The internet era for pandemics

KEYWORDS:

• COVID-19
• internet
• pandemic
• SARS-CoV-2

The first epidemic for which historical reports exist is the ‘Plague of Athens,’ which burst into the city in 430 BC. The still unidentified pathogen responsible for this killer epidemic may have been a bacterium (e.g. typhus, typhoid, plague) or a virus (e.g. smallpox), but no symptomatology of diseases known to us today covers what is described in detail by the Athenian historian, Thucydides [1,2]. The epidemic killed about one fourth of the population (75–100 thousand), crucially contributing to the later defeat of Athens in the years-long Peloponnesian war against Sparta and its allies.

Historical killer epidemics continued in later centuries, including the major pandemic outbreaks of bubonic plague in the Middle Age and later. It is accepted that only three of these resulted, collectively, in the loss of more than 250 million people worldwide. Thereafter, in addition to several regional epidemics caused by different pathogens, the world has seen the post-Colombian import of European diseases into the Americas, and of syphilis to Europe (although the latter is nowadays doubted by some). The most recent major pandemics were the Spanish flu at the end of WW1 and, jumping into the present modern world, the emergence and spread of AIDS, which has already cost the loss of up to 45 million lives.

I suggest that most of these historic pandemics could be divided into two classes: the first one would comprise those that occurred before the discovery of antibiotics, while the second class would include the post-1930 ones, even if no direct causal therapies exist yet for epidemics that are due to viral infections (e.g. recurring flu epi- and pandemics, Ebola). I would say that AIDS should be considered the last globally important pandemic of the second class, while the present, COVID-19 pandemic should be mentioned as the first member of a novel, third kind: the Internet pandemics.

I base my conclusions on scientific papers and, also, crucially on information derived from international TV news shows, newspaper articles, and ‘dedicated’ internet texts such as blogs. Witnessing the reactions of the non-experts (broad public and, especially, politicians) to the emergence and spread of COVID-19 over the last year led me to the belief that the present situation represents a novel kind of pandemic.

Within weeks from the first indications that a ‘new virus’ created havoc in Wuhan, China in December 2019, not only had the virus spread to all continents but also real and fake stories had spread at a speed that was faster than the spread of SARS-CoV-2. According to some of the many conspiracy theories that I have read, the virus was ‘manufactured’ in China, often as the result of the ideas of specific – named – billionaires (depending on the originator of the theory), and for completely different reasons (again depending on the originator of the theory). Needless to say that the theories on the etiology of the disease were supplemented with diverse theories on its therapy and prevention, and accompanied by discussions on which one of those theories was closer to the ‘truth.’ Interestingly, these therapeutic and preventive measures were, at best, grounded on very preliminary observations, though in many cases they were based on neither scientific nor clinical evidence, and they were often linked to other conspiracy theories such as ones regarding vaccination.

This ‘PCR-like’ amplification of conspiracy theories and, often promoted by physicians and biologists who one would never describe as experts in virology or infectiology, and neither as epidemiologists or public health specialists, found its way, through a cataract of internet-based information, stemming from patients or ‘potential patients.’ Before studies were concluded, journalists and politicians ‘knew’ the answer to the pharmacological merit, useless or useful, of bleach, chloroquine, remdesivir, steroids, convalescent plasma, etc., and insisted that one or more of these be used.

In a sense, research on the COVID-19 pandemic can only be compared to the Gold rushes in the late 19th century: A search for ‘COVID-19’ on Pubmed on 18 December 2020 yielded 84,679 results, all published in less than one year. This compares to 98,654 results when searching for ‘malaria’ including entries already published in 1828. The present epidemic, up until 18 December, has resulted in ~1.45 million deaths as opposed to, historically, tens of millions of malaria victims. Interestingly, the number of Pubmed hits for 2020 for AIDS-related entries is presently 11,222 or about one eighth of that for COVID-19. Is it an abstruse thought that only the prospect of research funds has driven a large part of the research in the field?

The speed at which information and, importantly, misinformation travel nowadays has led to the second area of intense debate which involves both medics and life scientists, as well as politicians. While the former often do not include the economy and costs to society as factors of proposed measures aimed at restricting the pandemic, the latter are confronted by a public that are their potential voters. They are, thus, prone to decisions that will satisfy both these potential voters and groups of people (including some ‘medics’) that want to promote their own ideas without often admitting this.

I have witnessed, from the outside, of course, such discussions that a priori should be restricted among specialists but which, unfortunately, get out of hand because of their politicization. There are numerous examples from different countries that I could cite, such as President Trump and his promotion of chloroquine, the policies around testing in several countries (one included as protagonists the Editor of this journal and local politicians), the need or not for extensive lockdowns involving real experts, and the need to expand by more than 400% the number of ICUs in different countries. The ‘venue’ for such discussions are TV shows and daily newspapers. One should also mention that the political forces that oppose restrictive control measures, mostly because they deem them to be ‘undemocratic,’ are often located at the two extremes of the political spectrum, forming a virtual alliance that could, at best, be characterized as unusual. The extremist political position of the supporters has, inevitably, often led to violent clashes between protesters and police in several countries.

Health agencies in several countries have misreported the number of cases and deaths of the current pandemic, this way adding fuel to the fire. The sheer stupidity of politicians interfering for short-term political gains has been demonstrated about a century ago, when the number of deaths during the dengue epidemic in Athens in 1928 was underreported ~50% for the fear that the truth would impact negatively on the economy: only a couple of years later the real numbers were reported by the previous opposition that, by that time, had won the next elections.

I will conclude here, but I will refrain from giving any specific recommendations to my colleagues. I would only like to stress the fact that we should all be aware that the Internet, like almost all human inventions, should be used logically, as it can often ‘hit’ in a way contrary to what was intended. I only wish that everybody will soon ‘calm down’ and concentrate on mitigating the effects of this pandemic, such that not only the number of victims is reduced but people can feel ‘free’ again to live the life they want. Needless to stress that I do not blame the Internet as such, but its misuse. Misinformation and fake news have been linked to pandemics and epidemics since old times and the blaming of the Jews for the Black Death in 1348 and the ensuing pogroms is a tragic example [3]. Perhaps, we should all think about how we would have handled COVID-19 before the internet times and act accordingly.

Disclosure statement

I declare no competing interests.