Мобильная версия

Журнал «Медицина неотложных состояний» Том 19, №6, 2023

Пандемії та їх географічне поширення

Авторы: N. Komilova (1), N. Mukhammedova (2), N. Ermatova (3), Z. Ibragimova (2), S. Bafoeva (2)
(1) — National University of Uzbekistan named after Mirzo Ulugbek, Tashkent, Republic of Uzbekistan
(2) — Navoi State Pedagogical Institute, Navoi, Republic of Uzbekistan
(3) — Jizzakh State Pedagogical Institute named after Abdulla Qodiriy, Jizzakh, Republic of Uzbekistan

Рубрики: Медицина неотложных состояний

Разделы: Справочник специалиста

Актуальність. Актуальність представленої статті зумовлена зростанням захворюваності на COVID-19 та виходом пандемії з-під контролю. У нинішніх умовах досвід попередніх поколінь і давніх пандемій буде корисним для подальшого вивчення ситуації. Мета: порівняння й аналіз досвіду подолання та перебігу пандемічних станів і періодів в історії людства, а також розробка можливих теоретичних методів впливу на сучасну ситуацію через цей досвід. Матеріали та методи. Для розкриття теми автори використали методи порівняльного аналізу, історичної перспективи, індукції та дедукції, а також звернення до архівних джерел та зарубіжних авторів. Результати. Завдяки отриманій статистиці захворюваності на коронавірус створені заходи щодо профілактики поширення пандемії, використання яких у майбутньому значно знизить ризики захворюваності. Висновки. У сфері вивчення COVID-19 досвід попередніх епідемічних періодів історії не застосовувався в світовому масштабі, що зумовлює новизну представленої статті.

Background. The relevance of the presented article is due to an increase in the incidence of COVID-19 and the pandemic getting out of control. In the current conditions, the experience of previous generations and ancient pandemics will be useful for further study of the situation. The purpose of the article is to compare and analyze the experience of overcoming and passing through pandemic states and periods in the history of mankind, as well as to draw up possible theoretical methods for influencing the current situation through this experience. Materials and methods. To reveal the topic, authors used the methods of comparative analysis, historical perspective, induction and deduction, as well as an appeal to archival sources and international authors. Results. Thanks to the derived statistics of the incidence of coronavirus, preventive measures have been created against the spread of the pandemic, the use of which in the future will significantly reduce the risks of morbidity. Conclusions. In the field of studying COVID-19, the experience of previous epidemic periods of history has not been applied on a global scale, which determines the novelty of the presented article.

Ключевые слова

пандемія; медична географія; спалах чуми; коронавірусна інфекція; ксенофобія; COVID-19

pandemic; medical geography; plague outbreak; coronavirus infection; xenophobia; COVID-19

doi: http://dx.doi.org/10.22141/2224-0586.19.6.2023.1617

Introduction

Many epidemics and pandemics on Earth have occurred at certain times. Their classification according to prevalence status and disease geography is divided into five by the authors. According to them, it covers the period from antiquity to the 20th century. Infectious diseases continue to affect the 21st century. This situation led to an epidemic that spread across countries, continents, and later even led to a pandemic. It is known that pandemic is derived from the Greek word meaning “whole nation”. Typically, a pandemic has a mass prevalent nature, affecting a large portion of the world’s population. According to the World Health Organization (WHO), a pandemic is a global outbreak of the disease [1]. The first epidemic on Earth was observed in 430 BC in Athens, the capital of Greece. Historian Thucydides commented on the epidemic, which he called the Athenian plague (Table 1).

The plague has also caused many pandemics in history. One such epidemic was the Antonine plague, which appeared in ancient Rome in 165–180 AD, and also known as the Galen plague. The disease named after a doctor who lived in the Roman Empire that was invaded by Roman troops returning from marches in the Middle East. Scientists say the disease resembles smallpox and measles, –proving that it corresponds to the cause of illness and death of Marcus Aurelius Antoninus, and the Roman emperor Lucius Verus.

