Table of Contents
· Challenges in recording earlier pandemics
· Difference between pandemic and epidemic
· The Black Death – 75 to 200 million deaths
· Smallpox – 56 million deaths
· Spanish Flu – 45 million deaths
· Plague of Justinian – 40 million deaths
· HIV/AIDS – 30 million deaths
· The Third Plague – 12 million deaths
· Antonine Plague – 5 million deaths
· COVID-19 – 3.9 million deaths (as of 28/06/2021)
A guide to every major pandemic throughout history, from the Antonine Plague to Covid-19
When the COVID-19 emerged in late 2019 it came as a complete surprise to many people. The devastation that it led to felt like a once in a lifetime experience.
But was this really the case?
How many pandemics have there been throughout history? How long did they last? How deadly has the COVID-19 pandemic been compared to the pandemics that came before it? Should we be expecting another pandemic within our lifetimes?
Today, we are going to answer all of the questions by looking back through the history of pandemics, studying how deadly they were, how they ended, and where those diseases are today. We will also be exploring the concept of ‘Pandemic Influenza.
We can learn a lot about pandemics from looking at their histories. While it does not make for very fun reading, you should take hope from the fact that some diseases that were once the deadliest in the world have now been wiped out.
What Is A Pandemic
According to the Merriam-Webster dictionary, ‘pandemic’ was the 7th most sought after definition in 2020.
A pandemic is defined as an outbreak of a disease that affects a whole country or the whole world. Since 2002 there have been 5 major pandemics.
It is possible to have a pandemic that only affects one nation or continent. An example of this is the 2014 Ebola epidemic that affected vast areas of Africa but had little to no effect in Europe and America.
How Many Pandemics Were There In History
We do not have records of the whole of history (sadly), so there is no way to know officially how many pandemics there have ever been.
However, we have pretty extensive records of life in the Common Era (CE, formally AD), so we have a fairly good understanding of everything that has happened during that time.
During the Common Era we have a record of 20 disease outbreaks that meet the pandemic criteria. 5 of which have happened in the last 20 years.
We will be going through each of these pandemics later in this article.
It is worth noting that our records of the earlier pandemics will not be as accurate as of the newer ones. There are many reasons for this.
Firstly, an accurate diagnosis was near impossible until about 70 years ago. Until then, there was no cocreate way to prove what somebody had died from. There may have been many people who died without being diagnosed or people who happened to die during a pandemic but not because of it.
Secondly, there were no accurate population counts for many thousands of years. We can only make guesses at population numbers and how many people were killed by these diseases.
Finally, communication was poor up until the early 20th century. In the dark ages, communicating between villages was difficult, let alone communication between continents. Studying the earlier pandemics is like putting together a very tricky puzzle.
Difference Between A Pandemic And An Epidemic
Throughout history, there have been thousands of Epidemics, but only 20 pandemics? What is the difference between the two? And what makes a pandemic different?
It can be difficult for the average person to understand the differences between the two, as doctors and politicians will often misuse these worlds on purpose to make their points seem more valid.
There are four ways to categories a disease outbreak:
ENDEMIC – an endemic is a level of disease that is near constant in a country or area. An example of this is Malaria in Central Africa.
OUTBREAK – an outbreak is an endemic that has spread in higher numbers or a new location when it wasn’t expected to. An example of this is the recent outbreak of Dengue fever in Hawaii.
EPIDEMIC – an epidemic is an outbreak that develops to affect a serious percentage of a specific population (a town, a city, a continent). Most countries have a yearly Flu epidemic.
PANDEMIC – a pandemic is an epidemic that has traveled to somewhere it was not expected to. Pandemics are cross border problems, and with the development in intercontinental travel, they have become global issues. COVID-19 is an example of a pandemic.
List Of Pandemics Throughout The History
Below is a list of the 20 pandemics that we have records for that took place during the Common Era.
Antonine Plague (165 CE)
This is the earliest Pandemic that we have a record of. Based on the surviving records of the physician Galen this was believed to be a disease that was relaxed to Small Pox or Measles. It was believed to have wiped out over 5-10 million Romans, Gauls, and Germans.
This pandemic was believed to have been brought into the Roman Empire with troops that were returning from Egypt or Turkey (the Near East). The first records we have of it come from Galen, who described witnessing the disease while sacking the Mesopotamian city of Seleucia.
The Romans then spread this disease along the shores of the Rhine (Germany) and into the Gaul territories (now France). The disease destroyed many villages and nearly wiped out the Roman army. It was even believed to have killed an Emperor – Lucius Verus the co-regent of Marcus Aurelius, in 169.
Plague of Justinian (541 CE)
The Plague of Justinian was caused by the bacteria Yersinia Pestis and was the second of the Old World Pandemics that we have records of. This stand of the plague is often referred to as The First Plague by historians.
