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This chapter explores how the evolving disease environments of the tropics shaped free and forced migration patterns at English sites. The globalization of forced labor markets and trade were catalysts in the spread of yellow fever and falciparum malaria, diseases that originated in Africa and that disproportionately weakened or killed English migrants to the tropics. These were the two deadliest mosquito-borne fevers that the English encountered in the tropics. The ways in which the English understood and responded to evolving tropical disease environments and their differential effects on European and non-European populations contributed to the rise of enslaved majorities in the tropics and informed ideas about human difference that would coalesce into nineteenth-century racism. The chapter will also show how epidemiology made English footholds in the tropics much more precarious and dependent on non-Europeans than the English footholds in other more temperate zones of the empire. The chapter relies on case studies of disease outbreaks in the Caribbean, on the West African Gold Coast, and in Sumatra at key points in the seventeenth century.
Epidemiology is about measuring disease or other aspects of health in populations, identifying the causes of ill-health and intervening to improve health, and we come back to these three fundamental components later in the chapter. But what do we mean by ‘health’? Back in 1948, the World Health Organization defined it as ‘… a state of complete physical, mental and social well-being’ (WHO, 1948). In practice, what we usually measure is physical health, and this focus is reflected in the content of most routine reports of health data and in many of the health measures that we will consider here; however, there are now methods to capture the more elusive components of mental and social well-being as well. Importantly, the WHO recognised that it is not longevity per se that we seek, but a long and healthy life. So, instead of simply measuring ‘life expectancy’, WHO introduced the concepts of ‘health-adjusted life expectancy’ (HALE) and subsequently ‘disability-adjusted life years’ (DALYs) to enable better international comparisons of the effectiveness of health systems.
The global pandemic of COVID-19 that began in late 2019 highlighted the importance of rapid and thorough investigations of outbreaks. The response to COVID-19 was at a scale not previously seen, involving all sectors of society, including government and private industry. To control and minimise the impact of COVID-19, huge and costly efforts were required to effectively coordinate many different organisations, many of which were not primarily concerned with public health. This type of re-focusing of resources is common in outbreak and public health emergency settings, but is rarely seen at such scale. In this chapter we look at outbreak investigation in more detail and, in doing so, focus on infectious diseases, although not exclusively, because other agents such as toxins and chemicals can also result in ‘outbreaks’ of non-communicable intoxications, injuries and cancer.
Surveillance of SARS-CoV-2 through reported positive RT-PCR tests is biased due to non-random testing. Prevalence estimation in population-based samples corrects for this bias. Within this context, the pooled testing design offers many advantages, but several challenges remain with regards to the analysis of such data. We developed a Bayesian model aimed at estimating the prevalence of infection from repeated pooled testing data while (i) correcting for test sensitivity; (ii) propagating the uncertainty in test sensitivity; and (iii) including correlation over time and space. We validated the model in simulated scenarios, showing that the model is reliable when the sample size is at least 500, the pool size below 20, and the true prevalence below 5%. We applied the model to 1.49 million pooled tests collected in Switzerland in 2021–2022 in schools, care centres, and workplaces. We identified similar dynamics in all three settings, with prevalence peaking at 4–5% during winter 2022. We also identified differences across regions. Prevalence estimates in schools were correlated with reported cases, hospitalizations, and deaths (coefficient 0.84 to 0.90). We conclude that in many practical situations, the pooled test design is a reliable and affordable alternative for the surveillance of SARS-CoV-2 and other viruses.
The WHO is designed to take advantage of the benefits of cooperation on health. It provides a loosely centralized agency where governments can share information about health and threats to health and get assistance in dealing with both new emergencies and long-running problems. COVID-19 provides an illustration of the WHO’s capacity and limits in the face of new threats to health. More than any other organization in this book, the WHO has taken on partnerships with private organizations to fund and organize its programs, and the organization therefore provides an intriguing illustration of the hybridization of global authority between public agencies and private foundations.
