Scientists and medical researchers have for years have differed over the exact definition of a pandemic (is it a pandemic, or an epidemic), but one thing everyone agrees on is that the word describes the widespread occurrence of disease, in excess of what might normally be expected in a geographical region.
Cholera, bubonic plague, smallpox, and influenza are some of the most brutal killers in human history. And outbreaks of these diseases across international borders, are properly defined as pandemic, especially smallpox, which throughout history, has killed between 300-500 million people in its 12,000 year existence.
In the realm of infectious diseases, a pandemic is the worst case scenario. When an epidemic spreads beyond a country’s borders, that’s when the disease officially becomes a pandemic.
Communicable diseases existed during humankind’s hunter-gatherer days, but the shift to agrarian life 10,000 years ago created communities that made epidemics more possible. Malaria, tuberculosis, leprosy, influenza, smallpox and others first appeared during this period.
The more civilized humans became, building cities and forging trade routes to connect with other cities, and waging wars with them, the more likely pandemics became. See a timeline below of pandemics that, in ravaging human populations, changed history.
The History of Pandemics
Pan·dem·ic /panˈdemik/ (of a disease) prevalent over a whole country or the world.
As humans have spread across the world, so have infectious diseases. Even in this modern era, outbreaks are nearly constant, though not every outbreak reaches pandemic level as the Novel Coronavirus (COVID-19) has.
Today’s visualization outlines some of history’s most deadly pandemics, from the Antonine Plague to the current COVID-19 event.
A Timeline of Historical Pandemics
Disease and illnesses have plagued humanity since the earliest days, our mortal flaw. However, it was not until the marked shift to agrarian communities that the scale and spread of these diseases increased dramatically.
Widespread trade created new opportunities for human and animal interactions that sped up such epidemics. Malaria, tuberculosis, leprosy, influenza, smallpox, and others first appeared during these early years.
The more civilized humans became – with larger cities, more exotic trade routes, and increased contact with different populations of people, animals, and ecosystems – the more likely pandemics would occur.
Here are some of the major pandemics that have occurred over time:
|Name||Time period||Type / Pre-human host||Death toll|
|Antonine Plague||165-180||Believed to be either smallpox or measles||5M|
|Japanese smallpox epidemic||735-737||Variola major virus||1M|
|Plague of Justinian||541-542||Yersinia pestis bacteria / Rats, fleas||30-50M|
|Black Death||1347-1351||Yersinia pestis bacteria / Rats, fleas||200M|
|New World Smallpox Outbreak||1520 – onwards||Variola major virus||56M|
|Great Plague of London||1665||Yersinia pestis bacteria / Rats, fleas||100,000|
|Italian plague||1629-1631||Yersinia pestis bacteria / Rats, fleas||1M|
|Cholera Pandemics 1-6||1817-1923||V. cholerae bacteria||1M+|
|Third Plague||1885||Yersinia pestis bacteria / Rats, fleas||12M (China and India)|
|Yellow Fever||Late 1800s||Virus / Mosquitoes||100,000-150,000 (U.S.)|
|Russian Flu||1889-1890||Believed to be H2N2 (avian origin)||1M|
|Spanish Flu||1918-1919||H1N1 virus / Pigs||40-50M|
|Asian Flu||1957-1958||H2N2 virus||1.1M|
|Hong Kong Flu||1968-1970||H3N2 virus||1M|
|HIV/AIDS||1981-present||Virus / Chimpanzees||25-35M|
|Swine Flu||2009-2010||H1N1 virus / Pigs||200,000|
|SARS||2002-2003||Coronavirus / Bats, Civets||770|
|Ebola||2014-2016||Ebolavirus / Wild animals||11,000|
|MERS||2015-Present||Coronavirus / Bats, camels||850|
|COVID-19||2019-Present||Coronavirus – Unknown (possibly pangolins)||6,400 (as of Mar 15, 2020)|
Note: Many of the death toll numbers listed above are best estimates based on available research. Some, such as the Plague of Justinian, are subject to debate based on new evidence.
Despite the persistence of disease and pandemics throughout history, there’s one consistent trend over time – a gradual reduction in the death rate. Healthcare improvements and understanding the factors that incubate pandemics have been powerful tools in mitigating their impact.
