Pandemics and their ends

When will the Covid-19 pandemic end? It depends on what sort of end.

A social end to a pandemic is when people grow tired of panic mode and learn to live with a disease. There are signs of reaching this point in New Zealand now, but that doesn’t rule out a resurgence at some time in the future.

A medical end can be difficult to determine, and only after it has ended. Id it ends at all, some diseases just carry on, like the common flu.

MSN/New York Times: How Pandemics End

According to historians, pandemics typically have two types of endings: the medical, which occurs when the incidence and death rates plummet, and the social, when the epidemic of fear about the disease wanes.

Endings “are very, very messy,” said Dora Vargha, a historian at the University of Exeter. “Looking back, we have a weak narrative. For whom does the epidemic end, and who gets to say?”

Will that happen with Covid-19?

One possibility, historians say, is that the coronavirus pandemic could end socially before it ends medically. People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smolder in the population and before a vaccine or effective treatment is found.

“I think there is this sort of social psychological issue of exhaustion and frustration,” the Yale historian Naomi Rogers said. “We may be in a moment when people are just saying: ‘That’s enough. I deserve to be able to return to my regular life.’”

It is happening already; in some states, governors have lifted restrictions, allowing hair salons, nail salons and gyms to reopen, in defiance of warnings by public health officials that such steps are premature. As the economic catastrophe wreaked by the lockdowns grows, more and more people may be ready to say “enough.”

To extent that has been happening in New Zealand over the last two weeks. Reports of a rush back to shopping yesterday, the start of the first weekend since we lowered to Level 2 restrictions that allowed all shops to re-open, suggest a getting back to normal. I drove through town yesterday and traffic was a busier than a normal Saturday, And I went for a trip right along the west side of Otago Harbour. It was quiet mid-morning but it was busier than normal by the middle of the day.

“There is this sort of conflict now,” Dr. Rogers said. Public health officials have a medical end in sight, but some members of the public see a social end.

The challenge, Dr. Brandt said, is that there will be no sudden victory. Trying to define the end of the epidemic “will be a long and difficult process.”

Many attempts are being made to have a vaccine ready by the end of the year, but it’s like to be months away at least. The Covid-19 virus is certain to continue, even if the fears subside.


Pandemics from history

Bubonic Plague

Historians describe three great waves of plague, said Mary Fissell, a historian at Johns Hopkins: the Plague of Justinian, in the sixth century; the medieval epidemic, in the 14th century; and a pandemic that struck in the late 19th and early 20th centuries.

The medieval pandemic began in 1331 in China. The illness, along with a civil war that was raging at the time, killed half the population of China. From there, the plague moved along trade routes to Europe, North Africa and the Middle East. In the years between 1347 and 1351, it killed at least a third of the European population. Half of the population of Siena, Italy, died.

That pandemic ended, but the plague recurred.

One of the worst outbreaks began in China in 1855 and spread worldwide, killing more than 12 million in India alone.

It is not clear what made the bubonic plague die down.

Smallpox

Among the diseases to have achieved a medical end is smallpox. But it is exceptional for several reasons: There is an effective vaccine, which gives lifelong protection; the virus, Variola minor, has no animal host, so eliminating the disease in humans meant total elimination; and its symptoms are so unusual that infection is obvious, allowing for effective quarantines and contact tracing.

But while it still raged, smallpox was horrific. Epidemic after epidemic swept the world, for at least 3,000 years.

It is thought to have been present in India as early as 1500 BCE, China 1122 BCE and Egypt 1145 BCE.

In 18th-century Europe it is estimated 400,000 people per year died from the disease, and one-third of the cases resulted in blindness.

It is estimated to have killed up to 300-500 million people in the 20th century. Two million died from smallpox in 1967.

The last naturally occurring case was diagnosed in October 1977.

1918 (Spanish) Flu

This raced around the world at the end of Word War 1, killing 50-100 million people.

After sweeping through the world, that flu faded away, evolving into a variant of the more benign flu that comes around every year.

There were about 9,000 deaths in New Zealand, 2.500 of them Māori.

Hong Kong Flu

In the Hong Kong flu of 1968, one million people died worldwide, including 100,000 in the United States, mostly people older than 65. That virus still circulates as a seasonal flu, and its initial path of destruction — and the fear that went with it — is rarely recalled.

Swine flu

This was a variant strain of the 1918 Spanish flu. It is estimated to have caused somewhere between 150,000 and 575,000 deaths, and it is estimated that 700-1500 million were infected. Fortunately most people were only mildly affected.

Ebola

In 2014 more than 11,000 people in West Africa had died from Ebola, a highly infectious viral disease that was often fatal.

