Past pandemics and epidemics may hold lessons for how to tackle future ones, researchers say
Monday marks the third anniversary of WHO declaring COVID-19 a pandemic
It's been nearly three years since COVID-19 was declared a global pandemic. But while some Canadians' habits have changed significantly since the height of pandemic lockdowns, some historians are saying the concern is far from over.
"Those people who've moved on have decided … they've had enough, and they're fortunate, probably, that they haven't been too affected health-wise," said medical historian and author Dr. Jacalyn Duffin.
"But we still don't know the full dimensions of long COVID. We can't know what kind of long-term effects there will be. We're still in a process of discovery for those things," she told The Current's Matt Galloway.
Duffin is the author of COVID-19: A History, and has looked at how previous pandemics and outbreaks evolved — and different generations responded to them.
She said that epidemics and pandemics tend to be repetitive with similar stages and reactions, which can be an equally comforting and depressing thing to grapple with.
"There is the idea that, at first, there's panic and chaos," she said. "Then, there's a certain amount of denial at the beginning of a crisis.
"Then there's an episode of putting the shoulder to the wheel and getting on with it and dealing with it; and then there are various ways pandemics and epidemics end."
The way pandemics end is of particular interest now.
But according to Erica Charters, a professor of the history of medicine at the University of Oxford, history shows that the end of the COVID-19 pandemic as we know it probably won't be marked by the virus's complete eradication.
"The medical or biological ending, that's usually associated with the end of disease, although we did note that most epidemics don't actually end with no disease," she told Galloway.
"Instead, they end with something to do with diseases becoming endemic."
Various endings
Charters is the lead of Oxford University's How Epidemics End project, which launched in December 2020.
It brought together epidemiologists, historians and philosophers, among others, to examine how epidemics have ended in the past — and how the lessons learned might help them better tackle current and future epidemics.
Charters said that the project found that most epidemics end in three key types of ways — one of which is the medical or biological ending, when a disease becomes endemic.
"That is lowering to something that people call a kind of acceptable or normal rate," she said. "But of course, that involves a lot of debate over what that supposedly normal rate is."
As an example, she described how influenza ebbs and flows over time.
"Influenza is … a disease that we've lived with for hundreds of years, but it kind of comes up and down in waves," she said.
"When it has a high wave, we call it an epidemic because we see it as a kind of unacceptable level of disease."
An epidemic may also meet its political ending — which Charters said is usually characterized by regulations getting lifted or the disease no longer be considered a political crisis.
Finally, there's an epidemic's social ending, which could include "rituals of memorialization" to help bring communities that had recently been splintered due to the epidemic's stressful times back together.
[It's] about education and how we can communicate the danger and how we can keep that esprit de corps … alive when it will become necessary again.-Dr. Jacalyn Duffin, medical historian and author
All of these endings are important, says Charters. But she stresses that the ending isn't always the same for every country, province or city.
"If we think back to previous epidemics and pandemics, something like HIV/AIDS, that's very much the case," she said.
"[It's] a manageable chronic disease for many people in, say, wealthy parts of the world, but it's still really an ongoing, quite urgent medical problem for other parts of the world."
And like HIV/AIDS, people in different parts of the world may have reached a different point in their own COVID-19 timelines.
"It shouldn't surprise us, when we look either within our own society or if we look globally, to realize that people are dealing with very different disease burdens," she said.
"There are parts of the world in which they have what they see as more urgent and pressing problems [than COVID-19], and perhaps even more urgent and pressing problems even over the past two years than this pandemic."
Non-stop pondering
Although history can offer some insight as to how current pandemics could end, Duffin says it's impossible to predict what the next pathogen will be.
"We need to ... look at the things that worked and the things that didn't work very closely, so that we can derive new knowledge specific to our most recent experience with COVID," she said.
She added that this should now only be studied scientifically, but also from a social viewpoint.
"[It's] about education and how we can communicate the danger and how we can keep that esprit de corps … alive when it will become necessary again," she said.
And according to Charters, we'll need to continue to study how epidemics and pandemics — even after they subside.
"In our day-to-day lives, we're constantly living with disease," she said. "If we don't really pay attention to that everyday kind of chronic disease … then it becomes much harder to understand that actually, these epidemics are part of these long-term, longstanding patterns."
Audio produced by Alison Masemann.
