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Is COVID-19 the new plague?

written by Dr. Stephen A. Berger

A frightening pandemic arises from animals in Asia and spreads westward, killing thousands in Italy, France, Spain, and many other countries. The more severe infections are characterized by cough and fever, leading to progressive pneumonia. There is no specific treatment available, and entire cultures live in fear and uncertainty.  

And so, during 541-542 C.E. Yersinia pestis the bacterium that causes bubonic plague, spread out from China into the Byzantine Empire. Few were spared, and an estimated 25 to 100 million Europeans went on to die during repeated waves of infection that struck the region over the next 200 years. As many as 5,000 plague deaths per day were recorded in the city of Constantinople. This “Justinian Plague” is named for the Emperor Justinian, who managed to survive an attack of the illness (less-fortunate victims included Pope Pelagius II and Wighard, Archbishop of Canterbury) 

In recent years, much is written regarding the risk of the spread of infectious diseases related to global warming. In fact, there is some evidence that the Justinian plague was the product of global cooling. Five years before the onset of the pandemic, emissions from a volcano may have significantly lowered atmospheric temperature, resulting in the migration of rodents deprived of food. Fleas, which spread plague from rodents to humans, are unable to efficiently digest their blood meals at low temperatures, causing them to vomit as they attempt to feed again – injecting contaminated material into their hosts. 

The Justinian plague largely spared the Arabian Peninsula, thus nourishing the rise of Islam and Arab armies which easily went on to conquer large areas of a devastated Europe. 

From 1347 to 1351, a second plague pandemic – The Black Death – killed 75 to 200 million humans – an estimated ten-to-sixty percent of the European population. Once again, the disease originated in Asia, entering through Sicily on Genoese galleys, and reaching Venice in 1348. The irony of a pestilence from China spreading through northern Italy is obvious in light of current events. Just as the Justinian Plague claimed the life of Bishop Wighard, the Black Death killed two Archbishops of Canterbury in a single year – Thomas Bradwardine and John de Ufford.   

Just as the Justinian Plague altered the future of Europe, the Black Death may well have paved a path into the Renaissance.  

As of March 2020, there is little similarity between COVID-19 and Bubonic plague; but the current massive disruption of society will surely have consequences for human civilization in years to come.

Read more on the global status of Major Coronaviruses

Read more on the global status of Plague

Death By Corona: What Are the Numbers?

   This morning, we learned that actor Tom Hanks and his wife have contracted COVID-19 infection. Indeed, 43 famous persons have already been affected by the disease, including six Iranian leaders and four European soccer players. We might speculate that this reflects a single exposure event in Iran…or the fact that European athletes travel frequently in a high-incidence environment. Perhaps similar reasoning can be used to explain the striking variation in coronavirus death rates between countries.

As of March 12, 126,258 cases of COVID-19 had been reported worldwide; and 4,368 died of the disease – a case-fatality ratio (CFR) of 3.6%. This figure varies widely from country-to-country. Indeed, The CFR in Mainland China is 3.9% – vs. 3.2% of all other countries combined. Only 1.0% of infected passengers aboard the Diamond Princess cruise ship died of the disease. Among countries reporting more than 500 cases to date, the CFR (in descending order) is Italy 6.6%, Iran 4.3%, Spain 2.8%, United States 2.8%, Japan 2.5%, France 2.1%, United Kingdom 1.7%, South Korea 0.8%, Netherlands 0.8% and Switzerland 0.7%. Fatal infection is notably rare among the Scandinavian countries: Sweden 0.2%, Norway 0%, Denmark 0%. Finland, which has experienced 109 cases, has reported zero mortality.

The CFR in each country is largely determined by how the disease is identified, defined and reported. The quality, training professionalism and available resources available Health-Care workers will also influence case-finding and treatment; as will Demographic and cultural differences related to age, nutrition, access to local health facilities, lifestyle and exposure to animals. I suspect that much of this variation in CFR for COVID-19 is related to the very definition of “cases”. The death of an infected patient will be obvious and easily documented; while asymptomatic or relatively minor infections could remain undocumented. Indeed, the total number of “cases” used to calculate CFR might only represent those cases who are sufficiently ill to seek medical care. The patient with a mild febrile illness will not be “counted”

These questions can be easily solved using a standard serological survey in relevant communities. Such a survey should include a questionnaire regarding recent symptoms, exposure, occupation, etc. If a large proportion of the general population is found to be seropositive toward SARS-2 virus, we might conclude that the disease is less dangerous than current statistics seem to indicate.

Histoplasmosis in Travelers

In 2019, several Canadian tourists acquired histoplasmosis while exploring caves in Cuba.  The Gideon database maintains an ongoing record of all cross-border Infectious Diseases events, including importation of animals and foods associated with zoonotic disease. [1-3]

As of 2019, 76 episodes of histoplasmosis had been associated with travel, involving at least 574 individual cases (8 fatal).  18 of these events were related to cave exposure, including two involving caves in Cuba.  Four publications described acquisition of histoplasmosis by Canadian travelers – two involving cave exposure.

