Pandemics and education: A historical review.

Major pandemics have tremendous effects on society. They precipitated the early decline of the Western Roman Empire and helped spread Christianity. There are countless such examples of infectious diseases altering the course of history. The impact of epidemics on education however is less well documented. This present historical account of the past 800 years looks specifically at how some aspects of education were shaped from the early medieval epidemics such as leprosy and the Black Plague to the Spanish Flu and COVID-19. Leprosy changed religious education, and the Black Plague may have contributed to the rise of medical schools, hospitals, public health education, and led to the implementation of lazarettos and the quarantine. The smallpox epidemic helped usher in public health education for immunization, while the 1918 Spanish Flu precipitated the rise of education by correspondence, and recently COVID-19 has catapulted remote digital learning to the forefront of higher education.

Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine.

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.

Devastating epidemics in recent ages Greek populations

In the recent Greek ages the most devastating epidemics were plague, smallpox, leprosy and cholera. In 1816 plague struck the Ionian and Aegean Islands, mainland Greece, Constantinople and Smyrna. The Venetians ruling the Ionian Islands effectively combated plague in contrast to the Ottomans ruling all other regions. In 1922, plague appeared in Patras refugees who were expelled by the Turks from Smyrna and Asia Minor. Inoculation against smallpox was first performed in Thessaly by the Greek women, and the Greek doctors Emmanouel Timonis (1713, Oxford) and Jakovos Pylarinos (1715, Venice) made relevant scientific publications. The first leper colony opened in Chios Island. In Crete, Spinalonga was transformed into a leper island, which following the Independence War against Turkish occupation and the unification of Crete with Greece in 1913, was classified as an International Leper Hospital. Cholera struck Greece in 1853-1854 brought by the French troops during the Crimean War, and again during the Balkan Wars (1912-13) when the Bulgarian troops brought cholera to northern Greece. Due to successive wars, medical assistance was not always available, so desperate people turned many times to religion through processions in honor of local saints, for their salvation in epidemics.

Microbial Genomics of Ancient Plagues and Outbreaks.

The recent use of next-generation sequencing methods to investigate historical disease outbreaks has provided us with an unprecedented ability to address important and long-standing questions in epidemiology, pathogen evolution, and human history. In this review, we present major findings that illustrate how microbial genomics has provided new insights into the nature and etiology of infectious diseases of historical importance, such as plague, tuberculosis, and leprosy. Sequenced isolates collected from archaeological remains also provide evidence for the timing of historical evolutionary events as well as geographic spread of these pathogens. Elucidating the genomic basis of virulence in historical diseases can provide relevant information on how we can effectively understand the emergence and re-emergence of infectious diseases today and in the future.

[History of human epidemic and endemic diseases in the southwest Indian Ocean]. / Histoire des épidémies et des endémoépidémies humaines dans le sud-ouest de l'océan Indien.

Smallpox has been known in the Mascarene Islands since 1729, and in 1898, the vaccinogenic and anti-rabies Institute of Tananarive, the future Pasteur Institute of Madagascar, was created to combat it. Cholera first arrived in the Mascarenes in 1819, but did not affect the Comoros Islands and Madagascar until the current pandemic. Bubonic plague has beset the ports of Madagascar and the Mascarenes since 1898. Girard and Robic developed the anti-plague vaccine in 1931 at the Pasteur Institute of Madagascar. The Mascarenes lost their reputation as Eden when malaria arrived in 1841, and this disease remains prominent in Madagascar and Comoros. Leprosy has been known in La Réunion since 1726 and is still very present in Mayotte, Anjouan, and Madagascar. Leptospirosis is a public health problem, except in Madagascar and the Comoros. Dengue, chikungunya, and Rift Valley fever are also present. HIV/AIDS is not a major concern, except in Mauritius, where it was spread by injection drug use, in the Seychelles and in Madagascar's largest cities. Madagascar is the principal site worldwide of chromoblastomycosis, first described there in 1914.

Insights from genomic comparisons of genetically monomorphic bacterial pathogens.

Some of the most deadly bacterial diseases, including leprosy, anthrax and plague, are caused by bacterial lineages with extremely low levels of genetic diversity, the so-called 'genetically monomorphic bacteria'. It has only become possible to analyse the population genetics of such bacteria since the recent advent of high-throughput comparative genomics. The genomes of genetically monomorphic lineages contain very few polymorphic sites, which often reflect unambiguous clonal genealogies. Some genetically monomorphic lineages have evolved in the last decades, e.g. antibiotic-resistant Staphylococcus aureus, whereas others have evolved over several millennia, e.g. the cause of plague, Yersinia pestis. Based on recent results, it is now possible to reconstruct the sources and the history of pandemic waves of plague by a combined analysis of phylogeographic signals in Y. pestis plus polymorphisms found in ancient DNA. Different from historical accounts based exclusively on human disease, Y. pestis evolved in China, or the vicinity, and has spread globally on multiple occasions. These routes of transmission can be reconstructed from the genealogy, most precisely for the most recent pandemic that was spread from Hong Kong in multiple independent waves in 1894.

