Category Archives: Epidemics and Society

I have come to learn a lot while taking the Epidemics and Society class taught by the beautiful Dr. Hinks. We have covered a variety of topics and diseases and how society and culture reacted to them as well as how the diseases affected humanity. We began with the introduction of our ancestors and their base knowledge (or lack thereof) of disease and infection. Beginning in Africa, the earliest evidence of our ancestors, I learned how we evolved from a hunter-gatherer, nomadic arrangement to staying into one place becoming settlers. The previous nomadic life of our ancestors exposed them to infectious diseases and vectors of parasites. This began zoonosis and the emergence of zoonotic diseases – that is, animal infections being transmitted to humans. However, since they were nomadic, they were not exposed to rotting meat or feces and exposure to parasites were limited. Groups were so small and isolated that “crowd” diseases requiring human-to-human contact transmission were not possible or severely limited. As time passed, so did the human population. Technological advancements such as tool making, the agricultural revolution and the industrial revolution led to an increase in humans becoming stagnant and settling down. As such, this led to an increase in a sedentary lifestyle. This allowed for better and more transmissions of disease.

I have also come to observe how societies were affected by epidemics. The greatest example of society, and arguable the world, being changed by epidemics was the arrival of plagues. There were three pandemic waves of plague. The first came under Emperor Justinian in 542 A.D. This was aptly named “The Justinian Plague”. This wave was spread via fleas and rats to human hosts. Soldiers also brought back the disease from conquering wars under the empire. The second plague was more deadly and infamous. Called “The Black Death”, it killed approximately 20-30% of the Eurasian population very quickly. People would collect mounds of rotting cadavers into mass graves. It killed people so quickly that they were not able to dispose of the bodies fast enough. Besides killing millions, there were several other variables and factors that changed because of this plague. Some of the variables being religion, societal views on certain ethnic groups such as Jews, and caused mass hysteria/panic and war. The final wave of plague that changed humanity came in China in 1855 and spread to Hong Kong by 1896.

We have also learned on that societies can affect epidemics as well. Beginning again with transitioning from a nomadic lifestyle to settlers, we as humans have affected the environment around us and subsequently epidemics and how they spread. For example, humans clustering together and staying in one place allowed for “crowd” diseases to emerge. Another example is the Irish potato blight. This was an incident occurring in the 1840s. By then, half of the Irish population was entirely dependent upon the potato as a main food source and crop. However, a Phytophthora infestation ravaged the potato crops, destroying them. This caused the “Great Famine” or the Irish Potato Blight. As a result of the ensuing famine, around a million people were killed either through starvation or disease (because when people are malnourished, they are vulnerable to infections). Many of the infections that ravaged the populace were measles, diarrhea, tuberculosis, whooping cough, intestinal parasites and cholera. This entire incident further affected disease and epidemics due to the resulting mass emigration to other countries – mainly the United States.

As immigration to the United States increased, so did disease. The mass immigration from Ireland and other countries in the 1800s caused an ever-increasing lack of space in local residents in cities such as Philadelphia, Boston, and New York City. High population density and poor sanitary conditions in these crowded tenements (with rooms housing as much as 10 or more people at a time) allowed for the swift spread of tuberculosis. Tuberculosis, an extremely infectious and fatal disease, spreads through contact with infected or infected articles of clothing and objects. It usually affects the victim’s lungs causing a bad cough, pain in the chest and coughing up blood.

Perhaps the most influential thing I learned in this class how today’s societies play a role on promoting and affecting epidemics in the modern times. While some diseases are re-emerging such as plague, cholera, and tuberculosis, there are afflictions considered “21^st century” concerns such as Human Immunodeficiency Virus (HIV), Human papilloma virus (HPV), Ebola, and severe acute respiratory syndrome (SARS). The most prominent of these is HIV. HIV is a deadly epidemic that has most recently began to spread across the world. It weakens a person’s immune system by destroying important cells that fight disease and infection. If left untreated, HIV evolves in Acquired Immune Deficiency Syndrome, or AIDS. It is transmitted through sexual activity, contact with bodily fluids or sharing needle/syringes. Thought to have come from certain species of chimpanzees, it is considered a 21^st century plague because it has most recently become an epidemic and threatens to turn into a pandemic. It is also a 21^st century concern because of the ways of transmission are taboo and relative to modern times- the two highest/most common being homosexuality/anal sex and drug abuse. The rise of homosexuality and acceptance of the LGBTQ community has allowed for this virus to be more prominent.