According to the Roman historian Dion Cassius (155–235), after nine years the disease flared up again. As a result, about 2,000 deaths per day were observed in Rome, and a quarter of those diagnosed with the disease died. This, in turn, led to a decline in the Roman population.

The next epidemic was also observed in the Carthage region of ancient Rome in 250–271. It is named the Cyprian plague after the bishop of Carthage. He described the symptoms of the disease in detail in his Book of Death. According to Byzantine historians, the epidemic in Roman and Greek cities claimed the lives of about 5,000 people every day. The epidemic also affected Alexandria and Carthage.

Pandemics in ancient times

The world’s first plague pandemic was named Justinian Plague during the reign of the Byzantine Emperor Justini-an I. It has spread from Europe and Southwest Asia to other parts of the world for nearly 200 years. The first outbreak of the plague occurred in 542 in Egypt and the city of Pelusium because of trade. As a result, the disease has long led to pandemic conditions around the world. The spread of the disease, as mentioned above, was connected by trade routes, first to Constantinople and then to the northern, southern, and eastern regions of Byzantium. After that, the epidemic situation covered North Africa, all of Europe, Central and South Asia, and Arabia, but had almost no impact on East Asia.

By 544, an epidemic was raging in the Byzantine Empire, and 5,000 people died every day in Constantinople, with the death rate reaching 10,000 on some days. In the sources of that period, no symptoms of pneumonic plague were observed in any person. The day a healthy person infected the plague from the outside, he died before the clinical signs of the disease appeared [3].

In the East, nearly 66 million people have died from the plague, with two-thirds of Constantinople population dying from the disease. In Europe, nearly 25 million deaths have been reported. According to some sources, the plague was also recorded in Ireland between 549 and 550. Many rulers and great men died from it. Among them, King Maelgwn Gwynedd and Finnian of Clonard, who died of a plague. The epidemic, which lasted nearly two centuries, killed approximately 85 million people worldwide.

The next stage of the epidemic was recorded in 698–701 in Constantinople, Syria and Mesopotamia. It started at the exotic animal market in the cargo port of Neorion in Constantinople. That is why researchers called it the Neorion plague. This plague epidemic affected parts of Europe and the whole of Southeast Asia [4].

The second plague pandemic in 1346–1353 posed a great threat to the population of the planet. Its recurrence, the se-cond wave, lasted until the 9th century, and spread to North Africa, parts of Asia, and Europe, killing tens of millions of people. In historical sources, this pandemic is called Black Death. The plague first began in Asia. It entered Europe from the northern shores of the Caspian Sea. From there, the disease spread to most parts of Eurasia and North Africa. Nearly 25 million of the world population has fallen victim to Black Death. Sources estimate that 30 to 60 % of Europeans die from the disease. This has affected European economy as well as its social situation. When Black Death was studied by scientists, its cause appeared to be the plague bacillus. Observation of mass death, the study of corpses and the biological conditions in them proved signs of plague. In 1582, a plague broke out in the Canary Islands, a Spanish municipality near the African continent. Because the disease started in the city of San Cristobal de La Laguna, it is referred to in sources as La Laguna Plague. Although this plague was short, it left a special mark on Spanish history with its mass death toll. The disease has claimed the lives of 5,000 to 9,000 people. This was about 35–45 % of the island population at the time. A major epidemic was observed in Russia in 1654–1655. The disease has killed between 10,000 and 100,000 people.

A plague epidemic broke out in England between 1665 and 1666, it was called Bubonic plague. The disease has killed 100,000 people, 20 % of London population. Although the epidemic was weaker than the previous Black Death pandemic in Europe, it was remembered as the Great Plague until the 17th century because it was the most dangerous of all diseases in England at the time. Even before the Great Plague, the bubonic plague of 1603–1604 killed 30,000 Londoners [5].

