Advances in science and technology have exposed the population to deadly pathogens never seen before, but they‘ve also given humanity more tools to protect itself from widespread outbreaks and death.
As the novel coronavirus pandemic transforms the contemporary world, similar outbreaks throughout history have shaped human society.
“It remains to be seen how it will unfold, but it will unfold in ways never seen before,” said Mitchell Hammond, a historian and professor at the University of Victoria. “Pandemics tend to expose weaknesses and challenges in society.”
Historically, a single disease, such as the plague, cholera or influenza, does not necessarily create a common, shared experience, he explained. Disease outbreaks can reveal inequities between ethnic groups, social classes, dominant cultures or people who are marginalized. And a number of factors impact mortality rates, including poverty, access to health care, and lifestyle. As an example, during the Spanish flu, indigenous groups around the world were disproportionately affected with mortality rates six to seven times higher than European communities.
“Yes, we’re all in this together, but we also have to look at how different communities are affected,” he said.
|University of Victoria professor Mitchell Hammond. (Photo courtesy of the University of Victoria)
The Modern World
Hammond explained a number of factors could be shaping how the modern world is experiencing pandemics and epidemics. Advances in science and technology have seen more pathogens discovered, but they’ve also shed light on some that existed but weren’t well documented or spread. The modern world is also very different with widespread air travel, bigger cities, mass agricultural production and denser exchange networks – all of which influence how pathogens can spread. With advances in communication, the general public is also being informed of outbreaks they wouldn’t typically hear about.
Matthew Little, an assistant professor at the University of Victoria’s school of public health and social policy, noted all of those advancements come with the opportunity for spillover events, exposing expanding populations to sources they wouldn’t normally have contact with. For example, the deforestation of the rainforest to make room for farming has put people in contact with pathogens not previously seen by the general population.
Historically, Little said 70 per cent of emerging infectious diseases (that can be sourced and tracked by the scientific community) have come from animals.
“On the other hand, we have much better surveillance to prevent these episodes from becoming a global pandemic like what we’re seeing now,” Little said, adding technology is advancing at a fantastic rate. “All of these things decrease the likelihood of pandemics … We’re always trying to stay one step ahead.”
And while the scientific community continues to encounter new pathogens, they’re also seeing re-emerging infectious diseases.
Coronavirus is a classification – or family – of viruses that can make both humans and animals sick. In humans, several strains are known to cause respiratory infections ranging from the common cold to more severe diseases, according to the World Health Organization (WHO).
By March 27, more Canadians had died from COVID-19 than severe acute respiratory syndrome (commonly known as SARS). That coronavirus, which had never been seen before in either animals or humans, was formally named SARS-CoV. WHO recorded 43 deaths and 251 cases in Canada. And during that outbreak, between November 2002 and Dec. 31, 2003, WHO received reports of 8,096 probable cases and 774 deaths worldwide. It did not declare a pandemic but took many other steps including activating emergency operation centres and limiting travel.
Healthcare workers accounted for 21 per cent of all cases and the world fatality rate for probable cases was 9.6 per cent, according to Infection Prevention and Control Canada (IPAC). There are no current cases of SARS in the world.
Hammond noted the Spanish flu of 1918 to 1919 is also in some ways a good comparison to COVID-19, as it was what many experts refer to as the first global pandemic. Both influenza and coronaviruses are respiratory diseases, he explained, which shapes how governments and individuals respond to them. Even a century ago, people used various forms of physical distancing and self-isolation. That outbreak was also the first big episode in public health history where people around the globe starting wearing masks, Hammond added. Before 1910, when a plague tore through China, people hadn’t started utilizing masks outside of surgeries.
“We think about disease very differently than people did 100 years ago,” Hammond said. “Ordinary people didn’t have the almost unconscious recognition of microbes as we do today.”
Influenza, combined with pneumonia, is one of the top 10 leading causes of deaths in Canada, killing 8,511 people in 2018, 7,396 in 2017, and 6,235 in 2016, according to Statistics Canada.
While both influenza and COVID-19 are infectious respiratory illnesses with similar symptoms, they are caused by different viruses. There are three main types of influenza viruses, influenza A, B and C. Influenza A and B are associated with seasonal flu and outbreaks, while influenza C is rare and does not usually cause epidemics or outbreaks, according to IPAC.
The 2019-2020 flu season began on Aug. 25, 2019, and as of March 28, there had been 42,355 confirmed cases of influenza in Canada, according to IPAC. Of that, 24,269 cases were influenza A and 18,086 cases were influenza B. That’s an increase from 39,192 total cases during the 2018-2019 season and is similar to the 2017-2018 season, which saw 55,059 cases.
Historically, counts ranged from a few thousand up to 17,000 between 1999 and 2012, with the exception of 2008-2009 which saw 23,376 cases and 2009-2010 which saw 39,018 cases due to a H1N1 virus commonly referred to as swine flu. During the 2012-2013 season, counts jumped to 31,737 and continued to range between approximately 28,000 and 43,000 until 2017.
Back in 1918-1919, the Spanish flu, which was caused by an H1N1 virus, was estimated to have infected approximately 500 million people or one-third of the world’s population, according to the CDC, with up to 50 million deaths worldwide.
As of May 8, there were 65,399 confirmed cases of COVID-19 in Canada, with 2,288 in B.C. A total of 4,471 Canadians had died with 126 deaths in B.C. Quebec had the highest number of deaths at 2,631, followed by Ontario with 1,540. Globally, Johns Hopkins University and Medicine’s coronavirus resource centre was reporting 3,910,738 confirmed cases and 272,578 deaths as of May 8.
“Collectively, we’re having these events not because some of us are primitive, but because we’re all connected,” Hammond explained, adding back in 1918 mass travel was done by steamship and people couldn’t move around the globe with the ease they do today.
With that has also come a shift in how the public understands the links between personal behaviour and society as a whole. “‘Flattening the curve’ is something we hear almost every day … That seeps into how ordinary people understand their lives.”
|Matthew Little, an assistant professor at the University of Victoria’s school of public health and social policy. (Photo courtesy of Matthew Little)
But unlike past outbreaks, Hammond said the world likely won’t see a tidy conclusion to the COVID-19 pandemic. Historical narratives of epidemics and pandemics often rise and fall – with early warnings, rising case counts, alarm, and death rates peaking, followed by decreasing cases and sober reckoning. “We tend to think of them as episodes,” he explained, adding even the word epidemic leads people to that belief.
While he wouldn’t speculate on how a vaccine could influence the outcome, he did note with how widespread COVID-19 has become, how connected the world is, and with so many variables in play, it will be interesting to see how science will shape future decisions. With advances in technology increasing testing capacities, and case tracking and public health surveillance being shaped by what the general population will stand for, the “new normal” could continue to see limitations put on survivors and those who haven’t been exposed yet.
Little added while there has been a push from governments around the world to come up with a vaccine, it needs to be something that has gone through the rigorous protocols currently in place for testing to ensure it is safe.
“The challenging thing about this is it in some ways feels like it’s moving in slow motion for those of us working from home … but research takes time,” Little said. “What we’re seeing now is not the new norm.”