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In this paper, we reintroduce Dr. John Cross' neglected and unusually complete historical data set describing a smallpox epidemic occurring in Norwich, England in 1819. We analyze this epidemic data in the context of early models of epidemic spread including the Farr-Evans-Brownlee Normal law, the Kermack-McKendrick square Hyperbolic Secant and SIR laws, along with the modern Volz-Miller random-network law. We show that Cross' hypothesis of susceptible pool limitation is sufficient to explain the data under the SIR law, but requires parameter estimates differing from the modern understanding of smallpox epidemiology or large errors in Cross' data collection. We hypothesize that these discrepancies are due to the mass-action hypothesis in SIR theory, rather than significant errors by Cross, and use Volz-Miller theory to support this. Our analysis demonstrates the difficulties arising in inference of attributes of the disease from death incidence data and how model hypotheses impact these inferences. Our study finds that, combined with Volz-Miller modeling theory, Cross' death incidence data and population observations give smallpox attributes which largely cohere to those used in modern smallpox models., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Olson, Reluga. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The issue of public health and epidemics is again in the spotlight today because of the recent epidemic we have experienced, which, although weaker, continues to be the object of our attention. In this article, we attempt to understand the relationship between the environment and public health, within this context exploring the main epidemics known to have occurred in Portugal in the Modern Age. Conditions in Portugal at that time were favorable for the spread of several epidemics; the environment encouraged the spread of disease and boosted virulence at a time when medicine was unable to cope, causing mortality rates to soar.

Objectives: To explore whether synergistic epidemics of measles and scarlet fever in 1860s-1870s Victoria, Australia could be characterized as syndemics, we apply the methods of Sawchuk, Tripp, and Samakaroon (Social Science & Medicine 2022, 295, 112956) to quantify the impact of each of the two major co-occurring epidemic events (1867, 1875) in terms of life expectancy (LE) changes. Sawchuk et al. posit the presence of a harvesting effect, indicated by a statistically significant increase in LE in the immediate post-epidemic "fallow period", as a criterion for identification of a historical syndemic. We test an alternate hypothesis that the same methods can identify a short-term scarring effect., Materials and Methods: Using annual age- and cause-specific death statistics and census population data, we constructed abridged period life tables for baseline period, potential syndemic year, and "fallow" year for each of the two periods (1860s and 1870s). We compared LE at birth using Z-tests. We decomposed age-cause-specific mortality according to Arriaga's method to identify age-and cause-specific contributions to LE change., Results: LE was significantly lower than baseline (1864-1865) in 1867 but not in the "fallow" year (1869). LE in 1875 and the 1878 "fallow" year were both significantly below baseline (1871-1873). Age-cause-specific decomposition showed similar patterns for 1867 and 1875 for measles and scarlet fever combined effects., Discussion: Evidence of a scarring effect following the 1875 measles/scarlet fever combined peak supports the interpretation of this event as a syndemic. We suggest the short-term scarring effect can be a useful additional criterion for identifying historical syndemics., (© 2024 The Author(s). American Journal of Biological Anthropology published by Wiley Periodicals LLC.)

The jet stream is an important dynamic driver of climate variability in the Northern Hemisphere mid-latitudes 1-3 . Modern variability in the position of summer jet stream latitude in the North Atlantic-European sector (EU JSL) promotes dipole patterns in air pressure, temperature, precipitation and drought between northwestern and southeastern Europe. EU JSL variability and its impacts on regional climatic extremes and societal events are poorly understood, particularly before anthropogenic warming. Based on three temperature-sensitive European tree-ring records, we develop a reconstruction of interannual summer EU JSL variability over the period 1300-2004 CE (R 2  = 38.5%) and compare it to independent historical documented climatic and societal records, such as grape harvest, grain prices, plagues and human mortality. Here we show contrasting summer climate extremes associated with EU JSL variability back to 1300 CE as well as biophysical, economic and human demographic impacts, including wildfires and epidemics. In light of projections for altered jet stream behaviour and intensified climate extremes, our findings underscore the importance of considering EU JSL variability when evaluating amplified future climate risk., (© 2024. The Author(s).)

