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Year : 2020  |  Volume : 3  |  Issue : 5  |  Page : 94-96

Into the past in the times of COVID pandemic

Department of Surgical Oncology, Tata Memorial Center, Parel; Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission07-Apr-2020
Date of Decision08-Apr-2020
Date of Acceptance09-Apr-2020
Date of Web Publication25-Apr-2020

Correspondence Address:
Pankaj Chaturvedi
Surgeon, Department of Head Neck Surgery, Deputy Director, Centre for Cancer Epidemiology; Professor, Department of Surgical Oncology, Tata Memorial Center, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_139_20

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How to cite this article:
Chaturvedi P, Ramalingam N. Into the past in the times of COVID pandemic. Cancer Res Stat Treat 2020;3, Suppl S1:94-6

How to cite this URL:
Chaturvedi P, Ramalingam N. Into the past in the times of COVID pandemic. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jun 1];3, Suppl S1:94-6. Available from: http://www.crstonline.com/text.asp?2020/3/5/94/283303

The present-day coronavirus disease 2019 pandemic with around a million cases and 50,000 deaths involving 199 countries as of April 3, 2020, has resulted in lockdowns in almost all countries, including India. Devastating pandemics and epidemics of the past are etched in the history books, underlining the gravity of the present situation looming over us. India, with its fair share of past epidemics and pandemics, is a prime example of this. In these desperate times of lockdowns and scares, it is prudent for all of us to look into these past episodes for solutions, hope, and a plan of action toward the current fiasco in the making.

The World Health Organization (WHO) defines an epidemic as “the occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related events clearly above normal expectancy.”[1] Let us look at some of the epidemics that affected India in the past.

  Ancient India Top

History books are clouded with scarce data and scattered entries regarding the epidemics in ancient India. Let us take a short look at these epidemics in ancient and medieval India.

Cholera in ancient India The earliest mention of cholera comes from Sushruta in the 5th century BCE, who described isolated cases of cholera-like illnesses. The 15th-century Portuguese historian and author, Gaspar Correa, described a disease in the Ganges Delta which the locals called “moryxy”, which had a high fatality rate. The described symptoms of vomiting, diarrhea, and cramps were similar to cholera, thus, qualifying this as one of the earliest accounts of cholera in India.

Tuberculosis in ancient India

Tuberculosis has been in India for a thousand years; it was described in the ancient Sanskrit manuscripts as “Sosha.[2] These manuscripts date back to 1500 BCE and give an account of this disease: wasting, cough, and blood in the sputum. Mythologically, the Moon-God was the first victim of this disease; hence, resulting in the name Rajayakshma, or King's disease.[3]Vichitraviriya[4]-an ancestor of the Pandavas and Kauravas was supposedly killed by tuberculosis, serving as a starting point for the events leading to the start of the Mahabharata. If not for a bacterium, we would not have an epic on our hands!

Plague in ancient India

The earliest reference concerning plague is from Sushruta who summarizes it as follows:[5] “Deep, hard swellings appear in the armpit, giving rise to a violent fever-like burning fire and internal-burning sensation. It kills the patient within 15 days. It is called Agairohini. It is due to samaipata (deranged condition of all the three humors: Vata, pitta, and kapha) and is an incurable disease.” The description of painful swellings in the axilla with violent fever rapidly terminating in death closely resembles that of the bubonic plague; thus, it was not unknown in ancient India. While these texts proceed to describe a multitude of similar diseases, there is enough reason to speculate on the presence of plague in ancient India.

  Modern India Top

Now let us look into the epidemics of the recent past for which enough statistics are available to throw light on these issues.