The bubonic plague epidemic has also occurred in other European countries. In 1679, in Vienna, the capital of Austria, a similar disease was recorded under the name Vienna plague. The epidemic peaked in a short period of time, and in the early 1680s, the impact was considerably diminished. Yet the disease has claimed the lives of about 76,000 people. In Vienna, the Holy Three Brothers religious organization set up special hospitals during the epidemic and treated thousands of children and adults. The medical care provided in these hospitals was much simpler compared to modern medicine, but much more effective compared to the medicine of other cities in this period. Doctors treated cases such as vomiting and bleeding with herbs and ointments. Still, the death toll was high. The bodies of the plague victims were taken to pits in areas outside the city. The bodies were left open for several days. As a result, rats and other animals spread the disease more widely.

There are reports that the Vienna plague entered Europe through traders from the Ottoman Empire, and the United Kingdom from the Netherlands. In London, between 1665 and 1666, the disease killed nearly a hundred thousand people. A plague epidemic began in 1666 in Cologne and on Rhine, Germany, and lasted until 1670. In the Netherlands, the disease spread from 1667 to 1669. The last plague epidemic in France occurred in 1668. The second wave of the plague began in the Ottoman Turkic Empire in 1675–1684 and soon occupied the present-day Asia Minor and the Balkan Peninsula.

We know that in 1700–1721 there was a fierce conflict between the countries of Northern, Central and Eastern Europe for the occupation of the Baltic Sea region, which called the Great Northern War in European history. Between 1708 and 1714, the bubonic plague spread around the Baltic Sea, killing millions of people. That is why this epidemic is called The Great Plague in the history of medicine. From 1708 to 1712, the disease affected Transylvania, Poland, Lithuania, the Kingdom of Prussia, Kurland, Swedish Livonia, Swedish Estonia, Pskov, Novgorod, Finland, Sweden, Pomerania, Denmark, Schleswig-Holstein, Germany, and Holstein, especially in regions such as Hungary, Bohemia, Moravia, Austria. In six years, more than a million Europeans have died from the disease.

The disease spread along trade routes from Central Asia via Constantinople to the Mediterranean coast, then to Europe and affected the war-torn northern regions of the continent in particular. The war process accelerated the spread of the plague. Soldiers fleeing the war spread the disease across countries, and many women and children died from the plague. During the war, the number of soldiers decreased due to the plague, and in some cases, the war was suspended. The disease was also recorded in the 14th century in the areas around the Baltic Sea. After a long time, in 1711, the disease entered the region through Prussia.

It was in the summer of this year that it reached Prague, Vienna and Central Europe. During this period, Prussia and Estonia in particular suffered greatly from the disease. In many areas, the death rate was 66 to 75 % of the population. Some farms and villages were completely burned. As a result, famine broke out and other diseases spread. The number of victims of this epidemic, known as the Great Plague, is very high in the sources, as all those who died were diagnosed with the plague. In particular, from July to December 1708, more than 23,000 of the 50,000 people died in Danzig, 10,000 of the 40,000 population in Königsberg between 1708 and 1710, and about 15,000 in Prussia each year. In Riga, between 1710 and 1711, about 7,350 out of a population of 10,500 died, while in Stockholm, between 18,000 and 23,000 people died, and in Hamburg in 1711, 10,000 out of 17,000 people died of disease. In Vienna, Austria, deaths also rose, and in 1713, the death rate was 132.6 per 1,000 people. It was the last major plague epidemic in Vienna.

Pandemics in modern times

In the late 19th and early 20th centuries, a third major pandemic of plague was observed worldwide. Many scientists have predicted that the third plague pandemic in the world will ever occur and cause even greater damage because from time to time this disease was spreading in some parts of the world. The plague first reached its peak in 1346–1382, the second time in 1545–1683, and the third time in 1710–1830. The starting point of the third plague pandemic was the Yunnan province of China, where the disease originated in 1855 and spread to all continents for decades. The death toll from this bubonic plague was so high that the total number of deaths in China and India alone exceeded 12 million. According to the WHO, the pandemic was repeated in 1959. However, the death toll was small, at 200 people worldwide.

