epidemics -- 1/12/23
Today's selection -- from Guns, Germs, and Steel: The Fates of Human Societies by Jared M. Diamond. The characteristics of epidemic diseases:
"Suppose that one counts the number of cases of some particular infectious disease in some geographical area, and watches how the numbers change with time. The resulting patterns differ greatly among diseases. For certain diseases, like malaria or hookworm, new cases appear any month of any year in an affected area. So-called epidemic diseases, though, produce no cases for a long time, then a whole wave of cases, then no more cases again for a while.
"Among such epidemic diseases, influenza is one personally familiar to most Americans, certain years being particularly bad years for us (but great years for the influenza virus). Cholera epidemics come at longer intervals, the 1991 Peruvian epidemic being the first one to reach the New World during the 20th century. Although today's influenza and cholera epidemics make front-page stories, epidemics used to be far more terrifying before the rise of modern medicine. The greatest single epidemic in human history was the one of influenza that killed 21 million people at the end of the First World War. The Black Death (bubonic plague) killed one-quarter of Europe's population between 1346 and 1352, with death tolls ranging up to 70 percent in some cities. When the Canadian Pacific Railroad was being built through Saskatchewan in the early 1880s, that province's Native Americans, who had previously had little exposure to whites and their germs, died of tuberculosis at the incredible rate of 9 percent per year.
|The spread of the Black Death in Europe and the Near East (1346–1353)
"The infectious diseases that visit us as epidemics, rather than as a steady trickle of cases, share several characteristics. First, they spread quickly and efficiently from an infected person to nearby healthy people, with the result that the whole population gets exposed within a short period of time. Second, they're 'acute' illnesses: within a short time, you either die or recover completely. Third, the fortunate ones of us who do recover develop antibodies that leave us immune against a recurrence of the disease for a long time, possibly for the rest of our life. Finally, these diseases tend to be restricted to humans; the microbes causing them tend not to live in the soil or in other animals. All four of these traits apply to what Americans think of as the familiar acute epidemic diseases of childhood, including measles, rubella, mumps, pertussis, and smallpox.
"The reason why the combination of those four traits tends to make a disease run in epidemics is easy to understand. In simplified form, here's what happens. The rapid spread of microbes, and the rapid course of symptoms, mean that everybody in a local human population is quickly infected and soon thereafter is either dead or else recovered and immune. No one is left alive who could still be infected. But since the microbe can't survive except in the bodies of living people, the disease dies out, until a new crop of babies reaches the susceptible age -- and until an infectious person arrives from the outside to start a new epidemic.
"A classic illustration of how such diseases occur as epidemics is the history of measles on the isolated Atlantic islands called the Faeroes. A severe epidemic of measles reached the Faeroes in 1781 and then died out, leaving the islands measles free until an infected carpenter arrived on a ship from Denmark in 1846. Within three months, almost the whole Faeroes population (7,782 people) had gotten measles and then either died or recovered, leaving the measles virus to disappear once again until the next epidemic. Studies show that measles is likely to die out in any human population numbering fewer than half a million people. Only in larger populations can the disease shift from one local area to another, thereby persisting until enough babies have been born in the originally infected area that measles can return there.
"What's true for measles in the Faeroes is true of our other familiar acute infectious diseases throughout the world. To sustain themselves, they need a human population that is sufficiently numerous, and sufficiently densely packed, that a numerous new crop of susceptible children is available for infection by the time the disease would otherwise be waning. Hence measles and similar diseases are also known as crowd diseases."