Dengue, an acute febrile disease transmitted by Aedes mosquitoes, is caused by the dengue virus (DENV), presenting a formidable challenge to global public health. By examining clues from ancient Chinese books and conducting a comprehensive review, this study elucidates the characteristics of potential dengue epidemics in China prior to 1978. This evidence indicates that China may not have experience dengue epidemics before 1840. During 1840-1949, however, it experienced a noticeable dengue occurrence and prevalence in the 1870s, 1920s, and 1940s. Then from 1949 to 1978, only sporadic reports were accounted. The disparity in the frequency of dengue occurrences across three time periods suggests that the persistent characteristic of dengue epidemics in China primarily arises from imported cases resulting from international exchanges, subsequently leading to local outbreaks influenced by global epidemic trend. This research offers a novel perspective on retrospectively examining the historical trajectory of dengue epidemics and provides valuable insights into exploration of DENV epidemic patterns., (© 2024. The Author(s).)

Penitentiary systems serve as breeding grounds for all kinds of diseases. Drawing upon new archival materials, this article examines the history of the management and reporting of epidemics in the Russian prison system from the late Imperial period to the present day. We use the case studies of cholera (1892-1893), typhus (1932-1933), and pulmonary tuberculosis (the 1990s) to examine how the general political and social conjuncture at different times affected the response of prison authorities to epidemics to show that, notwithstanding major shifts in society and polity, there was continuity in the management of epidemics by prison authorities in the long twentieth century. However, there were fundamental discrepancies in the way late Imperial, Soviet, and post-Soviet Russia reported epidemiological emergencies in prisons. We argue that Russia's tumultuous past has reinforced the tendency among the Russian penal administration towards a lack of transparency that has persisted to the present day, in relation to the latest, COVID-19, epidemic., (© The Author(s) 2023. Published by Oxford University Press.)

Server Kamil became one of the most prominent doctors during the period of the Ottoman Empirey. Server Kamil, who specialized in bacteriology and sanitation, made a name for himself primarily through his fight in the memories against epidemic diseases on the Caucasus front during World War I. He was sent to the Caucasus front as chief physician of Erzurum Red Crescent (Hilâl-i Ahmer) Hospital, and made great efforts to prevent the disease typhus-which was a major problem in the region-as soon as he reached the front line. He worked long and hard to develop a vaccine to prevent typhus, which affects thousands of soldiers and civilians. He also played a pioneering role in establishing important institutions such as the Sivas Smallpox Vaccine Laboratory and the Rabies Treatment Centre, which accomplished significant work and achieved great success both during the World War I and in the period that followed. This article attempts to clarify the activities of Server Kamil on Caucasus front during World War I based on the documents of the Turkish Red Crescent Archive, the reports of the Red Crescent Society., Competing Interests: Declaration of conflicting interestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Epidemics of a wide variety of infectious diseases were constantly recorded in Russia. Asian cholera occupied a special place among epidemic diseases. In 1892, cholera was imported into the Russian Empire through the Black Sea ports, which reached the territory of the Kuban region by the summer of the same year. In 1892, about 300 thousand people died of cholera in Russia. They still did not know how to treat this terrible disease, did not know its mechanism of spread, as well as the peculiarities of its course. The article, prepared on the basis of an analysis of documentary data from the Archive Department of the administration of the municipal formation of the city of Novorossiysk and the archival Department of the Administration of the municipal formation of the Mostovsky district, examines the cholera epidemic that swept the territories of the Kuban region in 1892 and 1910. The authors characterize the main factors that contributed to the rapid spread of infection and assess the measures that were taken to combat the disease: the implementation of anti-cholera measures organized by the authorities was greatly hampered by the lack of education, prejudices and superstitions of the vast majority of the population; representatives of the nonresident population not only did not comply with basic standards of personal hygiene, but also expressed distrust, and sometimes and hostility towards doctors. Using archival data, the authors investigate the impact of infectious diseases on the demographic indicators of these settlements.

Collected, primary resources enabled us to extract data that are scarcely present in medical literature of the two Breslauer morphologists of both the human body and - metaphorically - the society: Wilhelm Ebstein (1836-1912) and Sigismund Asch (1825-1901), particularly the latter, who described morphology of melanosis in his doctoral dissertation in 1846, to switch on reshaping social morphology of Wrocław (Breslau) in Virchow-like manner. In contrast to the main perspective of Ebstein's anomaly that has been finely described in past biographical papers, a primary aspect of infectious diseases is highlighted here in Ebstein's heritage. In 1869, his habilitation on recurrent typhus provided professional support for Asch. As Ebstein cared for the poor in shelters of Wrocław, Asch admitted poor patients from early morning hours to gain such a great esteem to be elected alderman. Asch's mentality corresponded to Ferdinand Lassalle's philosophy of the social democratic movement. In front of cholera epidemics, Asch contributed to medical control of meat, development of city canalization, establishment of green areas as well he deeply got involved in charity institutions for widows and orphans and was a model medical doctor to follow for much more famous Janusz Korczak who perished together with children from his orphanage in Nazi Concentration Camp in Treblinka. Asch was immortalized as "Doctor Klaus" in the popular play by Adolf L'Arronge and united people in progress from feudal discrimination to democracy and in fight for civil rights in industrial society to gradually replace aristocracy with meritocracy in the mainstream of development of modern society.

