Coronavirus Outbreak: How did the previous pandemics end? When will we know that it is over?

When will the COVID-19 pandemic end? It is like?

According to historians, pandemics tend to have two types of terminations: medical, which occurs when incidence and mortality rates plummet, and social, when the epidemic of fear of the disease decreases.

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"When people ask, 'When is this going to end?', They're asking about the social ending," said Dr. Jeremy Greene, a medical historian at Johns Hopkins.

In other words, an end can occur not because an illness has been overcome, but because people tire of the panic mode and learn to live with an illness. Allan Brandt, a Harvard historian, said something similar was happening with COVID-19: “As we saw in the debate about opening up the economy, many questions about the so-called end are determined not by medical and public health data, but by data sociopolitical. Law Suit ".

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Historians say the coronavirus pandemic can end socially before it ends medically.

The endings "are very, very confusing," said Dora Vargha, a historian at the University of Exeter. “Looking back, we have a weak narrative. For whom does the epidemic end and who can say?

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On the Path of Fear

An epidemic of fear can occur even without an epidemic of disease. Susan Murray of the Royal College of Surgeons in Dublin saw this firsthand in 2014, when she was a fellow at a rural hospital in Ireland.

In the previous months, more than 11,000 people in West Africa died of Ebola, a terrifying, highly infectious and often fatal viral disease. The epidemic appeared to be subsiding and no case occurred in Ireland, but the public's fear was palpable.

"On the streets and wards, people are anxious," Murray recalled recently in an article in The new English medical journal. “Having the wrong skin color is enough to catch the eye of your fellow passengers on the bus or train. Cough once and you will find them moving away from you.

Dublin hospital staff have been told to prepare for the worst. They were terrified and concerned about the lack of protective equipment. When a young man arrived at the emergency room in a country with Ebola patients, no one wanted to approach him; the nurses went into hiding and the doctors threatened to leave the hospital.

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Only Murray dared to treat him, she wrote, but his cancer was so advanced that all she could offer was a comfort treatment. A few days later, tests confirmed that the man did not have Ebola; he died an hour later. Three days later, the World Health Organization declared the Ebola epidemic to be over.

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Murray wrote: “If we are not prepared to fight fear and ignorance as actively and thoughtfully as we fight any other virus, it is possible that fear can cause terrible damage to vulnerable people, even in places that never see a single case of infection. during an outbreak. And an epidemic of fear can have far worse consequences when complicated by issues of race, privilege and language. "

Black death and dark memories

Bubonic plague has hit several times in the past 2,000 years, killing millions of people and altering the course of history. Each epidemic amplified the fear that came with the next outbreak.

The disease is caused by a strain of bacteria, Yersinia pestis, which lives on fleas that live on mice. But bubonic plague, which became known as the Black Death, can also be transmitted from an infected person to an infected person through respiratory droplets, so it cannot be eradicated simply by killing mice.

Historians describe three great waves of plague, said Mary Fissell, a historian at Johns Hopkins: Justinian's plague in the sixth century; the medieval epidemic, in the 14th century; and a pandemic that occurred in the late 19th and early 20th centuries.

The medieval pandemic began in 1331 in China. The disease, along with a civil war raging at the time, killed half the population of China. From there, the plague went through trade routes to Europe, North Africa and the Middle East. In the years between 1347 and 1351, it killed at least a third of the European population. Half the population of Siena, Italy, died.

"It is impossible for the human language to recount the terrible truth," wrote the 14th-century chronicler Agnolo di Tura. "In fact, someone who has not seen so much horror can be called blessed." Those infected, he wrote, "swell under the armpits and in the groin and fall off while talking". The dead were buried in wells, in piles.

In Florence, Italy, Giovanni Boccaccio wrote: "There is no more respect for dead people than for dead goats today." Some hid in their homes. Others refused to accept the threat. Boccaccio wrote that his way of dealing was "to drink a lot, enjoy life to the fullest, go out singing and having fun and gratifying everyone's wishes when the opportunity arose, and shrugging the whole thing off as a huge joke".

This pandemic ended, but the plague has returned. One of the worst outbreaks began in China in 1855 and spread across the world, killing more than 12 million in India alone. Health officials in Mumbai, India, burned entire neighborhoods trying to rid them of the plague. "No one knew if that made a difference," said Frank Snowden, a Yale historian.

It is not clear what caused the bubonic plague to die. Some scholars have argued that the cold climate killed disease-transmitting fleas, but that would not have stopped the airway spread, Snowden noted.

