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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 77-86

Pandemics those struck and those averted: How humanity survived!


1 Department of Ophthalmology, Consultant of Ophthalmologist, Yenepoya Specialty Hospital, Kodialbail, Mangalore, India
2 Department of Biochemistry, Kasturba Medical College, Manipal, India
3 Department of Dermatology, Venereology and Leprology, Kasturba Medical College, Mangalore, India

Date of Submission02-Apr-2020
Date of Acceptance20-Dec-2020
Date of Web Publication25-May-2021

Correspondence Address:
Dr. Madhurima K Nayak
B-9, KMC Staff Quarters, Light House Hill Road, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_15_20

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  Abstract 


Humanity has been exposed to and challenged by epidemics and pandemics from times immemorial. Humans have either lost the battle or won over these pandemics. Bacterial pandemics such as typhoid, plague, and cholera wiped off cities and civilizations altogether. Notable viral pandemics include influenza and smallpox. Influenza has been etched in the history of mankind as a recurring pandemic due to its antigenic variation. A few viruses such as yellow fever, ebola, severe acute respiratory syndrome, Nipah virus, and Zika virus have caused epidemics in the new millennium, although they have been identified a long time back. Human immunodeficiency virus/AIDS is a slow pandemic present since the 1980s, and COVID 19 is the pandemic that the world is facing presently. An effort is made to recall, compare various infectious pandemics, and to understand how humanity has fought back. Furthermore, we try to unravel lessons from history, global, and local health measures such as GSIRS, International Health Regulations, and Global Outbreak Alert and Response Network that were introduced to tackle many such pandemics and an ongoing effort to overcome the present-day pandemic – COVID-19.

Keywords: COVID-19, influenza, nipah virus, pandemic, plague, smallpox


How to cite this article:
Nayak MK, Belle VS, Nayak KA. Pandemics those struck and those averted: How humanity survived!. Muller J Med Sci Res 2020;11:77-86

How to cite this URL:
Nayak MK, Belle VS, Nayak KA. Pandemics those struck and those averted: How humanity survived!. Muller J Med Sci Res [serial online] 2020 [cited 2021 Jun 21];11:77-86. Available from: https://www.mjmsr.net/text.asp?2020/11/2/77/316689




  Introduction Top


The world is gripped today in the claws of COVID-19. As of July 24, 2020, there are 15,296,926 confirmed cases of coronavirus-infected individuals worldwide.[1] The pandemic has endangered humanity, and the entire human race is at stake. “Coronavirus” has become the most-heard-of word these days. As a feeling of fear and uncertainty surrounds us, there is also a hope that humanity will make it through the pandemic. Here is an attempt to take the readers back in time concerning various major pandemics that challenged humanity and how humanity fought back.

A pandemic is an epidemic that occurs worldwide, or over a wide area, crossing international boundaries/involving more than one continent and usually affecting a large number of people.[2] An epidemic is a sudden increase in the incidence of a particular disease than what is normally expected in a population. Whereas endemic is a disease that is constantly present in a population within a geographic area. Many pandemics have been faced by humanity.


  Classification and Causes of Pandemics Top


Pandemic is not a new experience for humanity and has been present for thousands of years. The explanations for the appearance of these periodic epidemics and pandemics are many, ranging from scientific, astrophysical, philosophical, to spiritual. Scientific explanations include possible new mutations within the bacterial or viral genome, leading to the indefatigability of the epidemic. Genetic shift and genetic drift are two variants of change in the genome that are caused by a rapid and slow change in the genome sequence. For example, a change in the antigenic sequence of the influenza virus leads to epidemics every 10–11 years.[3] Practices and behavior pattern on the part of the population also increase the susceptibility, exemplified by the rise of cases of Ebola virus in West Africa where there was a practice of people to care for the deceased and were unknowingly exposed to infection.[4] The appearance of periodic solar flares has also been implicated in the appearance of new viral strains.[5] A philosophical facet argues that nature revives herself, and pandemic is a way by which humans are being punished for their ill doings on nature. However, in recent years, a new element of pandemics is added by humans themselves in the form of biological warfare.

