The other name of the year 2020 is the Year of Prevention and Response. Humanity has faced a worldwide crisis with the new virus infection and is doing its best to develop vaccines and treatments for a quick end. However, in an interview with the British weekly Economist released on August 19 (local time), Bill Gates said that COVID-19's Pandemics will end at the end of 2021 after millions more died, and the World Health Organization (WHO) even warns that COVID-19 would become an "Endemic(periodic incidence)". Despite such grim expectations, people are attempting to discuss the lifestyle that will change after Corona under the name of 'post corona’. We are all desperate to return to our daily life, but rather than rushing forward, it would be wise to go backward and see how people dealt with pandemic in history. What kind of infectious diseases have humans faced in the 20-21st century so far, and how did we respond? What is the difference from the epidemic that has existed historically, what was the result and what lessons have been learned? I would like to look back on the history of symbiosis with the invisible virus.

1. 1918 Spanish flu

SPANISH FLU: In the beginning, it takes the form of a cold and flu, but it develops into pneumonia in a short time. Roy, who was working as medical staff at the time, stated "After about two hours of being hospitalized, a brown spot appeared near the cheekbones, and a few hours later, a blue spot appeared from the ears, spreading all over the face."

Camp Devens, the U.S. 76th Infantry Division's base, has been set up to accommodate up to 55,000 soldiers due to its excellent accessibility and training site in New England's Ayer. A number of soldiers passed through this area during World War I, eventually, the overpopulation was a fatal factor to this new epidemic.

In March 1918, more than 1,200 unidentified disease patients were reported in three weeks, since a kitchen police showed symptoms of pneumonia. The epidemic was unusual in that additional cases occurred sharply in April and May, when the newly conscripted soldier joined the unit after.

Although war and infectious diseases are closely related, the gathering of people who grew up in various environments and had a jagged immune system was a prominent reason. As a result, the outbreak began to occur on transport ships across the Atlantic Ocean. Millions of citizens, along with tens of thousands of soldiers in Devens, died from the Spanish flu from the summer of 1918 to the spring of 1919.

At this time, Americans began to wear gauze-masks. Meanwhile, the densely populated city, Philadelphia ignored government recommendations and pushed the march, so more than 2,600 people died in two weeks. The world's death toll from the Spanish flu is estimated at 25 to 50 million, and it was simultaneously prevalent around the world except in Australia, where the government does strict entry-prohibition quarantine measures.

According to the number of deaths from the common flu, it has a U-shaped graph with a high mortality rate among children under 3 and older, and the flu has a W-shaped graph with a higher death rate among adults between 20 and 40. The reason for this feature has not been fully revealed, but the ecological characteristics of large-scale military facilities where people living in rural and urban areas were called up to one place and lived together in cramped barracks are cited.

However, those who were not affected by the low death rate and environmental specificity were not influenced by Spanish flu, and when the WWⅠ ceasefire agreement was signed in November 1918, it became a familiar seasonal flu. However, the H1N1 virus, which caused the flu, changed to H2N2, known as the Asian flu, in 1957 and killed 2 million people. Since then, it has become the H3N2 virus in Hong Kong in 1968, causing 1 million deaths, making it the virus that still has the highest flu prevalence and mortality rates.

2. 1924 Plague

PLAGUE: An epidemic carried by fleas appearing in burrows inhabited by wild rodents such as marmots, spotted squirrels, and mice. Little damage occurs within most rodent populations, but it causes enormous damage when fleas or infected host animals approach human habitats. Lymph node-plague involves symptoms of severe bleeding and organ failure that turn the hand and feet black. Lung-plague has rapid necrosis of pneumonia, people die if not treated within 12 hours.

In the early 20th century, Latin American migrant workers began to live closely in Clara Street as demand for cheap labor increased. The tremendous growth in Los Angeles was largely attributed to settlers from Mexico, but the majority of white people treated them as absent. Meanwhile, an epidemiological investigation began in October 1924 when unidentified pneumonia killed a family living on Clara Street and people participating in the funeral began to show similar symptoms.

Hospitalized patients showed symptoms of severe pneumonia, such as spitting blood-stained phlegm and showing blueness. Similarities with the Spanish flu seemed to confuse diagnosis, but the possibility of plague was suggested by pathologist Dr. George Manner,  eventually, he discovered the deadliest pathogen in the heart of the United States in the 20th century.

