If you’ve spent any time at all on the internet
in the last few months, you probably feel very well-educated about how outbreaks start,
how diseases spread, and even how to protect yourself during a pandemic. But what about how pandemics end? How do we know when we’re in the clear and
it’s safe to go back to life as normal? Or, are we destined to spend the rest of our
lives in quarantine? To find out, let’s take a look back in time
at how some past pandemics have ended and see if there’s any hope of easing up on
social distancing before summer is over. Before we can talk about how pandemics end,
we first have to understand what the “end” of a pandemic actually means. How do we know when it’s over, and who exactly
is it over for? What specific criteria or milestones are we
aiming for before we can declare a pandemic over? And who actually decides that the pandemic
has ended? According to medical historians, pandemics
actually have two types of ending - a medical ending and a social ending. A medical ending happens where there are no
people left to get sick. That doesn’t necessarily mean that everyone
is dead - although that’s certainly one way a pandemic can end. An outbreak can be ended medically when the
infection can no longer spread, either because a significant percentage of people are immune
or have been vaccinated, or even because of strict social distancing measures making it
impossible for the infection to find new victims. The dreaded Bubonic Plague is the perfect
example of a pandemic ending medically because the disease ran out of victims. There have been 3 major outbreaks of the Plague
in history. The first one, called The Plague of Justinian,
wiped out nearly half the world’s population in the 6th century. It only ended when there was no one left to
die - the death rate was so high, and some experts theorize that the survivors must have
been largely immune, so eventually the outbreak ended when it ran out of new victims. The second and most famous outbreak was started
in China in 1331, killing half the population there before spreading to Europe, North Africa
and the Middle East. The disease killed 200,000,000 people in just
4 years, wiping out up to one third of the European population. Fun fact - we have this particular pandemic
to thank for the whole idea of “quarantine”. During the medieval outbreak people were still
clueless about how diseases really spread, but they were starting to catch on to the
idea that being in close proximity to an infected person was a great way to get sick. The city of Venice started making newly-arrived
sailors stay on their ships for a period of time after arriving in port before they could
enter the city. At first, it was 30 days, but it was eventually
increased to 40 days, a period of time called a “quarantino”. During later flare-ups of the disease in the
1500s, England imposed the first quarantine laws - any home with an infected person in
it was required to mark their house with a white pole, and carry the pole with them in
public so that other people could avoid them. England took things a step further during
another flare up in 1665 and banned all public entertainment and gatherings. That sounds awfully familiar... On top of these new quarantine measures, the
medieval Plague outbreak also planted the early seeds of social distancing. As the plague spread and the death toll continued
to climb, many people took shelter in their homes and hid out from the disease. Of course, we also saw the first glimpses
of the difficulties of getting people to stay at home - as the Plague ravaged Italy, many
were determined to live it up before the end. Defiant revelers took to the streets, drinking,
dancing and singing even as the bodies piled up around them. The last major outbreak of the Plague started
in China in 1855 and once again spread across the world. After it killed 12,000,000 people in India,
entire neighbourhoods were burned to the ground in a desperate effort to stop the disease
- even though no one knew at the time if that would even help. Experts aren’t sure exactly why each outbreak
ended - perhaps the Plague ran out of victims, or the colder weather weakened it, or it could
have mutated and become less deadly. Each of these outbreaks eventually did end,
but the disease wasn’t gone. In fact, it’s still around today. Plague outbreaks are endemic among prairie
dogs in the southwestern US, and from time to time it even makes its way to humans. Dr. Frank Snowden, a Yale historian, has a
friend who contracted the plague in the US a few years ago from a dog that had been infected
with Plague-ridden fleas. Remember earlier when we said that there are
two ways that a pandemic can end? We just talked about the many ways that a
pandemic can medically end, but pandemics can also have a social ending. According to Dr. Jeremy Green, a historian
of medicine at Johns Hopkins, “When people ask, ‘When will this end?’, they are asking
about the social ending.” A social end to the pandemic doesn’t mean
the disease is gone - it just means that people have learned to live with it. A pandemic can end socially when people stop
fearing the disease, become sick of quarantine restrictions, and decide they are willing
to risk getting the disease to go on with daily life. The infamous Spanish Flu outbreak of 1918
is a great example of a social end to a pandemic. The aggressive and deadly strain of the flu
virus that tore across the globe and killed millions, prompted one doctor to say that
it “demonstrated the inferiority of human inventions in the destruction of human life”
- and that’s saying a lot, considering the world was in the midst of the bloody trench
battles of World War 1 at the time of the outbreak. The virus eventually mutated into a less severe
form of the flu, and medically the pandemic slowly tapered off, even though the disease
definitely hadn’t gone away. But the pandemic ended socially even while
the disease continued to wreak havoc. By the time World War 1 was over, people everywhere