This paper examines the supply and utilization of traditional Chinese medicine (TCM) in Hong Kong during the influenza epidemics of the 1950s and 1960s. Existing narratives of TCM in Hong Kong have predominantly framed with within the dichotomy of Western medicine "Xiyi" and Chinese medicine "Zhongyi," portraying TCM as marginalized and nearly wiped out by colonial power. Departing from this binary opposition, this study views TCM as an autonomous space that had never been subjugated by the colonial power which opted for minimal interventionist approach toward TCM. By adopting diachronic and synchronic perspectives on Hong Kong's unique environment shaped by its colonial history and the geopolitics of the Cold War in East Asia, particularly its relationships with "China," this research seeks to reassess the role and status of TCM in post-World War II Hong Kong. In Hong Kong, along with other countries in East Asia, traditional medicine has ceded its position as mainstream medicine to Western medicine. Faced with the crisis of "extinction," Chinese medical professionals, including medical practitioners and merchant groups, persistently sought solidarity and "self-renewal." In the 1950s and 1960s, the colonial authorities heavily relied on private entities, including charity hospitals and clinics; furthermore, there was a lack of provision of public healthcare and official prevention measures against the epidemic influenza. As such, it is not surprising that the Chinese utilized TCM, along with Western medicine, to contain the epidemics which brought about an explosive surge in the number of patients from novel influenza viruses. TCM was significantly consumed during these explosive outbreaks of influenza in 1957 and 1968. In making this argument, this paper firstly provides an overview of the associations of Chinese medical practitioners and merchants who were crucial to the development of TCM in Hong Kong. Secondly, it analyzes one level of active provision and consumption of Chinese medicine during the two flu epidemics, focusing on the medical practices of TCM practitioners in the 1957 epidemic. While recognizing the etiologic agent or agents of the disease as influenza viruses, the group of Chinese medical practitioners of the Chinese Medical Society in Hong Kong adopted the basic principles of traditional medicine regarding influenza, such as Shanghanlun and Wenbingxue, to distinguish the disease status among patients and prescribe medicine according to correct diagnoses, which were effective. Thirdly, this paper examines the level of folk culture among the people, who utilized famous prescriptions of Chinese herbal medicine and alimentotherapy, in addition to Chinese patent medicines imported from mainland China. In the context of regional commercial network, this section also demonstrates how Hong Kong served as a sole exporting port of medicinal materials (e.g., Chinese herbs) and Chinese patent medicines from the People's Republic of China to capitalist markets, including Hong Kong, under the socialist planned or controlled economy in the 1950s and 1960s. It was not only the efficacy of TCM in restoring immunity and alleviating symptoms of the human body, but also the voluntary efforts of these Chinese medical practitioners who sought to defend national medicine "Guoyi," positioning it as complementary and alternative medicine to scientific medicine. Additionally, merchants who imported and distributed Chinese medicinal materials and national "Guochan" Chinese patent medicine played a crucial role, as did the people who utilized Chinese medicine, all of which contributed to making TCM thrive in colonial Hong Kong.

The Epidemic Diseases Act (EDA) was enacted in February 1897 by the Government of India to prevent and control the spread of the plague. Since then, the Act has become a key legal tool for the control of epidemics/pandemics in India. We attempted to understand the international and domestic pressures that led to the adoption of the EDA in three ways. First, we analyse the legislative structure (Bombay Municipal Act of 1888, Indian Railways Act of 1890, and Act I of 1870) that dealt with infectious or contagious diseases in colonial India before the EDA came into force. Second, we focus on the linkages between international and domestic pressures that necessitated the adoption of the EDA. Third, we analyse the discussions of the Council of the Governor General of India on the bill titled 'A Bill to Provide for the better prevention of the spread of Dangerous Epidemic Diseases', which later became the Epidemic Diseases Act No. III of 1897. We situate the EDA in an international context of International Sanitary Conferences, quarantine, trade concerns, and pilgrimage to Mecca in order to understand the pressures that impacted British epidemic policy formation in colonial India.