The third plague pandemic is so widespread around the world, the development of water, air and land transport has led to the development of trade, socio-econo-mic ties between countries. The disease was particularly prevalent in Chinese Manchuria and Mongolia between 1910 and 1911, when sources described it as the Manchurian plague. The Manchurian plague has caused great losses in Central and East Asia, especially in China. The plague has left most dangerous mark on the world. It has not posed a major threat to the world since then, but is still observed in some areas, such as the occasional outbreak on the African island of Madagascar between 2008 and 2017. Among the epidemics and pandemics that occur on Earth, plague stands out. Its spread across continents, rise among the population, and increasing death toll have left an indelible mark on the world community. For many years, the world’s population has suffered from this disease.

Cholera first broke out in Southeast Asia and the Middle East, in the Ganges valley, and formed a nosogeographic area around the world. Although the disease has been known since ancient times, the study of it began in 1821. Outbreaks appear to be exacerbated by pollution of the Ganges River, poor sanitation, and water-related ceremonies. A healthy person who was infected with cholera or infected with cholera bacteria but had no symptoms of the disease was also a carrier of the disease because the way cholera bacteria enter the human body is the mouth. The disease carrier spreads it by excreting bacteria into the environment through feces and vomit [1, 6].

India is the third-world country and has faced various epidemics and pandemics over time. Throughout history, influenza, plague, dengue, smallpox, and many other cases have been reported; when we manage to destroy some, many diseases still pose a threat to society. Sudden and rapid epidemics in India are not uncommon and many aspects are explained by malnutrition, lack of sanitation and lack of proper health care in such developing countries (Table 2) [3].

Cholera first began to occur on August 31, 1854, around the houses on Broad Street in London. The cause of the disease was well water consumed by the population of the region. The English physician John Snow first identified the origin of the disease from water. Bacteria that cause cholera are active in water and belong to the group of highly susceptible vibrios. Italian scientist Filippo Pacini discovered the cholera bacterium in 1854. The virus was re-examined in 1883 by Robert Koch and its main features were highlighted. This bacterium has rapidly infected the population. As a result, a pandemic has developed [7].

The world’s first cholera pandemic occurred in Southeast Asia, near Calcutta, India, in 1817–1824, and was first called the Asian cholera pandemic (Table 2) because during this period, cholera was widespread in a very large part of the Asian continent. It began near Calcutta and covered areas from Southeast Asia, the Middle East, East Africa and the Mediterranean coast of Europe. Because of this pandemic, millions of people died, creating a great tragedy for huma-nity [8].

In India, the commander of the British colonial armed forces, General Hastings, wrote in his diary on November 13, 1817, that many people were dying in the camps of Calcutta and the southern provinces, and that this was the cause of the epidemic. Researchers believe that the movement in the British Army and Navy accelerated the spread of the epidemic. Indian pilgrims, meanwhile, have been blamed for the spread of cholera in India. British troops carried the disease on land to Nepal and Afghanistan. Merchant ships have spread it to the shores of the Indian Ocean, including African countries and Indonesia, and from there to northern China and Japan. The outbreak of cholera has spread to other parts of the world. The following year, it moved to India, including Sri Lanka and other nearby islands, and then to China. In 1820, the disease was diagnosed in East Africa. In 1821, the British took him to Arabia, then to Persia, Turkey and the Caucasus.

The number of deaths in the first cholera pandemic in the world is not clear, but it is recorded in the history of some cities. Of these, 16,000 out of a population of 40,000 in Shiraz and 30,000 in Bangkok have died from the disease. In Semarang, in April 1821, 1,225 people died in eleven days. It can be seen that the impact of the disease varied in diffe-rent regions depending on the climate. Within the Russian Empire, the disease first appeared in September 1823 among the staff of the port of Astrakhan, where it was concluded that the disease came from Baku, Azerbaijan, because at that time there was epidemic in Baku. The prolonged cold in winter 1823–1824 stop the epidemic.

The second cholera pandemic (1826–1837) began in the Ganges plains in 1826 and lasted for more than a decade. In 1826–1828, the cholera spread from India to the east, China, the Indian subcontinent, as well as to Afghanistan, Khiva and Bukhara. In the Russian Empire, the disease entered Orenburg in 1829 through the Bukhara caravan. The epidemic, on the other hand, entered Russia from the Middle East through the command of the Lenkoran military brigade and spread to Astrakhan, the Volga region, and Moscow. That year, the disease spread to the Middle East and Egypt, killing up to 150,000 people in Egypt alone [8, 9].

