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Visualizing the History of Pandemics

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The History of Pandemics

Pan·dem·ic /panˈdemik/ (of a disease) prevalent over a whole country or the world.

As humans have spread across the world, so have infectious diseases. Even in this modern era, outbreaks are nearly constant, though not every outbreak reaches pandemic level as COVID-19 has.

Today’s visualization outlines some of history’s most deadly pandemics, from the Antonine Plague to the current COVID-19 event.

A Timeline of Historical Pandemics

Disease and illnesses have plagued humanity since the earliest days, our mortal flaw. However, it was not until the marked shift to agrarian communities that the scale and spread of these diseases increased dramatically.

Widespread trade created new opportunities for human and animal interactions that sped up such epidemics. Malaria, tuberculosis, leprosy, influenza, smallpox, and others first appeared during these early years.

The more civilized humans became – with larger cities, more exotic trade routes, and increased contact with different populations of people, animals, and ecosystems – the more likely pandemics would occur.

Here are some of the major pandemics that have occurred over time:

NameTime periodType / Pre-human hostDeath toll
Antonine Plague165-180Believed to be either smallpox or measles5M
Japanese smallpox epidemic735-737Variola major virus1M
Plague of Justinian541-542Yersinia pestis bacteria / Rats, fleas30-50M
Black Death1347-1351Yersinia pestis bacteria / Rats, fleas200M
New World Smallpox Outbreak1520 – onwardsVariola major virus56M
Great Plague of London1665Yersinia pestis bacteria / Rats, fleas100,000
Italian plague1629-1631Yersinia pestis bacteria / Rats, fleas1M
Cholera Pandemics 1-61817-1923V. cholerae bacteria1M+
Third Plague1885Yersinia pestis bacteria / Rats, fleas12M (China and India)
Yellow FeverLate 1800sVirus / Mosquitoes100,000-150,000 (U.S.)
Russian Flu1889-1890Believed to be H2N2 (avian origin)1M
Spanish Flu1918-1919H1N1 virus / Pigs40-50M
Asian Flu1957-1958H2N2 virus1.1M
Hong Kong Flu1968-1970H3N2 virus1M
HIV/AIDS1981-presentVirus / Chimpanzees25-35M
Swine Flu2009-2010H1N1 virus / Pigs200,000
SARS2002-2003Coronavirus / Bats, Civets770
Ebola2014-2016Ebolavirus / Wild animals11,000
MERS2015-PresentCoronavirus / Bats, camels850
COVID-192019-PresentCoronavirus – Unknown (possibly pangolins)6.9M (Johns Hopkins University estimate as of March 1, 2023)

Note: Many of the death toll numbers listed above are best estimates based on available research. Some, such as the Plague of Justinian and Swine Flu, are subject to debate based on new evidence.

Despite the persistence of disease and pandemics throughout history, there’s one consistent trend over time – a gradual reduction in the death rate. Healthcare improvements and understanding the factors that incubate pandemics have been powerful tools in mitigating their impact.

March 1, 2023 Update: Due to popular request, we’ve also visualized how the death tolls of each pandemic stack up as a share of total estimated global populations at the time.

Wrath of the Gods

In many ancient societies, people believed that spirits and gods inflicted disease and destruction upon those that deserved their wrath. This unscientific perception often led to disastrous responses that resulted in the deaths of thousands, if not millions.

In the case of Justinian’s plague, the Byzantine historian Procopius of Caesarea traced the origins of the plague (the Yersinia pestis bacteria) to China and northeast India, via land and sea trade routes to Egypt where it entered the Byzantine Empire through Mediterranean ports.

Despite his apparent knowledge of the role geography and trade played in this spread, Procopius laid blame for the outbreak on the Emperor Justinian, declaring him to be either a devil, or invoking God’s punishment for his evil ways. Some historians found that this event could have dashed Emperor Justinian’s efforts to reunite the Western and Eastern remnants of the Roman Empire, and marked the beginning of the Dark Ages.

Luckily, humanity’s understanding of the causes of disease has improved, and this is resulting in a drastic improvement in the response to modern pandemics, albeit slow and incomplete.

Importing Disease

The practice of quarantine began during the 14th century, in an effort to protect coastal cities from plague epidemics. Cautious port authorities required ships arriving in Venice from infected ports to sit at anchor for 40 days before landing — the origin of the word quarantine from the Italian “quaranta giorni”, or 40 days.