At the end of the 7th century, Chinese medicine was widely spread in the upper class of Japanese society, and Japanese emperors developed a medical based view on epidemics. At the beginning of the 8th century, emperors determined to reform by imitated the Tang to build a state ruled by law.They determine the way of TCM to relieve the epidemic in the form of legislation, and used medical measures in outbreaks on many occasions.However, with the spread of smallpox and other epidemics during the Tenpei year, Japan's backward medical level and poor medical resources were unable to cope with the epidemic, and the emperors turned to the epidemic as calamity. From the late 8th century to the end of 10th century, Japanese emperors responded with Buddhist, Shinto, and Confucian measures. Medical relief gradually became obsolete at the national level. But at the individual level of the emperors, they attached great importance to the use of Chinese medicine for epidemic prevention and treatment, in the mid to late 9th century, medical prevention measures were established in the court through legal means.

During the sixteenth century, Italian scholars revised their conception of the field of history so that its purposes went beyond providing political and morally edifying narratives. These scholars contended that history must also account for culture and nature in an encyclopedic fashion. In the same years, numerous newly available texts from antiquity, the Byzantine empire, and the Middle Ages provided insight into the character of earlier outbreaks of plague. Italian physicians, embracing new visions of the field of history, the culture of humanism, and an inductivist epistemology, used these texts to argue that there were continuities among ancient, medieval, and Renaissance epidemics. They catalogued plague and formed historical categories based on severity and perceived origins, leading to the rejection of the conclusions of fourteenth-century western Europeans who viewed the plague of 1347-1353 as unprecedented. These erudite physicians saw medieval plague to be one example of the extreme epidemics that have regularly occurred throughout history., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: During 2009-2010, pandemic influenza A (H1N1) pdm09 virus (pH1N1) infections in England occurred in two epidemic waves. Reasons for a reported increase in case-severity during the second wave are unclear., Methods: We analysed hospital-based surveillance for patients with pH1N1 infections in England during 2009-2010 and linked national data sets to estimate ethnicity, socio-economic status and death within 28 days of admission. We used multivariable logistic regression to assess whether changes in demographic, clinical and management characteristics of patients could explain an increase in ICU admission or death, and accounted for missing values using multiple imputation., Results: During the first wave, 54/960 (6%) hospitalised patients required intensive care and 21/960 (2%) died; during the second wave 143/1420 (10%) required intensive care and 55/1420 (4%) died. In a multivariable model, during the second wave patients were less likely to be from an ethnic minority (OR 0.33, 95% CI 0.26-0.42), have an elevated deprivation score (OR 0.75, 95% CI 0.68-0.83), have known comorbidity (OR 0.78, 95% CI 0.63-0.97) or receive antiviral therapy ≤2 days before onset (OR 0.72, 95% CI 0.56-0.92). Increased case-severity during the second wave was not explained by changes in demographic, clinical or management characteristics., Conclusions: Monitoring changes in patient characteristics could help target interventions during multiple waves of COVID-19 or a future influenza pandemic. To understand and respond to changes in case-severity, surveillance is needed that includes additional factors such as admission thresholds and seasonal coinfections., (© 2021 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)

Catastrophic decline of Indigenous populations in the Americas following European contact is one of the most severe demographic events in the history of humanity, but uncertainty persists about the timing and scale of the collapse, which has implications for not only Indigenous history but also the understanding of historical ecology. A long-standing hypothesis that a continent-wide pandemic broke out immediately upon the arrival of Spanish seafarers has been challenged in recent years by a model of regional epidemics erupting asynchronously, causing different rates of population decline in different areas. Some researchers have suggested that, in California, significant depopulation occurred during the first two centuries of the post-Columbus era, which led to a "rebound" in native flora and fauna by the time of sustained European contact after 1769. Here, we combine a comprehensive prehistoric osteological dataset ( n = 10,256 individuals) with historic mission mortuary records ( n = 23,459 individuals) that together span from 3050 cal BC to AD 1870 to systematically evaluate changes in mortality over time by constructing life tables and conducting survival analysis of age-at-death records. Results show that a dramatic shift in the shape of mortality risk consistent with a plague-like population structure began only after sustained contact with European invaders, when permanent Spanish settlements and missions were established ca. AD 1770. These declines reflect the syndemic effects of newly introduced diseases and the severe cultural disruption of Indigenous lifeways by the Spanish colonial system., Competing Interests: The authors declare no competing interest.

