Through the course of this semester, we have discussed various outbreaks, epidemics, and pandemics that have impacted the course of history. From smallpox, measles, and influenza to TB, cholera, and HIV/AIDS, we have learned the debilitating impact of not only the diseases itself, but its influence on society. We can also make the connection that society impacts disease equally as the disease affects society. Society encompasses a multitude of people and is affected by numerous entities; thus, the rise of plagues may be the product of a culmination of those factors. As long as the modern world (i.e. technological, political, or economical) continues to change, disease will continue to shift and affect billions.

The rise of plague resulted from a combination of factors. The most prominent being the change of a hunter-gatherer lifestyle to a stationary, sedentary lifestyle. As hunter-gatherers, being constantly on the move generated smaller population groups and fewer human-to-human transmission, thus limiting exposure to parasites and the susceptibility of disease. However, the conversion from migrating to farming facilitated agriculture and domestication of animals, thus, increasing our vulnerability to infections and diseases (associated with animals). Diseases (i.e. smallpox, influenza, malaria, etc.) then evolved and adapted to humans, and human transmission became prominent as contamination/pollution by food and water increased in denser populations (Artifact 1, The Sedentary Lifestyle).

Increase in population created denser environments which multiplied the vulnerability of air borne transmission. Debris infested streets became the ideal breeding compound for rats overrun by fleas and the expansion of trade (linking of countries) further enhanced the diffusion of disease). Not only did this bring fanatical and uncompromising pursuit of religious ideals, like ‘The Flagelence,’ it also brought about methods of controlling the transference of plague (i.e. isolation/quarantine). And although countries still experience undesirable situations similar to generations past, the formation of health boards and the accumulation of intelligence through surveillance undoubtably aided in combating transmission/diffusion (Artifact 3, Plague – Yesterday and Today).

However, as we see throughout time, the virulence of disease never dissipates. This can be attributed by societal and cultural factors of that era. For example, during the smallpox epidemic, the intertwinement of war, exploitation and migration severely impacted the distribution of this disease. Smallpox was used as a method of biological warfare, targeting immunologically virgin communities, in hopes to gain the ability to conquer lands (Artifact 4 – Significance and History of Smallpox). Between 1700 and 1840, the devolving economic relationships between Ireland and England compelled the Irish to become solely dependent on potatoes. The blight associated with the potatoes then resulted in mass starvation and famine-induced ailments such as measles, diarrhea, TB and more. Additionally, the panic from the potato blight prompted mass immigration and overcrowding, followed by poor living conditions and an increased risk for other transmittable diseases (Artifact 6 – Irish Potato Blight and Molecular Technologies).

As indicated by the previous examples, disease affects society, just as much as society affects disease. Needless to say, the various factors that increased the susceptibility of transmission in the past are still active in this time period. This includes factors such as malnutrition, poverty, contamination, etc. (Artifact 6 – TB – The People’s Plague). Though, in the 19th and 20th century, we made steady progress in mitigating some diseases by preventing access to contaminated water. Trade, colonization, and urbanization exacerbated the spread of cholera, until the origin of the outbreak was determined, and precautions were met to alleviate the problems (Artifact 8 – Cholera).

Following each epidemic/pandemic, people not only gained knowledge but also learned to respond to certain situations. For example, after the cholera pandemic, epidemiological findings demonstrated the importance of public health and knowledge of its community and organizations (Artifact 8 – Cholera). This is turn prompted action; actions such as forming World Health Organizations (WHO) to coordinate, respond, and combat global diseases. For third-world countries, limited access to resources and aid make the situation difficult to alleviate. However, attempts are constantly being made to provide clean water, public health infrastructure and access to public health care to developing countries. HIV/AIDS programs and interventions (i.e., condom distribution) are one of many programs that have been launched in order to educate individuals and provide relief (Artifact 9 – HIV/AIDS).

Presently, diseases are beyond the control of man. We are unable to stop the ongoing evolution of disease. We have no control whatsoever on the re-emergence of once eradicated diseases nor do have the ability to control diseases that have evolved. However, what we can do, is further research these epidemics and work towards providing adequate diagnoses and treatments. It is vital to identify societal factors in order to elevate the possibility of an outbreak from spiraling out of control. As a society, it is our duty to be vigilant and mitigate behaviors that put us at risk.