Being a computer science major, I did not know what to expect coming into a class meant for biology majors. I have traded coding and computers for lab coats, research and caution about the future. It is interesting to learn about disease and how it spreads, but it has been invaluable to learn how to prevent it and how deadly some diseases in the world are. This has caused me to look at life differently i.e. more through the eyes of caution, as we do not know how vulnerable we really are. From the beginnings of our ancestors and their struggle, to the modern day medicine we possess that combats disease, my eyes have been opened to how far we have come and how far we have yet to go to understand and eradicate disease forever – if possible.

HIV, or Human Immunodeficiency Virus, is a deadly epidemic that has spread across the world. It weakens a person’s immune system by destroying important cells that fight disease and infection. If left unchecked, HIV evolves into Acquired Immune Deficiency Syndrome, or AIDS. You can get or transmit HIV only through specific activities. The most common activities being sexual behaviors and needle/syringe use. It is thought to of come from a certain species of chimpanzees. However, it is considered a 21^st century plague. This is because the discovery and the subsequent pandemic that followed is recent. World leaders refused to acknowledge that it was a problem. Moreover, the causes of transmission are also 21^st century taboo topics – the two highest/most common being homosexuality/anal sex and drug abuse. This well-known fact, along with the acquisition of HIV itself, can have major effects on victims. It is common for those that have HIV to feel guilt and shame. Another impact on our culture is that we shun and actively avoid those who contract this virus as if they have the plague. There have also been several impacts to American culture due to this pandemic. First, the LGBTQ community was (after already being outcasted) further ostracized from society and received the blame for the virus spreading in the United States. Another impact, perhaps a more positive one, is that it brought more awareness to sexually transmitted diseases and practicing safe sex.

Although over 36 million people are currently infected with HIV, there has been progress in the road to recovery and aid. The first is prevention and education in regards to HIV. Practicing safe sex and having the younger generation be more knowledgeable about the disease can help. There is also a “preventative” medicine that humans can take if they are at very high risk for HIV or if they believe they have been in contact with it. This medicine is called Pre-Exposure Prophylaxis or PrEP. PrEP significantly lowers the chances of becoming infected with HIV- by more than 90%. The next step is treatment for HIV. Once infected, people can take Antiretroviral drugs, or ARV. These drugs can slow down the virus to a near halt, stopping it from spreading in the body and killing the victim.

HR: cdc.gov, CANVAS documents, WHO.org

Vibrio cholerae, or cholera is an acute, diarrheal illness caused by infection of the intestine and is spread by ingestion of contaminated food or water. It is also spread by feces contaminated water. As with all infectious diseases, poverty, malnutrition and lack of saniation were the more prominent methods that allowed cholera to spread so quickly and effectively. Over the past 200 years, seven pandemics of cholera carried the disease to countries around the world. Trade also played a role. By 1820, cholera was transmitted along trade routes to China, Japan, and the Philippines. Cholera found its way into Africa and North America via the slave trade. The second pandemic thrashed Russia, where it spread through Europe. This caused Irish immigrants to carry the infection across the Atlantic into Canada and New York. Next, the third pandemic began in 1852 and is considered to have been the most deadly. It was during this era that John snow published his landmark epidemiological studies on cholera.

Dr. John Snow, born in 1813, studied cholera tansmission during the 1854 epidemic in London. His hypothesis was that contaminated water was the cause of cholera. The problem was that there were those who opposed his hypothesis. Many had different theories but the most prominent opposer of his theory were those that adhered to the “miasma” model of infection. One such person was Henry Whitehead. Henry Whitehead was a Church of England priest in Soho during the 1854 cholera outbreak. Whitehead was a firm believer in the miasma model of disease. However, he became a supporter of Snow’s conclusions. Later, Snow identified the Broad Street Pump as a source of contaminated water. He had the pump handle removed. Snow and Whitehad’s work set a new precedent for the new science of epidemiology as a science of determining distribution, determinants, and deterrents of disease.

Italian researcher Filippo Pacini officially discovered the cause of cholera coincidentally around the same time as John Snow. Pacini performed autopsies with his microscope and discovered comma-shaped bacillus. He would later publish several papers on cholera but was largely ignored. He described the disease as a massive loss of fluid and electrolytes due to the local action of the bacteria. Pacini went on to recommened injections of 10 grams of sodium chloride in a liter of water to manage the illness.