This article describes the emergence of health concerns relating to the epidemics that occurred during the twentieth century in La Pampa, a province in Argentina. Epidemics such as smallpox drove such policies, which frequently originated in Buenos Aires, the country's capital. The spread of many epidemics was due to shortages: water, sewage and adequate refuse disposal, an insufficient number of health care workers, the presence of disease transmission vectors such as mosquitos, and, ultimately, poverty. The historical experience described in this text highlights the importance of analyzing the impact of SARS-CoV-2 beyond the big cities.

Competing Interests: Competing interests: None declared.

Background: During COVID-19, a Kaggle challenge was issued to data scientists to leverage text mining to provide high-level summaries of full-text articles in the COVID-19 Open Research Dataset (CORD-19) data set, a data set containing articles around COVID-19 and other epidemics. A question was asked: "What if nursing had something similar?", Purpose: Describe the development and function of the Nursing COVID and Historical Epidemic Literature and describe high-level summaries of abstracts within the repository., Method: Nurse-specific literature was abstracted from two data sets: CORD-19 and LitCOVID. LitCOVID is a data set containing the most up-to-date literature around COVID-19. Multiple text mining algorithms were utilized to provide summaries of the articles., Discussion: As of July 2020, the repository contains 760 articles. Summaries indicate the importance of psychological support for nurses and of high-impact rapid education., Conclusion: To our knowledge, this repository is the only repository specific for nursing that utilizes text mining to provide summaries., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The SARS-CoV-2 crisis of 2020 triggered a number of unprecedented reactions of European states, in particular in the form of either constitutional emergency measures or statutory anti-epidemic emergency measures. Poland chose to deal with the crisis by delegating powers to the executive by ordinary legislative means and declared a nationwide state of epidemic emergency on 13 March 2020 and a week later a state of epidemic on the basis of the Act of 5 December 2008 on preventing and combating infections and infectious diseases. For a century, Poland has been dealing with epidemics by delegating powers to the executive by ordinary legislative means. Anti-epidemic emergency measures were developed under the relevant acts of 1919, 1935, 1963, 2001, 2008 and now form an autonomous normative model authorised directly by Article 68 (4) of the Constitution of the Republic of Poland of 2 April 1997. The Constitution of 2 April 1997 authorises also extraordinary measures in situations of particular danger, "if ordinary constitutional measures are inadequate". This article analyses anti-epidemic emergency regimes under Polish law in a comparative, historical and jurisprudential perspective.

Cholera, as an acute, high-risk and widespread infectious disease, has been studied by many scholars. Based on the data from , this research investigated the spatial distribution of the cholera epidemic and natural environment mechanism of the cholera epidemic in the Jiangnan area, from the year 1820 to 1821. We applied a set of spatial statistical analyses to investigate the spatial heterogeneity and the factors that influence the cholera epidemic in the Jiangnan area. Results show that: 1) Spatial distribution of cholera epidemic lied at different geographical scales. The cholera epidemic was highly concentrated in Shanghai, Nanjing and Hangzhou; There was a north-south difference of cholera epidemic distribution at the regional scale. The cholera epidemic was more concentrated in the north part than in the south part of the Jiangnan area; Meanwhile, there was an east-west difference in cholera epidemic distribution where the intensity of the cholera epidemic decreased from east to northwest and southwest. 2) A land-sea distribution of cholera can be also found. The Chang-Hang line and the Hu-Jia line were the two boundaries of the cholera epidemic in the Jiangnan area. 3) There was a close relationship between the distribution of the cholera epidemic and natural environment in the Jiangnan area. The influence intensity of natural factors on epidemic disasters followed the order of temperature (0.760) > precipitation (0.663) > river distance (0.413) > river density (0.398) > elevation (0.395). The present investigation is conductive to establish a prevention system for public health emergencies, which contributes to the sustainable development of society and human health., Competing Interests: The authors have declared that no competing interests exist.

Modern scholarship has drawn hasty and numerous parallels between the Yellow Peril discourses of the 19th- and 20th-century plagues and the recent racialization of infectious disease in the 21st-century. While highlighting these similarities is politically useful against Sinophobic epidemic narratives, Michel Foucault argues that truly understanding the past's continuity in the present requires a more rigorous genealogical approach. Employing this premise in a comparative analysis, this work demonstrates a critical discontinuity in the epidemic imaginary that framed the Chinese as pathogenic. Consequently, those seeking to prevent future disease racialization must understand modern Sinophobia as fundamentally distinct from that of the past.