Covid-19

This has spread around the world and in about five months over 308,000 people have died, but this total is likely to grow quite a bit yet – the death toll has doubled over the last month.

In New Zealand the last of 21 deaths was on 6 May, and cases have just about stopped – the peak daily cases were from 24 March and had dropped to 29 by 11 April.

Virtually shutting down the borders has stopped the re-introduction of Covid. But how long will we keep our borders closed? While we may socially think the health problem is over some significant restrictions could persist for months.

We are no longer shut in our homes but we remain shut in our country.

But we have the benefit of modern health care and modern science.

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44 Comments

  1. Vaccine fear of UK’s PM dismissed

    A scientist at the forefront of New Zealand efforts to find a Covid-19 vaccine has dismissed a warning from British Prime Minister Boris Johnson science might fail.
    “In a worst-case scenario, we may never find a vaccine,” Mr Johnson was reported saying earlier this week.

    However, Malaghan Institute director Prof Graham Le Gros yesterday said he was “quite comfortable” a vaccine would be found.

    Science knowledge and technology had, he said, advanced dramatically since the first, failed attempts in the 1960s to produce a coronavirus vaccine – for the common cold.

    “However, with SARs and MERs it became very clear, when you had enough information, you could make some strong neutralising antibodies, and there was a recipe for making an effective vaccine.”

    Prof Le Gros said Covid-19 was a single virus scientists could focus a lot of attention on.

    “We can make animals resistant to it through antibody production.

    “It’s not a magic virus; it’s just a simple old coronavirus that’s just got the jump on us.”

    https://www.odt.co.nz/news/national/vaccine-fear-uk%E2%80%99s-pm-dismissed

    Reply
    • We’ve had nuclear races and space races. We may now be having a vaccine race.

      President Donald Trump unveiled a crash effort on Friday aimed at developing a coronavirus vaccine by the end of the year but said the country would return to normal with or without one.

      “I just want to make something clear, it’s very important. Vaccine or no vaccine, we’re back” Trump said during a midday event in the Rose Garden. “And we’re starting a process.”

      The formal announcement of “Operation Warp Speed” came as researchers around the world scramble to develop a vaccine for the virus that has killed more than 300,000 people globally.

      Many view an effective vaccine as the only way life can return to normal for people under stay-at-home orders or businesses whose operations have been limited. But Trump made clear Friday he does not share that view, insisting the economy is already rebounding as some states loosen their rules.

      Even as he projected confidence that a vaccine would be available within months, he downplayed the importance it might have in helping Americans return to normal.

      “We think we are going to have a vaccine in the pretty near future, and if we do, we are going to really be a big step ahead and if we don’t, we are going to be like so many other cases where you had a problem come in, it’ll go away at some point, it’ll go away,” Trump said.

      https://edition.cnn.com/2020/05/15/politics/trump-vaccine-effort-coronavirus/index.html

      Some pandemics do just ‘go away’ Some don’t.

      Reply
    • artcroft

       /  17th May 2020

      Never found a vaccine for HIV though. And there was a lot of interest put into that. And a Dengue Fever Vaccine is available but is used cautiously because it can make instances of the disease worse. So modern medicine isn’t omnipotent.

      Reply
    • Ray

       /  17th May 2020

      I have always had an interest in these things and it is really interesting to read the section in the Otago Daily Times that gives the news as it was printed 100 years ago.
      The 1918 flu just rushed through the country, a couple of months and it was done, not every body caught it, 60% to 70% were believed to have been infected so there were plenty who either had no contact or had some immunity due to earlier flu events.
      But 100 years ago there were reports of the flu spreading through the Balclutha region. No deaths reported but the Health Officers were keeping a close eye on the spread.
      So maybe we just have to learn to live with it, vaccination or not.

      Reply
      • In the not too distant past pandemics and widespread deaths were normal and I guess just expected as the way things were. On of my great grandmothers died when she was young of TB, and a few years later (early 1900s) two of her three sons also died of TB, both when aged 18.

        When babies and children die now it is seen as very tragic. At the start of last century the infant mortality rate in New Zealand was 100 deaths per 1000 live births.

        It was just 5.0 per thousand in 2008 and 3.8 in 2018, so from 1 in 10 to about 1 in 250.

        https://www.stats.govt.nz/news/infant-mortality-rate-declines

        Reply
      • Duker

         /  17th May 2020

        “The 1918 flu just rushed through the country, a couple of months and it was done”

        There was a second wave which was deadlier
        “When a new form of influenza first appeared in early 1918, there was no immediate cause for alarm. The disease was different to other strains experienced in the past – for example, it was unusually prevalent amongst young healthy adults. But most people affected by what would turn out to be the first wave of the pandemic recovered.”