One of the first instances of relying on geography and statistical analysis was in mid-19th century London, during a cholera outbreak. In 1854, Dr. John Snow came to the conclusion that cholera was spreading via tainted water and decided to display neighborhood mortality data directly on a map. This method revealed a cluster of cases around a specific pump from which people were drawing their water from.

While the interactions created through trade and urban life play a pivotal role, it is also the virulent nature of particular diseases that indicate the trajectory of a pandemic.

Tracking Infectiousness

Scientists use a basic measure to track the infectiousness of a disease called the reproduction number — also known as R0 or “R naught.” This number tells us how many susceptible people, on average, each sick person will in turn infect.

Diagram showing R0, or how many people are infected on average by someone with a specific virus

Measles tops the list, being the most contagious with a R0 range of 12-18. This means a single person can infect, on average, 12 to 18 people in an unvaccinated population.

While measles may be the most virulent, vaccination efforts and herd immunity can curb its spread. The more people are immune to a disease, the less likely it is to proliferate, making vaccinations critical to prevent the resurgence of known and treatable diseases.

It’s hard to calculate and forecast the true impact of COVID-19, as the outbreak is still ongoing and researchers are still learning about this new form of coronavirus.

Urbanization and the Spread of Disease

We arrive at where we began, with rising global connections and interactions as a driving force behind pandemics. From small hunting and gathering tribes to the metropolis, humanity’s reliance on one another has also sparked opportunities for disease to spread.

Urbanization in the developing world is bringing more and more rural residents into denser neighborhoods, while population increases are putting greater pressure on the environment. At the same time, passenger air traffic nearly doubled in the past decade. These macro trends are having a profound impact on the spread of infectious disease.

As organizations and governments around the world ask for citizens to practice social distancing to help reduce the rate of infection, the digital world is allowing people to maintain connections and commerce like never before.

Editor’s Note: The COVID-19 pandemic is in its early stages and it is obviously impossible to predict its future impact. This post and infographic are meant to provide historical context, and we will continue to update it as time goes on to maintain its accuracy.

Update (March 1, 2023): We’ve adjusted the death toll for COVID-19, and will continue to update on a regular basis.

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Healthcare

Mapped: Diabetes Rates by Country in 2021

Diabetes affects millions of people around the world, but the spread isn’t equal. This map highlights diabetes rates by country in 2021.

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Shareable diabetic population

Mapping Diabetes Rates by Country in 2021

Despite advancements in healthcare lengthening life expectancy across the world, there are still many diseases that are hard to beat. One of these growing and costly diseases is diabetes, but each country is being hit differently.

One of the leading causes of death and disability globally, over half a billion people are living with diabetes today. The World Bank’s IDF Diabetes Atlas reveals that diabetes was responsible for 6.7 million deaths in 2021 alone.

In this graphic, Alberto Rojo Moro uses this World Bank Atlas to map diabetes rates by country, highlighting the countries with the highest rates of the disease.

What is Diabetes?

Diabetes (also known as diabetes mellitusis) a long-lasting condition that affects how the body turns food into energy.

Normally, our bodies break down the food we consume into glucose (a sugar) and release it into our blood. When our level of blood sugar rises, insulin produced by our pancreas signals the body to use excess glucose as energy or store it for later consumption.

Diabetes restricts the pancreas from producing this life-saving insulin properly, thus causing high blood sugar levels. These high glucose levels can eventually impact the heart, kidney, and vision. There are two main types of diabetes:

  • Type 1 Diabetes: The immune system attacks and destroys the cells in your pancreas that make insulin. Causes are believed to be genetic and environmental.
  • Type 2 Diabetes: The body becomes resistant to insulin or doesn’t produce enough insulin to regulate blood sugar levels. It is caused by a mix of lifestyle factors (including obesity, physical inactivity, poor diet, and smoking) and genetics.

Type 2 diabetes is by far the most common form of the disease, making up between 90-95% of global cases.

Diabetes Rates by Country

With close to 33 million (31%) of its adult population suffering from diabetes, Pakistan was the country with the highest prevalence of diabetes.

