Pandemics – a walk through the historical lane

Throughout the course of history, pandemic have ravaged humanity. A pandemic is an outbreak of global proportions. It happens when infection due to a bacterium or virus becomes capable of spreading widely and rapidly. There are many pandemics, dating from prehistoric to modern times. About 5,000 years ago, a disease wiped out a village in China. The bodies of the dead were stuffed inside a house that was later burned down. The archaeological site is now called “Hamin Mangha”. Around 430 B.C., an outbreak of infection killed the 100,000 people of Athens and lasted for five years. 

During 1346-1353, the plague known as “The Black Death” traveled from Asia to Europe, leaving devastation in its wake. Some estimates suggest that it wiped out over half of Europe’s population. In 1665-1666, around 100.000 people died in “The great Plague of London.”

With the industrial age, new transport links made it easier for influenza viruses to wreak havoc in 1889-1890. In just a few months, the Flu pandemic spanned the globe, killing 1 million people. In 1918-1920, an estimated 500 million people from the South Seas to the North Pole fell victim to Spanish Flu. In 1957-58, the Asian flu pandemic was another global showing for influenza. With its roots in China, the disease claimed more than 1 million lives.

Black Death 1350 – 2^nd Pandemic caused by Bubonic Plague ¹ (Source History.com)

In present time, H1N1 Swine Flu pandemic (2009-2010) infected as many as 1.4 billion people across the globe and killed between 151,700 and 575,400 people; which was followed by Ebola epidemic and Zika virus epidemic in 2014-2016. 

Swine Flu Pandemic 2009-2010 ¹ (Source History.com)

Currently the COVID-19 pandemic, also known as the coronavirus pandemic, is a continuing global pandemic of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronaviruses have caused concern due to their potential to lead to pandemics in recent years. Examples of coronavirus infections, in addition to SARS-CoV-2, include SARS and MERS. Previously, health agencies and government bodies managed to prevent coronavirus infections from becoming more than localized epidemics. MERS is still active, but outbreaks occur on a much smaller scale and less frequently.

The WHO declared the COVID-19 pandemic, a Public Health Emergency of International Concern on 20 January 2020, and later a pandemic on 11 March 2020. As of 5 April 2021, more than 131 million cases have been confirmed, with more than 2.85 million deaths attributed to COVID-19, making it one of the deadliest pandemics in history.

Present Global Scenario of Covid 19 pandemic

Globally as of 02/04/2021 there have been 12,92,15,179 confirmed cases of Covid 19 including 28,20,088 deaths, reported to WHO. As of 30/03/2021 a total of 54,77,27,346 vaccine doses have been administered.

Peri and Post Vaccination in India

Peri Vaccination Scenario

India has become only the second country in the world, after the United States, to add more than 100,000 cases of the coronavirus disease (Covid-19) in a single day at any time during the pandemic. According to the Union ministry of health and family welfare on 5^th April 2021, the country added 103,796 coronavirus disease cases recorded in the last 24 hours. The new cases have now pushed India’s infection tally up to 12,589,067, as per the health ministry’s dashboard. Till now 7,91,05,163 persons have been vaccinated in India, as per health ministry’s dashboard. 

Post Vaccination scenario –

Although India presently is at Peri vaccination stage only and it is difficult to predict the scenario of post vaccination stage; however the outcome of such a large-scale vaccination program will be dependent upon various factors such as long-term safety, efficacy and acceptance of these vaccines in the various sections of society of Indian population which is highly diverse and a mix of various cultures, religions and beliefs.

A SWOT analysis will help India configure the future course

Our strengths have been: a nationally coordinated response; step up in national capacity for production of medical equipment, drugs and test kits; ramp up in testing capacity; expansion of healthcare facilities for quarantine, isolation, intermediate and advanced care in hospitals; adoption of home care model for mild cases; expansible laboratory capacity across public and private sectors; ability to develop, evaluate and mass manufacture vaccines; mass vaccination, extensive mass media engagement for messaging on Covid-19 prevention.

Our weaknesses have been: inadequate primary and secondary healthcare infrastructure and staffing in many areas; absence of organised urban primary healthcare in the cities and towns that started and spread the epidemic; lack of public health expertise at various levels of the health system; inadequate contact tracing in many areas, leading to high rates of viral spread; excessive dependence on rapid antigen tests, which have a high rate of false negative results; data collection systems not providing complete, timely and accurate data in the public domain, on newly tested persons, ratio of nucleic acid tests like RT-PCR to rapid antigen tests, Covid-19 related deaths (in hospital and out of hospital), co-morbidities, antibody surveillance studies and hospital bed availability; inadequate citizen and NGO engagement; limited use of local community networks and influencers for case identification, contact tracing, risk communication and health education; stigma and fear that inhibited case and contact identification; poor adherence of many citizens to public health advisories on wearing of masks in the right manner, physical distancing and avoidance of large gatherings.

Despite the rapid spread of the coronavirus so far, there are several opportunities that we must utilise to control the pandemic. These Opportunities are: preventing or markedly slowing down the spread of the virus to and between villages in rural India will contain the epidemic, because low crowd density, short commutes to work and more open spaces yield a lower ‘R’ (reproduction factor) than in urban areas; shielding of the elderly and persons with severe co-morbidities will reduce rates of severe morbidity and death; home care for mildly affected and asymptomatic persons with infection is now a well-accepted modality of care and will reduce the load on hospitals; available evidence that ventilators are needed only in a very small fraction of infected persons and that secondary care facilities, which can provide free-flowing oxygen, can treat many sick patients; potential for using now well-recognised clinical symptoms for syndromic household surveillance and early detection of suspect cases for prompt testing, isolation and contact tracing; domestic production and wide availability of drugs, which have so far shown benefit in large clinical trials (steroids and Remdesivir); many of the primary care functions can be performed by trained, young citizen volunteers or groups like National Service Scheme (NSS) or National Cadet Corps (NCC), and an energetic civil society can mobilise community resources for active citizen engagement.

The Threats that need to be guarded against are: non-adherence of people to public health measures such as physical distancing; unrestricted travel between urban and rural areas; lack of firm action by local administration to prevent large gatherings; high crowd density in urban areas, especially in slums, many areas of indoor employment and in public transport; lack of threat perception among many citizens and even some policymakers, with trust in an imminent arrival of ‘herd immunity’ as a sure saviour; Failure of existing vaccines due to mutation in current strain of corona virus; neglect of the essential needs of non-Covid-19 health services, which will superimpose a secondary public health emergency on the primary health emergency we are battling now.

Conclusion

Indian people and government have to give emphasis on implementing on the Strengths & Opportunities taking stringent and necessary steps and at the same time also need to watch over how to decrease the chances of weaknesses and threats in the implementation of not only vaccination program but also all the safety measures to decrease further spread of this deadly Pandemic.

Acknowledgements

I am thankful to Dr Ravinder Kumar Sah, Professor, Dept of Pharmacology, Lady Harding Medical College, New Delhi for his valuable inputs towards this article.

References

1. Pandemics That Changed History: Timeline – HISTORY   www.history.com/topics/middle-ages/pandemics-timeline  accessed on 05.04.2021 09.00 hrs.
2. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data  www.covid19.who.int  accessed on 05.04.2021 at 09.00 hrs.

Supplement

WHO Coronavirus Dashboard ² (Source Courtesy WHO data from who.int)

WHO Coronavirus Dashboard ² (Source Courtesy WHO data from who.int)