At the early stage of an emerging disease, information is often insufficient for governments to determine what actions are necessary to contain its transmission. Taiwanese society was not prepared when the SARS epidemic hit in 2003. After the SARS epidemic, Taiwan began to overhaul its Communicable Disease Control Act authorising the government to act in a murky situation without the fear of violating due process. In hindsight, the new law has contributed a large part to the effective containment of Covid-19 in Taiwan. However, a new issue emerged concerning the conflict between an individual's freedom of confidential communication and the government's use of cell phone positioning to monitor self-quarantine. Although Taiwan's Council of Grand Justices previously resolved the concern over potential breaching of due-process, the legislature may have to strike a balance between public health emergency and the use of an electronic footprint to trace individual activities.

Epidemic nowcasting broadly refers to assessing the current state by understanding key pathogenic, epidemiologic, clinical and socio-behavioral characteristics of an ongoing outbreak. Its primary objective is to provide situational awareness and inform decisions on control responses. In the event of large-scale sustained emergencies, such as the COVID-19 pandemic, scientists need to constantly update their aims and analytics with respect to the rapidly evolving emergence of new questions, data and findings in order to synthesize real-time evidence for policy decisions. In this Perspective, we share our views on the functional aims, rationale, data requirements and challenges of nowcasting at different stages of an epidemic, drawing on the ongoing COVID-19 experience. We highlight how recent advances in the computational and laboratory sciences could be harnessed to complement traditional approaches to enhance the scope, timeliness, reliability and utility of epidemic nowcasting.

Since Hippocrates, the cornerstone of medical practice has been the doctor-patient relationship. The question here is whether these basic principles are still compatible with this unusual COVID-period. This pandemic represents a serious threat to human health, leading to profound changes in behavior in daily life but also in health care. Because of limited resources, health-managers must choose well-balanced solutions able to protect patients and citizens on the one hand and to provide maximal benefit for the society on the other hand. We are going through a moment of rupture that we must acknowledge. Here, we discussed how the doctor-patient relationship could be compromised. Doctors are focused on cares whereas patients are focused on scare. Profound changes occur presently, from the way we present ourselves to each other (including the masks), the poor conditions for physical examination, the mental suffering of both patient and caregiver until sometimes terrible end-of-life conditions. The historical point-of-view helps us to keep in mind previous experiences, and the philosophical perspective helps to contextualize this unedited situation. We should stop briefly our daily rush to put these considerations into perspective to overcome these challenges. Nothing is as effective as trust: let's rebuild it., (Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Background: Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time., Methods: We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response., Results: Seventy-six outbreaks from 34 countries were included. Median delays spanned 1-2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5-5), detection (5 days, IQR 5-6), investigation (7 days, IQR 5.8-13.3), response (10 days, IQR 7-18), and confirmation (11 days, IQR 7-16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5-9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7-61.0, p = 0.03)., Conclusions: From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.

As cases of the coronavirus disease (COVID-19) continue to rise, psychological endurance is a challenge many people will face. For mental health, heightened stress responses to the pandemic, is likely to manifest in three ways: 1) development of a new episode of a disorder in those with a predisposition to a major psychiatric disorder or an acute exacerbation in those who already have such a disorder, 2) development of a trauma or stressor related disorder, such as acute stress disorder, Post Traumatic Stress Disorder (PTSD), or adjustment disorders, and 3) development of a symptomatic stress response that does not meet the diagnostic criteria of a psychiatric disorder. The authors reviewed existing literature on past epidemics, natural disasters, and COVID-19 with a focus on psychiatry and mental health. Psychological effects of past epidemics (Severe Acute Respiratory Syndrome CoV-1, Ebola, Middle East Respiratory Syndrome, the Anthrax threat), past natural disasters, and current COVID-19 data suggest numerous psychological effects following the pandemic. Alcohol use, PTSD, anxiety, anger, fear of contagion, perceived risk, uncertainty, and distrust are a few of the immediate and long-term effects that are likely to result from the COVID-19 pandemic. Identifying people in need of mental health care and determining the appropriate psychiatric services and therapy needed will be important. Increasing the use and availability of telehealth, group meetings, and online resources are some ways that health care workers can prepare for the increasing demand of psychiatric services during and following the pandemic.