The Plague of Justinian was the first and largest outbreak of The First Plague. It was named after the Byzantine emperor in Constantinople, Justinian I – who caught and recovered from the plague according to Procopius, the court historian at the time.
Turkey, Egypt, most of mainland Europe, and the Mediterranean Basin were affected by this pandemic. And it is thought to be one of the deadliest pandemics of all time.
Japanese Smallpox Epidemic (735 CE)
This pandemic was short lived but incredibly deadly. The outbreak lasted for just two years, but in this time it was believed to have killed a third of the people living in Japan at the time.
It was believed that a group of fishermen contracted this strain of Smallpox in Korea before bringing it back to the island nation.
The disease killed peasants and nobles alike, with many of the most powerful families losing entire generations to the disease. So many farmers were killed by this outbreak that rice farming was affected for two decades afterward.
Black Death (1347 CE)
The Black Death was a Bubonic Plague outbreak that was the deadliest pandemic of all time. It is possible that this disease killed over 200 million people. The Bubonic Plague is also referred to as The Second Plague by historians.
The entirety of Europe as well as Northern and Central Africa was affected by this plague. The outbreak began in Central Africa but was first recorded in Crimea. Fleas infected with the disease then travel throughout Europe on the back of rats causing havoc wherever they went.
Bubonic Plague is also caused by Yersinia pestis but is not directly related to The First Plague.
Smallpox (1520 CE)
In 1520 CE the Spanish landed in South America and introduced Smallpox into the indigenous population.
This pandemic aided the Spanish’s conquest of the region, as the population had never been exposed to it before. Some records suggest that Smallpox wiped out 40% of the Aztec population in a year.
This outbreak also killed the Incan ruler, Huayna Capac, and 200,000 others in his kingdom.
Other studies suggest that Smallpox and other European diseases contributed to the deaths of 56 million natives in both North and South America.
Italian Plague (1629 CE)
This outbreak was the second wave of The Second Plague (Bubonic Plague) to hit Italy – a country that had been completely devastated by the first wave (The Black Death).
This pandemic was believed to have killed around 1 million people across Italy. Which accounted for 25% of the county’s population at the time.
Vancian soldiers returning from the 30 Year’s War were believed to have brought the Plague back to Italy.
Verona was the hardest hit city and lost around 60% of its population to the Plague.
Great Plague of London (1665 CE)
In 1665 London was hit with a new wave of the Second Plague (Bubonic Plague), and the outbreak lasted for around 18 months.
The outbreak killed around a quarter of London’s population, 100,000 people. This was the hardest time England was hit by the Bubonic plague during its entire history.
The outbreak was so bad that the King and his Royal court were moved out of the city.
Another disaster brought an end to the Plague in 1666. It is believed that enough of the rats and fleas in the city were killed by The Great Fire of London to put a stop to the outbreak.
Cholera Pandemics (1817 CE)
This pandemic originated in a small village outside of Calcutta before spreading across India, Asia, East Africa, and as far north as the Mediterranean. It was one of the first pandemics to affect nearly every country in Asia.
The actual death rate of this pandemic is unknown as records at the time were poor. India reported nearly 9 million deaths across the whole of the pandemic, but many believe this to be over exaggerated.
We do know that one of the worst affected places was the island of Java who lost over 100,000 people to the disease.
Third Plague (1885 CE)
Although this pandemic started in 1885, WHO did not consider this pandemic to have finished until the 1960s. This was the third major outbreak of a Bubonic plague strain (the first being the Plague of Justinian, and the second being the Black Death). Many of the following pandemics we are going to cover were further outbreaks of the Third Plague.
The Third Plague began in China and killed over 2 million people in that country alone. This outbreak was mostly contained in Asia but eventually spread to every inhabited continent in the world.
Yellow Fever (late 1800s CE)
In the late 18th century and early 19th century, America and the Caribbean were hit by a Yellow Fever pandemic.
The disease is believed to have originated in Central Africa, but it caused devastation when it arrived in America via the Caribbean.
Philadelphia was the first city to get hit by the disease, and over 7 years around 20% of its population (10,000 people) were killed.
The disease also spread to Haiti, Georgia, Bermuda, New Orleans, Virginia, Texas, and the Panama Canal. Due to a lack of records, it is hard to get an idea of the total death rates of this disease in the Americas, but it could be over 1 million.
Russian Flu (1889 CE)
The Russian Flu was the second major wave of the Third Plague. It was first reported within the Russian Empire. However, the Trans-Capsian railroad caused the plague by over 3200km in less than six months. The Russian Flu had reached America by late 1889. And it reached Mexico 2 months later. It was one of the first truly global epidemics.
Russian Flu was believed to kill over 1 million people worldwide. With the majority of the deaths taking place in Russia and Europe.
