Did We Learn from Past Pandemics ?

By (Dr) Surjit Singh Bhatti, Formerly Dean (Sciences ), Guru Nanak Dev University, Amritsar

 

COVID-19 confirmed infections, by the end of 2020, throughout the world have risen above 70 million and the number of deaths is about 1.5 million. What is less known is that thousands of people have died as an indirect result of this pandemic. The second wave is already seen to be worse than the first. Unemployment, caused by repeated lockouts, has shot up and supply chains of essential goods are already shaking. Social life is in disarray, and the United Nations has warned that the planet was facing “multiple famines of biblical proportions.” These are some factors, among others, that had led to the disintegration of many societies in the past.The Hebrew Scriptures, Plato, and the German historian Oswald Spengler, among some more,  had hinted at such possibilities in the past, in their own ways. During the Cold War (1947 – 1991), for instance, the possibility of nuclear attacks had pushed the world to the brink of near total destruction. Some people fear that worse consequences of the current coronavirus may be lurking ahead.

The 20th Century Pandemics

The first pandemic in the 20th century, (erroneously) called “Spanish Flu”, was caused by an H1N1 virus with genes of avian origin, during 1918-20. About 500 million people (about one-third of the then world population) were infected and at least 50 million died. These included mostly children younger than five, adults 20 to 40 years old, and seniors 65 years and older. With no available vaccine and no globally coordinated control, the efforts worldwide were limited to mere non-pharmaceutical (social and personal) preventive interventions. It ended as people developed immunity.

The virus strand of the Spanish flu, however,  did not disappear. The virus mutated, passing through humans, pigs, and other mammals, and morphed into seasonal flu. Descendants of H1N1 made up the influenza viruses, which persists even  today. Two other influenza pandemics occurred at an interval of one decade during the 20th century. One, a milder pandemic, called “Asian Flu” (1957-58) was caused by an A(H2N2) virus. The other, called “Hong Kong Flu”(1968-69) was caused by an A(H3N2) virus. These caused about four million deaths each.

The 21st Century Pandemics

SARS-CoV-1 (Severe Acute Respiratory Syndrome) first occurred during 2002. It  was caused by coronavirus and was first identified in Foshan, Guangdong, China. Over 8,000 people from 29 countries were infected, and about 1000 died worldwide. In December 2019,  SARS-CoV-2, a new closely-related strain of coronavirus was first detected in Wuhan, China. It became the cause of the presently ongoing COVID-19. It is suspected that this strand of coronavirus probably hopped from some wild animals to humans.

The first (swine) flu pandemic of this century occurred during 2009-10 and was caused by an A(H1N1) virus. It was the first pandemic for which many countries had developed comprehensive plans describing the public health measures to be taken. For the first time, pandemic flu vaccine was produced, and became available in many countries. Globally this pandemic caused between 100,000 and 400,000 deaths. Children and young adults were disproportionately affected in comparison to seasonal influenza, which causes severe disease mainly in the elderly and persons with pre-existing chronic conditions.

MERS-CoV (Middle East Respiratory Syndrome) appeared next in 2012 in the Saudi Arabia. Unlike in common-cold-causing flu, these coronaviruses, which are enclosed-RNA viruses,  spark a viral-induced storm in the blood of a person’s organs. The chest scans reveal COVID-19’s patterns which are distinct from those of pneumonia. It killed many times more than seasonal flu deaths, in all age group, except in kids under nine.

Some Medical Aspects

COVID-19 and common flu are respiratory diseases, and their symptoms are similar.  These include fever, and cough that progresses to pneumonia, followed by viral replication, immune hyper-reactivity, and pulmonary destruction. The lungs normally make mucus that protects them from pathogens and keeps the breathing passage moist. Normally, the lung cilia cells surround the mucus and clear out the debris.  Viruses kill cilia cells, filling the airways with fluids, leading to shortness of breath.  Human bodies step up to fight the disease by flooding the lungs with immune cells. But viruses kill everything in their way, including healthy cells. Lungs which replenish the body with oxygen are thus rendered ineffective. These viruses, (as in the case of SARS and MERS), also invade other cells or receptors (with proteins on their outside) and damage intestines, colon, and the gut, producing leakage of fluids. resulting in diarrhea. They also spread via feces.

These viruses create more liver enzymes, while lowering white blood cells (WBC), platelet count, and blood pressure. This leads to acute kidney and liver injury, and cardiac arrest.  Liver cells release some enzymes into bloodstream but raised levels of enzymes in blood result in liver failure. In a healthy person, the numerous microscopic distilling units (nephrons) in kidneys filter blood, sending the waste down to bladder as urine. These nephrons are damaged by the viruses. Renal failure  results from multi-organ failure or being connected to a ventilator for too long.

As these new vaccines for COVID-19 become available for millions of people, we require facilities for their safe storage below ( ) 200 C.  For some vaccines, huge quantities of dry ice (solid carbon dioxide) is needed to maintain ultra-cold conditions as low as ( – ) 700 C.  During shipments, only maintaining such low temperatures can ensure a safe and regular supply chain.  This necessitates availability of a very large number of extreme-chill medical freezers.  The ways to prevent infection are still the same; avoiding exposure to the virus and the precautions recommended during 1918-20. Today, personal hygiene,  rigorous testing and quarantine  seem to be the main ways out.

