Plague in the Ancient and Medieval World

I shouldn’t respond to crackpots.

Dr. Mountain Dew has convinced himself that everyone who doesn’t buy into his conspiracy theory about the coronavirus hoax must be part of the conspiracy themselves.

Here is my theory.

There have been eight major pandemics since 1700. Of those, seven had a larger second wave and peak approximately six months after the first peak. Major pandemics typically happen every 50 years or so and the last major influenza pandemic was the Hong Kong Flu in 1968.

In the 20th century, there were three influenza pandemics. The 1957 and 1968 influenza pandemics began in China and Hong Kong. There is also strong evidence that the Spanish Flu began in China in 1917. Thus, it is not surprising that 50 years after the 1968 Hong Kong Flu that we are facing another major pandemic that started in China. The H1N1 pandemic of 2009 began roughly 50 years after the 1957 influenza pandemic. The 2020 COVID-19 pandemic has arrived right on schedule.

During the American Revolution, three times as many American soldiers died from diseases like smallpox, dysentery and malaria than from combat with the British. As John Adams said, “the smallpox is ten times more terrible than Britons, Canadians and Indians, together.” George Washington himself vaccinated the entire Continental Army to defeat smallpox. He died of pneumonia. After losing his son to smallpox, Benjamin Franklin bitterly regretted not inoculating him for the rest of his life. Franklin died of pleurisy not unlike people who die from COVID-19.

“… when the pain and difficulty of breathing entirely left him, and his family were flattering themselves with the hopes of his recovery, when an imposthume, which had formed itself in his lungs, suddenly burst, and discharged a quantity of matter, which he continued to throw up while he had power; but, as that failed, the organs of respiration became gradually oppressed; a calm, lethargic state succeeded; and on the 17th instant (April 1790), about eleven o’clock at night, he quietly expired, closing a long and useful life of eighty-four years and three month.”

Two thirds of the American soldiers who died in the Civil War died of infectious diseases like pneumonia, typhoid, dysentery and malaria. The overwhelming majority of deaths in the Spanish-American War on both sides was due to diseases like malaria. Far more Americans died of the Spanish Flu than in World War I although one third of all deaths in that conflict were also due to disease.

In 1900, the three leading causes of death in the United States were infectious diseases like pneumonia, tuberculosis and dysentery. Diseases like smallpox, cholera, typhoid fever, dysentery, influenza, malaria and yellow fever killed more Americans than anything else until the early 20th century:

“Deaths from infectious diseases have declined markedly in the United States during the 20th century (Figure 1). This decline contributed to a sharp drop in infant and child mortality (1,2) and to the 29.2-year increase in life expectancy (2). In 1900, 30.4% of all deaths occurred among children aged less than 5 years; in 1997, that percentage was only 1.4%. In 1900, the three leading causes of death were pneumonia, tuberculosis (TB), and diarrhea and enteritis, which (together with diphtheria) caused one third of all deaths (Figure 2). Of these deaths, 40% were among children aged less than 5 years (1). In 1997, heart disease and cancers accounted for 54.7% of all deaths, with 4.5% attributable to pneumonia, influenza, and human immunodeficiency virus (HIV) infection (2). Despite this overall progress, one of the most devastating epidemics in human history occurred during the 20th century: the 1918 influenza pandemic that resulted in 20 million deaths, including 500,000 in the United States, in less than 1 year–more than have died in as short a time during any war or famine in the world (3). HIV infection, first recognized in 1981, has caused a pandemic that is still in progress, affecting 33 million people and causing an estimated 13.9 million deaths (4). These episodes illustrate the volatility of infectious disease death rates and the unpredictability of disease emergence.

Public health action to control infectious diseases in the 20th century is based on the 19th century discovery of microorganisms as the cause of many serious diseases (e.g., cholera and TB). Disease control resulted from improvements in sanitation and hygiene, the discovery of antibiotics, and the implementation of universal childhood vaccination programs. Scientific and technologic advances played a major role in each of these areas and are the foundation for today’s disease surveillance and control systems. Scientific findings also have contributed to a new understanding of the evolving relation between humans and microbes (5).”

CAN YOU BELIEVE THEY TRUST DOCTORS AND SCIENTISTS?

After the 1930s, degenerative diseases eclipsed infectious diseases as vaccines became available and public health improved to become the leading causes of death in the United States:

“This article examines how the epidemiologic transition and the reduction of the urban mortality penalty gave rise to the current mortality regime of the United States and demonstrates how the 1918 influenza pandemic signaled its advent. This article approaches those issues through the analysis of urban-rural mortality differentials from 1890 to 1930. Until 1910, infectious diseases dwarfed degenerative diseases in leading causes of death, and generally, the more urban the location was, the higher infectious disease and overall death rates were-a direct relationship. But by 1930, degenerative diseases had eclipsed infectious diseases, and infectious disease mortality had ceased to differ between cities and rural areas. The 1918 influenza pandemic broke out toward the end of these changes, and the larger the city was, the lower influenza and overall death rates were in that year-an inverse relationship. Such gradations characterized a new mortality regime emerging in the late 1910s and foreshadowed urban-rural mortality differentials in 1930 among persons aged 45 years or older, the group whose high rates of degenerative disease death would symbolize that regime. Thus, intertwined changes in the late 19th and early 20th centuries-a shift in leading causes of death from infectious diseases to degenerative diseases and a concomitant shift from a direct relationship to an inverse relationship between urban environment and mortality-produced the current mortality regime of the United States.”

It remained that way all the way down until April 2020 when COVID-19 became the leading cause of death in the United States. We’ve been living through a historical bubble in the late 20th century and early 21st century when infectious diseases were not the leading cause of death.

The wolf has been held at bay for so long now that lots of Americans have started to believe that vaccines, public health, scientists, doctors and hospitals, not infectious diseases, are the real problem. The ordinary flu and common cold are the only infectious diseases that most Americans now have any experience with. SARS and Ebola were stopped. The 1957 and 1968 influenza pandemics were relatively mild and had a low case fatality rate. In the 1957 pandemic, we had a vaccine before the virus even arrived in the United States. In the 1968 pandemic, we had a vaccine not long after Woodstock. In short, it doesn’t seem real and conspiracy theorists and truthers are convinced it is all a hoax because it has happened so swiftly and because it has been a long time since anything like this has happened in America.

Previous generations of Americans who were scarred by tuberculosis, typhoid fever, cholera, malaria, yellow fever, polio and smallpox were not so naive. Conspiracy theories weren’t necessary to explain what until very recent history was a brutal fact of life in most of the world.

Note: Some of favorite history YouTubers have been churning out some excellent videos recently. Enjoy!