AIDS Death toll rising


  1. AIDS running amok

2. Divining an undivine future

3. Past plagues


King Edward Hospital in Durban, South Africa, where the infection rate among children had soared to 35 percent in 2000. At least 50 percent of adults seen at the hospital are infected. USAID.


Parallels to the AIDS epidemic?
Smiling nurse holds scared-looking baby.As AIDS reaps yet more victims, we wonder if a look back at some earlier pandemics may help understand how disease outbreaks can change history.

1.) JUST JUSTICE Justinian's plague (540-590). Emperor Justinian was trying to rebuild the Roman Empire, with headquarters in Constantinople (modern-day Istanbul). Then a plague stepped in, killing, some historians say, up to 100 million people. The plague is commonly assumed to have been bubonic plague, caused by the bacterium Yersinia pestis, but there's no proof.

The resulting power vacuum allowed Goths, Franks and other northern "barbarians" to divide the Roman Empire, ushering in the Dark Ages. However, the resulting labor shortage may have led to the elimination of slavery.


Black Death, Standard Narrative: Rats infected with bubonic plague (Yersinia pestis) carried fleas into Europe about 1346. The fleas bit and infected people. The rats moved around. By 1350, the agonizing black sores caused by bubonic plague had killed about one-third of Europe's population, reaching as far as Greenland. Successive waves of plague caused further devastation.

Black Death, Revised Narrative: Nobody questions whether black death killed millions, but was it bubonic plague? Not according to skeptics who point to inconsistencies between black death and bubonic plague. (The best information on bubonic plague comes from the well-studied Yersinia pestis epidemic in China and India that started about a century ago.)

The Why Files talked to Samuel Cohn, a professor of medieval history at the University of Glasgow, and author of The Black Death (see bibliography), who told us that the natural history of plague does not match what's known about black death.

Survivors gained immunity to black death, but not to bubonic plague.

Black death was worst in Italy's hot summers, when rats and fleas were presumably inactive. "In the Mediterranean, where I concentrate, black death peaks consistently at the lowest ebb in the rat-flea fertility cycle," says Cohn. "If it was modern bubonic plague, it occurs at the least likely moment. That's confirmed everywhere in Europe."

Black death spread something like influenza, but killed faster. It may have been a hemorraghic fever, perhaps a relative of Ebola.

Rather than being spread by ticks, black death may have spread through the air, like influenza.

Although Cohn is convinced that black death was not bubonic plague, we've also read reports that DNA from bubonic plague -- Yersinia pestis -- has been recovered from the teeth of victims of black death.

We'll let the experts duke that out and shift to a more pertinent question. What was the historic impact of so much dying? Was, as Cohn asserts, the black death a key to the Renaissance?

The first outbreak, in 1346, caused 'massive mortality," says Cohn, "and the doctors themselves say 'it's beyond our power, we can do nothing about it.' You got the burning of Jews, processions of [religious] flagellants in 1348."

But when a second wave of black death arrived a few decades later, the survivors' immune systems were primed to fight back, affecting both death rates and psychological responses. For more than a century, Jews were not thrown into wells as vengeance, Cohn says, and the medical profession also gained stature.

Death rates are expected to soar in Asia, followed by Latin America. Sub-Saharan Africa, where death rates are already high, the relative increase will be smaller.
These trend lines are sobering enough, but the authors of this report say they underestimate actual death rates. The projections are by Murray & Lopez (1996), Bongaarts (1996) and the Global AIDS Policy Coalition (Mann and Tarantola 1996). CIA.

Observers, he says, quit "saying that doctors are fools. Instead, they start recommending their recipes [to avoid plague]." These recipes, contained in early books called "plague tracts," became "an explosion of a new form of popular literature" which helped spur publishing, a key industry of the early Renaissance.

Plague tracts "become a new form of literature about sanitary behavior, how you should wash your hands with hot water and blow your nose to prevent catching disease from someone else," says Cohn. "They talk about how priests should hear confessions from outside the window ... or come in with a sponge over the mouth."