Samples of the bones of 47 individuals from 46 Czech and Moravian ossuaries were dated by the 14C method and analyzed for the collagen isotopic composition of carbon (δ13C) and nitrogen (δ15N). Most of the data for the ages of the remains corresponded to the cooler and damper periods described over the past 1000 years. Of the studied samples, the greatest number of remains corresponded to the Spörer (1400–1570), Dalton (1790–1830) and Wolf minima (1280–1350). One sample studied falls within the Maunder minimum (1645–1715). It can be assumed that these minima are connected with a reduced production of food and fodder, that may have initiated famines, epidemics and armed conflicts. Individual climatic minima showed positive correlations between δ13C and δ15N values, indicating that the individuals studied consumed complementary plant or animal diets to different degrees. The elevated δ15N values in our studied samples compared to the skeletal compositions of the population of the La Tène period (380 – 150 BC) and Germanic inhabitants in the territory of Bohemia (5th–6th centuries AD) and Great Moravia (9th–early 10th centuries AD) might reflect the effect of greater consumption of animal proteins or the proteins of omnivorous animals and fish, which compensated for the lack of plant foodstuffs during the colder periods.
The isotopic composition of carbon and nitrogen of the bone collagen for the Spörer and Dalton minima differs from the Wolf minimum. The younger minima show higher δ15N values for a given δ13C value.
This paper investigates the events and lessons from the 1848–49 cholera epidemic in Hungary. For contemporaries, the ongoing revolution and civil war pushed the devastation of the cholera epidemic into the background, even though the death rate was similar to that of the earlier 1831 infection. The epidemic hit the country in a period when the revolutionary Hungarian state was waging a war of self-defense. This article strives to refute the historiographic view that the movements of the different armies had a considerable influence on the development of the epidemic. Instead, this article argues that the cholera epidemic was a demographic crisis unfolding in the background of war, but for the most part independently of it. It mattered that most people of that time had already directly experienced cholera and that the Hungarian government did not want to cause panic with restrictive measures. In 1848, cholera was not a “mobilizing factor,” but in 1849 it contributed to the demoralization of the hinterland and frequently appeared in the political propaganda of the civil war.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
Pandemics and epidemics have affected human populations throughout recorded history. Larger human communities make it possible for epidemics to occur, and also promote maintaining infections in endemic form. Regardless of the organisms involved and the nature of the illness caused, certain themes are common to all in terms of the impacts and outcomes of the outbreaks in health, social, and political terms, and the measures used in attempts to control these events. In some instances, these measures have exerted some beneficial effects by changing the rate of spread of outbreaks, although not necessarily the numbers affected. it is only recently, with the advent of vaccination, that it has it become possible to effectively reduce the impacts of pandemics. Given the frequency with which people are exposed to novel infections and the speed with which some organisms can mutate, the need for readiness to combat pandemics on a worldwide basis is paramount.
Introduction of African swine fever (ASF) to China in mid-2018 and the subsequent transboundary spread across Asia devastated regional swine production, affecting live pig and pork product-related markets worldwide. To explore the spatiotemporal spread of ASF in China, we reconstructed possible ASF transmission networks using nearest neighbour, exponential function, equal probability, and spatiotemporal case-distribution algorithms. From these networks, we estimated the reproduction numbers, serial intervals, and transmission distances of the outbreak. The mean serial interval between paired units was around 29 days for all algorithms, while the mean transmission distance ranged 332 –456 km. The reproduction numbers for each algorithm peaked during the first two weeks and steadily declined through the end of 2018 before hovering around the epidemic threshold value of 1 with sporadic increases during 2019. These results suggest that 1) swine husbandry practices and production systems that lend themselves to long-range transmission drove ASF spread; 2) outbreaks went undetected by the surveillance system. Efforts by China and other affected countries to control ASF within their jurisdictions may be aided by the reconstructed spatiotemporal model. Continued support for strict implementation of biosecurity standards and improvements to ASF surveillance is essential for halting transmission in China and spread across Asia.
This article provides a narrative about archival research experience in Sierra Leone as the coronavirus outbreak spread globally in early 2020. Coincidentally, the research concerned the country’s history of epidemics since 1787, when Freetown, its first city, accommodated freed Blacks repatriated from Britain and the Americas. As Sierra Leone prepared for another disease outbreak after Ebola in 2014, leaving or staying in Freetown (after seven months into a ten-month Fulbright US Scholar term) had health and research outcomes at stake. Historicizing the pandemic while engaging personal/social memory in historical accounts, the article highlights containment measures adopted against epidemics/pandemics across time.