Interactions between microbes and human hosts can lead to a wide variety of possible outcomes including benefits to the host, asymptomatic infection, disease (which can be more or less severe), and/or death. Whether or not they themselves eventually develop disease, asymptomatic carriers can often transmit disease-causing pathogens to others. This phenomenon has a range of ethical implications for clinical medicine, public health, and infectious disease research. The implications of asymptomatic infection are especially significant in situations where, and/or to the extent that, the microbe in question is transmissible, potentially harmful, and/or untreatable. This article reviews the history and concept of asymptomatic infection, and relevant ethical issues associated with this phenomenon. It illustrates the role and ethical significance of asymptomatic infection in outbreaks, epidemics, and pandemics-including recent crises involving drug resistance, Zika, and Covid19. Serving as the Introduction to this Special Issue of Monash Bioethics Review, it also provides brief summaries of the other articles comprising this collection.

Objectives: This paper seeks to provide a brief overview of epidemics and pandemics in Irish history and to identify any lessons that might be useful in relation to psychiatry in the context of COVID-19., Methods: A review of selected key reports, papers and publications related to epidemics and pandemics in Irish history was conducted., Results: Viruses, epidemics and pandemics are recurring features of human history. Early Irish sources record a broad array of plagues, pandemics and epidemics including bubonic plague, typhus, cholera, dysentery and smallpox, as well as an alleged epidemic of insanity in the 19th century (that never truly occurred). Like the Spanish flu pandemic (1918-20), COVID-19 (a new coronavirus) presents both the challenge of the illness itself and the problems caused by the anxiety that the virus triggers. Managing this anxiety has always been a challenge, especially with the Spanish flu. People with mental illness had particularly poor outcomes with the Spanish flu, often related to the large, unhygienic mental hospitals in which so many were housed., Conclusions: Even today, a full century after the Spanish flu pandemic, people with mental illness remain at increased risk of poor physical health, so it is imperative that multi-disciplinary care continues during the current outbreak of COVID-19, despite the manifest difficulties involved. The histories of previous epidemics and pandemics clearly demonstrate that good communication and solidarity matter, now more than ever, especially for people with mental illness.

Over the course of the last several million years of evolution, humans probably have been plagued by hundreds or perhaps thousands of epidemics. Little is known about such ancient epidemics and a deep evolutionary perspective on current pathogenic threats is lacking. The study of past epidemics has typically been limited in temporal scope to recorded history, and in physical scope to pathogens that left sufficient DNA behind, such as Yersinia pestis during the Great Plague. Host genomes, however, offer an indirect way to detect ancient epidemics beyond the current temporal and physical limits. Arms races with pathogens have shaped the genomes of the hosts by driving a large number of adaptations at many genes, and these signals can be used to detect and further characterize ancient epidemics. Here, we detect the genomic footprints left by ancient viral epidemics that took place in the past approximately 50 000 years in the 26 human populations represented in the 1000 Genomes Project. By using the enrichment in signals of adaptation at approximately 4500 host loci that interact with specific types of viruses, we provide evidence that RNA viruses have driven a particularly large number of adaptive events across diverse human populations. These results suggest that different types of viruses may have exerted different selective pressures during human evolution. Knowledge of these past selective pressures will provide a deeper evolutionary perspective on current pathogenic threats. This article is part of the theme issue 'Insights into health and disease from ancient biomolecules'.

Objective: To consolidate qualitative research studies that examined the experiences and needs of pregnant women, midwives, and nurses of maternity units to provide a way forward for future research and practices during the current pandemic and future epidemics and pandemics., Design: Qualitative systematic review and meta-synthesis., Data Source: Four electronic databases-PubMed, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health (CINAHL)., Review Methods: Qualitative studies with samples of pregnant women, midwives, and/or nurses of maternity units who experienced epidemics and/or pandemics were searched from 1 January 2000 to 4 April 2020. The included studies were critically appraised using the ten-item Critical Appraisal Skills Programme (CASP) tool., Findings: Eight studies were included in this review. Four themes emerged from the synthesis: (1) psychological responses, (2) challenges faced, (3) coping strategies, and (4) sources of support and support needs., Key Conclusions: Pregnant women, midwives, and nurses experienced negative psychological responses during epidemics and pandemics. Challenges, such as limited available information and public stigma, were faced. Various coping strategies, such as actively looking for more information and seeking solace in religions, were practiced by pregnant women, midwives, and nurses. Families were both sources of support and stress and they expressed needs for more informational, emotional, and financial support during pandemics., Implications for Practice: More culturally diverse research in the future that includes the development of technology-based programs, trained community volunteer-led programs, psychosocial interventions, and anti-stigma and awareness initiatives are needed to combat the current pandemic and future public health crises., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Rugao and Haian belonging to First Branch of Su-Wan Liberated Area found fulminant cholera in 1946. The fulminant cholera spread throughout the Su-Wan Liberated Area in a short period of time. Thus, local mass and military led by CPC actively launched the Movement of Epidemic Prevention. They took some actions to clear up the circumstance, eliminate the pathogen, prevent the food contamination and cut off the route of transmission. Vaccination was carried out on a large scale. As a result of these measure, the fulminant cholera was efficiently controlled.