While popular literature, wills, and writings of intellectuals all show "a new sense of optimism, hope and hubris," says Cohn, "the forerunner of this new sentiment is the plague doctors, who ... have this sense of conquest over nature. They are the first ones in Western civilization, I am convinced and have not been disproven, who say 'we have gone beyond the ancients in a secular branch of knowledge.'"

As plague lost some potency, Cohn continues, it became logical to question the sacrosanct "scientific" utterances of long-dead physicians like Galen. The reduced death toll, he stresses, 'was because of the human immune system, but they read it as their success. It built new a confidence of their ability to conquer nature."

A mistake, perhaps, but a beneficial one, Cohn concludes. "It's remarkable, and [historians] have not been able to deal with it successfully: the relationship of Europe's most monumental mortality, and following on its heels is the Renaissance." Epidemics can redraw the map of the world.

When Spaniards arrived to conquer the Western Hemisphere in the wake of Columbus, they carried a weapon more fearsome than the galleon or the musket. It was the smallpox virus, and it proceeded to wipe out 80 or 90 percent of the Amerindian population.

The smallpox virus is sometimes called the deadliest human pathogen in history, but the Spaniards, had, through generations of exposure, gained immunity. They also were immune to measles, another virus that hitchhiked on their galleons.

The smallpox epidemic turned the world of the survivors upside down, says Neil Whitehead, a professor of anthropology at University of Wisconsin-Madison, who has studied the aftermath of the epidemic. "It was a holocaust, deaths in the range of 80 percent to 90 percent within five years of arrival. It's hard to understand how that would not have changed everything."

Many, including William McNeill, author of the pioneering book Plagues and Peoples (see bibliography), think the Indians concluded that the Europeans were exempted from the epidemic due to a special status with the gods. That feeling, says McNeill, paved the way for the adoption of European religions, a key component in the colonists' toolkit for pacifying natives.

Whitehead, however, says the epidemic "left a deep suspicion of western ways, which were dangerous. It gave strength to military, aggressive postures, the feeling that it's a pretty tough world out there."

Over the long term, he says, the holocaust "has lead to this view of seeing the cosmos as very predatory, and not accepting that there is natural death. Even for people who now understand the transmission of smallpox, there is always a moral cause of disease. Why me? Why now? Why here? It's the enmity of others that causes disease."

On a geopolitical scale, he adds, the effects were drastic. While Africans, Europeans and Asians were more or less immune to the killers that devastated the Amerindians, native Americans were completely susceptible.

As a result, the Spanish, English, French and Portuguese had an easy time conquering the New World and colonizing it for hundreds of years. Elsewhere, the story was different, Whitehead says. "Colonization did not happen like this in Africa or Asia. They are still full of intractable people, the conquest was not as complete."

More on smallpox as a bioweapon.

Rates are rising fastest in Estonia and the Russian Federation, with Ukraine and Latvia close behind.
The AIDS epidemic is quietly exploding in Eastern Europe. As Africa showed, rates like these can quickly mushroom into catastrophe. UNAIDS 2002 "Barcelona" report, p. 35.

Less to be learned?
It's a tad disappointing. Despite their role in ending the Roman empire or repopulating the Americas, it's tough to find the lessons of past epidemics.

So much has changed. In this era of fast transportation, infections can act on a global scale. HIV is an unusual pathogen which, as far as we know, produces no immunity and no cures. And it kills so slowly that infected people can move long distances, spreading disease as they go.

As a slow-acting killer transmitted by sexual contact (and exchanges of bodily fluids), AIDS can best be compared to syphilis. Yet that illness was never deadly enough to change demographic statistics.

In seeking to illuminate the future by looking at the past, we found one disturbing lesson. In terms of social, political and economic changes, tiny bugs play second fiddle to no historic force. (Meet the fungus that changed Irish history.)

Look at a map of the Americas, with all those names rooted European languages. The map illustrates most sobering message of all. A major pandemic can redraw the map of the world.

Get help in our AIDS bibliography.




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