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  • The first world war was among the deadliest conflicts in history and killed more than 20 million people.

  • But an outbreak of flu that began as the war ended, turned out to be far more destructive.

  • It was known as the Spanish Influenza, and infected one in three humans on earth.

  • It was the worst pandemic in modern history and claimed the lives of between 50 and 100 million people.

  • Now, as a new strain of coronavirus spreads across the world, when does a disease become a pandemic and if it does, what happens next?

  • Disease experts use the term "pandemic" when a new infection spreads to multiple countries and continents at the same time, affecting many people.

  • That's different from another term, epidemic, which describes an infection outbreak that's larger than usual, but stays confined to a single location or region.

  • So when does a disease officially become a pandemic?

  • The World Health Organization is the body that decides when an infectious disease formally becomes a pandemic, but that choice is not always black and white.

  • The group's director-general says the WHO assesses whether to use the word "pandemic" by evaluating three things.

  • First is the geographical spread of the virus.

  • Second is the severity of the disease caused by the virus and lastly, the societal impact of the disease.

  • A disease is more likely to become a pandemic if it is caused by a new strain of a virus, as is the case with Coronavirus Disease 2019 or COVID-19.

  • The ease with which it infects people and spreads from person to person also play a role in the designation.

  • Past pandemic outbreaks have typically originated from animal viruses, before crossing over to humans.

  • These can spread rapidly around the world because people do not have the immunity needed to fight the new infection.

  • COVID-19 was declared a pandemic in March 2020, the sixth pandemic declared in about a century.

  • The 1918 Spanish flu was easily the deadliest flu pandemic of the 20th century, killing tens of millions of people.

  • The Asian flu outbreak followed in 1957, killing roughly 1.1 million people around the world.

  • Thankfully scientists were able to develop a vaccine quickly, effectively containing its spread.

  • Another influenza outbreak, the Hong Kong flu, started to spread from China in 1968.

  • It was caused by a compound virus, which combined the Asian virus from ten years earlier with a form of bird flu.

  • It killed around one million peoplemost of them older than 65.

  • HIV, which was first identified as the virus behind AIDS in 1983, was also considered a pandemic.

  • The human immunodeficiency virus severely damages the cells in your immune system and weakens your ability to fight everyday infections and disease.

  • In the past 40 years, it's killed 35 million people worldwide, about half of the people who were infected by the virus.

  • Then in 2009, a new outbreak, initially called the swine flu, was named a pandemic.

  • It infected nearly 61 million people, and experts estimate it killed up to 575,000 people in a single year.

  • The WHO declared the pandemic over in August 2010, but the virus has continued to circulate as a seasonal flu ever since.

  • In recent years, the WHO has changed how it decides whether an outbreak constitutes a pandemic, following criticism that the threat of the 2009 swine flu had been exaggerated.

  • Many governments stockpiled vaccines which ultimately went unused, while pharmaceutical companies profiteered from the ensuing panic.

  • The disease turned out to be milder than was originally thought.

  • Since then, the WHO has released a guide to manage flu pandemics at a national and international level.

  • According to its pandemic preparedness plan, national governments are required to follow specific protocolsif a pandemic is declaredto prevent or reduce the spread of a virus.

  • For instance, authorities at a regional and local level must fully mobilize health systems, hospitals and medical workers.

  • In addition, healthcare providers must plan for a surge in patients, and offer protective equipment to their workforce.

  • Governments must also limit social interaction, initiate quarantine measures and enforce isolation procedures.

  • Upgrading a disease to a pandemic outbreak also has psychological implications for how we think about a disaster.

  • According to the WHO "using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma."

  • Six months before the latest coronavirus outbreak, a WHO report noted that "many countries still lack a national pandemic influenza preparedness plan."

  • So what are the economic costs of a pandemic?

  • A previous coronavirus strain called SARS, which was detected in 2002, wasn't widespread enough to become a pandemic.

  • While it only infected more than 8,000 people, it still cost the global economy more than 50 billion USD in 2003.

  • You see, advances in medicine, communication and technology have brought mortality rates down.

  • But greater trade flows and cheaper air travel have seen the world economy become ever more interconnected and that causes the costs of a pandemic to rise.

  • A report now estimates that a pandemic will cost 570 billion USD a year.

  • That represents 0.7 percent of the world's total income.

  • A pandemic can overwhelm global health systems.

  • It can also force infected individuals to avoid the office or work less productively.

  • The fear of infection spread forces people to stay apart.

  • And that can be even more debilitatingshutting down schools, businesses and public services.

  • Insurance companies must also watch developments closely.

  • A pandemic can mean more travel claims, more hospital claims and choke up global supply chains.

  • The impact on corporate earnings can then cascade into financial markets all around the world.

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The first world war was among the deadliest conflicts in history and killed more than 20 million people.

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