Or maybe it was a change in the mice. In the 19th century, the plague was being carried not by black mice, but by brown mice, which are stronger, more cruel and more likely to live apart from humans.

"You certainly wouldn't like a pet," said Snowden.

Another hypothesis is that the bacteria has evolved to be less deadly. Or perhaps human actions, such as burning villages, have helped to stem the epidemic.

The plague never really went away. In the United States, infections are endemic among prairie dogs in the southwest and can be transmitted to people. Snowden said one of his friends was infected after a stay at a hotel in New Mexico. The previous occupant of his room had a dog, which had fleas that carried the microbe.

Such cases are rare and can now be successfully treated with antibiotics, but any report of a case of the pest arouses fear.

A disease that really ended

Among the diseases that have reached a medical end is smallpox. But it is exceptional for several reasons: there is an effective vaccine, which offers lifelong protection; the virus, Variola minor, has no animal host, so eliminating the disease in humans meant total elimination; and its symptoms are so unusual that the infection is obvious, allowing for effective quarantines and contact tracking.

But even though he was still raging, smallpox was horrible. Epidemic after epidemic has swept the world for at least 3,000 years. Individuals infected with the virus developed a fever, then a rash that turned into pus-filled patches, which became encrusted and fell, leaving scars. The disease killed 3 in 10 of its victims, usually after immense suffering.

In 1633, an epidemic among Native Americans "disrupted all native communities in the northeast and certainly facilitated English colonization in Massachusetts," said Harvard historian David Jones. William Bradford, leader of the Plymouth colony, wrote an account of the disease in Native Americans, saying that broken pustules would effectively stick a patient's skin to the carpet on which he was lying, just to be pulled out. Bradford wrote, "When they turn them over, one side will all fall apart at once, and it will be bloody blood, the most fearful to see."

The last person to contract smallpox naturally was Ali Maow Maalin, a hospital cook in Somalia, in 1977. He recovered and died of malaria in 2013.

Forgotten influences

The 1918 flu is maintained today as an example of the devastation of a pandemic and the value of quarantines and social detachment. Before it ended, the flu killed 50 to 100 million people worldwide. It preyed on young adults and middle-aged adults – orphaned children, depriving breadwinner families, killing troops in the middle of the First World War.

In the fall of 1918, William Vaughan, a prominent physician, was dispatched to Camp Devens, near Boston, to report on the flu that was raging there. He saw "hundreds of robust young men in his country's uniform entering the hospital wards in groups of 10 or more," he wrote. “They are placed on the beds until all the beds are full, and others pile up. Their faces soon wear a bluish tint; a distressing cough brings blood-stained sputum. In the morning, the corpses are piled up in the morgue like cord.

The virus, he wrote, "demonstrated the inferiority of human inventions in destroying human life".

After sweeping the world, the flu disappeared, evolving into a more benign variant of the flu that occurs every year.

"Perhaps it was like a fire that, having burned the available and easily accessible wood, burned," said Snowden.

It also ended socially. World War I ended; people were ready for a new beginning, a new era and eager to leave the nightmare of disease and war behind. Until recently, the 1918 flu was largely overlooked.

Other flu pandemics followed – none too bad, but still sober. In the 1968 Hong Kong flu, 1 million people died worldwide, including 100,000 in the United States, most of them over 65. This virus still circulates like seasonal flu and its initial path of destruction – and the fear that accompanied it. – is rarely remembered.

How will COVID-19 end?

Will this happen with COVID-19?

One possibility, historians say, is that the coronavirus pandemic could end socially before it ends medically. People can get so tired of the restrictions that they declare the pandemic over, even when the virus continues to burn in the population and before an effective vaccine or treatment is found.

"I think there is this kind of socio-psychological problem of exhaustion and frustration," said Yale historian Naomi Rogers. "We may be at a time when people are just saying, 'That's enough. I deserve to be able to get back to my normal life.'"

It is already happening; in some states, governors have lifted restrictions, allowing the reopening of hairdressers, nail salons and gyms, challenging public health officials' warnings that such measures are premature. As the economic catastrophe caused by the blockages grows, more and more people may be ready to say "enough".

"There is that kind of conflict now," said Rogers. Public health officials have a medical goal in sight, but some members of the public see a social end.

"Who can claim the end?" Rogers said. “If you retreat against the notion of your end, what are you retreating against? What are you claiming when you say, "No, it's not ending". "

The challenge, said Brandt, is that there will be no sudden victory. Trying to define the end of the pandemic "will be a long and difficult process".

Update date: May 11, 2020 6:52:11 PM IST

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