Another researcher that aided in fight against cholera was Dr. Robert Koch. One of the “founding fathers” of the science of bacteriology.

Today, cholera (although waining) remains a threat to humanity. It recently claimed victims in Haiti and Yemen. Eveidence suggest cholera was brought to Haiti by UN peacekeepers from Nepal. Factors such as poor sanitation (still) and lack of healthcare has allowed cholera to breach Haiti and Yemen claiming thousands of lives.

HR: modules/articles on Canvas, cdc.gov

Tuberculosis is considered one of the deadliest infectious diseases in human history. Spread easily through contact with infected or infected articles of clothing and objects, Tuberculosis usually affects the victim’s lungs causing a bad cough, pain in the chest and coughing up blood. Tuberculosis can be fatal. Despite being extremely infectious and spread easily on its own, there are/were several factors that led to an increase in susceptibility to tuberculosis.

The tuberculosis epidemic in Europe started in the 17^th century and reached epidemic proportions during the 18^th and 19^th centuries. High population density and poor sanitary conditions created a perfect environment for its propagation. Because of the epidemic, this led to a lot of emmigration to the U.S. by Europeans. Immigrants took up residence in crowded tenements in Philadeplhia, Boston, and NYC around 1850. These tenements were dark, constructed poorly, badly ventilated, and filthy. This allowed for the bacteria to spread quickly and efficiently. Physicians attributed 8,000 to 9,000 deaths a year to tuberculosis in these types of tenements. These tenements are a testament to how important a healthy lifestyle and a healthy immue system are in preventing the spread of tuberculosis.

Malnutrition played a big role in the spread of TB. Malnutrition makes people more likely to activate or switch from latent to active contagious infections. Malnutrition, sickness and other diseases led to an easy conquest for TB. Those with HIV are extremely vulnerable and susceptible to not only other diseases but also especially TB. This is because they have a weakened immune system. Also, the problem of antibiotic resistance occurs when multiple drug therapy is not adhered to. This has led to extremely resistant TB that is very difficult to treat and can be transmitted to others.

HR: Modules on canvas, articles provided on canvas, cdc.gov

The potato was an important and versatile crop for the country of Ireland between 1700 and 1840. It was a high yield crop producing healthy food with little labor needed. The Irish were “potato people” – they ate everything potatoes. They ate potatoes for breakfast, lunch and dinner. By the 1840s, almost half of the Irish population was entirely dependent upon the potato. It was because of this dependency that the “Great Famine”, also known as the Irish Potato Blight, (which occurred between the years of 1845 and 1852) was able to kill (either through disease or starvation) about a million people. This was because when people are malnourished, they are vulnerable to infections. Many of the infections that ravaged the populace were measles, diarrhea, TB, whooping cough, intestinal parasites and cholera.

It is important to note that the severity of the blight was enhanced due to several other external factors. The first of these was the economic relationship between Irealnd and England. The population in Ireland was increasing and there were exploitations by landowners. There were also enforced exports of food crops to England, which led to further famine. Also, those who were not killed off due to the blight emigrated from Ireland. This dropped its population by 20-25%.

The exact cause of the blight was found to be Phytophthora infestans. Historical samples recently found of the virus suggest that sometime in 1842 or 1843, the ancestor of HERB-1 strain of P. infestans made it out of Mexico and North America and then to Europe. They theorize that it was contained within the potatoes that ships carried as food for their passengers.

HR: all sources provided on CANVAS, https://en.wikipedia.org/wiki/Great_Famine_(Ireland)

Smallpox is/was a serious infectious disease caused by the variola virus. Originating in the agricultural valleys of the great rivers in Africa and India, it was highly contagious and was responsible for killing millions of humans without regard for race, color, creed, character, religion or social status. Those infected with Smallpox had a fever and developed the “signature” symptom of a skin rash that developed into pustules that are extremely painful. This disease dates back to ancient times, from Roman times (known then as the Antonine plague) to the 20^th century. It has terrorized humanity up until it was eradicated by the year 1980. Smallpox was most notably responsible for the fall of the Aztec Empire and “aided” Hernan Cortes in conquering them. What led to the eradication to this disease? How did early humans deal with this terror?

