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.