The first cases of what we now call COVID-19 were reported to the World Health Organization on 31 December, 2019 from Wuhan, China.

By 22 January, 2020, cases had been reported in Thailand, Japan, China, South Korea, Taiwan and the USA. By 26 January, Australia and Canada joined the list, and by 31 January, Italy, Sweden, Russia and the United Kingdom had cases too.

Many early Wuhan cases had connections with nearby Huanan Seafood Wholesale Market, but not all. Genomic sequencing suggests the first case probably occurred in November 2019. “Patient zero” remains unknown.

The spread of COVID-19 into Italy and the rest of Europe is an uncanny echo of “The Black Death”, or the Great Mortality. This bubonic plague outbreak changed the medieval world beyond recognition. 

The first historical record of bubonic plague is found in Central Asia around 1338. By 1346, it had reached China and India, and, by 1347, it was at Kaffa on the Black Sea (now Feodosia).

The infection was carried to Messina in Italy by a fleet of Genovese merchant ships. The harbourmasters tried to quarantine the crews but were too late; within a few days the pestilence had spread. Many residents fled, taking the disease with them.

Historical records and accounts help trace the plague’s progress through France, Castile, Portugal, England, Germany, Norway, and Russia. In the Middle East, the route encompassed Alexandria, Gaza, Lebanon, Syria, and Israel. Records also show Mecca and Mosul were infected, while Baghdad endured a second outbreak.

It’s widely believed that the Great Mortality started with rats or fleas, although some historians believe it began with infected marmots in Hubei Province. Still others pinpoint the Steppes of Central Russia as the likely origin.

Between 1346 and 1353, Black Death caused an estimated population loss in Europe alone of between 30% and 60%. It remains the pandemic with the highest mortality rate in history. 

Between 1852 and 1860, cholera spread along the Ganges River Delta before reaching Asia, North America, Africa, and Europe. The 1854 Soho outbreak began on 31 August. Within just 10 days there were over 500 deaths within 250 yards of the water pump at the junction of Broad Street and Cambridge Street.

Using hospital and public records, local physician Dr John Snow plotted fatalities on a geographical grid, tracking cases to local businesses, pubs, restaurants, and schools. He also tracked down details of those who had escaped cholera, noting whether they had used the pump.

A nearby workhouse and brewery both had their own wells. Cholera cases there were practically non-existent. A local factory had tubs of Broad Street water available for staff; 16 workers were lost. An aunt and her niece died some distance away; Snow learned that the aunt had often had bottles of pump water delivered, including on the 31 August 1954.

Snow persuaded reluctant town officials to remove the pump’s handle, making it impossible to draw water. The outbreak stopped almost at once.

Snow deduced the initial cause from a paper by Reverend Henry Whitehead. A mother from Broad Street had contaminated the pump when she washed her child’s diapers in a leaky cesspool nearby. The child had contracted cholera elsewhere.

Some military doctors in Europe were already reporting cases of a virulent influenza as early as 1917, but it is not known exactly where “Spanish” flu began. What is known is that H1N1 originated in birds. The first recorded case in America was spring 2018 when Fort Riley cook Albert Gitchell reported sick for duty.

Road, rail and sea routes used for troop transport, together with trade routes, spread the flu rapidly. It’s thought over 500 million people became infected – around a third of the population. Somewhere between 20 and 40 million perished. It was the worst pandemic in 20th century history.

Other notable outbreaks include Flu Pandemics in 1889-1890, 1956-1958, and 1968-70, and the sixth Cholera Pandemic in 1910-11. Between 2002 and 2004, severe acute respiratory syndrome (SARS) broke out twice, leading to potentially life-threatening and highly contagious forms of pneumonia.

The 2002 SARS-CoV spread rapidly to other Asian countries, with cases in the UK and Canada. The pandemic was controlled in July 2003, via strict isolation and screening techniques. Around a decade later, bats were identified as the reservoir of the SARS-CoV virus. The probable conduit of the disease to humans was a small carnivore, perhaps the palm civet.

The 2004 outbreak was linked to direct contact with a virus sample in a medical laboratory facility in China. In 2009, the H1N1 virus caused the Swine Flu outbreak, while in 2015, South Korea suffered an outbreak of Middle East respiratory syndrome - MERS-CoV. There were 185 laboratory-confirmed cases in the Republic of Korea, and 1 in China, with 38 recorded deaths. 

We now know that SARS-CoV-2, which causes COVID-19, is closely related to SARS-CoV, identified in November 2002 in Guangdong province, China. There is also strong evidence for a link from SARS-CoV-2 to pangolin and bat viruses.

Virologist Shi Zhengli (aka the “bat lady”) has extensive knowledge of bats and their diseases. She and her team discovered that SARS-CoV-2 is 96% identical to a coronavirus identified in horseshoe bats in Yunnan. Research was published in Nature, February 2020. 

While our modern-day pandemic mapping resources are astonishingly sophisticated, well-honed observation and detection skills remain essential. Some countries have already harnessed the power of our mobile phones, and others are considering it.

Mapping how diseases spread, and where they’ve come from, and back-tracking to the most likely point of origin, are essential steps in trying to work out how to cope in our never-ending battle with pandemics.

Disclaimer: The available evidence for COVID-19 is evolving constantly. The information in this article relating to COVID-19 was correct at the time of writing, 27 March 2020. 

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