When will the pandemic end?

A Sicilian fresco from 1445. The Black Death killed at least a third of Europe’s population in the previous century. Photo: Collected

As the novel coronavirus leaves a trail of death and socioeconomic angst, billions around the world under lockdown wonder when will the pandemic end, and how. Even with measures taken to curb the spread of the virus will our fates be same as Prince Prospero's from Edgar Allan Poe's 1842 short story "The Masque of Red Death" or if we live to tell the tale ─ how will that be?

In a recently published article in The New York Times, famous American science journalist Gina Kolata tried to delineate how the coronavirus pandemic might end ─ discussing previous outbreaks. According to historians, pandemics typically have two types of endings: the medical ending and the social ending. The medical ending occurs when the incidence and death rates plummet; and the social ending is when the epidemic of fear about the disease wanes.

"When people ask, 'When will this end?' they are asking about the social ending," said Dr Jeremy A Greene, a medicine historian at The Johns Hopkins University. Nodding to Greene's statement, Kolata writes that an end can occur not because a disease has been vanquished but because people grow tired of panic mode and learn to live with a disease.

According to Allan Brandt, a professor of medicine history at Harvard University said something similar was happening with Covid-19.

"As we have seen in the debate about opening the economy, many questions about the so-called end are determined not by medical and public health data but by sociopolitical processes," he stated.

An epidemic of fear can occur even without an epidemic of illness.

Black Death- dark memories and denouement

Bubonic plague has struck several times in the past 2,000 years and killed millions. Each epidemic amplified the fear that came with the next outbreak. The disease is caused by a strain of bacteria, Yersinia pestis, which lives on fleas that live on rats. But bubonic plague, which became known as the Black Death, also could be passed from infected person through respiratory droplets, so it could not be eradicated simply by killing rats.

Historians describe three great waves of plague: the Plague of Justinian, in the sixth century; the medieval epidemic, in the 14th century; and a pandemic that struck in the late 19th and early 20th centuries.

It is not clear what made the bubonic plague die down. Some scholars have argued that cold weather killed the disease-carrying fleas, but that would not have interrupted the spread by the respiratory route. Or perhaps it was a change in the rats. By the 19th century, the plague was being carried not by black rats but by brown rats, which are more likely to live apart from humans. Another hypothesis is that the bacterium evolved to be less deadly. Or maybe actions by humans, such as the burning of villages, helped quell the epidemic.

One disease that actually ended

Among the diseases to have achieved a medical end is smallpox. But it is exceptional for several reasons: There is an effective vaccine, which gives lifelong protection; the virus, Variola major, has no animal host, so eliminating the disease in humans meant total elimination.

But while it still raged, smallpox was horrific. Individuals infected with the virus developed a fever, then a rash that turned into pus-filled spots, which became encrusted and fell off - leaving scars. The disease killed three out of 10 of its victims, often after immense suffering. The last person to contract smallpox naturally was Ali Maow Maalin, a hospital cook in Somalia, in 1977. He recovered, only to die of malaria in 2013.

The forgotten influenzas

The 1918 flu is held up today as the example of the ravages of a pandemic and the value of quarantines and social distancing. Before it ended, the flu killed 50 million to 100 million people worldwide ─ amidst World War I.

Writings of a doctor from that time narrates: "Hundreds of stalwart young men in the uniform of their country, coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full, yet others crowd in. Their faces soon wear a bluish cast, a distressing cough brings up blood stained sputum. In the morning the dead bodies are stacked up in the morgue like cord wood."

After sweeping through the world, that flu faded away, evolving into a variant of the more benign flu that comes around every year.

"Maybe it was like a fire that, having burned the available and easily accessible wood, burns down," Yale historian Dr Frank Snowden said.

It ended socially, too. World War I was over; people were ready for a fresh start, a new era, and eager to put the nightmare of disease and war behind them. Until recently, the 1918 flu was largely forgotten.

Will that happen with Covid-19?

Historians say possibility is that the coronavirus pandemic could end socially before it ends medically. People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smolder in the population and before a vaccine or effective treatment is found.

"I think there is this sort of social psychological issue of exhaustion and frustration," said the Yale historian Naomi Rogers.

"We may be in a moment when people are just saying: 'That's enough. I deserve to be able to return to my regular life.'"

It is happening already; many countries have begun to reopen, in defiance of warnings by public health officials that such steps are premature. As the economic catastrophe wreaked by the lockdowns grows, more and more people may be ready to say "enough."

The challenge, Dr Brandt said, is that there will be no sudden victory. Trying to define the end of the epidemic "will be a long and difficult process."

Public health officials have a medical end in sight, but some members of the public see a social end. One might argue that the coronavirus is not only a plight, but may also seem a palaver at times; and that might just begin its end.