Pandemics are for the most part disease outbreaks that become widespread as a result of the spread of human-to-human

infection
- There have been many significant disease outbreaks and pandemics recorded in history, including Black Death,
Spanish Flu, Hong Kong Flu, SARS, H7N9, Ebola, Zika and the latest COVID-19 or coronavirus.
- The term “pandemic” as defined by many medical institution, includes some key features like wide geographic
extension, disease movement, novelty, severity, high attack rates and explosiveness, minimal population immunity,
infectiousness and contagiousness, which help us to understand the concept better, if we examine similarities and
differences among them.
- The pandemic related crises have been associated with enormous negative impacts on health, economy, society and
security of national and global communities. They have also caused significant political and social disruption.

DEFINITION OF PANDEMICS
- The word “Pandemic” originates from the Greek pan meaning “all” and demos meaning “the people”
- The internationally accepted definition of a pandemic as it appears in the Dictionary of Epidemiology is straightforward
and well-known: “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually
affecting a large number of people”
- The classical definition, however, includes nothing about population immunity, virology or disease severity.
- By On the basis of this dictionary definition, pandemics can be said to occur annually in each of the temperate
southern and northern hemispheres, given that the definition of the term is so wide
- Seasonal epidemics cross international boundaries and affect a large number of people. However this said, seasonal
epidemics are not considered pandemics.
- Modern definitions include “extensive epidemic”, “epidemic over a very wide area and usually affecting a large
proportion of the population”, and “distributed or occurring widely throughout a region, country, continent or globally”,
among others.
- In the case of influenza, biologists also require that pandemic strains undergo key genomic mutations, known as antigenic
shifts.
- For the World Health Organization (WHO) to pronounce a level six pandemic alert there has to be sustained transmission
in at least two regions at the same time.
- WHO’s standard definition of pandemic influenza refers to a situation in which a new and highly pathogenic viral
subtype, one to which no one (or few) in the human population has immunological resistance and which is easily
transmissible between humans, establishes a foothold in the human population, at which point it rapidly spreads
worldwide.
- A pandemic is an outbreak of global proportions. It happens when a bacterium or novel virus becomes capable of spreading
rapidly.
- It causes serious illness and can spread easily from one person to the next, from country to country.
- Pandemics are usually caused by an infectious agent that is newly capable of spreading rapidly across a wide
geographical area and affects & harms many people.
- An epidemic is specific to one city, region or country, one that is always present in a particular place or community; but a
pandemic spreads beyond national borders possibly worldwide
- Sometimes, pandemics are caused simply by a new ability to spread instantly, such as with the Black Death. Humans may
have little or no immunity against a new virus. Often a new virus cannot spread between people, but if it changes, or
mutates, it may start to spread easily.
- In this case, a pandemic can result and the death toll in a pandemic is generally higher than that in an epidemic
- In case of influenza, seasonal outbreaks or epidemics are generally caused by subtypes of a virus that is already circulating
among people.
- Pandemics, on the other hand, are generally caused by novel subtypes. These subtypes have not circulated among
people before.
- A pandemic affects more people and can be more deadly than an epidemic
- Antibiotic resistance increases the risk of future pandemics. It can also lead to more social disruption, economic loss, and
general hardship.
- The Spanish flu was the worst pandemic in history, killing 100 million people.

Post Peak Region: Levels of pandemic influenza in most countries with adequate surveillance have dropped below peak
levels.
- However, even though the situation is getting better, it's not over and there's still a possibility that the virus could
come back in a second wave, so it's essential to stay vigilant and prepared for a potential resurgence.
- The worst part of the outbreak has passed, but there's a warning that another wave of the disease could come.

Post Pandemic Region: Levels of influenza activity have returned to the levels seen for seasonal influenza in most countries
with adequate surveillance.
 - The disease is no longer spreading at pandemic levels, but the economic and social impacts are still severe due to
the consequences of the pandemic, including income loss, job loss, business closures, and lockdowns. It is important to
maintain surveillance and update pandemic preparedness and response plans accordingly and an intensive phase of
recovery and evaluation may be required.

HISTORY OF PANDEMICS
The Spanish flu pandemic, from 1918 to 1920, claimed 100 million lives and is considered the worst in history.
Some pandemics and epidemics that have occurred include:
a. Plague of Justinian (541 - 750)
- also known as the “Bubonic Plague”
- estimates believe 100 million people died during this time, which was half the world population
- caused by the bacterium Yersinia Pestis primarily found in rodents, particularly rats, and is transmitted to humans
through the bite of infected fleas (rodents - fleas - human - death) (it was the fleas that mainly caused the disease)

b. Black Death (1346 - 1350)

- also known as “the Great Pestilence, the Great Mortality or the Plague”
- it swept through Europe, Asia, and Africa, causing the deaths of an estimated 75-200 million people
- also caused by the bacterium Yersinia pestis which is the same bacterium responsible for the Plague of Justinian
- the rodents with infected fleas are now able to pass the infection onto humans by biting them or making contact

c. Cholera (1899 - 1923)

- intestinal infection caused by the Vibrio Cholerae bacterium
- its outbreaks are usually linked to contaminated water and poor sanitation
- killed an estimate of 800,000 to one million people
- Cholera leads to severe diarrhea and dehydration, which can be fatal if left untreated

d. Spanish flu (H1N1) (1918 - 1920)

