For many, the challenges brought by the rapid spread of COVID-19 is unknown territory. This is not to say that India is completely unfamiliar in dealing with epidemics and public health crises, some with exceptional success. Here’s a list of the epidemics that have occurred in the country since the 1900s.

What is an epidemic?

The World Health Organisation defines epidemics as the occurrence in a community or region of cases of an illness, specific health-related behaviour, or other health-related events clearly in excess of normal expectancy. The community or region and the period in which the cases occur are specified precisely. The number of cases indicating the presence of an epidemic varies according to the agent, size and type of population exposed, previous experience or lack of exposure to the disease, and time and place of occurrence. Epidemics are characterised by the rapid spread of the disease across a large number of people within a short period of time.

Encephalitis lethargica (1915-16)

* Encephalitis lethargica, also known as lethargic encephalitis, was a type of epidemic encephalitis that spread around the world between 1915 and 1926.

* The disease was characterised by increasing languor, apathy, drowsiness and lethargy and by 1919, had spread across Europe, the US, Canada, Central America and India.

* It was also called encephalitis A and Economo encephalitis or disease.

* The research goes on to say that it spread across Europe in 1917 after having first been discovered in Vienna in the same year. However, despite being witnessed in an epidemic form in Europe between 1917 and 1929, it was still “sporadic” in India by 1929.

* This virus appeared to spread through nasal and oral secretions.

* Approximately 1.5 million people are believed to have died due to this disease.

Spanish flu (1918-20)

* This epidemic was a viral infectious disease caused due to a deadly strain of avian influenza.

* The spread of this virus was largely due to World War I which despite drawing to a close by the time the epidemic had peaked caused mass mobilisation of troops in various parts of the world, whose travels helped spread this infectious disease.

* The death toll was significantly more than 50 million people.

* In India, approximately 10-20 million people died due to Spanish flu, which was brought to the region by Indian soldiers who were part of the war.

* During this pandemic, however, records show that word spread of the dangers of the disease, through official government channels as well as word of mouth.

* People began taking basic precautions of engaging in forms of social distancing and limited travel, perhaps contributing to the disease eventually tapering off in India.

Cholera pandemic (1961-75)

* Vibrio cholerae, one type of bacterium, has caused seven cholera pandemics since 1817. In 1961, the El Tor strain of the Vibrio cholerae bacterium caused the seventh cholera pandemic when it was identified as having emerged in Makassar, Indonesia.

* In a span of less than five years, the virus spread to other parts of Southeast Asia and South Asia, having reached Bangladesh in 1963 and India in 1964.

* In India, researchers have observed in academic papers that Kolkata’s climate and location in the Gangetic delta, including poor practices in water sanitation, make the city a hotbed for cholera and this pandemic was no different.

* From South Asia, it spread to West Asia, North Africa and then onwards to Europe. In this case as well, decreasing levels of sanitation, increasing populations and increased international travel contributed to the spread of bacteria across the world.

* By the 1970s, the bacteria had spread to Japan and the South Pacific.

* Medical research suggests that by 1991, it had spread to Latin America, where it killed approximately 10,000 people in Peru alone.

* By that time, the number of reported cases around the world totalled 570,000.

Flu pandemic (1968-69)

* This flu pandemic was caused by the H3N2 strain of the influenza A virus and appears to have emerged in Hong Kong in July 1968.

* By the end of July 1968, the outbreak spread to Vietnam and Singapore. In two months, it had spread to the Philippines, India, Australia and parts of Europe.

* American soldiers returning home after the Vietnam War in September 1968 brought this virus to the US, with the first few cases having been detected in California. By December, the virus had become widespread across the US.

* In 1969, the virus spread to other parts of the world, including Japan, Africa and South America.

* In the span of one year, the virus was estimated to have killed approximately 1 million people around the world.

Smallpox epidemic (1974)

* According to WHO, smallpox was officially eradicated in 1980.

* The infectious disease was caused by either of the two virus variants Variola major and Variola minor. Although the origins of the disease are unknown, it appears to have existed in the 3rd century BCE.

* This disease has a history of occurring in outbreaks around the world and it is not clear when it was first observed in India.