To put estimates of COVID-19 mortality into perspective, we estimate age-specific mortality for an epidemic claiming for illustrative purposes 1 million US lives, with results approximately scalable over a broad range of deaths. We calculate the impact on period life expectancy (down 2.94 y) and remaining life years (11.7 y per death). Avoiding 1.75 million deaths or 20.5 trillion person years of life lost would be valued at $10.2 to $17.5 trillion. The age patterns of COVID-19 mortality in other countries are quite similar and increase at rates close to each country's rate for all-cause mortality. The scenario of 1 million COVID-19 deaths is similar in scale to that of the decades-long HIV/AIDS and opioid-overdose epidemics but considerably smaller than that of the Spanish flu of 1918. Unlike HIV/AIDS and opioid epidemics, the COVID-19 deaths are concentrated in a period of months rather than spread out over decades., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

Dengue fever (DF) is a globally significant infection which causes a range of severe and non-severe clinical manifestations. It is transmitted by mosquitoes of the Aedes genus (primarily Aedes aegypti, but also Aedes albopictus). In this letter, a possible DF epidemic on Thasos Island in Greece, which is described in the Book of Epidemics I of the Corpus Hippocraticum, is presented and analyzed. To my knowledge, it is the first report of DF in the history of medicine., (© 2020 Mazokopakis EE.)

Here, we explore the dynamics of the response of the scientific community to several epidemics, including Coronavirus Disease 2019 (COVID-19), as assessed by the numbers of clinical trials, publications, and level of research funding over time. All six prior epidemics studied [bird flu, severe acute respiratory syndrome (SARS), swine flu, Middle East Respiratory Syndrome (MERS), Ebola, and Zika] were characterized by an initial spike of research response that flattened shortly thereafter. Unfortunately, no antiviral medications have been discovered to date as treatments for any of these diseases. By contrast, the HIV/AIDS pandemic has garnered consistent research investment since it began and resulted in drugs being developed within 7 years of its start date, with many more to follow. We argue that, to develop effective treatments for COVID-19 and be prepared for future epidemics, long-term, consistent investment in antiviral research is needed., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Pandemics are relevant for many fields of medicine from microbiology to economics and epidemiology. Many medical specialties which developed during the 19th century, e. g., urology, have had much impact on diagnostics and therapy, such as during the treatment of tuberculosis and sexually transmitted diseases. For some of them, including urology, treatment of, for example, sexually transmitted diseases, was constitutional and differed between countries.

In the past two centuries, several fatal infectious outbreaks have arisen in Iran. Presented here is a brief historical account of four fatal epidemics including cholera, plague, Spanish influenza of 1918 and smallpox between1796 and 1979. The lessons from these outbreaks could be helpful for better combatting other deadly epidemics including the present-day disastrous COVID-19 pandemic., (© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

The Spanish flu pandemic spread in 1918-19 and infected about 500 million people, killing 50 to 100 million of them. People were suffering from severe poverty and malnutrition, especially in Europe, due to the First World War, and this contributed to the diffusion of the disease. In Italy, Spanish flu appeared in April 1918 with several cases of pulmonary congestion and bronchopneumonia; at the end of the epidemic, about 450.000 people died, causing one of the highest mortality rates in Europe. From the archive documents and the autoptic registers of the Hospital of Pisa, we can express some considerations on the impact of the pandemic on the population of the city and obtain some information about the deceased. In the original necroscopic registers, 43 autopsies were reported with the diagnosis of grippe (i.e. Spanish flu), of which the most occurred from September to December 1918. Most of the dead were young individuals, more than half were soldiers, and all of them showed confluent hemor agic lung bronchopneumonia, which was the typical feature of the pandemic flu. We believe that the study of the autopsy registers represents an incomparable instrument for the History of Medicine and a useful resource to understand the origin and the evolution of the diseases.