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The Pandemics That Came before COVID-19

Mar 09, 2022 10:00AM ● By Anand Subramanian

Throughout history, infectious illnesses with pandemic potential have emerged and spread regularly. Few people reading this now will recall outbreaks of this size, but history demonstrates that, although tragic, what we are seeing now is nothing out of the ordinary. Since 1900, many big worldwide pandemics have killed millions of people. But how many people remember them? And how many pathologists, microbiologists, and clinical laboratory scientists working today have even been exposed to the most recent worldwide pandemics? Here is a summary of these significant pandemics to provide context for comparing the COVID-19 pandemic to other pandemics.

Spanish Flu - 

The 1918 influenza pandemic, sometimes known as the Spanish Flu, was the most severe and lethal epidemic of the twentieth century. This pandemic was triggered by an avian-derived new strand of the H1N1 virus. It is believed that one-third of the world's population was infected with the virus at the time. According to a CDC article, the 1918 flu pandemic killed at least 50 million people globally, with about 675,000 of those fatalities happening in the United States. This pandemic had an extremely high mortality rate among healthy people aged 15 to 34, and it reduced average life expectancy in the United States by more than 12 years. Scientists give numerous causes for the high fatality rate, including a six-year climatic anomaly altering disease vector movement, which increases the risk of disease transmission across bodies of water. Interestingly, specialists believe that the 1918 flu strain never completely left humanity, but rather weakened and grew less fatal as it evolved and spread among humans and other animals. Malnourishment, overcrowding in medical camps and hospitals, and poor cleanliness, aggravated by the war, facilitated bacterial superinfection, killing the majority of the patients after a normally extended death bed stay.

Figure 1 - Visual from Spanish Flu Pandemic. Source - Google

The Hong Kong Flu -

The so-called "Hong Kong flu" epidemic of 1968 began in China and lingered for many years there. More than 500,000 individuals had been infected with the flu within a few weeks of its appearance in densely crowded Hong Kong. The global spread of a highly infectious virus occurred within a few months. Flu A subtype H3N2 is likely to have developed from influenza A subtype H3N2 that caused the 1957 flu pandemic by antigenic shift, according to Encyclopedia Britannica. Antigen H3 (H3) was created in this instance by genetic mutation of the H1 antigen, which is found on the virus's surface. Those who had previously been exposed to the 1957 flu virus seemed to be resistant to the 1968 virus, which might explain the mildness of the 1968 pandemic, according to Britannica. An estimated one to four million people died as a result of the 1968 Hong Kong flu, with the United States accounting for around 100,000 of those fatalities. As of the end of 1968, a vaccine for the virus was available, and the outbreaks looked to be under control the next year. Seasonal influenza and viruses like H3N2 are still making the rounds across the globe.

Figure 2 - Hong Kong Visual. Source - Google

Swine Flu -

The new H1N1 influenza virus that triggered the Swine Flu pandemic was discovered in California in the spring of 2009. It quickly spread across the United States and the rest of the globe. This new H1N1 virus included a novel mix of influenza genes that had not before been detected in either animals or humans. When the World Health Organization (WHO) proclaimed the flu pandemic in June 2009, 74 nations and territories had reported confirmed cases of the illness. Between April 2009 and April 2010, the CDC estimated that there were 60.8 million instances of Swine Flu infections in the United States, resulting in roughly 274,304 hospitalizations and 12,469 fatalities. The true number of illnesses, which includes asymptomatic and moderate instances, might range from 700 million to 1.4 billion individuals. This epidemic, which was less severe than earlier pandemics, largely afflicted children and young and middle-aged people. Despite this, the H1N1 pandemic resulted in a significant rise in clinical laboratory test volumes.

Figure 3 - Swine Flu Visuals. Source - Google


With tremendous gains in treatment, knowledge, diagnostic capabilities, and monitoring in Western nations, it is easy to forget that HIV  is still considered a pandemic by specialists. The human immunodeficiency virus (HIV) attacks the immune system, weakening individuals' defenses against numerous illnesses and cancers that people with healthy immune systems can resist. Infected people become immunodeficient as the virus kills and inhibits the function of immune cells. The CD4 cell count is often used to assess immune function. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which, depending on the person, may take several years to develop if not treated. The development of certain malignancies, infections, or other serious long-term clinical signs of AIDS is what defines the disease. More than 32 million individuals have died as a result of HIV since the early 1980s. At the end of 2018, around 37.9 million individuals were infected with HIV.

Figure 4 - Visuals of HIV. Source - Google

Asian Flu -

The H2N2 virus that caused the Asian Flu originally appeared in East Asia in February 1957 and swiftly spread to other Asian nations. By the summer of 1957, the virus had reached the coastlines of the United States, where the number of illnesses continued to climb, particularly among the elderly, children, and pregnant women. According to the CDC, this H2N2 virus was made up of three separate genes from an H2N2 virus derived from an avian influenza A virus, including the H2 hemagglutinin and N2 neuraminidase genes. Between 1957 and 1958, the Asian Flu swept the globe, killing between one and two million people, including 116,000 in the United States alone. This epidemic, however, might have been considerably worse if it hadn't been for the work of microbiologist and vaccinologist Maurice Hilleman, Ph.D., who was Chief of the Department of Virus Diseases at Walter Reed Army Medical Center in 1958. Concerned that the Asian virus might wreak havoc on the United States, Hilleman spent four months researching and developing a vaccine for it. Without the rapid delivery of the vaccine, public health experts believe that the number of fatalities in the United States may have topped one million.

Figure 5 - Visual from Asian Flu. Source - Google

 Anand Subramanian is a freelance photographer and content writer based out of Tamil Nadu, India. Having a background in Engineering always made him curious about life on the other side of the spectrum. He leapt forward towards the Photography life and never looked back. Specializing in Documentary and  Portrait photography gave him an up-close and personal view into the complexities of human beings and those experiences helped him branch out from visual to words. Today he is mentoring passionate photographers and writing about the different dimensions of the art world.

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