Infectious pandemics can be classified as bacterial and viral pandemics. A timeline of important pandemics has been outlined in [Table 1] and [Figure 1].
Table 1: Bacterial and viral pandemics

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Figure 1: Timeline of all pandemics

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  Bacterial Pandemics Top


Plague of athens

In 430BC, ”the plague” had affected Athens, which originated in sub-Saharan Africa and spread northward until it reached Greece and Persia and persisted for 4 years. The pathogen responsible for the disease could not be identified, and there is speculation that it was caused by the plague, typhus, Lassa fever, smallpox, or typhoid, or even a combination of these.[6] A Greek historian, Thucydides, has recorded the features of the illness and describes it as a fever so high that people would want to be submerged in cold water and experienced severe thirst, congestion of eyes, and the people usually succumbed to the disease within a week. This disease had wiped off around a quarter of the population within 4 years.

Plague of Cyprian

It began in 250 CE in Ethiopia and spread to Rome and Syria in a year. The pandemic was named so because of St. Cyprian, the then Bishop closely observed the illness and documented it. The clinical presentation was diarrhea, congestion of eyes, high fever, deafness, blindness, and paraplegia with pedal edema suggestive of a multisystem disorder. The origin was thought to be supernatural as a punishment by the Gods, but the modern scholars hint the etiology toward bubonic plague, cholera, typhus, smallpox, or anthrax.[7] Some measures such as covering corpses with lime and burning the corpses were undertaken to prevent the spread of the disease. The pandemic gave a massive blow to the Roman empire as it nearly lasted 20 years, killing around 5000 people every day.

Plague of Justinian

It was the first recorded epidemic of bubonic plague and is named so, as it appeared during the rule of an Emperor Justinian I of Constantinople in 540 CE. The organism responsible is  Yersinia More Details Pestis and presented with features of pneumonic, septicemic, and mainly bubonic plague. It is supposed to have originated in China and East India, spreading to Africa through the sea route. The disease was transmitted by rats that traveled in the grain ships which were sent as a tribute to Constantinople. Some ancient historians blamed the emperor for his evil ways, and thus he was punished by Gods.[8] It spread to Europe by 750 CE, killing almost 40% of the population of Europe. People adopted various home remedies such as cold water baths, “blessed” powder, alkaloids, magic rings, so on and so forth as there was less access to physicians. The people with good immunity survived the pandemic.

Black death

Dating to the 14th century, the disease of bubonic plague was brought to land by a group of sailors from the black sea. It affected Europe and Asia. When the ship reached the coast of Messina, most of the soldiers were found dead, and some of them gravely ill covered with black boils and oozing blood and thus the name – black death.[9] It later spread to Syria, China, India, and Persia and killed around 20 million people in Europe too. Due to the lack of understanding about the disease and its pathogenesis, crude practices such as blood-letting and boil lancing were done. There were also other practices such as “Flagellants” where people would whip themselves with sharp-edged whips as a way of accepting punishment from God.

The concept of quarantine started during this episode of plague as the people knew it was spreading due to proximity. The soldiers and sailors were kept in isolation for 30 days (Trentino) and later extended for 40 days (Quarantino).[10] The exact reason why the number “40” was chosen is unknown. Major public health measures that were adopted were a rigid separation between healthy and infected patients either by the use of natural barriers (such as a sea or a ditch created around the facility) and quarantine. The hospitals used to confine Lepers were used to confine plague-stricken individuals – Lazerettos.[11] Thus, this pandemic was somehow brought under control after killing millions.

In 1665–1666 CE, London faced the worst of the plague that ended around the time of the Great Fire of London. Later, the plague recurred approximately every 20 years for 300 years, killing 20% of its population.