Help Received: Syllabus (handout for reflective essay), All Artifacts (and sources used in those Artifacts), Cadet Jones (structure and organization of information), Dictionary/Thesaurus

In the 21st century, HIV/AIDS is the modern pandemic. Various societal and cultural factors including political will and indifference, attitudes towards specific groups, fear, stigma, shame scientific ignorance, etc. have contributed to the epidemic of HIV in the United States (Artifact 9 handout). In accordance to research, other indicators such as poverty, lack of education, unsafe sexual encounters and injection drug use have been linked to the contraction of HIV/AIDS (HIV Surveillance Report). There is a severe lack of education in safe sexual interactions such as the use of condoms. Addressing issues regarding people’s knowledge, attitudes, and behaviors related to condom use can have strong impact on social norms (Condom Distribution as a Structural Level Intervention). Promoting condom usage can have a lasting effect on the reduction of HIV infection when combined with structural-level interventions such as distribution of free condoms (Condom Distribution as a Structural Level Intervention). The prevalence of unsafe/unsanitary needle usage (i.e. injecting drugs) have also been involved in the spread of HIV (HIV Surveillance Report). These behaviors severely increase the risk of HIV among at-risk groups (i.e. youth, drug-abusers). Additionally, lack of or limited access to health care constrain individual’s in attaining optimal treatment.

Condom distribution programs (CDPs) were implemented as preventive measures for HIV/STDs. By increasing the availability, accessibility, and acceptability of condom usage, the CDC thought that it would reduce the risk of the virus (Condom Distribution as a Structural Level Intervention). Over the past decade, the CDC has launched several CDPs. For example, in 2007, the New York City’s Department of Health and Mental Hygiene (DOHMH) distributed free safe sex products (i.e. male condoms, female condoms, and water-based lubricants) to organizations, businesses, and individuals (Condom Distribution as a Structural Level Intervention). The 2012, the CDC began a five-year HIV prevention funding cycle with health departments across the U.S., distributing over 248 million condoms (Condom Distribution as a Structural Level Intervention). In addition, the District of Columbia (DC) Department of Health HIV/AIDS, Hepatitis, STB, and TB Administration (HAHSTA) promoted the availability and accessibility of condoms, education of correct usage, and the distribution of sex products to partnering organizations and DC residents (Condom Distribution as a Structural Level Intervention).

Antiretroviral therapy or ART is the primary medication currently used to suppress the effects of HIV. It has been known to reduce the viral load (amount of HIV in the body) to low levels enabling the immune system to keep working and prevent illnesses (HIV Treatment as Prevention). A low viral load or an undetectable viral load is the best scenario for those with HIV to stay healthy. It reduces the amount of virus in the body helping to prevent the transmission of HIV to others through sex, syringe sharing, mother to child during pregnancy, birth, and breastfeeding (HIV Treatment as Prevention).

Though we are making steady progress through the efforts of modern medicine and technology, we find that HIV/AIDS is still rampant. Recent data has shown that the highest racial group for persons infected with HIV/AIDS were other racial groups (i.e. American Indian, Asian, Pacific Islander etc.) (25.4%), followed by Hispanics/Latinos (23.8%), whites (22.6%), and blacks/African Americans (22.0%) (HIV Surveillance Report). In terms of transmission, data showed that the highest percentage of persons infected was attributed by male-to-male sexual contact in addition to injection drug use (27.9%), followed by male-to-male sexual contact only (25.0%) (HIV Surveillance Report).

Unlike the past, modern advances have aided in the control of HIV symptoms. However, there are still many things that are unknown to us. The prevention/treatment of this virus is still being advanced/developed because drug resistance and mutation are very plausible cases. Like TB and other diseases, it is only a matter of time, funding, politics, and expertise that stands in between the prevalence of this virus.