Early “treatments” for Smallpox before the development of the vaccine were archaic. Many involved prayer and quack remedies. For example, in ancient Africa and Asia there were smallpox gods and goddesses that could be enlisted for protection. Another example is in 1314, Englishman John of Gaddesden suggested Smallpox victims could be helped by the color red, so those infected were dressed in red. Some of these bogus remedies continued up until the 1930s. Prior to the vaccine, there were other techniques to induce “inoculation” – or variolation (since the virus’s name dervied from the Latin word varus). The Chinese avoided contact with infected individuals and would have the person inhale power from the dried scabs shed by recovering patients or given powdered scabs to be inserted into their nostrils. In the East and Africa, material from a pustule was rubbed into a cut or scratch in the skin. Variolation was famously used by General George Washington in the American Revolutionary War prior to his taking of Boston. Today, prevention of smallpox is often assoicated with Edward Jenner’s method of turning a folktale into a reliable protection against Smallpox; that is, those who contracted cowpox developed mild reactions. After, neither cows nor humans developed any other symptoms. It is important to note that not everyone in that time wanted Jenner’s “vaccine” or methods for them or their children. After submitting his findings to the Royal Society, he came to find that his manuscript was rejected due to him being a lowly country doctor and not part of the scientific community. He faced reticule by popular press at the time and physicians rejected his ideas. However, he later gained great wealth, fame and respect for his findings. As a result of Jenner and his “vaccine”, controversy over vaccination rose.

Up until the 1900s, there were Anti-Vaccination Societies that believed the practice of vaccination to be dangerous and a violation of their rights and liberties. A good example is the “Milwaukee Riots’ in 1890. The city of Milwaukee pursued a strict policy of enforcement i.e. removing children suspected of being infected from their homes and placing them in the city’s isolation hospital. The residents fought back and protested, sometimes violently. The controversy did not end there. In 1901, a smallpox epidemic broke out in Boston. The Board of Health in the city established “virus squads” with orders that all inhabitants of the city must be vaccinated/re-vaccinated and forced to get the vaccine. In 1905, the U.S. Supreme Court ruled that although the state could not pass laws requiring vaccination in order to protect an individual, it could do so to protect the public in the case of a dangerous-communicable disease. Despite having good intentions, health boards and the government violated civil liberties for the common good. There are pros and cons to compulsory vaccination – the pros to this compulsory vaccination being containment and prevention of an epidemic and saving lives. The cons being that not everyone wants these vaccinations and if they choose to not partake, it could lead to the spreading of the disease and fatalities. The problem (problem used loosely in this instance) is that people decide what happens to them and their bodies – something that is still a hot topic of debate in 2018 via abortion.

HR: Sources on canvas, WHO, CDC.gov, most of the information came from “The Power of Plagues” by Irwin W. Sherman

Ethics are defined as moral principles that govern a person’s behavior or the conducting of an activity. Ethics play a major role when dealing with infectious diseases and epidemics. Such controversies include whom to quarantine and how, biases against certain groups due to fear and studies done with “shady” practices. When a disease (especially a lethal one such as HIV) begins to occur and spread rapidly, there is a backlash from human beings for obvious reasons. However, there have not been any severe actions taken like the ones seen in popular media such as the movie “I am Legend” or the video game “The Last of US”. A good example of an unethical issue/dilemma when dealing with infectious diseases was the Tuskegee syphillis experiment. The Tuskegee study was a clinical study to observe natural progression of untreated syphyllis in African-American men in Alabama while pretending to give free health care from the government. The participants were told they were being given treatment but in reality were receiving little to no treatment. Obviously, the participants did not know they were being ‘douped”. While it is true that some actions are necessary in the name of science to prevent and further study diseases, I personally believe what they did was not right. Finally, in the very “PC” (politically correct) world we live in today, if scientists keep “targeting” or doing studies on a particular group of race, religion or creed it will seriously hinder the medical field due to the backlash that will lead to an eventual stop to testing.

HR: resources on canvas, wikipedia

It can be argued that there is no other most influential disease in history. There were 3 pandemic waves of plague. The first was in 542 A.D under Emperor Justinian. The second was in 1347 during the medieval ages. That plague was aptly named “The Black Death”. Finally, there was the third wave in 1894 which was the Bubonic or modern plague. In the first wave, the plague was spread via fleas and rats to human hosts. Soldiers brought back the disease from conquering wars under the empire. The second plague, The Black Death, killed ~20-30% of the Eurasian population very quickly. People would collect mounds of rotting cadavers in mass graves. It killed so quickly that people were not able to dispose of the bodies fast enough. The final wave came initially in China in 1855 and spread to Hong Kong by 1896. In a 30 year period, more than 12 million died. What factors contributed to the spread of these plagues? What was the response and effects of these deadly diseases?