Historical research on urban epidemics has focused on the interaction of diseases with social and spatial gradients, such as class, ethnicity, or neighborhood. Even sophisticated historical studies usually lack data on health-related behavior or health-related perceptions, which modern analysts tend to emphasize. With detailed source material from the Finnish city of Tampere during a typhoid epidemic in 1916, we are able to combine both dimensions and look at how material and social constraints interacted with behavior and knowledge to produce unequal outcomes. We use data on socioeconomic status, location, and physical habitat as well as the self-reported behavior and expressed understandings of transmission mechanisms of the infected people to identify the determinants of some falling ill earlier or later than others. Applying survival analysis to approximately 2,500 cases, we show that disease avoidance behavior was deficient and constrained by physical habitat, regardless of considerable public health campaigning. Behavioral guidelines issued by authorities were sub-optimally communicated, unrealistic, and inadequately followed. Boiling water was hampered by shared kitchens, and access to laundry houses for additional hygiene was uneven. Centralized chemical water purification finally leveled the playing field by socializing the cost of prevention and eliminating key sources of unequal risk.
For any emerging pathogen, the preferred approach is to drive it to extinction with non-pharmaceutical interventions (NPI) or suppress its spread until effective drugs or vaccines are available. However, this might not always be possible. If containment is infeasible, the best people can hope for is pathogen transmission until population level immunity is achieved, with as little morbidity and mortality as possible.
Methods:
A simple computational model was used to explore how people should choose NPI in a non-containment scenario to minimize mortality if mortality risk differs by age.
Results:
Results show that strong NPI might be worse overall if they cannot be sustained compared to weaker NPI of the same duration. It was also shown that targeting NPI at different age groups can lead to similar reductions in the total number of infected, but can have strong differences regarding the reduction in mortality.
Conclusions:
Strong NPI that can be sustained until drugs or vaccines become available are always preferred for preventing infection and mortality. However, if people encounter a worst-case scenario where interventions cannot be sustained, allowing some infections to occur in lower-risk groups might lead to an overall greater reduction in mortality than trying to protect everyone equally.
We examined the association between face masks and risk of infection with SARS-CoV-2 using cross-sectional data from 3,209 participants in a randomized trial exploring the effectiveness of glasses in reducing the risk of SARS-CoV-2 infection. Face mask use was based on participants’ response to the end-of-follow-up survey. We found that the incidence of self-reported COVID-19 was 33% (aRR 1.33; 95% CI 1.03–1.72) higher in those wearing face masks often or sometimes, and 40% (aRR 1.40; 95% CI 1.08–1.82) higher in those wearing face masks almost always or always, compared to participants who reported wearing face masks never or almost never. We believe the observed increase in the incidence of infection associated with wearing a face mask is likely due to unobservable and hence nonadjustable differences between those wearing and not wearing a mask. Observational studies reporting on the relationship between face mask use and risk of respiratory infections should be interpreted cautiously, and more randomized trials are needed.
During the early stage of pandemics, primary health care (PHC) is the first point of contact with the health system for people. This study aimed to find the leading roles and challenges of the PHC system in dealing with the outbreak of infectious diseases
Methods:
The current scoping review was conducted in 2022 using the Arkesy and O’Malley framework. A bibliographic search was conducted in PubMed, Web of Science, and Scopus databases. Following a Google Scholar search, a manual search in some journals, reference checks for articles, and a review of organizational reports, websites, and other sources of information were also conducted. Data were analyzed using the content-analysis method.
Findings:
Finally, 65 documents (42 articles and 23 reports, books, and news) were included in the study. Initially, 626 codes were extracted, and 132 final codes were categorized into eight main themes and 44 sub-themes. The main themes for the roles of PHC included: service provision, education and knowledge, surveillance, access, coordination and communication, management and leadership, infrastructure change and rapid preparation, and patient and community management. Regarding the challenges faced by PHC in the epidemic of infectious diseases, 24 key challenges were identified and categorized into four major areas.
Conclusions:
Based on the results of the present study, there is a need for further studies to formulate and theorize the specific roles of PHC in managing infectious disease epidemics. The results of this study can be utilized by researchers and officials to inform their efforts in addressing this purpose.