        Later in year from August the second wave arrived of the more deadlier strain
        https://nzhistory.govt.nz/culture/1918-influenza-pandemic/begins

        We could have a second wave as well , like many countries, Sweden definitely will have another peak as winter returns later in year

        Reply
    • Duker

       /  17th May 2020

      Yes , we have a coronavirus vaccine for chickens. Yes it has some major differences from the human form, but its not seen as insurmountable to tailor it for humans. The people with deep understanding of these things seem very optimistic.
      The other choices could be a pill that has to be taken regularly as its not a vaccine, this could most likely be a combination of existing medicines that have been tested and shown to work as a ‘preventer’. This would be awesome for health care workers or for those working in homes for elderly.

      Im sure the usual suspects will jump on the comparisons shown with previous flu pandemics for the 50s and 60s. A critical difference not shown in the death numbers is
      1) Covid virus is about 2x as infectious as flu , from the longer period before symptoms show.
      2) Covid illness means those who need hospitalization is ’10x’ that of flu. Just to move from a general ward to the ICU to go on a ventilator needs 5X or more nursing care.

      Reply
  2. David

     /  17th May 2020

    Reality is hitting globally all at the same time as collectively everyone does the maths and says sacrificing old and unwell people who probably wont live too many more years is sad but its the only reality.
    Sooner or late you have to open up and the virus will do its thing, what is the alternative ?

    Reply
    • “what is the alternative ?”

      Not caring about older people and letting a lot of them die. That will cut down on pension costs too. Should we set an age beyond which health care isn’t available? That would save a lot of health costs too.

      Reply
      • David

         /  17th May 2020

        Its the maths done by governments everyday and uncomfortable as one may find it we dont give Pharmac an unlimited budget, we wont fund a drug that costs 150k a year to keep one patient alive. We wont spend more than 3 million dollars fixing a dangerous road if only 4 people a year die because on it nor will we put median barriers on all state highways.
        The virus is widespread, its going nowhere and will be there when things open up so its just delaying the inevitable.
        The only logical move is isolate those most at risk which say for NZ would be maybe 5000 people with most of those not having too much longer to live anyway, life adjusted quality years or whatever the term is. Not beyond our capabilities to design a liveable situation for them is it.

        Reply
        • “Not beyond our capabilities to design a liveable situation for them”

          Shut all old people off from the rest of the population? That might be a livable solution for younger people who don’t care about their parents and grandparents I guess.

          Reply
          • Duker

             /  17th May 2020

            Shipley and her colleagues tried to limit expensive hospital care for those over 70 as part of the ‘reforms’ in the early 90s.
            There was outrage over it , and in some hospitals they refused to follow the diktat and it was dropped.

            Reply
            • Gerrit

               /  17th May 2020

              Be nice to see a referenced link to prove the accuracy of that assertion Duker. Seems more like a figment of a fertile red imagination than the truth.

            • Duker

               /  17th May 2020

              Shipley and English
              In January 1995, James McKeown, a 76 year old Aucklander, was denied access to renal dialysis on the basis of the 1992 consensus conference guidelines. …

              In September 1997 Mr Rau Williams, a 63 year old man with renal failure, diabetes, and dementia, was denied access to renal dialysis by Northland Health.

              The guidelines were rationing based on their age

              https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115722/

            • Pink David

               /  17th May 2020

              This is still part of the system. Why do you think the QALY is used if it isn’t? That is how most spending is evaluated.

            • Duker

               /  17th May 2020

              “Shipley had set up a body called the Core Health Services Committee, chaired by Sharon Crosby, and the committee was charged with examining how New Zealand could move to a more affordable approach to costly procedures. The committee recommended that exclusion criteria be implemented for dialysis that would prevent people from receiving the life-saving treatment if they were:
              * Mentally ill
              * Intellectually handicapped
              * Having displayed anti-social behaviour
              * Suffering from other complicating illnesses
              * Aged 75 years-of-age or over – the list continued.”

              Essentially it was a form of national party delivered eugenics

              “Later, Shipley stood staunch arguing that a south Auckland man who became the human face of her policy called James McQuin ought not receive dialysis treatment. Shipley went on the Holmes Show arguing why the man ought to be left to die from his condition. She identified clinical reasons for her argument. South Auckland Health’s then CEO, Dr Lester Levy, returned from holiday to stand between the minister and his hospital’s patient – Levy ordered that James receive dialysis. Shipley was later found to have breached James’ privacy and was forced to make an apology. A year later I asked James how his extended life had been: “It’s great he said, I enjoy my days, I have a flutter on the races, I’m happy.” A year and a half after Shipley had argued that his treatment ought to stop, James slipped away feeling that his doctors at least valued his life.”
              https://www.scoop.co.nz/stories/HL0508/S00109.htm

          • David

             /  17th May 2020

            Not saying its fantastic but what if there is no vaccine for 2 or 3 years are we supposed to stay home until then.
            The country runs out of money and healthcare is rationed for younger healthier people and they die, what about them. What about having a cohort of younger persons not being able to get started on the economic ladder and their health and longevity is compromised.
            The opportunity cost of staying locked down for a temporary reprieve is no longer one the world is willing to pay.