- infected approximately one-third of the world's population, with an estimated death toll of 50 million to 100 million
people
- also known as “The Great Influenza”
- severe respiratory symptoms, including high fever, cough, and pneumonia
- H1N1 influenza A virus from avian origin: the virus have originated in birds or bird feathers and then jumped to humans

e. Asian flu (H2N2) (1957 - 1958)

- or “Asian Influenza” that came from the H2N2 subtype of the influenza A virus
- affected an estimate of 1 to 4 million people
- also came from an avian source: infected birds shed bird flu virus in their saliva, mucus, and feces and so disease is
transmitted through contact with these infected birds
- influenza viruses commonly circulate among birds, and occasionally, a new strain can emerge with the ability to infect and
spread among humans

f. Hong Kong influenza (1968 - 1969/ 2004 - 2006)

- was caused by the H3N2 influenza A virus
- believed to have originated from a reassortment of avian, human, and possibly swine influenza viruses
- direct contact or eating infected birds/poultry can lead to transmission as well as contact with their saliva, feces, blood, or
respiratory secretions

g. Avian flu (H1N1) (2009)

- also known as “Bird Flu”
- human infections with avian influenza typically occur through close contact with infected birds or their environments
- handling or close contact with infected birds or their body fluids, including saliva, feces, blood, and respiratory secretions
and consumption of undercooked or raw poultry products, such as meat or eggs, from infected birds
- can also be transmitted from person to person through respiratory droplets when an infected person talked, coughed, or
sneezed and the virus can also become aerosolized and remain in the air, potentially leading to transmission over longer
distances
- the virus can also survive on surfaces for varying periods so touching contaminated surfaces and then touching the face
can result in transmission.

h. COVID-19 (novel coronavirus) (2019)

- claimed more than 6.9 million lives
- COVID-19 stands for "Coronavirus Disease 2019”
- SARS-CoV-2: believed to have originated in bats and may have been transmitted to humans through an intermediate host
- primarily spreads through respiratory droplets when an infected person talks, coughs, or sneezes
- close contact with an infected person can lead to transmission, particularly if they are actively shedding the virus

Some viruses are present in animals but rarely spread to humans. Sometimes an event can happen that makes this
possible. Health authorities are concerned when a case arises of an animal virus passing to humans, as this can be an
indication that the virus is changing.

- Swine flu and bird/avian flu, refer to viruses that were common in pigs or feathered animals (birds), but not in humans,
until an antigenic shift occurred.
- In recent years, there has also been concern about viruses that have been linked to camels (causing Middle East
Respiratory Syndrome or MERS) and from monkeys (Ebola virus).

HIV (Human Immunodeficiency Virus) - attacks the immune system

- if left untreated, HIV can lead to the disease AIDS (Acquired Immunodeficiency Syndrome), which weakens the immune
system and makes the individual more susceptible to opportunistic infections and certain cancers
- believed to have originated from non-human primates, particularly monkeys or chimpanzees in Central Africa
- transmitted from person to person (caught through unprotected sex with an infected partner) through certain body fluids,
such as blood, semen, vaginal fluids, rectal fluids, breast milk, used needles, and genetics

THE STAGES OF PANDEMIC

- The etiology of pandemics can be split into six stages. The World Health Organization (WHO) has six stage influenza
program:
Stage 1: No animal influenza virus circulating among animals has been reported to cause infection in humans.

Stage 2: An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans
and is therefore considered a specific potential pandemic threat.

Stage 3: An animal or human-animal influenza reasserting virus has caused sporadic cases or small clusters of diseases in
people, but it has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks.

Stage 4: Human-to-human transmission of an animal or human-animal influenza reasserting virus able to sustain
community-level outbreaks has been verified.

Stage 5: The same identified virus has caused sustained community level outbreaks in two or more countries in one WHO
region.

Stage 6: In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at
least one other country in another WHO region.

THE MODERN PANDEMICS

If an influenza pandemic were to emerge today, the following problems could arise:
1.) People today are more internationally mobile and more likely to live in cities than in the past, factors which
increase the risk of a virus spreading.
2.) Faster communication increases the risk of panic, and the chance that people who may be infected will travel in an
attempt to escape the disease, potentially taking the virus with them.
3.) It can take months or years for a vaccine to become available, because pandemic viruses are novel agents.
4.) Medical facilities would be overwhelmed, and there could be shortages of personnel to provide vital community
services, due to the demand and illness.
- Medical science has advanced rapidly in recent years, but it is unlikely ever to offer full protection from a possible
pandemic, because of the novel nature of the diseases involved.
- The negative impacts of pandemics are serious. Pandemics have infected millions of people, causing widespread serious
illness in a large population and thousands of deaths.
- It represents a serious threat not only to the population of the world, but also to its economy.
- The impact of economic loss can result in instability of the economy, which is through direct costs, long term
burden, and indirect costs.
- The social impacts of pandemics were severe, including travel was strictly limited, and schools closing, markets
and sporting events were closed.
- All these are a likely reality should a pandemic with true potential for high morbidity and mortality emerge.
- A security threat of pandemic influenza is not a recent phenomenon. Global security is threatened from pandemics, in
terms of lives and economic stability an effective and efficient emergency response can reduce avoidable mortality and
morbidity and reduce the types of economic and social impacts.
- How to have an effective and efficient emergency management will be a critical task of governments to deal
effectively with disease outbreakS, our pandemic now and in the future.