A pandemic is an outbreak of an infectious disease that spreads across a large region, a continent, or even the world. According to the World Health Organization (WHO), a pandemic can start when three conditions have been met: the emergence of a disease new to the population, a disease that infects humans, causing serious illness, and one that spreads easily and persists among humans. A disease is not a pandemic because it is widespread or kills a large number of people. It must also be infectious. For example, cancer is responsible for a large number of deaths but is not considered a pandemic. The plague of Justinian in the sixth century that devastated the eastern capital of the Roman Empire in Constantinople was the first well-known pandemic in Europe. It also marks the first detailed record of the bubonic plague that later would be known in London as the Black Death. In Constantinople, while Justinian was the Roman Emperor, large quantities of grain were shipped from Egypt and it is thought that the disease was brought into Europe via rat and flea populations in the grain.

The bubonic plague came to be known in London, England, as the Black Death of 1664 because of the black boils in the armpits, neck, and groin of infected people, which were caused by dried blood accumulating under the skin after internal bleeding. People first experienced the bacterium of Black Death as chills, fever, vomiting, and diarrhea. Frequently the disease spread to the lungs and, almost always in these cases, the victims died soon afterward. For reasons unknown at the time some people never caught the disease even though they were in close contact with those who had. In 2005 Dr. Stephen O’Brien of the National Institutes of Health in Washington D.C. searched for descendants of those seventeenth century survivors. He was able to locate a number of them and from those people he took blood samples and recorded their DNA. Dr. O’Brien had been working with HIV patients and to his great surprise he discovered that the critical gene that saved the lives of Black Death survivors was the same gene that today enables people infected with the HIV virus to survive. It is known by the common name Delta 32.

In the twenty-first century two well-known experiences of pandemics, one closely related to terrorism and one accidental, illustrate the nature of this problem in contemporary society. The anthrax series of events that hit the United States in the same year as the terrorist attacks of September 11 was clearly an attempt to terrify the leadership of the nation because it was directed at government, media, and communications in general. In mid October, a few weeks after the devastation of 9/11 when the World Trade Center towers were destroyed and the Pentagon hit, letters containing anthrax spores began to arrive at various United States media centers and government offices in Washington, D.C. A photo editor in a Florida news agency was the first to be affected. He opened an envelope that arrived on October 15 and unknowingly inhaled some of the anthrax that fell out. Several days passed before the contents of the envelope were tested and identified. By then it was too late to do anything for the photo editor. He died two weeks later. By the end of October 2001, five people were dead from anthrax. The White House mail was quarantined and several government offices locked in order to check for spores while their staffs met elsewhere. For the first time in its history the Supreme Court convened away from its own chambers. The State Department cut off all mail to its 240 embassies and consulates worldwide.

The other pandemic, first known as “The Scars Epidemic,” appeared toward the end of the year 2002. It was a deadly form of pneumonia that appeared in southern China and quietly spread, ignored for a long time, and during that period of time spread within China and to various places around the world. As its deadly nature became clear to public authorities, it was given the name “Severe Acute Respiratory Syndrome (SCARS)” and fears arose that it might be a repeat of the 1918 flu pandemic. When the World Health Organization investigated the disease they found that the majority of cases occurred in food handlers and chefs in the Guangdong Province of Southern China who were engaged in a particular kind of food preparation and delivery. These workers were always in close contact with exotic snakes and birds that were kept alive and killed immediately before being served to customers. Once the nature and characteristics of the disease was defined and isolation of patients became standard practice around the world SCARS slowly disappeared.

The present fear of a human pandemic stems from the appearance of a new virus in birds that quickly causes death. As soon as it is observed in flocks of poultry the whole flock is killed. This virus has already mutated so that a few humans have caught it. The mutated strain has been analyzed and found to be without any parallel to previous viruses. That means humans have no immunity to use against it and this is why the few who have contracted it died quickly. In 2005 the United Nations General Assembly called for immediate international mobilization against this new avian flu because of the possibility of a mutation appearing that would spread easily from human to human. The present mutation does not do that. So far, the number of humans that have died from the disease is less than a hundred and they are almost all in Asia. There are fears that this virus might become a pandemic like the one of 1918. That flu pandemic originated from birds just as this one has. Fortunately, to date, it has not yet mutated into the form that the 1918 one took and which led to the deaths of tens of millions of people all over the world. This present virus could be worse than that of 1918 because, while there is much greater knowledge on how to cope with it, there is at the same time far greater and more frequent travel around the world.

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