This chapter examines the stories told about early epidemic disease in the North by Elders, missionaries, traders, and eventually anthropologists. Here we consider the implications of how we interpret evidence of past epidemics in the North to understand how often disease arrived with Europeans and thereby strive for a better understanding of how northerners could respond to novel pathogens. The absence of major smallpox epidemics is discussed in detail. The severe epidemics in the 1860s led the HBC to hire a physician, William MacKay, who along with missionaries provided medical care to the Mackenzie district posts. Colonial biomedicine existed alongside, and was still secondary to, traditional healing practices. This chapter considers some of these practices and the introduction of new tools to deal with new pathogens.
This chapter introduces the region, peoples, and historical changes underway in the mid-nineteenth century where the book begins. The lands lie along the Mackenzie and Yukon rivers and their tributaries, where waters flow north along the Mackenzie River into the Beaufort Sea and south-west down the Yukon River across into Alaska. These are the homelands of Inuvialuit, Gwich’in, Tłı̨chǫ, Dene, Tr’ondëk Hwëch’in, Tagish, Tutchone, Dënesųłıné, and Métis. This chapter introduces these peoples as well as the earliest Euro-Canadian colonizers and settlers: fur traders, explorers, missionaries, police, state officials, and their families who arrived in the nineteenth century and describes the book’s objectives: to learn about the historical significance of major northern epidemics before 1940 from those who survived; to use ecological approaches to disease to understand how colonialism shaped northern health; and to demonstrate the influence of flaws ideas about isolation and vulnerability in shaping past interpretations of the role of disease in the process of colonization.
Twentieth-century circumpolar epidemics shaped historical interpretations of disease in European imperialism in the Americas and beyond. In this revisionist history of epidemic disease as experienced by northern peoples, Liza Piper illuminates the ecological, spatial, and colonial relationships that allowed diseases – influenza, measles, and tuberculosis in particular – to flourish between 1860 and 1940 along the Mackenzie and Yukon rivers. Making detailed use of Indigenous oral histories alongside English and French language archives and emphasising environmental alongside social and cultural factors, When Disease Came to this Country shows how colonial ideas about northern Indigenous immunity to disease were rooted in the racialized structures of colonialism that transformed northern Indigenous lives and lands, and shaped mid-twentieth century biomedical research.
To assess gaps and barriers to effective health communication during epidemics, pandemics, and mass health emergencies.
Methods:
A systematic literature review was conducted in PubMed (National Library of Medicine, Maryland, USA), SCOPUS (Elsevier, Amsterdam, Netherlands), Cochrane (Cochrane, London, UK), and grey literature between 2000 to 2020.
Results:
16043 of 16535 identified citations were eliminated through title/ abstracts screening, 437 through full-text review and 55 articles were assessed qualitatively. Key barriers to effective health communication included misinformation, distrust, limited collaboration, and messaging inconsistency. Lack of information/ research was not the primary challenge. Major gaps were in mass and social media strategies, characteristics of messages, sociocultural contexts, digital communication, rapid response, providers’ attitude and perception, and information source characteristics. Health messaging should be adaptable to information outlets and tailored for the most vulnerable. Denigration of individuals with inaccurate beliefs increases misinformation and baseline knowledge differences and fears should be addressed without polarization. Involving frontline providers in health communication strategies is crucial.
Conclusions:
Primary reason for misinformation is the failure of health sector to convincingly convey accurate information. With input from all stakeholders, especially trusted members of communities and providers, health communication should include reinvestment in methods, multidimensional and multidisciplinary approaches, consistent frameworks, improved social media usage, clear, simple, and targeted messaging, and addressing systematic disinformation and misinformation with intention.
This chapter argues that the cosmological doctors arose as the result of a much wider realignment in Classical Greek medicine. As some doctors grew increasingly concerned about the many variables that can change from one case to the next, they rejected older forms of diagnostic handbooks in favor of new methods for organizing medical knowledge. We see this anxiety over individual differences not only in the works of the cosmological doctors but also in texts such as On Regimen in Acute Diseases, Prognostic, Airs Waters Places, and the seven books of Epidemics. In all of these texts, medical inquiry is defined, quite generally, as a search for commonalities. Doctors in this period were gathering together multiple accounts, noting the similarities and differences between those accounts, and isolating high-level generalizations that can unite and govern them all. Although the cosmological doctors took their search for commonalities farther than some of their contemporaries might have been willing to follow, they nevertheless responded to the same pressures that transformed nearly all the medical literature that survives from this period.