Will our questions ever end

A look at history: when does a pandemic actually end?

After weeks in lockdown and months in masks, many are asking only one thing: When will this pandemic end? If you want to know what could stop the coronavirus, you should browse the past. Pandemics existed centuries ago. What medical history teaches us, which old-fashioned measures could be useful now and why it depends on each individual.

It was the fall of 1918 when a chef in the United States suddenly developed a fever. A few days later, more than 500 men were sick at the Kansas military camp where the man worked. The chef could be the first patient of the Spanish flu, which to this day is an impressive example of how an infectious disease can keep the whole world in suspense. A few months after the outbreak in the USA - despite its name, Spain was probably not the country of origin - people in Asia, Australia and Europe fell ill. The infected died in rows: depending on which source you believe, the Spanish flu cost the lives of 20 to 100 million people. 300,000 alone are said to have died in the German Reich, most of them from lung failure, as historians know today.

Spanish flu and corona: socially and socially similar consequences

"The Spanish flu is the example of a pandemic that is most frequently used in comparison with Corona," says Prof. Dr. Heiner Fangerau, Director of the Institute for the History, Theory and Ethics of Medicine at the Heinrich Heine University in Düsseldorf. “The influenza virus belongs to a different group of viruses than the coronavirus. But the social, political and societal effects of the pandemic at that time are at least comparable with those of today. ”The Spanish flu, according to Fangerau, also encountered medicine around 100 years ago that did not know what to do with it:“ For them Modern medicine is almost an insult to COVID-19 - in principle it is there with next to nothing. "Then as now, ignorance and uncertainty prevailed and even the measures that should contain the infection are similar:" Ventilation, masks, hands wash - the strategies we use to stop COVID-19 are the same as with the Spanish flu, ”says medical historian Fangerau. “Schools were closed back then, too, the children were happy about the flu vacation.” The Spanish flu raged for almost two years and over this period ran in three waves - the second being the worst and causing the most deaths. "I expect the corona pandemic to proceed in a similar way," said Fangerau.

As long as there are neither drugs nor (widespread) vaccinations, political measures were and are the means of choice to bring a pandemic back under control. What caused the Spanish flu to end is not entirely clear, even among medical historians: "The most common theory is that people gradually developed immunity once they got over the disease," says Fangerau, a member of the National Academy of Sciences Leopoldina is. “The genetic structure of the influenza virus responsible also changed, so that its harmfulness was reduced. In addition, from a cultural point of view, awareness of the disease sank when the acute threat disappeared. ”What is certain is that the contact restrictions had an effect, as contemporary studies and a study from 2007 show: isolation, school closings and assembly bans have been reduced the number of flu deaths significantly. “We have now got used to influenza - and will probably have to get used to COVID-19 as well.” Fangerau does not believe that the coronavirus will eventually disappear: “It will never cease to exist. But we will learn to live with it. "The medical historian assumes that the current pandemic will end in April or May 2021, when it gets warmer again, and that COVID-19 will recur seasonally from then on:" Perhaps each will Many people get sick with it in autumn and winter ”, says the expert.

Tuberculosis and Corona: Changed spit and sneeze labels

In the past few months, people have given up the habit of holding their hands over their mouths when coughing so that the virus is not spread through their hands. Such changes in behavior had been effective strategies in the past to stop a pandemic, says medical historian Fangerau with a look back at history: “When tuberculosis spread in Germany in the 18th and 19th centuries and many people died from it, it was completely in the population normal to constantly spit on the floor. ”After a while, scientists found out that the pathogen was in saliva and that it was often used to contract tuberculosis. "From then on, health politicians used educational campaigns with posters and lectures to painstakingly teach people to use spittoons and spittoons instead of spitting on the floor - and the number of infections fell significantly," reports Fangerau. It may be trivial not to sneeze and cough in the palm of your hand, but in the crook of your arm. "But people have to learn such behavioral measures - and when they are learned, they can help to ease a pandemic."