Bombay experienced an epidemic of bubonic plague in 1896 when it was still a British Colony killing almost a million people within 1 year and a mortality rate of 22/1000. In 1897, the Epidemic diseases Prevention Act was passed, which checked modes of transport for the transmission of diseases. Ships were monitored when they arrived at ports. Several epidemics erupted meanwhile, and the battle against plague continued until Alexandre Yersin isolated the organism in 1894, following which, there were multiple developments in the field of microbiology that led to the use of antibiotics against the plague and its control development of a vaccine in 1931, use of streptomycin in 1947, and use of cotrimoxazole in 1973.[12] The WHO provides a readiness checklist to provide immediate support to countries with an outbreak of plague, to coordinate with the National Incident management system, response planning to provide resources to the affected country based on the current risk profile, establish a strong surveillance and detection system, to assess readiness to deploy a rapid response team, and provide safe delivery of health care to all individuals.[13] India has identified some parts of the country where there is a risk of contracting bubonic plague and provides preventive measures to travelers and provides advice on ensuring the camping area free of rodents, removal of potential nesting sources, avoiding direct contact with rodents, and making sure the pets are devoid of fleas.[14]

Cholera

Cholera has claimed innumerable lives in the 18th century. The first recorded pandemic occurred in the year 1817 in West Bengal in India and caused high mortality due to diarrhea and vomiting. It later spread to China, Indonesia, Afghanistan, Nepal, Java, Sumatra, the Middle East, and Africa. A severe winter controlled the spread of cholera beyond the Caspian Sea into Europe.[15] After this pandemic, six such epidemics severely affected Europe and North America, claiming millions of lives. In the first half of the 20th century, due to the improved lifestyle of the West, it did not suffer as much as the rest of the world. Extensive research went into understanding the etiology behind this devastating illness. Major public health reforms that took place in this period was the development of more Lazerettos. The patients were given cholera beds that are centrally pierced bed with a bucket placed below to prevent the spread of infection to the environment. Another bucket was placed near the head end to collect vomitus. Filippo Pacini, an Italian anatomist, discovered Vibrio cholerae in 1855.[16] It was rediscovered by Robert Koch 30 years later when there were outbreaks in Egypt and India. He was able to culture Vibrio. Tetracycline was discovered in 1948, which has become the first-line drug. Cholera keeps appearing in smaller epidemics presently, affecting around 1.3–4 million people every year.[17] In the present day, cholera is more easily controlled, though resistance is being reported to tetracycline in the El Tor strains.[18] In 2016, the WHO has introduced the “Cholera Kit” which consists of an investigative kit, laboratory materials, a treatment kit, and a hardware kit. This helps in developing preparedness for an outbreak.[19] The National Institute for communicable diseases, India, is continuously involved in recognizing outbreaks. Accordingly, a team of a clinician, an epidemiologist, and a microbiologist are rushed to the outbreak site, cholera treatment units are established, ORS and fluid infusion systems are provided along with a transportation facility to the nearest primary health center. Furthermore, various paraphernalia is provided for microbiological examination and epidemiological investigations. Chlorine tablets and bleaching powder are distributed for water sanitation. In India, sanitization and improvement in the clean water supply were the best strategies to reduce the cholera epidemic. A thorough diagnosis, treatment, and prevention remained the mainstay in controlling cholera outbreaks along with notification to the state and the WHO. The measures taken during the cholera pandemic in India were to drink water from safe sources, cook and reheat the cooked food and eat them when it is still hot, and avoid having ice creams and uncooked food.[20]

The WHO emphasized the community to follow measures like hand sanitization before and during and preparation of food and consumption of clean drinking water.


  Viral Pandemics Top


Smallpox

Smallpox has been affecting humanity since the Egyptian civilization as evidenced by pustules noted on the mummy of Pharoah Ramases.[21] Caused by the Variola virus, smallpox caused the Antonine plague in the 2nd century CE. It was called so, as it erupted during the rule of Marcus Aurelius Antonius in 165 AD. It is supposed to have originated in China and spread westward through the Silk Route to Rome. The Romans gave a divine angle to the origin of the disease, as they thought the disease was released as a Roman General, Lucius Verus, opened a closed tomb in Seleucia. Galen, a Greek Physician, witnessed the pandemic and has documented its features – fever, blackish diarrhea suggestive of GI bleed, vomiting, sore throat, and an exanthema which scarred after the scab fell off.[22] It was a highly contagious disease that affected children and killed thousands a day and 60–70 million people. The death rate was 30% and mostly due to viremia, heart failure, and pulmonary edema. This pandemic marked the beginning of the decline of the mighty Roman Empire.