Spanish Flu – (1918 CE)
The Spanish Flu was caused by the influenza A virus subtype H1N1. Despite its name, the Spanish Flu was first documented in the United States. However, false newspaper reports made it out that Spain had been badly hit by the virus, and it developed the name Spanish Flu.
The disease spread from America to Europe as the American army entered World War 1. The continent was already buckling under the pressure of the war and therefore conditions for the virus to spread were perfect.
Some historians believe that the high death rates caused by the virus lead to a peace treaty being drawn up and the war ending sooner than expected.
Asian Flu – (1957 CE)
Asian Flu was caused by the influenza A virus subtype H2N2. The influenza originated in Guizhou in southern China. In the year that it was active Asian Flu was believed to have killed between 1-4 million people around the world.
The pandemic slowly spread across Asia, hitting India particularly hard, before reaching the UK and the USA.
An American biologist called Maurice Hilleman developed a vaccine for the virus that is thought to have saved hundreds of thousands of lives. Without the vaccine death rates in the US were predicted to top 1 million.
Hong Kong Flu – (1968 CE)
Hong Kong Flu was a second wave of Asian Flu that reared its head in Hong Kong in the late 1960s.
Within 6 weeks, 15% of Hong Kong’s population became infected with this flu – that was 500,000 in infections in a month and a half.
Later the flu spread across Europe with a much higher death rate. The team that had been involved in making the vaccine for Asian Flu also created a vaccine for Hong Kong Flu that was given to 9 million people.
Without this vaccine, the death toll would have been much higher than the estimated 1-4 million people.
HIVAIDS- (1981 CE)
HIV can be spread in three ways – through sexual contact, bodily fluids, and from mother to child. 90% of the children who have HIV had it passed into them by their mothers. There is still no cure for HIV or an effective vaccine.
HIV was first discovered in New York in 1981 and was initially spread by a group of drug users sharing needles.
SARS – (2002 CE)
41 of the SARS fatalities were healthcare professionals who treated patients for the virus – including 2 nurses and a doctor from Canada.
SARS makes the pandemic not because of how many people it killed, but because of how far it spread.
SARS has also been given this elevated rating because of its relationship to the COVID-19 virus (which is also known as SARS-COV-2). The strains are closely related and attack the body in a similar way.
Swine Flu – (2009 CE)
Experts believe (because many sufferers were asymptomatic) that the number of people infected by Swine Flu falls between 700 million to 1.4 billion people (between 11-20% of the population at the time).
Swine Flu was the third major wave of H1N1 influenza virus infections (the first being Russian Flu and the second Spanish Flu). The flu got its name because it first emerged in Mexican Pig farms before appearing in humans in the US, it was also unofficially referred to as Mexican Flu.
The death toll of Swine flu is estimated to between 19,000 and 248,000 – with 18,449 lab confirmed deaths being officially reported.
Ebola – (2014 CE)
This Ebola pandemic occurred in West Africa and mainly affected the nations of Guinea, Liberia, and Sierra Leone. It was the biggest outbreak of Ebola the world has ever seen. The pandemic lasted for 3 years before being contained.
Cases of Ebola were also reported in Nigeria and Mali. Health workers returning to the United Kingdom and Spain also caught the disease. The UK was the only country outside of Africa to see a death during the pandemic.
During that time over 10,000 people were killed by the disease.
MERS – (2015 CE)
MERS has been endemic in the Middle East since its discovery in 2012. However, in 2015 a Korean businessman contracted the virus while visiting the Middle East and brought it back to South Korea with him.
A total of 186 cases were reported with 38 deaths. Most of these cases were in Korea, but some cases were also reported in China.
This MERS outbreak was treated as a pandemic in 2015 as the virus spread to a location it was not expected to, despite death rates being fairly low.
COVID-19 – (2019 CE)
Note – this pandemic is still going on at the time of writing.
COVID-19 is a strain of coronavirus that is closely related to SARS. Cases were first reported in Wuhan in late 2019. By early 2020 it had spread across the world, partly due to businessmen returning from trips to China.
It is also believed that if many governments had reacted faster to the threat, death rates would have been a lot lower.
So far 4 variations of COVID-19 have been identified, the most recent one having originated in India.
Multiple vaccines have been developed and a worldwide rollout is in progress.
The Deadliest Pandemics
The Black Death
75 – 200 million deaths
No other pandemic even comes close to the number of deaths the Black Death caused. And hopefully, no other pandemic ever will.
The second plague decimated the populations of Europe and Northern Africa. It is believed that 45-50% of Europe’s population was wiped out during the Black Plague.
London, Paris, and Hamburg all reported losing 50% of their populations during the pandemic. Florence’s tax records show that 80% of their population was killed in 4 months.
A large part of Europe’s community of monks and nuns died during the pandemic as they traveled around treating the sick.
