Epidemics and pandemics

The much greater fear from a public health problem is the evidently established HIV-AIDS epidemic and the devastating Hep C epidemic

The New Corona Virus is still spreading. It is an epidemic on the verge of becoming a pandemic. So far almost all those that are infected became infected while they were still in a particular area in China. Once new infections occur in patients that were never in that area or in those that are in other countries but became infected through contact with previously infected patients, then this epidemic will become a pandemic.

So far, it seems that the virus is spreading to other countries but the number of reported deaths from this infection is still relatively small. Fortunately over the last few decades public health measures as well as medical treatment have managed to control the spread of many diseases like that of the Ebola Virus, the Zika virus and the SARS and the MERS infections.

So far, more people die every year from the regular flu infections than from new and novel diseases. That said, it is important to remember that new infections can be much more devastating than expected. And some infections can be particularly dangerous when they arrive in poor countries that do not have the resources to combat them.

I wanted to write about the New Corona epidemic but it is still playing out, so it is a bit premature to make any definitive pronouncements about its health consequences. That said its economic consequences are becoming quite obvious. International trade is being severely affected. And travel is also becoming restricted between China and other countries.

The last major pandemic that led to millions of deaths occurred some hundred years ago. The Spanish Flu epidemic spread through Europe in 1918. Even in India, millions died. What that means is that in my grandparent’s generation many people died a relatively premature death.

One of the major reasons that particular flu spread all over the world was, that it coincided with the waning days of the First World War and soldiers from all over the world fighting in Europe brought the infection back home at the end of the war. Fortunately the Spanish Flue pandemic of 1918 ended almost suddenly.

Even though a significant percentage of the world’s population died as a result of that pandemic, since it coincided with the end of the war so its social, political and economic consequences were essentially mixed up with those of the war itself.

The next flu pandemic during the previous century is of particular interest to me. In 1957, Asian Flu spread all over the world and caused an estimated one to two million deaths. As a child I developed the flu at that time and evidently was quite sick with fevers running as high as 42 degrees Centigrade (108 degrees F). Fortunately being the son of two doctors and having a few more doctors in the family I received pretty good medical care and obviously survived with most of my mental faculties intact.

From a historical perspective, the plague pandemic also known as the Black Death that went through Asia and Europe during the middle of the fourteenth century CE has always fascinated me. There is much scholarly work done on its effects on Europe but little detailed information available on its effects on the heartland of the Muslim world.

During that pandemic, major cities in Egypt, Syria, Iraq and Palestine were devastated. As Marshall Hodgson in his Venture of Islam says, many cities with a population of up to a hundred thousand people just disappeared, and major cities like Cairo, Damascus, Baghdad and Jerusalem lost a significant number of people almost approaching half their populations.

The pandemics can bring about major changes and what happens with the New Corona Virus remains to be seen. I do believe that the effects though significant will be mitigated by modern medicine and public health measures.

Most Muslim historians cite the Crusades, the Mongol invasions especially the siege and sack of Baghdad by Hulagu Khan in 1258 CE or other factors for the collapse of the cultural and social centre of Muslim civilisation in the middle east. And of course some western ‘orientalists’ believe that it was the rise of Muslim ‘fundamentalism’ that was really behind the decline of Muslim empires in the Middle East.

Even though great Muslim empires emerged, the Ottomans in Turkey, The Safavids in Iran and the Mughals in India, Egypt and much of the Levant remained an Islamic backwater after the plague pandemic during the fourteenth century and much of the last millennium this area remained a part of the Ottoman Empire.

Even though the Black Death also decimated the population of much of Europe, most historians believe that the result of the decrease in population spurred economic growth in Europe. On the other hand in many Muslim countries that were at a height of social, cultural and scientific development, the sudden depopulation destroyed much that had been accomplished during centuries of Muslim rule.

Essentially the point I want to make is that pandemics can bring about major changes and what happens with the New Corona Virus remains to be seen. I do believe that the effects though significant will be mitigated by modern medicine and public health measures.

As far as Pakistan is concerned, even if we do get a local infection that can spread, it is unlikely to have a major impact. Yes we might get some deaths but I do not expect that it will have an effect as great as that of the Spanish Flu from a hundred years ago.

What I am much more afraid of from a Pakistani perspective is the already widespread infections from HIV-AIDS virus and the Hepatitis B and C viruses. We do have a true pandemic of these viral diseases in Pakistan. Hepatitis (Hep) C is a major health care problem with perhaps almost five percent of our population already infected.

As far as HIV-AIDS is concerned, almost every day there are news reports of new clusters being discovered. Known cases of this disease are said to be somewhere around a hundred and fifty thousand. This number represents much less than the tip of the proverbial iceberg.

The good thing about Hep C and HIV-AIDS is that both are now eminently treatable. But the bad thing about both is that the original symptoms of infection are relatively mild and might be missed or ignored but once the infection has become established, it can spread and second, the bad effects really emerge much later when medicine can be less effective.

Who should be tested for Hep C and HIV-AIDS is a difficult question to answer. When it comes to testing ‘populations at risk’ the problem with that was fully exposed by the recent HIV-AIDS epidemic in semi-rural Sindh. Most of the patients found to be infected were clearly not a part of the usually suspected at-risk populations.

Quite a while ago in response to reports that the government might mandate testing for thalassemia before people can get married, I had suggested that perhaps testing for HIV and Hep C might also be done at that time. Yes it is going to be difficult to enforce such a law, but we do have to start somewhere.

Finally, I am worried about the New Corona Virus arriving in Pakistan but for me the much greater fear from a public health problem is the evidently established HIV-AIDS epidemic and the devastating Hep C epidemic.

The writer served as professor and chairman, department of cardiac surgery, King Edward Medical University

Epidemics and pandemics in history