What did the world learn during 1920 -2020 ?

Despite medical advances, the world has neither been able to prevent the periodic  recurrence of these respiratory diseases nor contain them effectively. Once the danger passed, we seemed to forget whatever little was learnt from previous pandemics. After 2012, WHO and most countries appear to have made no serious attempt to prepare for the likelihood of another pandemic, like the one that swept across the world in 2020. Even when the emergence of the current coronavirus pandemic had become apparent by December 2019, some countries ignored it.

There was a great need to procure in large numbers essential items like masks, sanitizers, personal protection equipment (PPE), ventilators, deep freezers for vaccines and other accessories well in advance. At least one well-equipped hospital was needed in every city and big town (in every country) with sufficient beds to meet any emergent medical situation arising out of any (respiratory or other) pandemics. Had a systematic and concerted preparation been made after the 2012 pandemic, the horrendous situation that the world faced in 2020, would not have arisen. At least, the COVID-19 would have done much less loss to human life. The collateral damage done by it would also have been not so huge and widespread.

Consequences of Unpreparedness

The knee-jerk reactions like lockdowns and closures of large manufacturing establishments led to serious repercussions all over the world. Loss of employment among the daily-wagers and breakdown of essential supply chains of  consumable items hit almost everyone hard. The quarantines, social distancing and isolations, the shunned gatherings of all types, and the drastic cuts on travel by all public modes, led to a state of gloom, depression and strange virtual existence.  Working from homes and the total dependence on computers, internet, and other electronic devices, has become the new normal. It will probably become one of the new norms of our digital future, to which we may resign!  Life is changing fast from real to the seemingly unreal. The perennially crowded cities of the past are now almost empty. There are some compelling reasons for this un-nerving, ghost-like paradigm shift.

The Catastrophic Climate Changes and Pollution

The world has not been able to stem the severe global climate changes resulting from pollution, indifference to ecological requirements, and human craving for more land, energy, and favourite foods. The damage done by global warming so far to the planet is considered irreversible. Are we willing to spend more on preventive healthcare and continuous research on tackling diseases caused by our callous destruction of the environment, than on weapons of warfare ? Despite developing more ‘renewable energy’ sources, fossil fuels are still in demand and very much in use. This is necessary because the ‘green energy’ is inadequate to meet the growing human needs. Many people believe the climate changes will continue at least for another 50 years. The  devastating floods, melting of glaciers, deforestation and wildfires are likely to continue unabated, forcing loss of natural habitats and lives of humans as well as  animals, birds, and other living species. The increasing pollution of air, water and the soil are likely to add new diseases and cause more pandemics. Life on the planet Earth , it seems, will change beyond recognition.

Similar factors had done immense damage to the world in the past also. The Harappan civilization, which flourished in the Indus Valley for nearly a millennium, was destroyed mainly due to climate changes and the resulting outbreaks of some infectious diseases. The destruction of Maya civilization has been ascribed to deforestation, fires, and droughts, besides some social factors. The devastating fires across Australia and some other countries during the last five decades are just one of the many signs that this planet is already deep inside a major crisis.

The Social Aspects

The fear of pandemic-linked catastrophic situations arising in future is not entirely unfounded. In some dispensations, there is another very important factor contributing to such an exigency, the collapse of institutional safeguards. The result is that when disasters like pandemics, famines, wars or earthquakes strike, the permanent medical and social mechanisms that are meant to coordinate on such occasions,  fail to meet the huge challenge.

Safeguards in many countries had collapsed even before CoVID-19. For the last half a century, a large part of the world’s poor population had been deprived of pre-emptive healthcare. This left majority of the world extremely vulnerable to shocks like the pandemics. A co-ordinated economic system is needed, which has to be  based on international co-operation in healthcare and supply chains. Also, empathetic attitude to ecological balance is essential to avert such disasters. Otherwise, in future, pandemics-linked global systems collapse may be a matter of time. It is our ability to organize ourselves to solve these problems collectively, that alone can save the world.

The current pandemic has already given us a taste of what would happen when different countries of the world fail to meet the challenges unitedly. Rich nations are stockpiling new COVID -19 vaccines, with inadequate quantities of vaccines left for the rest. Some institutions are collapsing right now mainly due to greed of the wily people. Some of them are interested only in the continuation of their grip while mishandling the response to this pandemic, misrepresenting the facts, and pushing the embarrassing truth under the carpet. This is one of the  lessons we have to learn. These pandemics have now acquired unimaginable power to devastate the world, especially poor people and are also taking their huge emotional toll, all over the globe.

No country in the world today can survive in selfish isolation. Human survival is intricately dependent upon the survival of all forms of species of flora and fauna, as well as the well-being of people of other countries. We can not shut down our doors to other countries completely, as people will always need to travel abroad. Many of them will carry the infections with them unwittingly even if they test negative at borders. Infections will have to be tackled by all countries jointly with the WHO, and preventive steps will have to be taken by them well in advance to minimize the impact of any future pandemic. 

(surjitsingh.bhatti@gmail.com) 

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