Plague epidemic of 1896

The bubonic plague epidemic was identified and reported in Bombay around 1896 by Dr. A. C. Viegas.[6] Between 1896 and 1914, it resulted in over 8 million deaths in Western India. This resulted in large-scale measures by the state – mainly in the Bombay presidency to control its spread. Unfortunately, these measures provoked resistance, riots, mob attacks on the Europeans, and assassination of the British officials.[6] Mortality continued to rise between 1903 and 1907. This epidemic of plague was a part of the global Third Plague Pandemic affecting China, Hong Kong, Thailand, India, the Middle East, and the parts of Europe.

Spanish flu epidemic

The 1918-20 “Spanish” influenza pandemic had an estimated mortality of up to 50 million, approximately one-fourth of the world's total population.[7] Caused by the H1N1 strain of the influenza virus, this pandemic struck in two waves – the first wave in 1918, followed by a severe second wave in early 1919. India had an estimated mortality ranging from 10 to 20 million, accounting for a population loss of 14 million. It was brought to India by the returning British troops entering Bombay from the Middle East and spread to Southern and Eastern India.[8] Pertinent epidemiological conclusions based on the diminished virulence and reduced velocity of spread were made. The first conclusion was that the resulting competition among the strains of a rapidly spreading virus results in an equilibrium in which the persistent strain is less virulent and is less likely to travel faster than the strain that was present at the onset of the epidemic.[9] Second, absolute humidity due to rainfall contributed to the reduction of the severity as it spread across India. While India had its fair share of personnel loss in this epidemic, valuable lessons for containment were learned to tackle future pandemics.

Cholera epidemic

Starting from the first global pandemic to the seventh pandemic, India has always been either an epicenter or a thoroughfare for cholera. Endemic belts were located in areas with a high population density along the rivers and in areas with high rainfall and humidity.[10] Cholera is caused by toxigenic strains of Vibrio cholerae serogroups O1 and O139. At present, the V. cholerae O1 – El Tor biotype is the most prevalent in India. This biotype was the causative strain in the 1964 cholera epidemic in India as a part of the seventh global cholera pandemic. The lethality of this strain has been attributed to longer viability of El or outside the body, the ability to stay in carriers for a long time, and spread to cholera naïve areas.[11] During the past decade (1997–2006), there have been 68 outbreaks of cholera across India, with an estimated 823 deaths out of 2 lakh affected patients.[12]

Smallpox epidemic

One of the severe smallpox epidemics in India happened in 1974. Over 15,000 people were infected and perished from smallpox between January and May 1974. Most of the deaths occurred in the Eastern Indian states. India reported around 60,000 cases of smallpox to the WHO in this period. Efforts made by the government at the time have to be commended. Eradication of smallpox after its epidemic in the 1970s will always be a crowning achievement in the health sector in India. Before 1972, every smallpox eradication program failed because of under-reporting of cases, refusal to cooperate with vaccination, and the type of vaccine used. Along with the WHO, the Government of India launched a “surveillance-containment” technique along with the multiple puncture technique of vaccination. Every case was found and contained by the vaccination of all immediate family members; by 1975, no hotspots were discovered. From March to November 1976, 11 lakh houses in more than 5 lakh Indian villages and 260 urban areas were searched for new smallpox cases. In April 1977, the International Commission finally certified that India was free of smallpox.[13]

Plague epidemic 1994

On September 23, 1994, suspected pneumonic plague deaths were reported in the parts of Gujarat. Around 1061 cases were reported.[14] The migrant workers in these areas unwittingly transmitted the disease to the other parts of India. This is an example of “relocation diffusion,” thus explaining the presence of plague in far off regions such as Mumbai, Delhi, and Calcutta. The importance of containment can be learned from this epidemic as the migrant workers who fled the initial epicenter acted as a conduit for the spread.