Help Received: Artifact 9 handout, Cadet Jones (structure and organization of information), Dictionary/Thesaurus
HIV Surveillance Report – https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-21-7.pdf
Condom Distribution as a Structural Level Intervention – https://www.cdc.gov/hiv/programresources/guidance/condoms/
HIV Treatment as Prevention – https://www.cdc.gov/hiv/risk/art/

Responsible for seven pandemics in the past two centuries and the death of millions, cholera, also known as “King Cholera,” is water- or food-borne illness (Cholera PPT slides 3, 9). Caused by Vibrio cholerae, cholera can be transmitted by drinking water or by food that is irrigated, washed, or cooked with contaminated water (slides 10, 14). By inhabiting water, this disease kills ‘perfectly healthy people’ at profoundly alarming rates (slide 2). Symptoms of cholera include muscle cramps, diarrhea, and vomiting which results in radical dehydration. Often times, symptoms were exacerbated, leaving individuals drained of water and electrolytes within 24 hours (slide 7). Many victims lost their lives within one day, commonly appearing discolored and shriveled (slide 5).

In the 19th and 20th centuries, various societal/cultural factors such as trade and colonization enhanced the spread of cholera. For example, the Hindu pilgrimages and holy festivals in the Ganges river in India, as well as, the trade routes to China, Japan, Philippines, Persian Gulf, Africa, and central Asia aided in the transmission of this pandemic (slides 19, 24). The first pandemic/outbreak was in Calcutta from 1816 to 1823 (slide 24) Not long thereafter, the second pandemic held in Russia, rapidly spread throughout Europe, impinging Paris, London, and Ireland from 1829 to 1851 (slide 26).

Immigration and urbanization further developed the infection. Irish immigrants carrying the infection crossed to Canada and New York, then to the west coast of the U.S., and southwards into Mexico and Latin America. Cholera outbreaks then occurred with regularity in port cities such as New Orleans with high death rates and panic (slide 26). From 1852 to 1863, the third pandemic affected Africa, the U.S., Middle East, Europe, and India (slide 30). Immigration had created denser populations, expanding cesspools and garbage.

During the London epidemic of 1854, John Snow studied the transmission of cholera with the assistance of Henry Whitehead, a priest of the Church of England (slides 33, 67). Though there were many ideas regarding the diseases’ transmission, Snow found that the epidemic was centered in the Soho district close to his residence and believed that cholera was related to water contamination (slide 33). He observed various associations between cholera cases and contaminated water supplies (slide 49). Within his observations, he had noticed several anomalies. He discovered that paupers north of Broad Street used their own well and suffered very few cholera deaths and that none of the brewery workers east of Broad Street contracted cholera, possibly due to the fermentation of their beer (slide 54).

Accompanied by Reverend Henry Whitehead’s extensive knowledge of the local community and John Snow’s sources on the resident’s lives, he was able to identify the epidemic’s starting point. Thus, convincing the local authorities to handle the issues regarding the Broad Street pump (slide 68). Whitehead and Snow’s epidemiological findings demonstrated the importance of public health’s role and in knowledge of the community and its organizations (slide 75). Snow, however, did not determine the specific causative agent. In fact, Filippo Pacini, an Italian researcher, identified the cholera bacterium and published his work of the Vibrio cholerae within the same time frame Snow had discovered it, though he was unrecognized until his death (slide 76).

In 1883, unaware of Pacini’s work, Dr. Robert Koch along with Pasteur discovered the causative agent of cholera in the outbreaks in Egypt and Calcutta (slides 80-81). Although they had reached similar conclusions, Koch was more universally known due to the press and had received the Nobel Prize for Physiology/Medicine for his discovery (slide 81). Overall, with the scientific observations of all parties (Snow, Pacini, and Koch), they debunked the miasma theory of cholera and has helped limit the lethality of future cholera outbreaks (slide 86).

The fourth and fifth pandemic beginning in 1863 and 1881 were spread worldwide. Outbreaks in Naples, Spain, and Russia killed 200,000 between 1893-94, almost 1.5% of the population perished in Hamburg, and had widespread mortality in China, Japan, and South America (slide 88). In accordance to improved public health sanitation and water systems, the pandemic failed to reach the Americas and the last outbreak in Europe was in 1892 (slides 93, 96). However, in regions such as India, Arabia, Russia, Italy, Greece, Turkey, and the Balkans, where they did not progress in sanitation, it was severely affected by cholera (slides 94, 96).