Difference Between an Epidemic and a Pandemic
Epidemic is a term that is often broadly used to describe any problem that has grown out of control. An epidemic is defined as “an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population.”2
An epidemic is an event in which a disease is actively spreading. In contrast, the term pandemic relates to geographic spread and is used to describe a disease that affects a whole country or the entire world.
While casual use of epidemic may not require such nuance, it’s important to know the differences between these two terms (and similar ones like outbreak and endemic) when considering public health news. In addition, from an epidemiologic standpoint, terms like these direct the public health response to better control and prevent a disease.
List of Pandemics That Changed History
430 B.C.: Athens
The earliest recorded pandemic happened during the Peloponnesian War. After the disease passed through Libya, Ethiopia and Egypt, it crossed the Athenian walls as the Spartans laid siege. As much as two-thirds of the population died.
The symptoms included fever, thirst, bloody throat and tongue, red skin and lesions. The disease, suspected to have been typhoid fever, weakened the Athenians significantly and was a significant factor in their defeat by the Spartans.
165 A.D.: Antonine Plague
The Antonine plague was possibly an early appearance of smallpox that began with the Huns. The Huns then infected the Germans, who passed it to the Romans and then returning troops spread it throughout the Roman empire. Symptoms included fever, sore throat, diarrhea and, if the patient lived long enough, pus-filled sores. This plague continued until about 180 A.D., claiming Emperor Marcus Aurelius as one of its victims.
250 A.D.: Cyprian Plague
Named after the first known victim, the Christian bishop of Carthage, the Cyprian plague entailed diarrhea, vomiting, throat ulcers, fever and gangrenous hands and feet.
City dwellers fled to the country to escape infection but instead spread the disease further. Possibly starting in Ethiopia, it passed through Northern Africa, into Rome, then onto Egypt and northward.
There were recurring outbreaks over the next three centuries. In 444 A.D., it hit Britain and obstructed defense efforts against the Picts and the Scots, causing the British to seek help from the Saxons, who would soon control the island.
541 A.D.: Justinian Plague
First appearing in Egypt, the Justinian plague spread through Palestine and the Byzantine Empire, and then throughout the Mediterranean.
The plague changed the course of the empire, squelching Emperor Justinian’s plans to bring the Roman Empire back together and causing massive economic struggle. It is also credited with creating an apocalyptic atmosphere that spurred the rapid spread of Christianity.
Recurrences over the next two centuries eventually killed about 50 million people, 26 percent of the world population. It is believed to be the first significant appearance of the bubonic plague, which features enlarged lymphatic gland and is carried by rats and spread by fleas.
11th Century: Leprosy
Though it had been around for ages, leprosy grew into a pandemic in Europe in the Middle Ages, resulting in the building of numerous leprosy-focused hospitals to accommodate the vast number of victims.
A slow-developing bacterial disease that causes sores and deformities, leprosy was believed to be a punishment from God that ran in families. This belief led to moral judgments and ostracization of victims. Now known as Hansen’s disease, it still afflicts tens of thousands of people a year and can be fatal if not treated with antibiotics.
1350: The Black Death
Responsible for the death of one-third of the world population, this second appearance of the bubonic plague possibly started in Asia and moved west in caravans. Entering through Sicily in 1347 A.D. when plague sufferers arrived in the port of Messina, it spread throughout Europe rapidly. Dead bodies became so prevalent that many remained rotting on the ground and created a constant stench in cities.
England and France were so incapacitated by the plague that the countries called a truce to their war. The British feudal system collapsed when the plague changed economic circumstances and demographics. Ravaging populations in Greenland, Vikings lost the strength to wage battle against native populations, and their exploration of North America halted.
1492: The Columbian Exchange
Following the arrival of the Spanish in the Caribbean, diseases such as smallpox, measles and bubonic plague were passed along to the native populations by the Europeans. With no previous exposure, these diseases devastated indigenous people, with as many as 90 percent dying throughout the north and south continents.
Upon arrival on the island of Hispaniola, Christopher Columbus encountered the Taino people, population 60,000. By 1548, the population stood at less than 500. This scenario repeated itself throughout the Americas.
In 1520, the Aztec Empire was destroyed by a smallpox infection brought by African slaves.
Research in 2019 even concluded that the deaths of some 56 million Native Americans in the 16th and 17th centuries, largely through disease, may have altered Earth’s climate as vegetation growth on previously tilled land drew more CO2 from the atmosphere and caused a cooling event.