* India launched the National Smallpox Eradication Programme in 1962 with plans to engage in mass vaccination of the population to curb the disease. The programme did not yield the desired results, in part due to the size of the population and socio-cultural and demographic challenges.

* By 1966, although the disease had been eradicated in approximately 22 countries, it was still endemic in several other developing nations, including in the Indian subcontinent, Indonesia and Brazil.

* This disease resulted in the death of millions of people around the world in the 20th century alone, and countless more since it was first recorded.

Plague in Surat (1994)

* In September 1994, pneumonic plague hit Surat, causing people to flee the city in large numbers. This mass migration contributed to the spread of the disease to other parts of the country. Within weeks, reports emerged of at least 1,000 cases of patients afflicted with the disease and 50 deaths.

* Open drains, unsanitary garbage disposal, unclean distribution of piped water, dead rats lying in the open drains, all collectively contributed to the plague outbreak in a city that had not been built for the migrant population living within its growing confines.

SARS (2002-04)

* SARS was the first severe and readily transmissible new disease to have emerged in the 21st century.

* In April 2003, India recorded its first case of severe acute respiratory syndrome, which was traced to Foshan in China.

* The patient was a man who was believed to have contracted the disease in Singapore. Similar to COVID-19, the causative agent of SARS was a type of coronavirus, named SARS CoV, that was known for its frequent mutations and spread through close person-to-person contact and through coughing and sneezing by infected people.

* In the two years, three cases of SARS were recorded in India.

* The virus managed to spread to at least 30 countries.

Dengue / chikungunya outbreak (2006)

* The outbreaks of dengue and chikungunya virus in 2006 affected people in several states, including the Andaman and Nicobar Islands.

* Both are mosquito-borne tropical diseases and stagnation of water provides a breeding ground for these mosquitoes.

* The chikungunya outbreak impacted Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra and several other states.

* That same year, Delhi, Rajasthan, Chandigarh, Uttar Pradesh, West Bengal and Andhra Pradesh reported spikes in the number of patients with dengue, with the highest number of patients in Delhi.

* Across the country, at least 50 people died that year due to dengue.

Gujarat hepatitis outbreak (2009)

* In February 2009, reports emerged that approximately 125 people in Modasa, Gujarat, were infected with hepatitis B, an infectious disease that affects the liver.

* The disease is caused due to transmission of infected blood and other body fluids. Doctors were suspected of having administered treatments on patients with used and contaminated syringes.

Odisha jaundice outbreak (2014-15)

* Several towns in Odisha witnessed an outbreak of jaundice in September 2014, with the first few cases having been reported from the town of Sambalpur.

* Investigators concluded that drain water had possibly seeped through pipelines for drinking water, contaminating hundreds of people.

* The official death toll according to the state government was 36, but researchers estimated it to be higher, closer to 50.

Swine flu outbreak (2014-15)

* In the last few months of 2014, reports emerged of an outbreak of the H1N1 virus, one type of influenza virus, with Gujarat, Rajasthan, Delhi, Maharashtra and Telangana being the worst affected.

* By February 2015, India reported at least 12,963 affected cases and 31 deaths.

* By March 2015, according to the health ministry, approximately 33,000 cases had been reported across the country and 2,000 people had died.

Encephalitis outbreak (2017)

* The city of Gorakhpur in Uttar Pradesh has had a history of being affected by encephalitis. In 2017, it witnessed an increase in numbers where several children died of encephalitis, specifically Japanese encephalitis (JE) and acute encephalitis syndrome (AES), caused primarily due to mosquito bites.

* Both are viral infections that cause inflammation of the brain, leaving long-term physical disabilities and even resulting in death.

* By September 2017, more than 1,300 children had died.

Nipah outbreak (2018)

* In May 2018, a viral infection attributed to fruit bats was traced in Kerala, caused by the Nipah virus that had caused illness and deaths.

* The spread of the outbreak remained largely within Kerala due to efforts by the local government and various community leaders who worked in collaboration to prevent its spread even inside the state.

* Between May and June, at least 17 people died of Nipah virus and by June, the outbreak was declared to have been completely contained.

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