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PANDEMICS / A SHORT HISTORY OF DISEASE

From Justinian's plague to the COVID-19 era — thirteen panels of contagion, catastrophe, and the slow accumulation of public-health wisdom.

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From Justinian's plague to the COVID-19 era — thirteen panels of contagion, catastrophe, and the slow accumulation of public-health wisdom. Key sections include: PANDEMICS; A SHORT HISTORY OF DISEASE; THE PLAGUE OF JUSTINIAN; THE BLACK DEATH; SMALLPOX CROSSES THE ATLANTIC; THE GREAT INFLUENZA; HIV / AIDS; SARS — THE NEAR MISS; H1N1 — "SWINE FLU"; EBOLA IN WEST AFRICA.

Key sections

  • 01PANDEMICS
  • 02A SHORT HISTORY OF DISEASE
  • 03THE PLAGUE OF JUSTINIAN
  • 04THE BLACK DEATH
  • 05SMALLPOX CROSSES THE ATLANTIC
  • 06THE GREAT INFLUENZA
  • 07HIV / AIDS
  • 08SARS — THE NEAR MISS
  • 09H1N1 — "SWINE FLU"
  • 10EBOLA IN WEST AFRICA
  • 11COVID-19
  • 12LESSONS FROM THE FIELD
  • 13THE NEXT ONE
  • 14KEEP STUDYING. KEEP WASHING.
Slide outline
  1. 01PANDEMICS
  2. 02A SHORT HISTORY OF DISEASE
  3. 03THE PLAGUE OF JUSTINIAN
  4. 04THE BLACK DEATH
  5. 05SMALLPOX CROSSES THE ATLANTIC
  6. 06THE GREAT INFLUENZA
  7. 07HIV / AIDS
  8. 08SARS — THE NEAR MISS
  9. 09H1N1 — "SWINE FLU"
  10. 10EBOLA IN WEST AFRICA
  11. 11COVID-19
  12. 12LESSONS FROM THE FIELD
  13. 13THE NEXT ONE
  14. 14KEEP STUDYING. KEEP WASHING.
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Slide 01

PANDEMICS

  • PUBLIC HEALTH BULLETIN — SERIES No.13
  • A SHORT HISTORY OF DISEASE
  • From Justinian's plague to the COVID-19 era — thirteen panels of contagion, catastrophe, and the slow accumulation of public-health wisdom.
  • WASH HANDS
  • COVER COUGH
  • VACCINATE
  • STAY HOME
  • EST. 541 AD — PRESENT DAY
  • CLASSIFIED · ESSENTIAL READING
Slide 02

THE PLAGUE OF JUSTINIAN

  • CHAPTER I · 541 – 549 AD
  • Bubonic plague arrives at Constantinople via Egyptian grain ships. Procopius records 10,000 dead in a single day. The Byzantine empire — at its medieval zenith under Justinian I — staggers.
  • ~25–50 million dead across the Mediterranean
  • Manpower collapse stalls Justinian's reconquest of the West
  • First documented pandemic of Yersinia pestis
  • Recurs in waves for ~200 years
  • 25–50M DEAD
  • FLEAS · RATS · GRAIN
  • SAMPLE · BUBONIC
Slide 03

THE BLACK DEATH

  • CHAPTER II · 1346 – 1353
  • Plague returns from the steppes along Mongol trade routes. Genoese galleys bring it to Sicily. Within seven years, between a third and half of Europe is dead.
  • Yersinia pestis — bubonic, septicemic, pneumonic
  • Quarantine (quaranta giorni) is invented in Ragusa, 1377
  • Wages rise; serfdom collapses; the old order frays
  • Plague doctors don beak masks stuffed with herbs
  • DANGER · KEEP DISTANCE
  • QUARANTINE · 40 DAYS
  • 30–50%
  • OF EUROPE PERISHED
  • ~75–200M
  • EURASIAN DEAD
Slide 04

SMALLPOX CROSSES THE ATLANTIC

  • CHAPTER III · 1500s
  • European contact unleashes Variola on populations with no immune memory. Within a century, demographic collapse engulfs the Aztec, Inca, and a thousand smaller nations.
  • Up to ~90% of indigenous populations lost over 150 years
  • Tenochtitlán falls in part to a smallpox-weakened defense (1521)
  • Jenner's vaccine (1796) — the first — finally turns the tide
  • Smallpox declared eradicated in 1980
Slide 05

THE GREAT INFLUENZA

  • CHAPTER IV · 1918 – 1920
  • An H1N1 strain — likely from a Kansas army camp — rides troop ships across a war-mobilized world. Censored by belligerents, it is misnamed the "Spanish flu."
  • ~50 million dead — possibly more than all of WWI's combatants
  • Cytokine storm pattern killed young, healthy adults
  • Three waves; the autumn 1918 wave was deadliest
  • St. Louis masked and closed early — and survived best
  • WEAR A MASK
  • CLOSE THE THEATERS
  • OPEN THE WINDOWS
  • WARNING
  • INFLUENZA SPREADS BY DROPLET
  • WASH HANDS · COVER COUGH
Slide 06

