mid-1970 [15]. From 2002 to present, influenza virus and several coronavirus pandemics have emerged worldwide. Influenza ix x Introduction (H1N1), swine flu, SARS, MERS, and SARS-CoV-2/COVID-19 have killed and infected several million people [16]. What is noteworthy is that in the last 100 years, intervals between pandemics have become shorter. In this book, we have identified three main causes for the development of pandemics: 1. Human development, including trade, commerce, intensive agricultural methods, animal domestication, farming, and crowded cities 2. Changes in natural ecosystems, including climate change, natural disasters, human interface with wild ecosystems, and deforestation 3. Migration and transportation, which we have defined as human movement caused by wars, political and economic displacement, natural disasters, business travel, and vacation travel It is important to note that with the advent of the industrial era, pandemics’ time- line has shortened. For instance, SARS-CoV-2/COVID-19 is certainly not the last pandemic we will face, which is why it is of paramount importance to learn from the various missteps made over the past 2000 years. Therefore, it is urgent to educate the population and bring a heightened awareness to the scientific community, public health officials, as well as governments to plan for the next pandemic. Never has been so striking to our modern civilization the negative impact of the SARS-CoV-2 pandemic in society. Over half of the Earth’s inhabitants have seen the direct impact of a communicable disease in their daily life, through travel restrictions, trade route reorganizations, new forms of communication, new ways to reorganize societies, and even facing mandatory confinements [17]. These profound changes have been driven by the sickness and death threat caused by the SARS-CoV-2 pandemic. The pandemic has made major headlines in January 2020, and as of January 2023 with the Omicron variant which, as of now, is far from being controlled. Could we have done better? It is thinkable that 70–100 million people could have died from the disease, and the health systems of various nations could have collapsed under the pressure of hundreds of thousands of sick people brought to the hospitals [18]. This situation is, however, not new to humanity. Pandemics have always happened, as long as communicable diseases could propagate through travel, natural disasters, trade, and war. They have brought more casualties than all wars cumulated and have impacted the course of history’s civilizations dealing with imported epidemics. In most cases, the causes remained unknown, considered as acts of God to punish sinners or most frequently as the other’s fault [19]. In the last 2000 years, pandemics have been mainly documented by physicians and historians, although described as rare but dramatic events, such as the various plagues destroying cities and seriously endangering empires’ or kingdoms’ stability. Five hundred years ago, we developed the ability to sail around the globe, enabling the epidemics to spread over continents, in some cases becoming global. Interestingly, the frequency of pandemics slowly increased until 1000 ad; then the pace accelerated, occurring every century until 1800 and almost every decade in the last 70 years. At the same time, advances in medical sciences led to cures, partially managing adverse consequences of population growth. This health management Introduction xi was indeed efficient enough to ensure steady development of the civilizations, but far from avoiding contagious disease outbreaks, nor curing such diseases efficiently [20]. The causes of the diseases have been found during the past 100–150 years: bacteria and viruses taking advantage of the human biology to reproduce and attack the immune system. However, these biological organisms have to first reach humans before wreaking havoc. In the vast majority, humans are affected by viruses and bacteria by acute self-limited infections. Where do they come from? What are the factors that enhance their capability to reach and then transmit between humans? There is strong evidence that human activities and behaviors are one of the main causes that contribute to the development of pandemics. This vision and the questions raised led us to review through a broader angle the past pandemics over 2000 years, not only as diseases and their microbiological origins, but also as consequences of our impact on the environment, such as eating habits, travel, and trade. In this book, we have illustrated the path of the propagation of diseases causing pandemics and its dire consequences, through individual human histories and documents from local physicians, historians, and philosophers who witnessed and described previous pandemics. Scientists have also developed tools to lessen diseases, using initially simple but efficient isolation measures such as (1) quarantines to control the spread of diseases, (2) identification of pathogens, (3) treatments, and (4) effective global vaccination programs to eradicate pandemics. Ultimately, our objective is to bring awareness for the future when choices have to be made for our children and the future of mankind. Progress in science and technology has been important to understand, improve, and mitigate healthcare and the social impact of pandemics. If we carefully look at the past, a little more than 100 years ago, the world faced the deadliest pandemic in human history that gripped the world’s attention. The culprit then was an H1N1 influenza virus that became known as the “Spanish flu.” In only 2 years, 1918–1920, the pandemic claimed at least 50 million lives, after having infected around half billion people, one-third of the world’s population at the time. Approximately 675,000 people died in the United States alone. The Spanish flu’s first cluster, identified in the United States, was detected in soldiers stationed at an army base in Kansas during the spring of 1918 [21]. The mortality patterns of the 1918–1920 Spanish flu differed from SARS-CoV-2/COVID-19. In both pandemics, individuals over age 65 were at particular risks, but children younger than 5 years old and adults between 20 and 40 years old also faced a high rate of death from the Spanish flu. Spanish flu was particularly virulent among young adults and women with child- bearing potential or who were pregnant, while SARS-CoV-2/COVID-19 was particularly deadly for older adults and patients with previous comorbidities. However, the shape of the pandemic was altered when younger people got admitted into intensive care units, who later died. Moreover, the ability of SARS-CoV-2/COVID-19 to quickly mutate led us to apply more extensive epidemiological methods to identify clusters of new viral variants. Beyond the high death toll, the full impact of the 1918–1919 pandemic (also known as the Spanish flu—first wave) would not be understood until more than 60 years later. In 2009, an interesting study from Finch and Crimmins analyzed epidemiological data on individuals born in 1919,