In the following screen-shot, the frame to the left displays an interactive chronicle of cross-border histoplasmosis.  Users can sort data by year of event, country of exposure / origin, etc.  In this example I’ve selected “Setting” in order to study cases related to “cave exposure.”  Additional details and electronically-linked references appear when the user clicks on “Show event notes”

References:

  1. Gideon Online.  www.GideonOnline.com
  2. Berger S. Histoplasmosis: Global Status, 2019. Gideon e-books, https://www.gideononline.com/ebooks/disease/histoplasmosis-global-status/
  3. Berger S. GIDEON Guide to Cross Border Infections, 2019. 256 pages, 134 tables, 4,543 references.  https://www.gideononline.com/ebooks/travel/

Note featured on ProMED

Filgen distributes GIDEON in Japan

Filgen logoWe are pleased to announce that Filgen (フィルジェン株式会社) will be selling GIDEON in Japan.

Filgen, Inc. was founded in 2004 at Nagoya, Japan.
Filgen is a leading company of life science in Japan and offers various and cutting-edge analysis services by utilizing many technologies such as microarray, mass spectrometer, and next generation sequencing. The company also provides many biological reagents, instruments, and bioinformatics software. In addition, the company manufactures and provides machines for the nano-scientific field.

More information from Filgen about GIDEON

GIDEON at the Charleston Conference

On November 2nd, GIDEON will be exhibiting at the Charleston Library Conference.

Please stop by table 32 and meet Dr. Steve Berger to say hi or answer any questions you have.

 

 

GIDEON July webinar

EBSCO publishing will be hosting a GIDEON Webinar next week with Dr. Steve Berger, co-founder and Chief Medical Officer of GIDEON.
The session will consist of a 30-minute overview of all of the GIDEON modules, followed by a 30-minute live hands-on demo / question and answer session. Please join in and pass this on to colleagues.

Topic: Global Infectious Disease Informatics and Decision Support – A Case Study – July 2015

Date: Wednesday, July 29, 2015

Time
7:00 am, Pacific Daylight Time (Los Angeles, GMT-04:00)
10:00 am, Eastern Daylight Time (New York, GMT-04:00)
3:00 pm, GMT Summer Time (London, GMT+01:00)

Sign-in details
1. Go to https://ebsco.webex.com/ebsco/onstage/g.php?MTID=e81d311b6d7045a4ef510d32022f2d53f
2. Click “Join Now”.

MLA 2015 – Austin TX – booth 507 #mlanet15

See GIDEON in action at the EBSCO Health booth #507 at the Medical Library Association annual meeting in Austin, Texas next week.

GIDEON Demo at Singapore Travel Conference

Dr. Steve Berger has been invited to demonstrate Gideon at the 9th Asia Pacific Travel Health Conference, to be held in Singapore during May 2 through May 5, 2012. His session will take place during Workshop 05 (“Resources in Travel Medicine”), on May 5, between 14:00 to 15:30. All Conference attendees will be offered a free copy of the new 2012 edition of Infectious Diseases of Singapore (395 pages, 111 graphs, 1,492 references). This is one of a series of Gideon e-books which summarize the status of every disease, in every country of the world.

Further information on the conference is available at:
http://www2.kenes.com/apthc/

GIDEON at IMED 2011 in Vienna, Austria

Dr. Steve Berger will be presenting GIDEON at the International Meeting on Emerging Diseases and Surveillance (IMED 2011) in Vienna, Austria on Saturday, February 5, 2011 at 7am.

See the program for the full schedule.

This will be a good chance to hear about both the GIDEON web application and the GIDEON ebook series.

As a bonus access to a free ebook ($49 value) will be provided.

GIDEON in Korea

Dr. Steve Berger will be presenting GIDEON this weekend at the BIT’s 1st World Congress of Virus and Infections 2010 (WCVI-2010)  in Busan, Korea.

He will be giving the keynote speech entitled “Informatics and Decision Support in Clinical Virology: A Global Web-based Program“.

Time: 14:10, August 1, 2010 (Sunday)

Place: Room No. 201, 2nd Floor, Convention Hall, BEXCO

Abstract:

A Global Web-based System for Disease Simulation and Informatics in the Field of Geographic Medicine

Stephen A. Berger, M.D.

347 generic infectious diseases are distributed haphazardly in time and space; and are challenged by 342 drugs and vaccines. Over 3,000 pathogenic bacteria, viruses, parasites and fungi have been described in human disease. An ongoing project for decision support and informatics will serve as a paradigm to demonstrate an approach to web-based systems for Geographic Medicine. The first module in the program generates ranked differential diagnoses based on signs, symptoms, laboratory tests, exposure history, country of acquisition and incubation period; and can be used to diagnose or simulate any infectious disease scenario. Additional capabilities include bioterrorism simulation and syndromic surveillance. The second module follows the epidemiology of individual diseases, including their global status and occurrence in each endemic country. As of 2010, this module contains 3 million words of text in 18,500 country-specific text notes; 32,095 graphs; 5,100 images (clinical, microscopic, life cycle, etc); 345 maps; 150,000 linked references; 10,200 outbreaks and 21,101 disease prevalence and serosurveys. The third module follows the pharmacology and usage of all anti-infective drugs and vaccines. The fourth module is designed to identify and characterize all species of bacteria, mycobacteria and yeasts. Application of such systems for use in diagnosis, surveillance and education will be discussed. Since all data in the program are generated at the server level from modular sources in electronic spread sheets, a subprogram has been designed to generate entire text-books (e-books) on the diseases of individual countries and diseases. At present, 411 such books (95,000 pages) have been generated – all of which will be updated yearly.

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