Since then, smallpox had been spreading in Africa, Portugal, Spain, the Caribbean, Central, and South America, North America, and then to Australia by the late 18th century. One of the early control measures was variolation, where fluid from the pox vesicles was injected into nonimmune people to prevent an attack of smallpox. The concept of vaccination started in the late 1700s by Dr. Edward Jenner, where material from the sore of cowpox was injected into the forearm of a 9-year-old child, and when the child was exposed to several cases of smallpox, he did not develop smallpox. The WHO took the responsibility of smallpox eradication in 1959, and smallpox was declared to be fully eradicated in 1980.[23] The last case of Variola Major was a 3-year-old girl in Bangladesh in 1975. Smallpox and it is the only pandemic-causing infection that has completely been eradicated using vaccination.

Influenza

Influenza has been making periodic appearances from the times of Hippocrates and has caused massive outbreaks. The two properties of an influenza outbreak which give it a pandemic status are when there is worldwide spread and when caused by a novel strain.

H3N8 and H2N2

In 1889–1890, the flu broke out in Uzbekistan of variant H3N8 and H2N2. It rapidly spread to North America, South America, India, and Australia, thus encircling the whole world. Modern transport facilities helped in the spread of the infection and caused a million deaths worldwide and 13,000 in the USA alone.[24]

The 1918 H1N1

In 1918, influenza struck again – H1N1 variant of the influenza virus, of avian origin, causing a devastating blow to many countries. It was probably the worst of the flu pandemics. It followed the first world war and reached many countries through the soldiers, killing almost 50 million people worldwide and 17 million in India.[7] The pandemic erupted in Kansas, the USA, and then spread to Europe, North Africa, India, China, Japan, and finally Australia. By then, the first wave had started to recede. The first wave was mild, and the mortality rate was not high. It was followed by a deadly second wave in late 1918, the third wave in 1919, and a minor fourth wave in 1920. The main symptoms were sore throat, fever, headache, and more severe acute respiratory distress. There was an increased propensity to bleed from mucous membranes and was believed to be a part of the cytokine storm. Thus, young and healthy individuals with good immunity succumbed to the disease due to an increased immune response and cytokine storm.

There was no vaccine available and no antibiotics to prevent secondary bacterial infections. Major public reforms included nonspecific practices such as the use of antiseptics, quarantine, use of face masks, and improved personal hygiene. Maritime quarantine was done on islands such as Iceland, Australia, and is believed to have saved many lives. Social distancing was the main factor that helped in flattening the curve.

In 1932, the influenza virus was first isolated in the laboratory. Epidemiology of the virus shows that virus flares up in the colder months of the year, and transmission increases with overcrowding.

The 1957 H2N2

H2N2 struck in 1957 in Hong Kong, spreading to China, Singapore, Taiwan, Japan, India, Europe, North America, and thus involved the whole world. Most of the deaths were due to secondary bacterial pneumonia, and there were typical symptoms.[28] It affected 4.5 million and caused 1.1 million deaths. Influenza recurred again every 10–12 years in the form of milder epidemics. Various strains that occurred have been shown in [Table 2].
Table 2: The strain of influenza virus responsible for major periodic pandemics[38]

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1968 H3N2 influenza

It originated in 1968 and caused around 4 million infections. The strain of the virus was H3N2, caused by an antigenic shift from the 1957 virus. As this new strain had Neuraminidase from the previous virus, immunity was partly present in the general population, and thus fatality was much lower. However, due to its high infectivity, it soon became a pandemic. The most affected were infants and the elderly.