No one welcomes the reemergence of the plague: It killed 25 million people across the Mediterranean Basin in the 6-8C and up to 50 million people in the 14C second pandemic. Also, it was only 10 years after all the plagues found in California were declared gone. To avoid responsibility, health authorities doubted the validity of the test. Reporters published articles with real names of the dead and dismissed them as a "happening only for Latin Americans" when the exact cause had not been determined.

As the situation worsened, Los Angeles did restrictions on the movement of about 4,000 people. The city and health authorities, however, still refused to acknowledge the truth, and local newspaper editors argued that the closure was only a vicious form. At the same time, in the eastern part of New York, the company has benefited from assertive, provocative articles. Diseases with a fatality rate of 90 percent had no clear cure other than quarantine and rapid isolation of patients. But it was miserable. All the areas where Mexicans live have been set up as restricted areas, and anyone suspected of having a disease or having come into contact with a patient has been sent to an isolation ward. The chamber also did not provide additional aid to prepare emergency food. Most of the support was from private organizations, but it was far from enough.

In a gloomy situation, the plague serum treatment worked dramatically, and on January 12, 1925, the plague that scared the entire U.S. disappeared. To prevent infection from forest rodents to urban rat populations, the CDC monitors the occurrence of wild rodents plague in wildlife management centers. If an epidemic spread among animals is judged to have reached a dangerous level, a warning is issued to state parks and campgrounds banning contact between squirrels and humans, which are the main culprits of the early spread of the infection. Despite these precautions, about three people in the U.S. get plague every year, and this year, there have been lymph node-plague in China. As long as humans invade wild habitats and break their balance, the plague will continue to occur on a small scale. The development of public health has reduced the possibility of becoming a pandemic as much as in the past, but humans will have to continue to worry about coexistence with nature.

3. 2003 SARS

SARS: It is so highly toxic that it has the nickname "Poison King". The main symptoms are fever, boredom, muscle aches, chills, headaches, etc. so there are no specific symptoms. Infection usually occurs in the second week, when many patients suffer from hydrophobic diarrhoea without blood or mucus. Due to rapid respiratory failure, about 20 percent of severe patients suffer from oxygen shortages that require intensive care. The mortality rate is estimated to be 0 to 50 percent depending on age groups, but the overall mortality rate is 11 percent.

Where population density is highest on Earth, Hong Kong, unusual terrain and subtropical climate are optimized conditions for the spread of respiratory diseases. The city's stratum is a unique geographical condition that can absorb toxic substances in a short period and create it again no matter how much rain falls. Guangzhou, the most populous region in China, is located nine minutes away by train. It means there are too many creatures in and outside Hong Kong. The unusual respiratory disease began to spread in November 2002 when humans and livestock gathered too many to live well. The researcher collected secretion samples from 20 Chinese respiratory patients and conducted experiments to respond to the common viruses and bird flu, but none of them responded. Severe Acute Respiratory Syndrome, it was the beginning of SARS.

On February 21, 2003, doctor Liu Jianlun examined the unusual respiratory symptoms of a seafood vendor in Guangdong. And he died on March 4 after transferring symptoms to 28 people in the emergency room and 16 flight attendants and guests who stayed with him at the Metropole Hotel. He was confident because he wore a mask and gloves throughout the treatment, but he got SARS. An overseas travel warning was issued by the WHO on March 12 and Southeast Asia's tourism and financial markets plunged. Meanwhile, the epidemic had already begun to spread to countries due to a 72-year-old doctor on a flight from Hong Kong to Beijing. However, a few people knew about the epidemic, and very few were aware of the dangers. "What is this we've encountered now? What do we know?"  Hong Kong Health Minister Margaret Chan, who later became WHO Secretary-General recalled the day.

The turning point in the situation was the beginning of a proper epidemiological investigation. Thomas Tsang Ho-Fai, an infectious disease consultant at the Ministry of Health and Welfare, focused on the case after 15 residents of the residential complex, Amoi Garden, were found to be SARS patients for a day. It was not easy to block the spread of the virus when the body of SARS (viral or bacterial) or the medium of infection (air or nasal) was not sure. However, he noted that most of the patients lived in building ‘E’,  he began the investigation. Amoy Garden is a middle-class house built-in 1981. Each building was 33rd floor and eight households lived on each one. With 19,000 residents, it was thought to be an elegant residence to solve the housing shortage problem, but it was a prime example of the ideal environment for the spread of SARS. The patient occurred at the corners of the building corresponding to room 7 and 8 on each floor. In other words, the bottle was moved in a vertical. To find out the process, the epidemiological investigation began with a traditional method and it turned out that ventilation fans in the bathroom played a crucial role in SARS infection.