In to the 21st century, poor water quality and sanitation in relation to public health infrastructure and health care access, has ensured the prevalence of cholera (slide 98). By February 2009, there were 128,548 cases of cholera in sub-Saharan Africa along with 4,053 fatalities (slide 99). In 2008-2009, the outbreak in Zimbabwe had reached mortality levels of 5.7%, surpassing the 1% typically associated with large-scale cholera epidemics (slide 102). Additionally, the 2010-2011 outbreak in Haiti recorded 473,649 cases and 6,631 deaths (107).

The cholera outbreak in Haiti intensified during the rainy season with increased flooding (slides 125-126). With the UN taking responsibility for the epidemic in 2016, the biggest priority has been on sanitation and clean water access (slide 124, 126). Distribution of cholera vaccinations such as Shanchol has also been acted upon (slide 127). Additionally, the recent cholera attacks in 2017 displayed that war has devastated the infrastructure and economy of Yemen leading to little or no access to clean water and malnourishment (slides 133, 136, 140).

Studies regarding the treatment of cholera is ongoing. Today, we have made progress in developing rehydration fluid that can be administered orally (slide 143). ORS or oral rehydration salts is currently the mainstay of treatment for cholera and all diarrheal illnesses (slide 144). Despite this, cholera is a constant, ongoing threat to millions of people who lack clean water in many third world countries.

Help Received: Cholera PPT, Artifact 8 handout, Cadet Jones (structure and organization of information), Dictionary/Thesaurus

Tuberculosis or TB is a chronic or acute infection caused by a bacterium called Mycobacterium tuberculosis. Affecting the lungs, kidneys, bones, lymph nodes, and the brain, this deadly bacterial infection is spread from one person to another through the air (Tuberculosis PPT, slide 3). Due to the easily transmissible nature of TB, the disease reached epidemic proportions during the 18th and 19th century (slide 35). In fact, various factors during this time period increased the susceptibility of TB, including immigration, malnutrition, crowding, and poverty (Artifact 7 handout). The high population density and the poor sanitary conditions characterized in most cities created the most fitting environment for its propagation (slide 35). In the 19th century, immigration soared in the United States. Immigrants took up residence in crowded tenements in the hub of Philadelphia, NYC, and Boston, aiding in the expansion of TB. In addition, immigrants worked under dire working conditions and resided in poorly constructed, badly ventilated and filthy tenements (slide 49).

Though malnutrition, poverty, social stigma are still prevalent factors in the susceptibility of TB, various contemporary problems, like the role of HIV, have been introduced (Artifact 7 handout). However, today, we face a bigger problem with TB becoming more resistant to drugs and treatment (slide 92). Treating TB is a time-oriented task. It is critical for those with TB to strictly adhere to a schedule of taking multiple drugs (slide 94). Currently, there are 10 drugs approved by the FDA (INH, RIF, EMB, and PZA) that active TB patients can take during the 6-9-month treatment process (slide 91). However, poor adherence to treatment will put you at risk of becoming resistant to those drugs. Inconsistency may result in delayed resolution or worsening of symptoms, transmissibility of resistant strains, increase in treatment costs, and an overall increase in the probability of death (slide 94).

There has been substantial progress in the number of patients diagnosed and treated, however, TB still remains a global public health emergency. It is responsible for more deaths than any other infectious disease (Reid, 2019, pg. 1). There has been slow progress of TB since 1993 as a result of various political, societal, scientific, and strategic shortcomings (pg. 6). To name several, there have been insufficient investments and political will due to the decline of TB in high income countries, failure to target resources at hot sports and high-risk populations and so much more (pg. 6-7). The adverse effects of TB extend well beyond one individual. Thus, it is crucial to implement quality improvement, assessing effective strategies, prioritize high risk active groups, etc. (pg. 15-17).