were sick of death and tragedy, and they were ready for a fresh start. After the horrors of war, people were willing
to risk disease to return to “normal” life as soon as possible. The fact is, it’s not an either-or situation. Pandemics don’t end medically or socially
- most end socially before they end medically, and a true medical ending is actually nearly
impossible. In most cases, we learn to live with the disease
and manage its spread to prevent widespread outbreaks, but it’s rare that a disease
is truly medically eradicated. Smallpox is one of the very few exceptions. Smallpox had plagued the world for more than
3,000 years, and 30% of those who contracted the dreadful illness died a painful death. In 1633, shortly after the first European
explorers arrived in the New World, a Smallpox epidemic devastated the native populations. The disease had arrived with the explorers,
and since none of the native people had any kind of immunity against the disease, it spread
like wildfire, killing up to 90-95% of the native population in some of the hardest hit
areas. There are a few different reasons why our
efforts to fight Smallpox were so successful. The most important development was the discovery
of a successful, lifelong vaccine. The disease’s unusual symptoms - a rash
that turns into pus-filled spots which crust and then fall off - also made it easy to identify
the illness, and infected people could be quarantined quickly, limiting the spread of
the disease. Another thing that helped defeat Smallpox
was the fact that it can’t be transmitted by animals, meaning that once the disease
was eliminated in humans, we no longer had to worry about it continuing to circulate
and mutate in animals and reemerging as a threat in the future. All of these factors combined to make Smallpox
one of the few diseases that we can now confidently say has been medically eradicated. The last person to contract Smallpox naturally
was a man named Ali Maow Maalin, a hospital cook in Somalia in 1977. Ali thankfully recovered from the Smallpox
infection and went on to live a long life. He died in 2013 of Malaria, another extremely
problematic infectious disease. The social aspect of a pandemic can be just
as dangerous as the disease itself - sometimes moreso! Back during the Ebola outbreak in West Africa,
an epidemic of fear about the disease spread faster than the disease itself. Dr. Susan Murray, who worked in a hospital
in Ireland during the outbreak, recalls the atmosphere of fear and panic, even as the
outbreak was tapering off. She remembers some health professionals refusing
to treat potentially infected patients, and people beginning to look at foreigners with
suspicion. Dr. Murray said: “If we are not prepared
to fight fear and ignorance as actively and as thoughtfully as we fight any other virus,
it is possible that fear can do terrible hurt to vulnerable people, even in places that
never see a single case of infection during an outbreak.” The fear generated by each new outbreak also
amplifies the fear of the next one. Since a next outbreak is inevitable, it’s
important that we learn to deal with the fear that surrounds a pandemic to minimize the
social harms caused by outbreaks. Pandemics are one of the biggest threats we
humans face in modern times. EndingPandemics.org has projected that the
next big pandemic could cost upwards of $60 billion and could kill 30 million people in
just 6 months. They explain that because the number of new
infectious diseases is rising, and people are travelling further and faster than ever
before, the risk of a major global pandemic continues to climb. This might sound daunting, but don’t worry
- EndingPandemics.org has a plan for how to minimize the impact of the next outbreak. Because most outbreaks in humans start in
animals, they believe that better monitoring of disease outbreaks in animal populations,
as well as better communication and a faster response to new infections, will help prevent
future outbreaks and give countries time to prepare for the next one. So, that brings us to the million dollar question
- when and how will this particular pandemic end? Well, it won’t medically end at least until
we have a vaccine - and then it will take time to vaccinate the whole world and be able
to say that the pandemic is medically over. Even then, we’ll still need to be watching
out for new strains of the virus. Socially, though, it looks like this pandemic
could end quite soon, regardless of whether it’s medically safe or not. People are getting frustrated with social
distancing and quarantine measures, and the economic and social impacts of months of shut
down are starting to scare people more than the disease itself. The end of the pandemic won’t be a sudden
victory. Even if a vaccine is developed, it will take
time to get the whole world vaccinated. Before that happens, the pandemic will likely
start to end socially, as communities and countries begin to ease up on quarantine measures. Another factor that makes it tricky to pinpoint
the end of a pandemic is the fact that the outbreak affects different areas differently. Even when an outbreak spreads all around the
world, some areas might experience intense outbreaks and high death rates, like what
we saw in New York, while other areas might not see any cases at all. At some point, the World Health Organization
will declare the global pandemic emergency to be over, but individual countries might
have already beaten them to the punch, while some others might still be battling the outbreak. Whatever happens, we’re going to need to
learn to live with the disease and manage its spread while we wait for a medical ending
to the pandemic. And, since the next pandemic might be just
around the corner, we’d be wise to keep our quarantine and social distancing skills
sharp for the future. If you liked this video, be sure and check
out our other videos, like this one called “Coronavirus COVID-19 vs. H1N1 Swine Flu
- How Do They Compare?”. Or, maybe you’ll like this other one instead.