Nipah epidemic 2018

Between 1998 and 2015, around 600 cases of the Nipah virus infection were reported in South-east Asia.[15] India had two outbreaks of this, in 2001 and 2007, with a case fatality rate of 68% during the first outbreak. Both these outbreaks occurred in the state of West Bengal. The recent epidemic in May 2018 resulted in the death of 17 people in 7 days. The effort to counter this epidemic is a prime example of the “One Health” approach. This approach encourages teamwork among the fields of human medicine, veterinary medicine, and environmental sciences to improve the ecology and connected health of people, animals, and ecosystems.[15]

[Table 1] describes the major epidemics in modern India with the mortality figures.
Table 1: Summary of major epidemics in India

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  Conclusion Top

India has faced all types of epidemics in the past. As a country with a long history, we have survived these epidemics, and coronavirus spread is likely to match those calamities. Lessons have to be learnt from the current problem to build an efficient and healthy nation. Simple hand washing will not only stop the coronavirus spread but also many other similar fomite-borne illnesses. Coughing or sneezing in napkins will reduce the spread of tuberculosis, influenza, and other seasonal flu. Observance of personal spacing and stoppage of public spitting will decrease the spread of many infections. The lessons learnt from these experiences will prepare society to fight other grave public health problems such as tobacco, alcohol, drugs, and road traffic accidents that kill millions every year.

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Conflicts of interest

There are no conflicts of interest.[16]

  References Top

Available from: https://www.who.int/hac/about/definitions/en/. [Last accessed on 2020 Apr 08].  Back to cited text no. 1
Herzog BH. History of Tuberculosis. Respiration 1998;65:5-15.  Back to cited text no. 2
Bhishagratna KK. An English Translation of the Sushruta Samhita. Calcutta: S. L. Bhaduri; 1916.  Back to cited text no. 3
Available from: https://sites.google.com/site/whoswhoinmahabharat/vichitravirya. [Last accessed on 2020 Apr 09].  Back to cited text no. 4
Plague in ancient India. Ind Med Gaz 1899;34:347.  Back to cited text no. 5
Chandavarkar R. Plague panic and epidemic politics in India, 1896-1914. In: Epidemics and Ideas. Cambridge, UK: Cambridge University Press; 1995. p. 203-40. doi: 10.1017/cbo9780511563645.010.  Back to cited text no. 6
Johnson NP, Mueller J. Updating the accounts: global mortality of the 1918-1920 “Spanish” influenza pandemic. Bull Hist Med 2002;76:105-15.  Back to cited text no. 7
Chandra S, Kassens-Noor E. The evolution of pandemic influenza: evidence from India, 1918-19. BMC Infect Dis 2014;14:510.  Back to cited text no. 8
Berngruber TW, Froissart R, Choisy M, Gandon S. Evolution of virulence in emerging epidemics. PLoS Pathog 2013;9:e1003209.  Back to cited text no. 9
Swaroop S, Pollitzer R. Cholera studies. 2. World incidence. Bull World Health Organ 1955;12:311-58.  Back to cited text no. 10
Mackay DM. Cholera research laboratory in Dacca, Bangladesh-a brief history. Trop Doct 1979;9:31-2.  Back to cited text no. 11
Kanungo S, Sah BK, Lopez AL, Sung JS, Paisley AM, Sur D, et al. Cholera in India: an analysis of reports, 1997-2006. Bull World Health Organ 2010;88:185-91.  Back to cited text no. 12
Bhattacharya S. Uncertain advances: a review of the final phases of the smallpox eradication program in India, 1960-1980. Am J Public Health 2004;94:1875-83.  Back to cited text no. 13
Dutt AK, Akhtar R, McVeigh M. Surat plague of 1994 re-examined. Southeast Asian J Trop Med Public Health 2006;37:755-60.  Back to cited text no. 14
Chattu VK, Kumar R, Kumary S, Kajal F, David JK. Nipah virus epidemic in southern India and emphasizing “One Health” approach to ensure global health security. J Family Med Prim Care. 2018;7:275-83.  Back to cited text no. 15
Ali M, Nelson AR, Lopez AL, Sack DA. Updated global burden of cholera in endemic countries. PLoS Negl Trop Dis 2015;9:e0003832.  Back to cited text no. 16


  [Table 1]


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