The 2009 H1N1

It began in 2009 and infected around 700 million people worldwide. It was primarily zoonotic and acquired by droplet infection from pigs and then transmitted human to human. The outbreak started in Mexico and then traveled worldwide. The strain involved was H1N1 but the number of fatalities was not as much as in the 1918 Spanish flu. The probable reasons are a low reproduction number of the infection (R), antibiotics for secondary bacterial pneumonia, vaccines, antiviral, and ventilator facilities. The reproduction number averaged at 1.8 (interquartile range [IQR] 1.47–2.27) in 1918 Spanish flu and 1.46 (IQR 1.30–1.70) in the 2009 Swine flu.[26] The causes of death were pneumonia, acute respiratory distress syndrome, and rarely myocarditis. Vaccination was provided in the form of the killed virus through nasal spray by November 2009. Its effectiveness was found to be around 40%–60%.[27] Oseltamivir also has promising results in treating infection. The second line of drug available is zanamivir, which can be used in cases of resistance to the former.

Some major global platforms have surfaced in the direction of control of influenza by the WHO. It all began in 1947, where an interim body of the WHO started the Global Influenza program, which collected and analyzed data from various parts of the world, and in 1957, the GISRS, Global Influenza Surveillance, and Response system came into existence.[28] These are supported by a chain of National Immunization Centers, which are actively involved in collecting specimens and isolation of viruses. These surveillance systems help nations define risk groups, transmission, clinical features, and prepare for epidemics. Also included in these surveillance systems are FluID (global influenza epidemiological data-sharing platform), Pandemic Influenza Severity Assessment, and PSS (Pandemic Influenza Special investigations and Studies). These systems help in identifying index cases, developing vaccines, and increasing preparedness for every epidemic. In 2004, the WHO H5 reference laboratory network was established which is involved in understanding changes in the genome of the H5 variant and preparation of vaccines for the same. The WHO also provides numerous guidelines for influenza preparedness and impact management.

Yellow fever

Yellow fever is a viral hemorrhagic fever endemic to Africa and South America caused by an Arbovirus and transmitted by Aedes Aegypti mosquitoes. The patients demonstrate fever, jaundice (hence called yellow fever), nausea, vomiting, chills, and myalgia. An epidemic broke out in North America in the late 1700s when a colony of slaves arrived from the Caribbean to flee from the slave culture. Within days, the number of deaths increased rapidly and it was declared an epidemic. The epidemic flared, killing around 50,000 people in a matter of 3 months.[29] The change in temperature and severe winter led to the killing of mosquitoes and hence controlled the epidemic and thus probably averted conversion into a pandemic. It then appeared in various parts of America over the next 100 years in the form of small outbreaks. Yellow fever vaccine-17D is highly effective in controlling infection and was introduced in 1939, following which a million people received the vaccination.

A global strategy to Eliminate Yellow Fever Epidemics (EYE) is an ongoing long-term global strategy launched in 2017 by the WHO.[30] This program aims at mass vaccination in endemic areas, inclusion as a universal childhood vaccine in endemic areas, and rapid containment through early detection, vector control, and case management.

Human immunodeficiency virus/AIDS

The human immunodeficiency virus (HIV) and AIDS is an ongoing slow pandemic that began in 1984. This sexually transmitted disease has an immense effect on the social morale. Opportunistic infections associated with HIV/AIDS are responsible for the morbidity and mortality associated with it. With the advent of antiretroviral therapy and newer antimicrobials, there is a significant reduction in mortality rates, but the rate of infection remains unchecked. Important life-threatening opportunistic infections are tuberculosis, toxoplasmosis, cryptococcosis, cytomegalovirus infections, etc.Modalities for decreasing transmission rates are the use of condoms, sex education, vaginal tenofovir gel,[31] preexposure prophylaxis, and use of antiretroviral therapy to decrease mother-to-child transmission.

There are numerous nongovernment organizations (NGOs) involved in the control of AIDS such as the International AIDS Society, Kaiser Family Foundation, and UNAIDS, which are actively involved in activities to increase awareness and increasing availability for treatment for HIV/AIDS.[32] Furthermore, the Government of India, Ministry of Health has launched the National AIDS Control Program in 1992.

