Very few phenomena throughout human history have shaped our societies and cultures the way outbreaks of infectious diseases have; yet, remarkably little attention has been given to these phenomena in behavioral social science and in branches of medicine that are, at least in part, founded in social studies (e.g., psychiatry).
This lack of attention is intriguing, as one of the greatest catastrophes ever, if not the greatest one in the entire history of humankind, was an outbreak of a pandemic . In a long succession throughout history, pandemic outbreaks have decimated societies, determined outcomes of wars, wiped out entire populations, but also, paradoxically, cleared the way for innovations and advances in sciences (including medicine and public health), economy, and political systems . Pandemic outbreaks, or plagues, as they are often referred to, have been closely examined through the lens of humanities in the realm of history, including the history of medicine . In the era of modern humanities, however, fairly little attention has been given ways to plagues affected the individual and group psychology of afflicted societies. This includes the unexamined ways pandemic outbreaks might have shaped the specialty of psychiatry; psychoanalysis was gaining recognition as an established treatment within medical community at the time the last great pandemic was making global rounds a century ago.
The Athenian Plague of 430 B.C.
The Athenian plague is a historically documented event that occurred in 430–26 B.C. during the Peloponnesian War, fought between city-states of Athens and Sparta. The historic account of the Athenian plague is provided by Thucydides, who survived the plague himself and described it in his History of the Peloponnesian War . The Athenian plague originated in Ethiopia, and from there, it spread throughout Egypt and Greece. Initial symptoms of the plague included headaches, conjunctivitis, a rash covering the body, and fever. The victims would then cough up blood, and suffer from extremely painful stomach cramping, followed by vomiting and attacks of “ineffectual retching” .Infected individuals would generally die by the seventh or eighth day. Those who survived this stage might suffer from partial paralysis, amnesia, or blindness for the rest of their lives. Doctors and other caregivers frequently caught the disease, and died with those whom they had been attempting to heal. The despair caused by the plague within the city led the people to be indifferent to the laws of men and gods, and many cast themselves into self-indulgence . Because of wartime overcrowding in the city of Athens, the plague spread quickly, killing tens of thousands, including Pericles, Athens’ beloved leader. With the fall of civic duty and religion, superstition reigned, especially in the recollection of old oracles . The plague of Athens affected a majority of the inhabitants of the overcrowded city-state and claimed lives of more than 25% of the population . The cause of the Athenian plague of 430 B.C. has not been clearly determined, but many diseases, including bubonic plague, have been ruled out as possibilities . While typhoid fever figures prominently as a probable culprit, a recent theory, postulated by Olson and some other epidemiologists and classicists, considers the cause of the Athenian plague to be Ebola virus hemorrhagic fever .
The Antonine Plague
While Hippocrates is thought to have been a contemporary of the plague of Athens, even possibly treating the afflicted as a young physician, he had not left known accounts of the outbreak . It was another outbreak that occurred a couple of centuries later that was documented and recorded by contemporary physicians of the time. The outbreak was known as the Antonine Plague of 165–180 AD and the physician documenting it was Galen; this outbreak is also known as the Plague of Galen . The Antonine plague occurred in the Roman Empire during the reign of Marcus Aurelius (161–180 A.D.) and its cause is thought to be smallpox . It was brought into the Empire by soldiers returning from Seleucia, and before it abated, it had affected Asia Minor, Egypt, Greece, and Italy. Unlike the plague of Athens, which affected a geographically limited region, the Antonine plague spread across the vast territory of the entire Roman Empire, because the Empire was an economically and politically integrated, cohesive society occupying wide swaths of the territory . The plague destroyed as much as one-third of the population in some areas, and decimated the Roman army, claiming the life of Marcus Aurelius himself . The impact of the plague on the Roman Empire was severe, weakening its military and economic supremacy. The Antonine plague affected ancient Roman traditions, leading to a renewal of spirituality and religiousness, creating the conditions for spreading of new religions, including Christianity. The Antonine Plague may well have created the conditions for the decline of the Roman Empire and, afterwards, for its fall in the West in the fifth century AD .
Quarantine
Drawing from experiences from ancient cultures that had dealt with contagious diseases, medieval societies observed the connection between the passage of time and the eruption of symptoms, noting that, after a period of observation, individuals who had not developed symptoms of the illness would likely not be affected and, more importantly, would not spread the disease upon entering the city. To that end, they started instituting mandatory isolation. The first known quarantine was enacted in Ragusa (City-state of Dubrovnik) in 1377, where all arrivals had to spend 30 days on a nearby island of Lokrum before entering the city. This period of 30 days (trentine) was later extended to 40 days (quarenta giorni or quarantine) . The institution of quarantine was one of the rarely effective measures that took place during the Black Death and its use quickly spread throughout Europe. Quarantine remains in effect in the present time as a highly regulated, nationally and internationally governed public health measure available to combat contagions .
Ebola Outbreak (2014–2016)
Ebola virus, endemic to Central and West Africa, with fruit bats serving as a likely reservoir, appeared in an outbreak in a remote village in Guinea in December 2013. Spreading mostly within families, it reached Sierra Leone and Liberia, where it managed to generate considerable outbreaks over the following months, with over 28,000 cases and over 11,000 fatalities. A very small number of cases were registered in Nigeria and Mali, but those outbreaks were quickly contained . Ebola outbreak, which happened to be the largest outbreak of Ebola infection to date, gained global notoriety after a passenger from Liberia fell ill and died in Texas in September of 2014, infecting two nurses caring for him, and leading to a significant public concern over a possible Ebola outbreak in the USA. This led to a significant public health and military effort to address the outbreak and help contain it on site (Operation United Assistance).
Covid -19
Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV), which was first identified amid an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China. [1] It was initially reported to the WHO on December 31, 2019. On January 30, 2020, the WHO declared the COVID-19 outbreak a global health emergency. [2, 3] On March 11, 2020, the WHO declared COVID-19 a global pandemic, its first such designation since declaring H1N1 influenza a pandemic in 2009.
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