Plague and Corona: The time of the masks

Similar to the current mask requirement, people tried to protect themselves against the plague in the Middle Ages - in contrast to today, however, in vain. Medical historian Fangerau, who published a book on “Plague and Corona” in April 2020, explains: “Between 1340 and 1347, the Black Death depopulated entire regions in Europe, in some places 40 percent of the population died. Back then, people thought that the infection was via vapors. ”In order to ward off the“ breath of plague ”, many wore masks in which they placed fragrant herbs. Some even believed that mustaches prevented the infection because they kept the fumes from getting into the nose. With today's knowledge of infectious diseases, it is clear that the breeze does not exist and that the pathogen - the bacterium Yersinia pestis - passed from rats to humans via fleas. "At some point the plague infections receded and the pandemic ran out," said medical historian Fangerau. But not because of the herbal masks: "It probably ended because people had developed a certain immunity, adapted their environment through hygiene measures or because the harmfulness of the pathogens changed." The pandemic in the Middle Ages is considered to be the second wave of plague - had for the first time the plague raged globally as early as the sixth century. It was not until the third major plague pandemic, which began to spread from Central Asia shortly before the beginning of the 20th century, that Europe no longer hit that hard: In the meantime, people were familiar with the transmission route via rats and their fleas, resulting in better hygiene and sewage systems could prevent uncontrolled spread.

What is stopping the corona pandemic?

Although distance, hand hygiene and masks measurably contain the infection rate with COVID-19, there are a few things that make it difficult to bring the pandemic to a standstill: The disease is not always clearly recognizable - some people develop no symptoms at all. And whoever has some is often infected days in advance without knowing that they are carrying the virus. "Nevertheless, COVID-19 has to be brought under control", Prof. Dr. Clara Lehmann, specialist in infectious diseases and head of the Infection Protection Center and the COVID-19 convalescent outpatient clinic at Cologne University Hospital, is convinced. “However, we need the appropriate tools.” The most effective tool, according to the doctor, is a vaccine “because it has a preventive effect”. Medicines - in the case of SARS-CoV-2 antivirals - could also be part of a solution, "but of course only work when the disease has already broken out".

Lehmann fears that if we let the corona pandemic approach us without taking action, the whole thing could end in a humanitarian catastrophe: "The numbers would rise rapidly and a large number of people would have to be treated in hospital." into the difficult situation of having to decide: Which patient gets the free bed in the intensive care unit - and which one doesn't? Who will receive the last ventilators? It is called “triage” when doctors decide in an exceptional situation so that as many people as possible survive. Such an uncontrolled infection process, says Lehmann, leads to chaos, but the smarter we now deal with the pandemic, the sooner everyone can concentrate on other things and live their normal lives. "For example, it shouldn't happen that the medical staff is only busy looking after COVID patients - there are other diseases too."

Everyone's role

Infectiologist Lehmann is convinced that every citizen can help to influence the course of the SARS-CoV-2 pandemic in Germany and to effectively contain the spread of the disease: "To take back personally for the common good is alien to many in our society. But it would be extremely important right now. ”If everyone consistently implemented the infection protection measures in the coming period, says Lehmann, a lot could be achieved. "However, we have to understand that each and every one of them is important." So it is a little bit up to everyone whether, when and how this pandemic ends. That was already the case during the Spanish flu.

Endemic, epidemic or pandemic - what's the difference?

Endemic: when a disease occurs regularly in a certain area and the number of infected people is relatively constant throughout. Typical examples of endemics are malaria and yellow fever, which can be infected all year round in tropical countries. Measles is endemic in Germany.

epidemic: when a disease suddenly occurs excessively, but the infections are concentrated in a certain area and are limited in time. Typical examples are Ebola outbreaks in Africa or the flu, which occurs in Germany every year in autumn and winter. If epidemics cannot be contained adequately, they can develop into pandemics.

pandemic: when a disease affects the whole world and spreads across continents, but for a limited time. In addition to COVID-19, more recent examples are the SARS virus (2002) or swine flu (2009), older pandemics are the plague or the Spanish flu.

All three definitions say nothing about the dangerousness of a disease or the number of infected people - comparatively harmless diseases can also develop into a pandemic with only a few people affected, or life-threatening diseases as endemic can remain regionally limited. The World Health Organization (WHO) declared an "international health emergency" on January 30 and declared COVID-19 a pandemic on March 11, 2020.

Where does the word "quarantine" come from?
In the Middle Ages, the Venetians suspected that shipping would promote the spread of the plague. Therefore, they asked travelers to isolate themselves for 40 days. “Quaranta” is the Italian word for the number 40 - and is said to be the origin of today's term “quarantine”.