            Reply
            • If it takes 2-3 years to get a vaccine then our economic problems certainly increase, unless people stop caring about catching Covid and the Government and Ministry of Health stop restrictions.

              It’s a big gamble – but letting a lot more people die based on the ‘sooner or later’ theory is a bigger gamble for those who don’t survive, especially if a vaccine doesn’t take long. Trump wants one by the end of the year. He’s such a great leader who achieves surely that’s going to happen.

      • Pink David

         /  17th May 2020

        “Should we set an age beyond which health care isn’t available?”

        Most public health care services already do this.

        Reply
    • Griff.

       /  17th May 2020

      Reality is hitting globally all at the same time as collectively everyone does the maths and says sacrificing old and unwell people who probably wont live too many more years is sad but its the only reality.

      Yip so hit 60 retire and off to the recycling plant to make Soylent Green.
      You righties disgust me .
      I can not find numbers for NZ In the US 60 % of adults have at lest one condition that makes them more susceptible to Covid 19.
      I can name many regulars on here that would be susceptible due to such as cancer survivor, high blood pressure, obesity and asthma .
      Such conditions alone will not kill them for years if ever .

      We have virtually eradicated the virus in the wild here in NZ.
      We can, should and will take on going measures to stop it returning .
      If that comes at an economic cost so be it. The majority of kiwis place the lives of the aged over a few more dollars unlike the greedy self centered right wing {redacted} on here .

      Reply
      • David

         /  17th May 2020

        We wernt talking about here, why does everything have to be a right wing conspiracy with you. Just try logically to address the point, try a thought process devoid of hatred for people with differing political persuasions and give us your take on what Italy should do with debt at 136% of GDP already, youth unemployment nearing 50% in some places, a massive migrant bill to cover ? Someone has to be sacrificed, its a choice of either isolating those at risk or isolating everybody.
        They literally cant afford to keep locked down without a sacrifice.

        Reply
  3. duperez

     /  17th May 2020

    There could be no greater motivation for coming up with a virus. Becoming very rich and very famous are great incentives. That it’s good for people and communities worldwide could come into it too. 🙃

    Reply
    • Gezza

       /  17th May 2020

      It’s a bit of a struggle to find any interesting news in NZ or overseas on anything other than Covid-19 to read & post about or discuss in blogs these days. Even Al Jazeera’s wall-to-wall CV-19.

      Same old arguments about stats n death rates n too soon or too late or too unnecessary lockdowns etc.

      That & Trump, or Trump-associated, shite.

      But, still, that’s what the terminally blog-addicted want to discuss, & it’s really all the the msm are covering in their tedious & repetitious efforts. And someone’s bound to mention my birdlife obsession now, I suppose. 😎

      It’s getting hard to remember the times when there were other things going on worthy of note & comment in yer average week.

      Reply
      • 3 is having the odd story about things that are not the c-word.

        You are obsessed with birdlife.

        Reply
      • Alan Wilkinson

         /  17th May 2020

        Life is about choices and chances. Take them away and you merely have existence.

        We are in mourning for our little chihuahua who died suddenly from a heart attack but had brought us joy and happiness every day with her antics and affection and fullness of life.

        She lived on the edge and we always worried for her tiny but incredibly fit little body as she got into various scrapes but she was so fantastically alive and joyful.

        People are the same. You can hide from risk and be a living corpse or you can choose to live and manage risk as best you can forsee depending what you want to do and need. It isn’t for anyone else to make your choices and map your life for you.

        Those who are ruled by fear are doomed by it. Those who set out to manage it may or may not succeed but they will have lived.

        Reply
  4. Alan Wilkinson

     /  17th May 2020

    Ex WHO director thinks Covid 19 may die out naturally because the population has more natural immunity than feared:
    Coronavirus could ‘burn out naturally’ so vaccine not needed, former WHO director claims. Says a similar pattern is showing up everywhere.

    https://www.telegraph.co.uk/news/2020/05/16/coronavirus-could-burn-naturally-vaccine-not-needed-former-director/

    Reply

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