Pandemic

“ A week passed, during which a bulletin from the Government Health Service announced official suspicion that the human race was suffering a mysterious, pandemic affliction which was as yet undiagnosed. Although the symptoms, as reported by hundreds of clinics, were relatively mild, the effect on the nation's economy was growing serious. ”

“ In recognizing the public health risk, I noted that on March 11, 2020, the World Health Organization announced that the outbreak of COVID–19 (the disease caused by SARS–CoV–2) can be characterized as a pandemic. ”

“ That universal epidemic, or pandemic, is usually counted as one of the great historical waves of influenza; and in the annals of that wonderful disease it stands the first which was well recorded by competent foreign observers, including Ingrassias, Gesner, Rondelet, Riverius, Dodonaeus, and Foreest. The corresponding sickness in England in 1557 (still more severe in 1558) , which carried off many of the wealthiest men, and made so great an impression that it is noticed by Stow and Speed, has missed being noticed by English physicians, with a single exception, and that a casual one. ”

“ In the history of influenza morbidity, as in that of its mortality, we must content ourselves for information prior to the nineteenth century with the very general estimates made by contemporary historians. During the last century the statistics have been more numerous and more nearly correct. As far back as the first recognized pandemic, 1510, the extremely high morbidity has been a recognized characteristic. Thomas Short in speaking of this pandemic says, “The disease ... attacked at once and raged all over Europe, not missing a family and scarce a person.” ”

“ Lancaster, Pa.
iii PREFACE. Following every widespread epidemic or pandemic of influenza, the contemporary literature becomes virtually flooded with reports of scientific studies on the etiology and the epidemiology of the disease. By the time that recrudescences have ceased, interest has usually lagged and eventually research in this subject has practically ceased, only to be revived with the development of the next extensive epidemic. ”

“ It turns out that, in fact, we've got the potential for the sort of pandemic that we have not seen in this country since 1918 when the Spanish Flu swept the entire world and tens of millions of people were killed. ”

“ As a rule the virulence does not become so great as to cause a true pandemic, but at rare intervals, usually of decades, or thereabouts, the epidemic virus becomes so greatly enhanced, perhaps from passage to new territory and through non-immune individuals, that it eventually commences on its wild career around the earth. ”

“ Sometimes we can distinguish a direction of spread in the relatively small community affected, it frequently being observed that the disease will start up in a large city which has experienced the illness during the first pandemic, and from there will spread to small nearby localities which may have remained free until that time. Again, any clearcut direction of spread may be entirely 45lacking. It is rare indeed that an epidemic following another by a short interval will follow a definite line over an entire country or continent. ”

“ For example, he told his mother that there wasn’t much flu around and that the medical facilities were excellent whereas one of the few things my father told me about the flu pandemic was the large number of men with the flu at the base in Corfu with little or no medical attention. He and others with the flu were, he said, left there to die in the opinion of some. ”

“ An additional difficulty is that after an epidemic has once become prevalent, we must combat not only the virus causing the disease but also the secondary invaders.
Epidemiologic work has shown that crowd gatherings are instrumental in the spread of influenza. The density of population has not been as definitely proven to be a factor. Crowding, however, does play a part. Close crowding in communities must facilitate the spread, but pandemics of influenza were known before the great metropoleis existed. Hygienic conditions play their part in the etiology. ”

“ They are also the diseases which have given rise to the most bitter controversies among medical men as to the means of their propagation and the best methods of prevention. Plague, cholera, yellow fever, and typhus are those with regard to which this difference of opinion has chiefly occurred—one party considering their chief cause to be contagion, or specific germs derived directly or indirectly from the bodies of the sick; the second party declaring that they are due to filth plus an unknown something, which is variously termed epidemic constitution, pandemic wave, Providence, or x. ”

“ The epidemiography of each country should therefore be kept apart; and [Pg 397] within a given country care should be taken to prevent the illusion of universal sickness, which is apt to be created in the bringing of scattered centres of disease (such as plague) together in the same page.
But there are instances of what are called pandemics, or universal epidemics, of sickness. The Black Death was one such, covering a period of perhaps four years in Europe, from 1347 to 1350, the curve of the disease in each locality lasting about six months. ”

“ Rather than being damaged by it, China has worked hard on disinformation. It has greatly exaggerated its work to counter the virus and develop vaccines, and has sown seeds of doubt about the origins of the virus, to make the world believe that China was not at fault. Further, it appears positioned to capitalise on the damage to world economies and may well emerge from the pandemic stronger than before—and certainly stronger relative to many other countries that have suffered from the pandemic. ”

“ Remember that it is easier to prevent an epidemic than to stop one when conditions become dangerous.
“Don’t frighten people about the situation, but constantly prevail upon them to be careful in not exposing themselves to disease or spreading it. ”

“ People seldom do. But if you realize that this is international, that every worker on Thurston's Disease has a niche to fill, the picture will be clearer. We're doing our part inside the plan. Others are, too. ”

“ Requests for aid from stricken communities should be made to the nearest representative of the Department, who will refer them to the physician in charge of the Epidemic Emergency District. This includes calls for doctors, nurses, aids, materials and any other form of relief. The Department will make a supreme effort to satisfy all such needs as rapidly as possible. However, where these are at hand, they should be obtained locally. * * *
“All attendants should wear masks. * * *
“Treatment of Influenza and Pneumonia. ”