Zika virus

It is a Flavivirus transmitted by the bite of the Aedes mosquito. It was isolated in a rhesus monkey in 1947 in the Zika forests of Uganda.[33] It slowly has spread through Tanzania, Nigeria, and Gabon along the east coast of Africa for a decade. Usually, the infection produces nonspecific features similar to dengue, i.e., fever, rash, headache, arthralgia, myalgia, and more significantly Guillian–Barre syndrome. However, it has significant effects on the fetus, leading to microcephaly. The recent outbreak was in 2007 in Micronesia and Polynesia, spreading to Japan, Cambodia, and then to Central and South America by 2016. They are no specific treatment or vaccine available. There were no cases reported of the Zika virus after 2017. The reason for this remains largely known, maybe herd immunity or a decrease in pathogenicity of the virus.[34] Thus, the pandemic of Zika was averted.

In India, a key control for the Zika virus was mainly through vector surveillance and vector management. In vector surveillance, larval surveys were done by checking the water holding container (for larvae using five indexes – House index, Container Index, Breteau Index, and Pupae Index) and Landing/biting collection, Resting collection, Oviposition traps for adult surveys.

In vector management, environmental manipulation by changing the habitat of the vector so that breading is halted. Change in human habitation so that contact between human and vector is broken and environmental modifications by overhead mosquitos proofs, creating an underground reservoir and utmost importance was improved water supply reduced the incidence of new cases.

The WHO strongly recommended the use of light colored covering the almost full body to be used by vulnerable groups such as pregnant women, children, and women of reproductive age. Window screens, applying mosquito repellents in the day and early evenings, and the use of mosquito nets while sleeping were key measures taken to reduce the transmission of infection.[35]

Ebola

Ebola virus disease gets its name from the River Ebola, which is now in the Democratic Republic of Congo and the disease was first reported in 1976 as mainly a disease of primates.[36] It spreads from person to person by direct contact with body fluids and even by aerosol. A very widespread outbreak occurred in 2014–2016 in West Africa, causing around 11,000 fatalities.[37] This disease has a high mortality rate of around 50%. However, it had limited cases in the USA, Italy, Spain, and the United Kingdom. The outbreak subsided, and some practices such as safe burial practices and changes concerning mourning led to early control of the epidemic. However, a vaccine, rVSV-ZEBOV, is approved and has high efficacy.

In the Indian scenario, this disease was controlled by educating and communicating the information regarding the disease, its transmission, and control. Reducing the fear about Ebola virus attack and coordination between the epidemiological surveillance team, the laboratory that tests the Ebola virus, and the social intervention team. The WHO also stressed that health-care workers were at high risk during the Ebola virus outbreak, education, and training to practice strict infection control measures were given such as standard biosafety precautions, good clinical laboratory practices, use of Personal protection equipment, regular disinfection of objects, material, and equipment and finally, disposal of infected individuals and safe burial practices.[38]

Nipah virus

Nipah virus is a type of paramyxoviridae that was first seen in Nipah, a village in Malaysia in 2008 when it caused more than a hundred deaths.[39] In 2018, a series of mysterious deaths rocked southern India, which were found to be due to a zoonotically transmitted viral infection. Nipah virus is highly infectious and is acquired by the ingestion of food contaminated with Bat urine or saliva, and from person to person is transmitted through body fluids. Clinical features present within 3–14 days with fever, headache, drowsiness, disorientation, and confusion. The cause of death is encephalitis. This outbreak was very well contained through mass quarantine and education about the disease and thus caused only 19 cases, of which 17 succumbed.[40] The state of Kerala displayed excellent infection control measures through strict lockdown of the daily activities and individual movement, familiarization of health-care professionals with case definition, and adequacy of personal protection equipment helped in controlling this epidemic that had a very high potential to turn into a highly fatal pandemic. No preventive vaccines are available for Nipah Virus. The only way to reduce transmission is by creating awareness, public education, and recognizing the outbreak. The WHO emphasizes on cleaning and peeling of fruits before consumption and discarding fruits with signs of the bite.[41]

COVID-19

The human coronavirus was discovered as early as the 1960s in children with the common cold. After almost three decades, in 2002–2003, an animal origin coronavirus epidemic erupted in southern China, causing severe acute respiratory syndrome (SARS). It was reported in 29 countries in Asia, North America, Europe, and Africa and caused around 750 fatalities.[42] This epidemic was controlled very well by changing animal husbandry practices, mapping the viral genome, and development of reliable diagnostic tests.[43] The SARS 2003 contributed to the understanding of the structure and pathogenesis of the disease caused by it.

