A pandemic is essentially an intercontinental epidemic. Since early 2020, the world has experienced the pandemic known as Covid-19, caused by a coronavirus. It’s the most serious pandemic in a century, since the world was swept by the Spanish Flu (which did not start in Spain).

Epidemiologists have known for many years that we would experience a pandemic, so humanity was not entirely taken by surprise. Over the last couple of decades, local epidemics have broken out and were contained; they introduced several candidates for the next pandemic.

Covid-19 seems to have originated in a virus mutation in animals, capable of jumping to humans when the animal was handled. Some researchers think it began in pangolins in a wet market somewhere in China. A disease originating in some animal that jumps to humans is called ‘zoonotic,’ and it’s actually quite common. Something like 75% of emerging diseases are zoonotic. An example of past zoonotic diseases includes smallpox and the bubonic plague.

Perhaps the scariest candidate for the next pandemic is Ebola. The virus spreads through direct contact with infected body fluids such as blood, urine and feces. This makes it particularly dangerous in developing areas that do not yet have adequate sanitation systems. Ebola has occasionally broken out in several African nations, including Burundi, Ghana, Rwanda, Uganda and Zambia, with its origins in the Democratic Republic of Congo (DRC).  In 2014 an outbreak in West Africa accounted for more than 28,000 cases, and claimed more than 11,000 lives. That’s a fatality rate of nearly 40%, compared to the 1% to 2% of Covid-19.

Another candidate for the next pandemic is Marburg Virus, from the same virus family. It carries the name of a German town where the accidental release of the virus in a lab killed several researchers. There has not yet been a substantial outbreak, although in 2005 in Angola there were about 200 cases. The overall fatality rate is simply not known, but it so far hovers around a 90% fatality rate.

Yet another candidate is Lassa Fever. This is a hemorrhagic fever that damages internal organs, like both Marburg and Ebola. It is often transferred by contact with the urine or feces of mastomys rats (native to Africa). Lassa does not conform to the outbreak and suppression model. It regularly occurs in West Africa, with perhaps 100,000 to 300,000 infections a year. Its impact is not well known; the fatality rate is estimated between 1% and 15%, with a current annual toll of about  5,000 deaths.

There are other candidates. One is MERS-COV, Middle Eastern Respiratory Syndrome. There is a vaccine being developed. The condition was identified in 2012 in Saudi Arabia. So far there have been about 2,500 known infections with more than 800 deaths. Another, this time in South Asia, is Nipah. This disease was identified in 1998. Nipah is associated with close contact with pigs and bats. An outbreak in Kerala in India in 2018 was quickly contained. Nipah may kill up to 75% of infected people. Other candidates include SARs (which broke out in 2003 in 37 nations) and Zika. Zika is a mild disease but is very dangerous to pregnant women and their fetus; it emerged in 2016 in Brazil.

Many dangerous diseases stem from animal-human contact. The problem is intensifying as environmental degradation has led to increased contact between humans and wildlife. Domestic animals can also be dangerous. Swine flu is carried by pigs, avian flu by birds, MERS can be carried by camels and yellow fever appears to be switching from humans to monkeys and back.

There will be another pandemic, that much is certain. Pandemics cannot be avoided. What we can do is be medically alert to possibilities, and when something seems to be starting, we need to know about it immediately and start to counter it as soon as possible. That requires international cooperation, and considerable investment of medical equipment and personnel in the developing countries where these candidate diseases primarily exist.

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