“ It is imperative that the lives and health of physicians, nurses and lay workers be conserved for service to the vast number afflicted. Accordingly in each hospital (emergency, tent-hospital or otherwise) or in each community which has been organized against the epidemic, a system should be devised to apportion the time and labor of all workers as equally as possible, according to the character of their work. All precautions against infection must be constantly observed, e. ”

“ As for reporting, you can’t combat a disease until you know where it is established and whither it is spreading. So, I say, any health officer who succeeds in spurring up the medical profession, and in dragging the Great White Plague out of its lurking-places into the light of day ought to have a medal.”
“What about the other diseases? Is the same true of them?”
“Not to the same extent. No man can tell when or why the epidemic diseases—scarlet fever, measles, whooping-cough, and diphtheria—come and go. By the way, what about your diphtheria death rate here?” ”

“ The Progress of an Epidemic That it is at least as difficult to stay a moral infection as a physical one; that such a disease will spread with the malignity and rapidity of the Plague; that the contagion, when it has once made head, will spare no pursuit or condition, but will lay hold on people in the soundest health, and become developed in the most unlikely constitutions: is a fact as firmly established by experience as that we human creatures breathe an atmosphere. ”

“ At the present moment, when the subject of epidemics is attracting so much attention, it may be interesting to call attention to the more important diseases comprised under that head, and to point out some of the main facts connected with their origin and distribution. {422} The principal epidemic diseases, then, are: small-pox, scarlet-fever, measles, typhus, relapsing fever, Oriental plague, yellow fever, diarrhoea, typhoid or enteric fever, cholera, dysentery, ague and remittent fevers, influenza, the sweating sickness, and the dancing mania. ”

“ When any large proportion are down at once, the doctors call it an epidemic, and it is attributed to a “wave”—an epizootic or influenza wave, for example, according as the victims are horses or men (the poor animals depend upon the elevated race for their habits, and never have disease except these are unphysiological) ,—when, in fact, the so-called epidemic, whether it be10 scarlet or yellow fever, diphtheria, or what not, is the result chiefly of the uniformly bad living habits of our people and their consequent predisposition to sickness. ”

“ If the question is asked how we are to reconcile the great variations in the mortality of puerperal fever in different seasons and places with the supposition of contagion, I will answer it by another question from Mr. Farr's letter to the Registrar-General. He makes the statement that "five die weekly of small-pox in the metropolis when the disease is not epidemic,"—and adds, "The problem for solution is,—Why do the five deaths become 10, 15, 20, 31, 58, 88, weekly, and then progressively fall through the same measured steps?" ”

“ But the most careful and stringent quarantine regulations may not be sufficient absolutely to exclude the disease. The progress of medical and sanitary science has been such, however, that if approved precautions are taken at once to put all of our cities and towns in the best sanitary condition, and provision is made for isolating any sporadic cases and for a thorough disinfection, an epidemic can, I am sure, be avoided. ”

“ Much real injury has, however, been sustained from a propensity to identify with this epidemic, and to call by the same name, fevers of very different kinds, which have been known at all times and in all countries, and never have been placed among those deemed contagious. As we advance in our knowledge of this disease, as facts develop the sources from which individuals receive it, the state authorities charged with the care of the public health, and Congress with that of the general commerce, will become able to regulate with effect their respective functions in these departments. ”

“ The frightful suddenness of the rarer disease, and the condensation of its epidemic fatality into some single year, give it more apparent importance than belongs to the familiar name of typhus; but I can assure your Hon. Court, that if a large amount of preventable death, and a still larger amount of preventable misery, be strong arguments for sanitary improvement and activity, those arguments are more abundantly derivable from the constant pressure of fever and its kindred maladies, than from the sharper but infrequent visitations of the foreign pestilence. ”

“ Surely the places where dangerous infectious diseases are constantly propagated on a gigantic scale, and disseminated therefrom into the bodies of millions of animals and mankind, should be the very possible or probable source of epidemic disease. ”

“ Facts such as these help us to understand the production and propagation of disease through the medium of an infected atmosphere, whether on a large scale, as in the case of an epidemic which rapidly extends over a nation or a continent, or on a small scale, in the sick chamber, the dissecting room, the church, and the church-yard. ”

“ Until recently the most reliable test of health rights not enforced was the number of cases of preventable, communicable, contagious, infectious, transmissible diseases, such as smallpox, typhoid fever, yellow fever, scarlet fever, diphtheria, measles, whooping cough. By noticing streets and houses where these diseases occurred, students learned a century ago that the darker and more congested the street the greater the prevalence of fevers and the greater the chance that one attacked would die. ”

“ This epidemic Proteus is at once a great difficulty and a most instructive fact. It opens up the very old doctrine of “epidemic constitutions” of the air, which to many moderns savours of unscientific vagueness; and it brings us face to face with degrees or kinds of infectiveness which are, in matter of fact, more wonderful or more incomprehensible than the deadlier infections, such as the plague or Asiatic cholera. The most familiar instance of the kind is influenza. ”

“ In all epidemics which increase to such a degree as to become contagious, it is of importance to distinguish which of these causes are the more powerful, the predisposing or epidemic causes, which originate the proneness to the disease, or the proximate causes, among which, in the generality of cases, contagion is the most prominent. ”

“ That the termination of epidemics is peculiar, since they cease suddenly at the exact period when the greatest number of persons is affected by them, and when the greatest mortality prevails. This fact is inexplicable under the supposition that epidemics owe their spread from person to person. To suppose that a disease which is propagated by contagion can rapidly decline and even suddenly cease, just when most persons are affected and the mortality is greatest—that is, when the contagious matter is proved to be in its most active and malignant state—is utterly absurd. ”