1665: The Great Plague of London
In its second recorded appearance, the bubonic plague led to the deaths of 20 percent of London’s population. As human death tolls mounted and mass graves appeared, hundreds of thousands of cats and dogs were slaughtered as the possible cause and the disease spread through ports along the Thames. The worst of the outbreak tapered off in the fall of 1666, around the same time as another devastating event—the Great Fire of London.
1817: First Cholera Pandemic
The first of seven cholera pandemics over the next 150 years, this wave of the small intestine infection originated in Russia, where one million people died. Spreading through feces-infected water and food, the bacterium was passed along to British soldiers who brought it to India where millions more died. The reach of the British Empire and its navy spread cholera to Spain, Africa, Indonesia, China, Japan, Italy, Germany and America, where it killed 150,000 people. A vaccine was created in 1885, but pandemics continued.
1855: The Third Plague Pandemic
Starting in China and moving to India and Hong Kong, the bubonic plague claimed 15 million victims. Initially spread by fleas during a mining boom in Yunnan, the plague is considered a factor in the Parthay rebellion and the Taiping rebellion. India faced the most substantial casualties, and the epidemic was used as an excuse for repressive policies that sparked some revolt against the British. The pandemic was considered active until 1960 when cases dropped below a couple hundred.
1875: Fiji Measles Pandemic
After Fiji ceded to the British Empire, a royal party visited Australia as a gift from Queen Victoria. Arriving during a measles outbreak, the royal party brought the disease back to their island, and it was spread further by the tribal heads and police who met with them upon their return.
Spreading quickly, the island was littered with corpses that were scavenged by wild animals, and entire villages died and were burned down, sometimes with the sick trapped inside the fires. One-third of Fiji’s population, a total of 40,000 people, died.
1889: Russian Flu
The first significant flu pandemic started in Siberia and Kazakhstan, traveled to Moscow, and made its way into Finland and then Poland, where it moved into the rest of Europe. By the following year, it had crossed the ocean into North America and Africa. By the end of 1890, 360,000 had died.
1918: Spanish Flu
The avian-borne flu that resulted in 50 million deaths worldwide, the Spanish flu is theorized to have originated in China and been spread by Chinese laborers being transported by rail across Canada on their way to Europe. In North America, the flu first appeared in Kansas in early 1918 and was visible in Europe by spring. Wire service reports of a flu outbreak in Madrid in the spring of 1918 led to the pandemic being called the “Spanish flu.”
By October, hundreds of thousands of Americans died and body storage scarcity hit crisis level. But the flu threat disappeared in the summer of 1919 when most of the infected had either developed immunities or died.
1957: Asian flu
Starting in Hong Kong and spreading throughout China and then into the United States, the Asian flu became widespread in England where, over six months, 14,000 people died. A second wave followed in early 1958, causing an estimated total of about 1.1 million deaths globally, with 116,000 deaths in the United States alone. A vaccine was developed, effectively containing the pandemic.
First identified in 1981, AIDS destroys a person’s immune system, resulting in eventual death by diseases that the body would usually fight off. Those infected by the HIV virus encounter fever, headache, and enlarged lymph nodes upon infection. When symptoms subside, carriers become highly infectious through blood and genital fluid, and the disease destroys t-cells.
AIDS was first observed in American gay communities but is believed to have developed from a chimpanzee virus from West Africa in the 1920s. The disease, which spreads through certain body fluids, moved to Haiti in the 1960s, and then New York and San Francisco in the 1970s.
Treatments have been developed to slow the progress of the disease, but 35 million people worldwide have died of AIDS since its discovery, and a cure is yet to be found.
2019 Coronavirus disease (COVID-19)
A new coronavirus was first identified in Wuhan, Hubei, China, in late December 2019, as causing a cluster of cases of an acute respiratory disease, now referred to as coronavirus disease 2019 (COVID-19), which had been identified in December 2019. According to the media report, more than 170 countries and territories have been affected, with major outbreaks in central China, Italy, South Korea and Iran. On March 11, 2020, the World Health Organization characterized the spread of COVID-19 as a pandemic.
Tracking Pandemics Infectiousness
Scientists use a basic measure to track the infectiousness of a disease called the reproduction number — also known as R0 or “R naught.” This number tells us how many susceptible people, on average, each sick person will in turn infect.