Furthermore, the outbreak led to the formation of the International Health Regulations (IHR). IHR came into enforcement in June 2007, with a purpose to prevent, protect against, control, and provide a public health response to the international spread of disease without causing interference with international traffic and trade.[44] This body helps in the detection and reporting of potentially hazardous emergencies worldwide and involves 196 countries. It defines a potential public health emergency of international concern (PHEIC) based on a few criteria.[45] Based on these, if a member country identifies a PHEIC, it should report to the WHO within 24 h. Since 2010, the monitoring process of the IHR has evolved a self-assessing questionnaire. In 2018, a new self-assessment tool called SPAR has been developed. From the conception of IHR, five PHEICs have been declared by the WHO: H1N1, Polio, Ebola, Zika virus, and now – COVID-19.

A novel strain of coronavirus was detected in the Wuhan city of Hubei province of China, causing a cluster of outbreaks in December 2019. The source is thought to be the wet market of Wuhan. Then, the disease spread to most parts of China, Thailand, Korea, part of Russia, and Australia. By February 2019, the disease had spread to most of North America, and by March, it had spread to most of Europe, India, South America, and a few parts of Africa. COVID-19 was declared a pandemic on March 1, 2019, by the WHO, and by March 20, 165 countries were in its grip. The knowledge about coronavirus procured during the 2002 epidemic led to several public health measures such as the use of sanitizers, face masks, social distancing, and lockdown policies. In comparison to SARS (14% in the general population and around 50% in those aged more than 65 years),[46] COVID-19 has a lower mortality rate ranging from 0.25% to 3%.[47]

Several drugs are being tried with variable results – hydroxychloroquine, azithromycin, ivermectin, lopinavir, dexamethasone, tocilizumab, and others. Tocilizumab, an interleukin-6 monoclonal antibody, has been found to effectively reduce mortality in critically ill patients with COVID.[48] Vaccine for the COVID-19 disease is still under trial.

In the year 2000, the Global Outbreak Alert and Response Network (GOARN) was established by the WHO involved in rapid identification, confirmation, and responding to a public health hazard. It is a network of various public health institutions, laboratories, and NGOs to identify epidemics. In the present situation, GOARN is actively involved in the control of COVID-19 by association with many countries. This year marks the 20th anniversary of GOARN. Furthermore, an important landmark in Indian law, as the amendment to the Epidemic diseases act of 1897, was made this year. Accordingly, the act empowers health workers for protection from violence against them and provided higher powers to the Central Government to control infection spread through major routes of transport.[49]


  Summary Top


The year 2019 marks the birth of the COVID-19 pandemic, which has killed more than half a million individuals worldwide. The earlier viral and bacterial pandemics taught a lesson to prepare to handle the consequences arising due to the birth of newer pandemics or rebirth of earlier pandemics but still many countries including India were not very well prepared.

Several pandemics during the BC-era caused by bacteria such as plague and typhoid that affected humanity, led to huge losses of human life. With advances in microbiological methods, identification of microorganisms and their mode of transmission, vaccine developments, and development of antimicrobials, humanity has tried to fight back against infectious pandemics. The reasons for control of pandemics were a sudden change in weather or climate, change in the genetic makeup of the viral strain, improved personal hygiene methods, strict quarantine, development of vaccine or treatment, and in many cases, the reason remains unknown. Major public health reforms in the form of improved sanitation, social distancing go a long way in controlling infections. At the global and international level, many organizations and networks are formed by the WHO, which play an important role in identifying a global threat and efforts to control it. The involvement of the National Government bodies in implementing laws for the control of epidemics cannot be overemphasized. There is a need for higher indulgence and cooperation between these global partners, national-level institutions, and state institutions to control an infectious epidemic. To date, smallpox is the only infectious pandemic that has been successfully conquered by humanity. Whether or not we can overcome the present pandemic – COVID-19 is still a mystery.

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Conflicts of interest

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