Help Received: Tuberculosis PPT, Supplementary readings – Building a TB free world Lancet Commission, Artifact 7 handout, Cadet Jones (structure and organization of information), Dictionary/Thesaurus

Part 1:

Between 1700 and 1840, there was an immense growth in the Irish population. Due to devolving economic relationships between Ireland and England, half of the Irish population were highly dependent on potatoes for substance (PPT: Potato blight and famine, slide 2). Potatoes are high yield crops that can be produced with little labor investment. Additionally, they hold substantial nutritional value and can be used in a multitude of ways (appetizer, dinner, and dessert), making it a staple food item in the Irish diet (PPT slide 3).

However, from 1845 to 1852, the Irish potato production was ravaged by blight (PPT slide 4). Accounting for a loss of 1/3 to ½ of all acreages in 1845, and ¾ of all potato crops in 1846, the potato blight resulted in mass starvation and disease. Considering 2/5 of the population were solely reliant on potato production, many experienced famine-induced ailments such as measles, diarrhea, TB and more. As a result, the famine wiped out 20-25% of Ireland’s population (PPT slides 4-5).

The potato blight, or phytophthora infestans, is a strain of P. infestans HERB-1 (PPT slides 26 and 31). The pathogen originated in Mexico, then migrated to North America and Europe (PPT slide 32). Doubt and panic prompted mass immigration (traditional route was the United States), which had profound social and political impacts (Sherman, pg. 30). First, Irish-Americans dominated key positions in railroading, mining, civil engineering, law enforcement, and politics. Second, there was an immense population of poor, unskilled Irish immigrants crowding the cities. Third, their social activism and unionization changed political party platforms (Sherman, pg 30-31).

Part 2:

Today, we are introduced to various threats. For example, climate changes increase risk to crop production through droughts and pests. With genome-editing technologies such as CRISPR, we show promise in addressing these challenges (Scheben and Edwards, pg. 1122). Our ability to modify genes of plants, animals, and so forth have brought out many benefits. For example, a benefit could be to boost crop production for the growing population. However, for every benefit, there is always a disadvantage. As of right now, the growth of genome-edited crops faces many sociopolitical challenges (i.e. government regulation, public acceptance, etc.) (Scheben and Edwards, pg. 1123). Though a scientific breakthrough, genome-editing may create harm, if used improperly (Jones).

Help Received: PPT: Potato blight and famine, Supplementary readings – Irish potato blight (Sherman), Genetically modified crops – Science article (Scheben and Edwards), Cadet Jones (structure and organization of information), Dictionary/Thesaurus

With no respect for social class, occupation, or age, smallpox killed and disfigured kings and queens, children and adults, rich and poor alike (Artifact 4 sheet). Similar to the plague, smallpox was indiscriminate, unforgiving, and ruthless. Intertwined with the war, exploitation, and migration, smallpox changed the course of world history; without it, outcomes of the world would have been unrecognizable. The disease affected the course of British, European, and American history, effecting immunologically virgin communities, trade, and battles (Artifact 4 sheet).

As Spanish conquerors invaded the New World in the 1500s, smallpox aided in the subjugation of the Amerindians. Unknown to the natives, exposure to this disease was deadly. And With no immunity towards it, smallpox drastically weakened the once powerful force; contributing to the settlement of North America (slides 15-16). The lost in accordance to the disease, sparked the need for a larger labor force, instigating the enslavement of West Africans who were regarded as ‘immune’ to the disease (slide 17).

In the early 1760s, smallpox was used as biological warfare. In hopes spreading the disease, the British gave gifts from smallpox infirmaries to nearby native tribes (slide 18). This caused prominent health issues during and after the Revolutionary war (slide 94), which hindered the Americans’ ability to conquer lands. As problems ensued because of bio-warfare, George Washington recommended inoculation for preventive measures (slides 95-96). Such procedures (and other various remedies) were conducted until the introduction of the smallpox vaccine in 1796, that inoculated a person with cowpox to gain immunity towards smallpox.

By striking at various important points in history, smallpox indisputably wreaked havoc for centuries. Tales of its horror have been documented in multiple countries and languages. Clearly insinuating the drastic effects, it had on our world. Though heartbreaking, without smallpox, or other diseases/viruses, our world would be drastically different. We would not be as aware or knowledgeable in this field and would not have developed our preventive measures.

