PANDEMICS BEFORE COVID-19: A HISTORICAL PERSPECTIVE

The word “pandemic” has a Greek origin meaning an epidemic of a contagious disease that has spread across several countries and continents infecting a large number of people.

Infectious diseases have killed human beings throughout history. In the wake of the present COVID-19 crisis that our planet is going through, it is quite evident that no amount of technological advancement can stop pandemics from happening. Experts have always warned that there are undiscovered viruses and other microorganisms whose number may run into millions and a pandemic happening in the foreseeable future was only a matter of time.

Since prehistoric times, disease outbreaks have wreaked havoc, to the extent of ending entire civilizations. As civilizations developed and progressed, a large number of people living in close proximity to each other and to domestic animals, provided conducive conditions for infectious diseases to grow and spread. The conditions were further aggravated by poor nutrition and poor sanitation. The first global pandemics were created due to overseas trading routes that spread the infections far and wide.

The earliest evidence of a possible epidemic comes from  a prehistoric site (Hamin Mangha in northeast China) where human remains of juveniles, young and middle aged adults were found stuffed inside a 5000 year old house. Researchers have called it a “prehistoric disaster” and have concluded that a possible epidemic might have resulted in the deaths and wiping out of an entire village. Another prehistoric mass burial site (Miaozigou, northeastern China) which approximately dates back to the same time period indicates that the region might have been epidemic prone. However, the nature of the disease can only be guessed.

An epidemic that lasted for five years ravaged the people of Athens at around 430 B.C. Scientists have long debated the nature of this epidemic. However, its severity can be understood from the words of Greek historian Thucydides -” people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath.” (Source: https://www.livescience.com)

The Antonine Plague may have killed around 5 million people in the Roman empire during the time period A.D. 165-180. The disease which is believed to have been smallpox was first brought into the Roman empire by soldiers who had returned from a war. The epidemic contributed to an end of a peaceful period in Roman history, resulting in growing instability and civil wars. A vaccine for smallpox was introduced by Edward Jenner in 1796. Extensive immunization has completely eradicated smallpox.

Another epidemic, the plague of Cyprian is estimated to have taken 5000 lives per day around A.D.  250-271. The severity of this epidemic was  so immense that contemporary religious leaders signalled it to be the end of the world. Archaeologists have excavated burial sites in the city of Luxor, with dead bodies covered with lime which was a popular disinfectant used in ancient times.

The bubonic plague of Justinian (A.D. 541-542) marked the beginning of the decline of the Byzantine empire. It spread across Europe, Asia, North Africa and Arabia. Some reports estimate the loss of almost half of the world population to the pandemic.

Leprosy is a highly contagious bacterial disease that causes deformities in the human body. Europe saw leprosy taking pandemic proportions during 11 th century. Superstitions and absence of scientific temperament led to the belief that it was a punishment from God and victims of the disease faced social ostracization. Presently, leprosy is treatable with antibiotics.

An epidemic named “the black death” (1346-1343) caused by a now extinct strain of the bacterium Yersinia pestis brought about significant changes in Europe’s history. The dead were so large in number that it became hard to find labor. In the absence of scientific understanding of the cause behind the disease, forced isolation was imposed on sailors arriving in the port cities until they furnished proof of not being sick. An isolation of 30 days was known as a “trentino” but with time the forced isolation was extended to 40 days or a “quarantino” thereby coining the term “quarantine”. As an after effect of this epidemic, the surviving workers started getting better wages and lack of cheap labor accelerated technological innovation.

London, one of the major cities of the world, experienced a plague outbreak roughly every 20 years beginning from late 14 th century to late 17 th century – 40 outbreaks in 300 years. To prevent spread of disease, plague victims were forcibly confined to their houses (marked with red crosses), all public entertainment was banned, laws were formulated to separate and isolate the sick and the dead were buried in mass graves. Surprisingly, measures taken to contain pandemics are strikingly similar even in the 21 st century!