HIV / AIDS

  • CHAPTER V · 1981 – PRESENT
  • A retrovirus crosses from chimpanzees in central Africa, dormant for decades. By the 1980s it is a global crisis — and a moral test of public-health response.
  • ~40 million dead since the epidemic began
  • HAART (1996) and modern antiretrovirals turn HIV into a chronic condition
  • U=U: undetectable viral load = untransmittable
  • PrEP transforms prevention; vaccines remain elusive
  • ~40M
  • CUMULATIVE DEATHS
  • ~39M
  • LIVING WITH HIV TODAY
  • 1996
  • HAART · TURNING POINT
  • PrEP
  • PREVENTION REVOLUTION
Slide 07

SARS — THE NEAR MISS

  • CHAPTER VI · 2002 – 2003
  • A novel coronavirus jumps from civets in Guangdong markets. Carlo Urbani identifies it; international cooperation contains it within months. We got lucky — and we knew it.
  • ~8,000 cases · ~800 deaths in 26 countries
  • Spread peaked after symptom onset — easier to isolate
  • Hong Kong, Toronto, Singapore: wake-up calls
  • Birthed pandemic-preparedness frameworks worldwide
  • CONTAINED
  • TRACE · ISOLATE · TREAT
Slide 08

H1N1 — "SWINE FLU"

  • CHAPTER VII · 2009
  • A reassortant H1N1 — pig, bird, and human lineages — emerges in Mexico. It spreads globally within weeks, but mortality is mercifully low.
  • WHO declares pandemic in June 2009
  • Estimated 100,000–400,000 deaths worldwide (year one)
  • Vaccine produced and distributed within ~6 months
  • Lessons: communication trust matters as much as logistics
  • PANDEMIC
  • DECLARED 11 JUN 2009
  • ~6 MO
  • FROM EMERGENCE TO VACCINE
  • REASSORTANT
  • PIG · BIRD · HUMAN
Slide 09

EBOLA IN WEST AFRICA

  • CHAPTER VIII · 2014 – 2016
  • A Zaire ebolavirus outbreak ignites in Guinea, then leaps borders into Liberia and Sierra Leone — the largest Ebola outbreak in history. Mortality near 40% of recorded cases.
  • ~28,600 cases · ~11,300 deaths
  • Burial rituals and weak health systems amplified spread
  • Community-led contact tracing turned the tide
  • rVSV-ZEBOV vaccine licensed in 2019 — a public-health triumph
  • PPE · ISOLATION
  • SAFE BURIAL
  • RING VACCINATION
  • DO NOT TOUCH
  • CONTACT PRECAUTIONS REQUIRED
Slide 10

COVID-19

  • CHAPTER IX · 2019 – PRESENT
  • SARS-CoV-2 emerges in Wuhan and meets a hyper-mobile world. Lockdowns slow it; mRNA platforms — incubated for decades — deliver vaccines in under a year. The first true pandemic of the mass-mobility era.
  • ~7M reported deaths · likely 18–30M excess deaths
  • mRNA vaccines (Pfizer · Moderna) authorized in < 12 months
  • Variants Alpha, Delta, Omicron reshape transmission
  • Long COVID becomes the unfinished chapter
  • ~7M
  • REPORTED DEATHS
  • mRNA
  • A PLATFORM TRIUMPH
  • ~12 MO
  • FROM SEQUENCE TO SHOT
  • LONG COVID
  • UNFINISHED BUSINESS
Slide 11

LESSONS FROM THE FIELD

  • DEPARTMENT MEMORANDUM
  • SURVEILLANCE
  • Genomic monitoring, sentinel hospitals, wastewater. You can't fight what you can't see.
  • SUPPLY CHAINS
  • PPE, reagents, vaccine glass. Single-source bottlenecks are strategic vulnerabilities.
  • COMMUNICATION
  • Honest uncertainty beats false confidence. Trust is harder to build than a vaccine.
  • EQUITABLE ACCESS
  • A virus anywhere is a virus everywhere. Hoarded doses are tomorrow's variants.
Slide 12

THE NEXT ONE

  • FORECAST · NEXT THREATS
  • Pandemics are not black swans — they are recurring weather. Preparedness is low-cost insurance against catastrophic loss.
  • H5N1 avian influenza in dairy cattle — watch the spillovers
  • Novel coronaviruses from bat reservoirs
  • Antimicrobial resistance — the slow pandemic
  • Lab biosafety: dual-use research and accident risk
  • 100-day mission: vaccine in 100 days from sequence
  • PREPARE NOW
  • FUND SURVEILLANCE
  • STOCKPILE PPE
  • TRAIN STAFF
  • SPILLOVER EVENTS · ANNUAL
Slide 13

KEEP STUDYING. KEEP WASHING.

  • END OF SERIES · FURTHER READING
  • BOOKS
  • The Great Influenza — John M. Barry
  • Plagues and Peoples — William H. McNeill
  • Spillover — David Quammen
  • The Premonition — Michael Lewis
  • The Coming Plague — Laurie Garrett
  • VIDEO ARCHIVE
  • 1918 Flu Pandemic — YouTube
  • mRNA Vaccine Explained — YouTube
  • STAY HOME WHEN SICK
  • WASH HANDS · COVER COUGH
  • — END OF BULLETIN —
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