56 million deaths
Mummies that showed evidence of Smallpox contraction over 3000 years ago have been found in Egypt. This disease caused many epidemics across the planet until it was eradicated in 1979.
The number above refers to the number of natives that are believed to have been killed by Smallpox in the Americas. This disease was introduced by European colonists – some historians think intentionally in a few cases.
Smallpox is one of two deadly diseases to have been eradicated. It is believed that in the 20th century alone Smallpox killed 500 million people. With case numbers peaking at 50 million new cases a year. 80% of children who caught smallpox were killed by it.
45 million deaths
The death rates of the Spanish Flu are believed to have been anywhere between 45-100 million. We may never know as the world was war torn as the disease broke out and record keeping was lax.
The most dangerous thing about the Spanish Flu was that it didn’t just kill the young and the old like other influenza, but it was also killing a lot of young adults. These young adults would have been unaffected by other strains of flu. 92% of the people who were killed by the Spanish Flu were under 65.
An unusual fact about the Spanish Flu was that it killed far more men than women, and men were more likely to die if they caught it.
Plague of Justinian
40 million deaths
This was the first outbreak of The First Plague, a disease that is believed to have killed up to 100 million people (around 60% of Europe’s population at the time) over the 250 years it was active.
Records at the time suggested that the Plague of Justinian was killing 10,000 people a day at its peak – although there is no way of verifying these numbers. It is, however, believed that this pandemic killed 40% of the population of Constantinople at the time.
The strain of Yersinia Pestis that caused this plague seems to have evolved separately from the plagues that later afflicted Europe.
30 million deaths
HIV/AIDS is believed to have caused between 35-45 million deaths since 1981.
The initial outbreak of aids was amongst the American gay community. However, most cases can now be found in Africa and South America.
Despite still killing over 600,000+ people a year there is still no cure or vaccine for HIV/AIDS. One of the key ways to prevent the virus from spreading is to use protection during sex.
However, there are many places in the world where the needed types of contraception are hard and/or to acquire. Many of the world’s major religions also preach against the use of contraception like condoms.
The Third Plague
12 million deaths
The first two major outbreaks of the Third Plague were believed to have killed 12 million people. 2 million people in China, and 10 million people in India. Some experts suggest that these numbers were actually closer to 15 million people.
The pandemic began in Yunnan, China in 1885 and spread across China and the Indian subcontinent. Like the previous two plagues, it is believed to be spread by infected fleas traveling on rats.
This plague was killing 100s of people a year up until the mid 1960s. Some areas in China are still considered health risks for new plague outbreaks.
5 million deaths
Conservative estimates put the death rates of the Antonine Plague at 5 million deaths. But some historians believe this could be as high as 10 million. The disease spread across most of the Roman empire, as well as spreading into Germany and Gaul territories.
The Plague lasted for over 15 years, and in that time it nearly wiped out the whole of the Roman army. The Plague was estimated to have killed at least a third of the Roman Empire. One report from Cassius Dio stated that the plague killed 20,000 people in Rome in just one day.
3.9 million deaths (as of 28/06/2021)
Note – this pandemic is still going on at the time of writing.
There have currently been 3.93 million recorded COVID-19 deaths. The UK, USA, and India being some of the hardest hit nations.
182 million cases have been recorded across the world. There have been two waves of the virus, with a third one believed to be approaching. 4 new COVID-19 variants have been recorded (as of writing).
Vaccinations against the virus began in the UK in December 2020. WHO is planning a worldwide vaccine rollout with the aim of vaccinating the majority of the world by the start of 2023.
What Is a Pandemic Influenza
Pandemic Influenza is a pandemic caused by a strain of influenza.
Many of the early pandemics were caused by strains of plague and smallpox. However, smallpox has since been eradicated and bubonic plague numbers are low. Now, the major cause of pandemics is influenza strains. Some experts believe they will become more frequent.
Influenza are highly effective viruses because they mutate too quickly for medical science to keep up with them. New flu vaccines are being developed every year, but the dominant strain of flu can change multiple times during the season.
We have seen with COVID-19 that influenza can easily evolve into something more infectious. An example of this is the Delta variant which is believed to be 70% more infectious than the original Alpha strain that emerged in late 2019.
Luckily, COVID-19 vaccines have been effective against all of the variants so far.
Looking through the history of pandemics, there is much for us to learn today.
The success of Asian and Hong Kong Flu vaccines suggests that vaccination is the best weapon against pandemics. Particularly in a world where intercontinental travel is so common, and it is much easier for viruses and diseases to spread.
We can also look to the eradication of Smallpox as a sign of a brighter future. Where, hopefully, today’s deadliest diseases will also be eradicated.
We should also be very grateful that we haven’t had to live through an outbreak of the Bubonic Plague. Yet…
Every disease that we encounter as a species pushes science further forward. Each pandemic helps us to prepare better for the next one and will help us to prevent more deaths.