Help Received: PPT (Smallpox – The Speckled Monster), Smallpox Documentary (Is Smallpox Still a Threat?), Cadet Jones (structure and organization of information), Dictionary/Thesaurus

There are numerous ethical issues associated with infectious diseases; including vaccines, isolation/quarantine, bias, experimental studies etc. (Artifact 5 sheet). Today, there have been frequent debates on the use of vaccines due to possible (negative) risks. Complications related to vaccines continue to instill fear among people, though immunization is still regarded as the most effective preventive measure for diseases. With that being said, vaccination is a choice; you cannot coerce another person in to getting vaccinated. Similar to the fact that no one can force you to participate in an experimental study (Jones).

The Tuskegee Syphilis Study highlighted many ethical concerns such as medical misconduct and an indifference towards human rights. The primary targets of the experiment were poor, African American sharecroppers (“expendables”), deceived by the promise of care (The Deadly Deception). Underestimation of those infected with syphilis, diverged the original focus of the study from a treatment plan to the research and collection of data on untreated syphilis. Unknowingly, individuals who were once patients were converted in to research subjects (The Deadly Deception).

At the time, there were no regulations or protective measures to ensure full disclosure or protection from unnecessary risks. Many subjects of human experimentation were primarily individuals who were medically and socially disadvantaged (had to comply to their owners) (The Deadly Deception). Unconcerned by their welfare, many participants were deceived in to partaking in ‘treatments,’ without ever being informed of the true nature of their illness, or the dangers they faced. Thus, gambling the lives of hundreds of men (The Deadly Deception).

This influenced the making of The Belmont Report; specific ethical principles and guidelines for research involving human subjects. The Belmont Report formed three basic principles: respect for persons (acknowledge autonomy and protect those with diminished autonomy), beneficence (maximization of possible benefits and minimal possible harms), and justice (equal treatment). acknowledge autonomy and protect those with diminished autonomy). They applied the general principles by requiring, informed consent, conducting proper risk/benefit assessments, and use fair procedures in the selection of research subjects (The Belmont Report).

Despite this, it does not excuse the methods that were taken place. The ideals and methods of this experiment were incredibly flawed and unjust. Instead of furthering ‘science,’ it created an ambivalence towards scientific research and an extreme distrust towards those in medical professions (within the African-American community) (The Deadly Deception).

Help Received: The Deadly Deception: Tuskegee Syphilis Experiment video (YouTube), Artifact sheet, The Belmont Report (HHH.gov), Cadet Jones (structure and organization of information), Dictionary/Thesaurus

Historically, the plague originated from the bacteria, Yersinia pestis. Incidentally infected, this bacterium was responsible for the largest plague epidemics in the world (i.e. Justinian Plague, Black Death, and Bubonic Plague) (Plague History PowerPoint, slides 3-4). Accounting for ~100 million of the Eurasian population (slide 38), the bacterium’s ability to invade and diversify showed the unrestrained capabilities of this disease. Infection was not isolated to one method of transmission and could spread either by blood (septicemic) or air (pneumonic) (slide 12).

Societal factors greatly contributed to the virulence of these plagues. The increase in population created denser environments, multiplying the vulnerability for air borne transmission. Debris infested streets became the ideal breeding compound for rats overrun by fleas, and expansion of trade linking Western Europe and China further enhanced the diffusion of disease. Frightened by mortality, many succumbed to the plague, abandoned any attempts to help those infected, and fixated on self-preservation. In an endeavor for repentance of their sin, the people turned to zealotry, a fanatical and uncompromising pursuit of religious ideals. Fanatics whipped themselves in a brutal imitation of Christ’s suffering and further lead them in to hysteria, persecution, and mass murder (The Plague History Channel Documentary).

As all authoritative (i.e. medics, clerics, nobles, etc.) figures failed to protect the people from pestilence, the masses turned to other methods for salvation. Primarily, they relied on ‘The Flagelance,’ figures who displayed extreme measures of self-harm to ward off the disease and avert God’s wrath. Others, convinced that God was punishing them for their sins, persecuted the Jews and took combative measures. The majority were forced to make false confessions of conspiracies and were either expelled or burned alive (The Plague History Channel Documentary).