While epidemiologists from Tsang and the Department of Health conducted epidemiological surveys about the Metropole Hotel, microbiologists were trying to uncover the body of SARS. The government made a provisional announcement as the possibility of SARS increased. (It was uncertain but the situation was so serious) Later, 39 random primers were used to identify a type of coronavirus. Previously, the coronavirus had been a major problem in veterinary science. The microbiological community did not give much weight to human infection because mild respiratory infections occurred. After determining the cause, the Health Ministry implemented quarantine measures for people with and without symptoms, and many public institutions and private companies pushed ahead with the facility shutdown despite the expected massive damage.

Sporadic cases of infection continued throughout the world, unlike the WHO's strong recommendation to sanction travel to the hot spots and flu, the situation did not deteriorate because it did not remain in the air for a long time. However, a study that civet cats and bats be cited as the medium of the virus shows that indiscriminate capture and ingestion of wild animals has caused what. Thanks to advanced Internet communication technology, it can also monitor diseases that have not been detected in a single country. At the same time, it can be confirmed that disaster will occur if the case is tried to cover up due to concerns over short-term interests.

4. 2019 COVID-19

COVID-19: An infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. 

Here is the ‘Seafood Market. However, a wide variety of wild animals, including baby wolves, crocodiles, and snakes, are sold here. Historically, there have been many infectious diseases that have put humans at bay. However, the only infectious disease that has stopped all of the world's economies, industries, and health care systems at once is unconfirmed pneumonia from Wuhan in China, COVID-19. It has a mortality rate of 3.4 percent, but it can be transmitted even during the incubation period. After almost a year since the first outbreak, there is no clear cure. Also, cases of suffering from various aftereffects add fear to us.

Similar to the process of all the aforementioned epidemics, there was ample possibility of an early stop. Towards doctors who diagnose patients with similar symptoms as flu or bronchitis, Dr. Li Wenliang posted on SNS that atypical pneumonia patients tested positive for SARS. When he was severely reprimanded by the public security for the reason that the possibility of community proliferation was communicated beyond official channels, we could easily predict the end of this situation.

It was a completely new coronal virus that had never been experienced. Although the spread of the virus had to be taken before it increased exponentially, Wuhan authorities feared negative public opinion facing China's biggest holiday(Chinese New year). To avoid being caught by the central government, Wuhan covered up all the news raising suspicions, and even Chinese President Xi Jinping reportedly didn't get the right information until the third week of January. Since then, the government has implemented measures to isolate Wuhan and its adjacent areas, but it has been almost impossible to restrict the movement of 50 million people. Also, about 5 million people had already left Wuhan, China's hub of domestic and international transportation, and left the country.

The 3 weeks have become a boomerang named ‘9 months’ and have not yet to return. Many are suffering, some have lost their lovers, and medical staff continues to fight silently. When COVID-19 is transmitted, the virus enters the respiratory tract and is combined with certain receptors on the surface of the cells in the body. The virus enters into and disassembles in the cell and begins the proliferative process with the release of the virus RNA. At this time, symptoms (such as sore throat, fever, and runny nose) can be accompanied and the condition may recover or deteriorate naturally depending on whether the underlying disease is. It may be out of the blue, but it's not just the process of infection. Much like this, our nature was exhibiting various symptoms. From the SARS, Ebola, and Zika viruses to AIDS, humans continued to face various infectious diseases before Corona. To the constant warnings of nature, we must lower our posture and respond with a proper prescription and sufficient rest to suit the symptoms.

French author Albert Camus said, "We tell ourselves that infectious diseases are just evil spirits that exist in our heads, nightmares that will disappear." However, infectious diseases exist and can come in at any time without a warning. They are not evil spirits. The best way to cope with the consequences is to find a solution directly related to the cause. We have to think about how infectious diseases, which have been circulating only in humans and separate species, have become transmitted to humans and what regulations and efforts are needed to avoid reenacting similar situations. We also must make an effort to better ourselves by taking the mistakes we've made as a mirror. There is no longer a problem that is not related to me in the international community of the 21st century, where exchanges and interventions between countries have become close. Believing that each country is bound up by international cooperation and trust, it is necessary to make transparent disclosure of what happened within the country and share information. We must reflect on our past mistakes and deal with it humbly, acknowledging that it is a matter for all of us. Ecologists estimate that there are about 13,000 types of coronavirus that have yet to be discovered. Fear is human nature but I believe in the power of solidarity stronger than it is. I look forward to seeing the human race mature from this situation.

[Reference]

The Pandemic Century_ Mark Honigsbaum