The second cholera pandemic also entered Ukraine in 1830 and peaked in 1831, with 26,946 people dying from the disease in the summer of that year. The pandemic continued to spread around the world. In 1831, the cholera spread to Central and Western Europe, killing 6,536 people in London and nearly 200,000 in France. In 1832, French colonial forces carried the disease to Africa, and European immigrants carried it to North America and Australia. Тhe New York government issued an order in June 1832 not to approach the city if there was any doubt as to plague on a ship. However, the disease was rampant, and in September, when the pandemic stopped, about 3,500 of the city’s 250,000 people died. The pandemic has spread to all continents. It has caused many casualties, especially in Europe, the United States, China, Japan and Russia. The disease has not stopped there, causing several more pandemics around the world.

The third cholera pandemic occurred between 1846 and 1863. During this period, the world’s population was 1,248 million (according to 1850 data), the incidence and mortality from cholera were higher than from other diseases. Based on the above pandemic situation, the nosogeographic hotbed is India, from where the disease has spread all over North Africa and the Americas. The spread of cholera from India to the Persian Gulf states was due to Muslim visits to the holy shrines. Between 1831 and 1912, there were 27 cholera epidemics in Mecca. This is because many Muslims come from India, North Africa, and the Middle East for Hajj [10, 11].

The third cholera pandemic reached the shores of the Black and Azov Seas in 1847, first covering Odesa and then the entire Asia Minor, Russia and Poland. This wave coincided with the Crimean War, when battles were observed in the Caucasus, the Danubian Principalities, the Amur, Kamchatka, and the Kuril Islands, along the Baltic, Black, Azov, White, and Barents Seas. Between 1853 and 1854, cholera re-emerged in London, infecting more than 23,000 people and killing more than 10,000. In recent years, water pollution in the city has led to an outbreak of the disease.

This cholera pandemic did not affect the United States. Because in 1863 a new quarantine law was introduced in New York, the ships were not brought close to the city. In all, scientists today have identified seven cholera pandemics. However, three cases of cholera pandemics were considered dangerous, and they were observed briefly and frequently in the regions from 1863 to 1975.

In the summer of 1892 in Hamburg, Germany, the level of the Elbe fell, and the river was warm and used as untreated drinking water and was polluted by the sewage system, creating a favorable environment for the spread of cholera. During this period, the conditions in the city did not meet sanitary requirements. In Hamburg, cholera epidemics occurred from time to time in 1822, 1831–1832, 1848–1859, 1866, and 1873. In 1892, the disease reached its peak in the city. After that, work began on filtering drinking water in Hamburg. A total of 16,956 people became ill and 8,605 died during the Hamburg cholera epidemic. On December 28, 1892, the Institute of Hygiene and the Environment was established in Hamburg. New laws have been passed against the construction of housing in unsanitary conditions. In 1893, the filtration plant of the Hamburg waterworks was built in Kaltehofe.

In the fall of 1911, cholera broke out in Venice. Venice is a city in northeastern Italy that has been visited by many tourists since ancient times. It was precisely because of the influx of tourists that the cholera broke out in the city, cau-sing many deaths.

Pandemics of the 21st century and COVID-19

A cholera epidemic can also occur due to damage to water supplies caused by natural disasters. In Haiti in 2010, for example, Hurricane Thomas and an earthquake caused unsanitary conditions and a cholera epidemic. The WHO has announced that the epidemic is likely to become the first cholera pandemic of the 21st century. The disease has also been reported in neighboring Dominica, Venezuela and Mexico and the United States.

Despite the fact that cholera has been studied extensively in modern times, it is still showing its effects in some deve-loping and especially backward countries. Poor sanitation, overpopulation, and large-scale migration play an important role in the spread of the disease when drinking unsterilized water. It should be noted that the emergence and develo-pment of cholera in a particular area might be due to endo-genous and exogenous conditions. Endemic regions include South and Southeast Asia, Africa, and Latin America. Cholera is recorded throughout the year in these areas. In the hot season, children often become ill, while adults do not show clinical signs because they have already developed immunity. The cholera coming from abroad is related to the migration of the population.