The plague of the Philistines and other pestilences in the Ancient World: exploring relations between the religious-literary tradition, artistic evidence and scientific proof.

In ancient times the term pestilence referred not only to infectious disease caused by Yersinia pestis, but also to several different epidemics. We explore the relations between references in the Bible and recent scientific evidence concerning some infectious diseases, especially the so-called Plague of the Philistines and leprosy. In addition, some considerations regarding possible connections among likely infectious epidemic diseases and the Ten Plagues of Egypt are reported. Evidence suggesting the presence of the rat in the Nile Valley in the II millennium BC is shown; a possible role of the rat in the plague spreading already in this historical period should be confirmed by these data. While the biblical tale in the Book of Samuel may well report an epidemic event resembling the plague, as to date this infectious disease remains unknown, it is not conceivable to confirm the presence of leprosy in the same age, because the little palaeopathologic evidence of the latter disease, in the geographic area corresponding to Egypt and Palestine, is late, dating back only to the II century AD.

[Health service organization during the age of pestilence. 2]. / Excursus sull'organizzazione dell'assistenza in tempi di pestilenza. Seconda parte.

The author presents the history of the places where patients with epidemic pathologies were isolated. Since the study of medicine began, such places have been known as asclepiei, xenodochi, hospices, lazarettos, sanitary cordons, and quarantine stations and they contributed to controlling epidemics in Europe. Important not only in the context in which they were created, these structures expressed the medical culture and point of view of that age. Although very far from discovering the cause of the pathology due to their lack of scientific knowledge, the medical class sometimes knew how to effectively organize the isolation of patients. The history of such structures interweaves with the long history of Christianity and with the emerging nations of Europe and the city-states of the Italian Renaissance. Previously, in classical Greece and Imperial Rome there had also been "homes for the sick" to isolate patients. Today the world is periodically hit by epidemics. In such moments the medical profession uses its research ability and organizational capabilities but also historical memory to reduce epidemic contagion.

[Ecological interactions among Yersinia in their common reservoir, the rodent]. / Interactions écologiques des Yersinia au sein de l'hôte réservoir commun, le rongeur.

Plague, due to Yersinia pestis, is still active in various foci in the Americas, in Africa and Asia, whereas it has been absent from Europe since the end of the 18th century, after having killed the two-thirds of the continent's inhabitants within four centuries. Various hypothesis have been proposed to attempt to explain the spontaneous "eradication" of plague from Europe, including the improvement of hygiene and habitat, changes in the rat population and cross-immunity induced by other infections, such as salmonellosis, leprosy and other yersiniosis. The only Yersinia currently isolated in Europe are the species genetically related to Y. pestis, Y. pseudotuberculosis and Y. enterocolitica, which are less virulent and mostly enteropathogenic. Y. pestis and Y. pseudotuberculosis have a DNA relatedness of 90%, whereas it is of only 60% with Y. enterocolitica. Y. pseudotuberculosis has been used as efficient vaccine against plague. Present world epidemiological data show that Y. enterocolitica is progressively replacing Y. pseudotuberculosis. Experimental infection by Y. enterocolitica, inducing a transitory and spontaneously cured infection in the immunocompetent host, only inducing opportunistic infections in the immunodeficient host, promotes efficient immunity against plague. Thus, it seems likely that the emergence of some variants of Yersinia, less virulent than Y. pestis, but able to induce a long-lasting protective immunity against plague, have contributed to its eradication by a silent enzootic infection among the wild reservoirs of rodents.

[History of the changes in infectious diseases]. / Erkenntnisse zum Wandel von Infektionskrankheiten.

The spectrum of infectious diseases is not at all constant, it changes. This statement is relevant for the great epidemics as well as for nosocomial infections and simple infectious processes. The epidemiological situation of plague, lepra, cholera and diphtheria is discussed. As concerns nosocomial infections four periods are separated: the time before Semmelweis and Lister, the period of the introduction of antiseptic/aseptic measurements to the hospitals and the chemotherapy-time (period until 1965) and the time afterwards. The spectrum of nosocomial infections and its changes as observed in the Cologne area are presented. But also the types of a certain bacterial species are changing as discussed on the example of S. aureus phagetype 80/81. As far as known factors involved in these changes are mentioned. The increasing use of plastic materials in medicine (i.e. intravenous catheters, Spitz-Holtershunts, hipps, valves, etcetera) is the cause of infectious complications, S. epidermidis being the dominant organism.

[Incidence of bacterial diseases (author's transl)]. / Incidence des affections bactériennes.

Bacterial diseases world incidence figure is not easily reckoned on account of the lack of reliability from original notifications. However the present situation is characterized by: --the regression of diseases under International Health Regulations; --the great diffusion of sexually transmitted diseases; --the keeping-up of the activity of digestive or respiratory transmitted disease, including tuberculosis.