During the 16 th century, diseases from Europe and Asia were brought to the Americas by European explorers. The Inca and Aztec civilizations met their end as these indigenous people had zero immunity against these imported illnesses, thereby paving the way for the Spanish to take control of their territories. DNA studies of victims’ skeletons from an epidemic in Mexico and Central America (1545-1548) have revealed the disease to be enteric fever caused by S. paratyphi C. This remains a major threat to human health even today!

Plague epidemics continued to ravage Europe in the latter part of the 17 th century to the end of the 18 th century. One of the major causes of transmission was fleas from infected rodents. Loss of life continued, only the ones with immunity survived.

19 th century onwards, with the advent of the industrial age, a new set of diseases were found to inflict human populations across the world. Notable among them are – Cholera, Influenza, Measles and Polio. Although advancement in medical science and research in this period led to the creation of vaccines for many of these diseases, pandemics continued to occur.

The first cholera pandemic started in Russia in 1817. Cholera is a bacterial disease infecting the small intestine and spreads through water and food. The soldiers and sailors of the British Empire were instrumental in spreading cholera to India, Spain, Africa, China, Japan, Italy, Germany and America. According to rough estimates, around 1, 50,000 people lost their lives. Cholera has been mostly eradicated in the developed countries but it continues in the third world due to inadequate sewage facilities and absence of clean drinking water.

One third of Fiji’s population lost their lives to a measles pandemic in 1875. The disease was carried to the island nation by royal officials of the Queen of England, who contracted it during an official visit to Australia.

 A flu pandemic which started in Russia during 1889-1890, quickly spread across the globe in a matter of months aided by new transport links. Around 1 million people lost their lives to the virus.

Influenza pandemics have continually reappeared in various forms till recently. The Spanish flu of 1918-1920 infected around 500 million people of which one-fifth succumbed to its lethality. An avian borne virus was behind this disease and war time conditions brought about by World War I is estimated to be one of the reasons behind the spread.

The Asian flu of 1957 and 1958 originated in Hong Kong and thereafter spread to China, US and England. This flu virus had an avian origin. Over a million deaths were reported across the world before a vaccine effectively contained it. The H1N1 Swine flu pandemic of 2009-2010 was caused by the H1N1 virus that originated in pigs and then spread from person to person. The highly contagious nature of the H1N1 virus resulted in over a billion infections worldwide and casualties that went above 5 lakhs. This contagious disease is preventable by vaccination now.

The ongoing COVID-19 pandemic, believed to have originated in Wuhan, China is caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). As of 2 June 2020, more than 6.25 million cases of COVID-19 have been reported in more than 188 countries and territories, resulting in more than 375,000 deaths; more than 2.69 million people have recovered.

(Source: https://en.wikipedia.org)

I conclude by quoting Benjamin Franklin –“An ounce of prevention is worth a pound of cure.”

GREENERY: THERAPEUTIC PROPERTIES AND WAYS TO ACHIEVE THEM

Most of us feel better when surrounded by nature even if it’s just strolling in the garden around our house. Green spaces filled with grass, trees and vegetation have always attracted the attention of human beings across race, culture and nationality. Nature with its color, perfume and beauty enchants the mind, giving a feeling of freedom. “Kaviguru” Rabindra Nath Tagore has rightly said-

And Joy is everywhere; it is in the earth’s green covering of grass: in the blue serenity of the sky: in the reckless exuberance of spring: in the severe abstinence of grey winter … “

 These days excess carbon dioxide is building up in the earth’s atmosphere due to burning of fossil fuels and rampant industialization, which in turn is contributing to climate change. Trees are known to absorb CO2 from the atmosphere, storing the carbon and releasing the oxygen back into the air. Trees provide shade and cool the air around them thereby reducing the ambient temperature. Trees also increase atmospheric moisture by the process of transpiration. Time spent with trees and nature reduces mental fatigue by letting our minds calm down.