The number of cholera cases reported by the WHO has remained high for the past few years. In 2019, 923,037 cases were reported in 31 countries, of which 1,911 were fatal. The main reasons for this are the rapid growth of international trade, the recurrence of many wars and the migration process. One branch of the global warming problem is related to epidemic diseases, and if climate change intensifies, new diseases will appear and mutate in some viruses if severe colds are not observed.

The WHO declared the coronavirus disease 2019 outbreak a Public Health Emergency of International Concern (PHEIC) on January 30, and a pandemic on March 11, 2020. This is the 6th time WHO has declared a PHEIC since the International Health Regulations came into force in 2005. As of June 19, 2020, there were 10,193,723 confirmed cases of COVID-19 and the death toll reached 503,867 worldwide [14, 15]. As of April 30, 2020, a total of 2,039 cases of coronavirus were diagnosed in the Republic of Uzbekistan [16].

The COVID-19 pandemic is a current pandemic caused by the spread of the SARS-CoV-2 and is still ongoing (Table 3). At its onset, food shortages were exacerbated, primarily due to increased panic among people. Due to quarantine, there has been a reduction in emissions of pollutants, especially greenhouse gases. In nearly 180 countries, schools, universities and colleges have closed nationally or locally, affecting about 98.5 % of the world’s school- and student-age population.

Xenophobia has been observed in various countries, with panicked shoppers buying large quantities of consumer goods. United Nations Secretary-General António Guterres has warned that hatred and xenophobia are on the rise in the communities due to a novel coronavirus [6]. The shortco-mings during the initial period of combating the pandemic included slow epidemiological surveys, with only 10–15 % of infection sources identified. Quarantine and control measures were poorly organized, with no focus on secondary and tertiary sources of infection. There was a lack of strict control over compliance with quarantine requirements in schools, preschools, higher education institutions, commercial and industrial enterprises. Public transport was overcrowded, often carrying 2–3 times more passengers than available seats, without proper monitoring or recommendations to address this issue. Additionally, the efforts in sanitary advocacy to prevent coronavirus infection among the local population were weak.

However, from mid-2020, medical supervision in this regard intensified significantly. The experience of medical staff, doctors has increased reliably, mortality decreased.

Conclusions

Pandemics are geographically distributed in different countries and regions of the globe, and have an impact on the demographic situation, economy, and emotional well-being of the population. However, in addition to the above negatives, we, as direct participants in the recent pandemic, believe that it has strengthened people’s feelings of kindness, humanity, parenthood, and closeness to their families and well-educated humanity. Аs of January 23, 2022, a total of 350,228,900 patients were diagnosed with coronavirus infection in 221 countries, of which 278,686,563 recovered and 5,611,429 died.

The disease ranks first in the U.S. in confirmed cases, where, according to the WHO, the total number of registered patients is 70,495,874, and 865,968 deceased. India is in second place — 39,237,264 and 489,409, respectively; Brazil ranks third — 23,931,609 and 623,191. France is in fourth place with 16,506,090 registered cases, 129,505 deaths, and the United Kingdom is fifth — 15,891,905 and 154,298, respectively.

Among measures to be taken in the future there are:

— carrying out epidemiological surveys at the required level;

— strengthen control in the field, in patients with omicron strain, control of foreign nationals during the incubation period of the disease;

— placement of patients according to the results of laboratory tests in the treatment and prevention facilities allocated for coronavirus infection to prevent re-infection of different strains;

— strengthen control over strict compliance with qua-rantine requirements against new coronavirus infection by all medical and preventive institutions, schools and preschools, higher education institutions, as well as commercial and industrial enterprises in the country;

— recommendations to relevant organizations in order to eliminate overcrowding on public transport;

— it is advisable to carry out extensive sanitary-epidemiological work to prevent coronavirus infection among the population.

Received 18.08.2023

Revised 03.09.2023

Accepted 07.09.2023

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