Other attempts to control the transference of plague was introduced in 1377. Maritime quarantine was held for 40 days based off Hippocrates theories regarding acute illnesses, mathematical equations, and biblical reasoning (slide 43). Boards of health oversaw isolation of the exposed individuals, managed medical and burial services, and kept record of causes and tolls of death. Based off the intelligence gained by surveillance, confined hospitals were designed and managed to isolate those exposed (slide 44). By the third wave (Modern Plague), Westerners highly criticized poor sanitation conditions and responded draconically. Victims were extremely isolated, clothing and cadavers were burned, houses were fumigated, and slums were razed (slide 60). Immigrants had severe limitations to their personal freedom and were forced to receive experimental and anti-plague vaccines (slide 68)

Today, plague transmission is primarily through the exposure from species to species. Many types of animals such as wood rats, prairie dogs, mice, rabbits can be affected by the plague and serve as long-term hosts for vectors (Plague Today PowerPoint, slide 11). Exposure or contact with contaminated fluid from plague-infected animals primarily result in the bubonic and septicemic plague (slide 17-18). In the U.S., plague mostly occurs as scattered cases in rural areas. Based off reported cases of human plague (1970-2012), majority occur in northern New Mexico, northern Arizona, and southern Colorado, California, southern Oregon, and western Nevada (slides 8-9).

Currently, the highest concentration of plague is in sub-Saharan Africa; predominantly Madagascar (slide 25). The plague re-emerged in Madagascar in the 1990s but reached epidemic levels after 2009, putting the country in a perilous state of public health. Political upheaval coupled with drastic cuts in foreign assistance crippled basic government services (i.e. waste disposal), investments in clean water and infrastructure collapsed, and development of poverty became rampant (slide 29). Cultural factors (i.e. burial practices), lack of health care facilities, co-habitation with animals, and climate effects were other variables that affected the lack of control in Madagascar (slides 30-33).

From our experience, disease is an ongoing threat. Many of the factors that contribute to the escalation of disease is through human behavior and societal issues. We have made vast improvements in our identification and treatment of notable diseases. However, as a society, we must always be vigilant to mitigate behaviors that put us at risk; we never know when the next outbreak will occur. To do so, we must act. For example, we should provide adequate health care, reduce unsanitary behavior, inform the public, etc.

Help Received: PPT History of Plague, PPT Plague Today, The Plague History Channel Documentary, Cadet Jones (structure and organization of information), Dictionary/Thesaurus

In our experience and understanding of previous outbreaks, we have learned that diseases never remain stagnant. Diseases once eradicated return, diseases evolve, and entirely new diseases emerge. We may not be able to stop the ongoing evolution of disease; however, we can further research these epidemics and provide adequate diagnoses and treatments as preventive measures. It is vital to identify pathogens that are at risk for spillover to prevent an outbreak from spiraling out of control. As a society, it is our duty to be vigilant and mitigate behaviors that put us at risk.

Viruses are continually advancing. However, unlike bacteria that can live and reproduce on their own, viruses occupy hosts. They invade species and diversify their range for survival (Spillover video). Their ability to jump species increases the vulnerability of spillover that much more prominent. Hence, the importance of zoonotic diseases. Once infected, casual contact can be the start of an epidemic with an explosive consequence. With the world consisting of millions of species, we are not short handed with the liabilities we face. It has become a growing global threat and accounts for various prominent diseases of the modern age. For example, the Nipah virus that had been widespread in Bangladesh. With a distinguished population of fruit bats, these creatures were culprits in the contamination of tree sap, a delicacy of sort, that quickly spread throughout the country (Spillover video).

Naturally, social and cultural issues also play a role in outbreaks. Primarily from the decisions and behaviors of humans. For instance, there have been debates between pro-vaccination vs. anti-vaccination. Questions on the risks and benefits of vaccination, including whether or not the act of getting vaccinated endangers the lives of others is commonly discussed. There have also been instances where vaccinations have caused allergic reactions and debilitating side effects, negatively affecting people. Thus, opening the floor for continuous debate on risk-benefit analysis (YouTube).