In the twenty first century we are surrounded with more technology than human beings have ever been before. Too much of technology has left its effect on our wellbeing by creating anxiety, stress and other adverse health conditions. The question is how can we find a balance and do we have a way out?

 The Japanese are known to spend deliberate time amongst nature (forests) practicing what is called “forest bathing”. The Japanese term for this activity is “Shinrin-Yoku” – “shinrin” meaning forest and “yoku” meaning bath. The Ministry of Agriculture, Forestry, and Fisheries of the  Japan government coined the term “Shinrin-Yoku” in the 1980s . This has nothing to do with bathing in a forest. It refers to spending time in a forest to improve one’s health and wellbeing. The appreciation of nature has been a strong cultural tradition of the Japanese people. Shintoism- the traditional religion of Japan is known as a nature religion. The people of Japan have long understood intuitively that the woods do us good, while distance from nature promotes sickness.

Shinrin-Yoku is not exercise or hiking or jogging. In its purest form it actually involves doing nothing but being in nature, connecting with it through sense of sight, hearing, smell and touch. It may involve choosing a tree one feels drawn to and spending time connecting with it. One may embrace the tree of their choice or connect with it in any other way they feel is best, focusing on opening the senses to note what they see, smell, hear and feel. It is about building a connection with nature by simply taking in the sounds of the forest, its scent, the fresh and clean air playing through the leaves to ease stress and worry, to relax and think more clearly. It is more like an exercise in mindfulness.

Several scientific studies have been carried out to verify the health benefits of the practice of forest bathing. Experiments conducted in forests across Japan have shown that forest environments promote lower concentrations of cortisol. For the uninitiated, cortisol is the human body’s main stress hormone. Reduction of prefrontal cerebral activity, lower blood pressure and heart rate, stabilizing of autonomous nervous activity, improvement of sleep and cognitive functioning, reduction of ADHD symptoms in children, increased human natural killer activity (activity of immune cells that eliminate virus infected cells and cancer cells) and higher levels of intracellular anti-cancer proteins are the other scientifically verified therapeutic effects of forest bathing trips on humans. Shinrin-Yoku demonstrates significantly positive psychological effects on the human mind suggesting forest environments may have preventive effects on lifestyle related diseases that city environments promote.

To investigate the healing powers of trees and human health benefits associated with spending time with nature, a new branch of medical science called “forest medicine” has been established. An internet search reveals this as an interdisciplinary science belonging to the categories of environmental and preventive medicine. The Japanese society of forest medicine has been operational since March, 2007. The society is actively involved in promoting research on forest medicine and educational training on the practice of forest bathing trips. Their untiring efforts have provided a platform for enterprises, universities and local governments for effectively using forest resources for stress management and promotion of good health conditions.  A visit to the website of International Society of Nature and Forest Medicine (INFOM) reveals that the Japanese government has spent millions funding research and promotion of Shinrin-Yoku. Many Hollywood celebrities and wellness gurus who have adopted the practice in their lives are spreading the word about forest bathing and its benefits.

Most of the current world population is attracted to the city life thereby spending lesser and lesser time with the natural world. But even a few hours of taking in the forest through one’s senses can have real health benefits. For readers who are wondering where to find a forest nearby, the good news is one can forest bathe anywhere – by taking a walk through a park or the garden around the house. A location which is easily accessible with minimum human built structures is suitable.  But, remember to leave your devices (mobile phones, camera) behind.

Set aside few hours from your daily routine and allow nature and greenery to just capture you. Work with the forest as a partner. Breathe in the air slowly to notice its smell. Move slowly keeping in tune with the natural rhythm of the forest. To keep track of your stress levels and other important health parameters you may visit your physician to chart your progress.

So, let’s chalk up a plan to include greenery in our lives to be better prepared physically in fighting contagions and see the benefits getting reflected in our medical bills. HAPPY “FOREST BATHING”. 

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