In general, the plague created fear and panic spread. During the plague in the medieval times, they thought miasma was the cause for the plague. As a result, many people refused to bury the dead and so the Becchini (Brotherhood of Gravediggers) would ride into town to ransack plague victims’ homes then charge a hefty fee to cart away the many corpses that littered the streets. Many factors or people were blamed for the cause/spread of the disease. One particular group were the Jews. People believed that the Jews were bent on world domination and were poisoning wells of Christian towns. As a result, thousands were slaughtered. The spread of the Black Death was aided due to the hygiene and lifestyle of those in that time. Many people lived with their animals in their house nearby and rats ran rampant. Many people cooked with clay pots and utensils but after the plague epidemic, used more expensive metal. Social classes began to blend due to aristocracy and nobility being killed off and due to the general apathy that followed the plague. Two popular uprisings, La Jacquerie in France in 1358 and the Peasant’s Revolt in England in 1381 followed the Black Death. The plague was also known to be a contributor to the downfall of feudalism and the rise of the mercantile class. Another societal factor that the Black Death contributed to was the emergence of plague hospitals to care for the sick and the use of quarantine and confinement.

Plague is still prominent today (although not as it once was). It was first introduced into the United States in 1900 by rat-infested steamships from Asia. Epidemics occurred in port cities. From rats, in transferred to domestic animals and animals commonly used on farms for work and food (cattle, horses, etc.). Any animal can be infected by plague such as squirrels, dogs, mice and rabbits. This began the spread in the western part of the country. It is believed that rats and their fleas serve as long-term reservoirs for the plague since they do not get killed off by it as quickly. Transmission to humans occurs by flea bites, contact with contaminated fluids or tissue and infectious droplets (coughing, sneezing). Today, plague is most commonly found in sub-Saharan Africa and Madagascar. The reason for the spread in Madagascar is due to the state of the country- millions in poverty, poor health care and hygiene, living with animals in homes and burial practices involving un-burying the dead to consult with them

HR: class notes, resources provided by Dr. Hinks, http://www.brighthubeducation.com/history-homework-help/88775-social-effects-of-the-black-death/

Africa is considered the cradle of humanity. The earliest evidence of our ancestors was found in Africa. The fossils found date to about4.2 to 3.8 million years and were known to be “apelike humans”. It is inferred from the fossils of their teeth that they ate things like fruits, seeds and plants – not meat. However, as humans evolved more and become more intelligent, they developed tools to hunt game and eat meat. This in turn exposed them to other infectious diseases and vectors of parasites. Thus, was the beginning of zoonosis- or animal infections being transmitted to humans. With evolution comes change in cultural and societal practices. We began as hunter-gatherers who roamed distances to find plants, hunt and find water. In other words, we were nomadic. As a result, humans were not exposed to rotting meat or feces and exposure to parasites was limited. Groups or tribes were small, isolated bands so “crowd” diseases requiring human-to-human contact transmission was absent or severely limited. Some of the infections these types of early humans were probably exposed to were intestinal worms, lice/fleas, malaria, yellow fever and tularemia. As time continued to pass, the human population in the world increased. Some major factors that contributed to this include tool making, the agricultural revolution, scientific-industrial revolution. This increase in in population led to an increase in disease. Agricultural technology and advancement, sedentary or stagnant lifestyle and globalization are responsible for the increase in variety and especially transmission of diseases. Finally, slavery played a large part in disease. The slave trade bringing over workers brought malaria and small pox with them.

Part 2

Globalization and technological advancements such as airplanes and other transportation technology has significantly changed infectious diseases. A good case study is the increase and spread of sexually transmitted diseases like chlamydia, genital herpes, and recently AIDS. The AIDS epidemic has been prevalent over the last 20 years. The increase in climate has also contributed to the spread of infectious diseases. Vectors such as malaria and bird flu (or diseases and infections of those variety) have also been allowed to survive and spread rapidly through animals and insects such as mosquitos.