Since the 1900s, we have had a drastic increase in population growth. In dense throngs, pathogens spread easily and quickly develop resistance to drugs (Yong, 2018). Therefore, increases in globalization and densely populated areas pose a tremendous risk. Having the potential to spread explosively, it can quickly escalate from a local epidemic to a world-wide pandemic. For example, in 2003, a Chinese seafood seller hospitalized in Guangzhou passed sars to dozens of doctors and nurses, one of whom traveled to Hong Kong for a wedding. In a single night, he infected at least 16 others, who then carried the virus to Canada, Singapore, and Vietnam. Within six months, sars had reached 29 countries and infected more than 8,000 people (Yong, 2018).

Pathogens do not have boundaries. They do not have borders or political interests. Anything at an international level begins at a local level (Spillover video). With that being said, I find it difficult to believe that we are prepared for a large and sustained outbreak. Though we have been successful in creating new vaccines and have implemented various preventive measures to identify new pathogens, I believe that the world would have a difficult time in effectively containing an outbreak of such parameters. Essentially, we would have to react extremely quickly and activate all precautionary measures such as rapid detection, diagnosis, and treatment at a local level. However, because these outbreaks are typically generated in places where they are not capable of providing effective care, it is difficult to ‘cut it at the root.’ In conclusion, a weak health system anywhere poses a threat everywhere (Spillover video).

Plagues originate from various contributing factors. The most prominent being the shift from a hunter-gatherer lifestyle to a stationary, sedentary lifestyle. The conversion from migrating to farming facilitated both positive and negative consequences. As hunter-gatherers, roaming, searching, and moving was expected. By following animals as their source of food, bearing children was considered less than ideal. The ongoing pace made the process difficult, however, they did reap several benefits. Constantly being on the move resulted in small population groups, reducing human-to-human transmission, in addition to, limited exposure to parasites (commonly associated with rotting food and feces). As hunter-gatherers, infections were unavoidable; fleas adapted, and wild animals were the reservoirs for various diseases (i.e. malaria, relapsing fever, yellow fever, etc.). Yet, due to the spaced-out, small population, illnesses typically made isolated appearances and seldom affected the group in its entirety (CANVAS slides).

Once the agricultural revolution and domestication of animals were set, other major factors such as the scientific-industrial revolution and tool making steadily affected the growth of the population. This development led to a sedentary lifestyle – cultivating modern foods and attracting animals for further domestication. Soon, food production became the backbone for the people, enticing the population to stay in one place. Animal domestication brought out many benefits, including, food, clothing, transport etc. However, as populations grew, and the accumulations of pathogens increased, the spread of infections began to run rapid. In the past, separation and isolation aided the prevention of disease. Now, the squalid conditions and proximity of animals harbored various vectors of infectious diseases (CANVAS slides).

The human diet was deteriorating, and many were developing nutritional deficiencies (i.e. iron deficiency, anemia) due to their concentrated efforts in growing and eating single crops. Lack of nutrition increased their vulnerability to infections and diseases began to arise from concentrated areas. Diseases (i.e. smallpox, influenza, malaria, etc.) from animals evolved and adapted to humans. Human transmission or ‘crowd’ diseases went rampant in dense populations as contamination/pollution by food and water became prominent.

Today, other factors such as globalization, climate change, human health changes, and societal issues, are key in the diffusion of disease. For example, in China, the modeling of medium-scenario warming indicates that the transmission zone of freshwater snail–mediated schistosomiasis will extend northward, putting another 20 million people at risk by 2050 (McMichael). Additionally, diverse health risks are also posed by the deprivation, displacement, and conflict from shortages of fresh water. In many populations, such as Bangladesh, Vietnam, Egypt, and Iraq, river flows are threatened by the loss of glacier mass and snowpack due to global warming and increased diversion of flow by neighbors upstream (McMichael).

Numerous factors play a role in the diffusion of disease. In order to mitigate the risk of a pandemic disease, it is vital for us to be aware and conscious about our actions. Proper sanitation, abiding by standards, and being informed on global (large-scale) impacts and changes, are just several of the actions that we can do to minimize the distribution of disease. Though we do not have control on the evolution of viruses and bacteria, as people, we can make considerable impact on overall health if we are aware and make attempts to aid the situation.