RankCountry% of Diabetic Population Aged 20-79
1🇵🇰 Pakistan30.8
2🇵🇫 French Polynesia25.2
3🇰🇼 Kuwait24.9
4🇳🇷 Nauru23.4
5🇳🇨 New Caledonia23.4
6🇲🇭 Marshall Islands23.0
7🇲🇺 Mauritius22.6
8🇰🇮 Kiribati22.1
9🇪🇬 Egypt20.9
10🇦🇸 American Samoa20.3
11🇹🇻 Tuvalu20.3
12🇸🇧 Solomon Islands19.8
13🇶🇦 Qatar19.5
14🇬🇺 Guam19.1
15🇲🇾 Malaysia19.0
16🇸🇩 Sudan18.9
17🇸🇦 Saudi Arabia18.7
18🇫🇯 Fiji17.7
19🇵🇼 Palau17.0
20🇲🇽 Mexico16.9
21🇵🇬 Papua New Guinea16.7
22🇦🇪 United Arab Emirates16.4
23🇰🇳 Saint Kitts and Nevis16.1
24🇫🇲 Micronesia15.6
25🇻🇺 Vanuatu15.6
26🇯🇴 Jordan15.4
27🇹🇴 Tonga15.0
28🇸🇾 Syria14.9
29🇧🇿 Belize14.5
30🇹🇷 Turkey14.5
31🇧🇩 Bangladesh14.2
32🇧🇧 Barbados14.0
33🇴🇲 Oman13.8
34🇵🇷 Puerto Rico13.3
35🇬🇹 Guatemala13.1
36🇧🇲 Bermuda13.0
37🇰🇾 Cayman Islands13.0
38🇸🇷 Suriname12.7
39🇹🇹 Trinidad and Tobago12.7
40🇬🇩 Grenada12.6
41🇻🇮 United States Virgin Islands12.4
42🇹🇿 Tanzania12.3
43🇿🇲 Zambia11.9
44🇦🇬 Antigua and Barbuda11.7
45🇰🇲 Comoros11.7
46🇨🇼 Curacao11.7
47🇩🇲 Dominica11.7
48🇬🇾 Guyana11.7
49🇱🇨 Saint Lucia11.7
50🇸🇬 Singapore11.6
51🇧🇭 Bahrain11.3
52🇱🇰 Sri Lanka11.3
53🇧🇳 Brunei11.1
54🇯🇲 Jamaica11.1
55🇦🇫 Afghanistan10.9
56🇨🇱 Chile10.8
57🇿🇦 South Africa10.8
58🇮🇶 Iraq10.7
59🇺🇸 United States10.7
60🇨🇳 China10.6
61🇮🇩 Indonesia10.6
62🇩🇴 Dominican Republic10.5
63🇧🇹 Bhutan10.4
64🇪🇸 Spain10.3
65🇦🇱 Albania10.2
66🇦🇩 Andorra9.7
67🇹🇭 Thailand9.7
68🇹🇳 Tunisia9.6
69🇻🇪 Venezuela9.6
70🇳🇮 Nicaragua9.3
71🇲🇻 Maldives9.2
72🇵🇸 Palestine9.2
73🇼🇸 Samoa9.2
74🇧🇦 Bosnia and Herzegovina9.1
75🇮🇷 Iran9.1
76🇲🇪 Montenegro9.1
77🇲🇦 Morocco9.1
78🇵🇹 Portugal9.1
79🇷🇸 Serbia9.1
80🇺🇾 Uruguay9.0
81🇭🇹 Haiti8.9
82🇧🇸 Bahamas8.8
83🇧🇷 Brazil8.8
84🇨🇷 Costa Rica8.8
85🇻🇬 British Virgin Islands8.7
86🇱🇾 Libya8.7
87🇳🇵 Nepal8.7
88🇨🇾 Cyprus8.6
89🇰🇵 North Korea8.6
90🇹🇱 Timor8.6
91🇮🇱 Israel8.5
92🇸🇨 Seychelles8.5
93🇨🇴 Colombia8.3
94🇵🇦 Panama8.2
95🇱🇧 Lebanon8.0
96🇲🇹 Malta8.0
97🇻🇨 Saint Vincent and the Grenadines8.0
98🇭🇰 Hong Kong7.8
99🇲🇴 Macao7.8
100🇨🇦 Canada7.7
101🇨🇺 Cuba7.6
102🇵🇾 Paraguay7.5
103🇧🇬 Bulgaria7.4
104🇩🇯 Djibouti7.4
105🇸🇲 San Marino7.4
106🇰🇭 Cambodia7.3
107🇲🇼 Malawi7.3
108🇩🇿 Algeria7.1
109🇨🇿 Czechia7.1
110🇲🇲 Myanmar7.1
111🇵🇭 Philippines7.1
112🇭🇺 Hungary7.0
113🇺🇿 Uzbekistan7.0
114🇩🇪 Germany6.9
115🇲🇳 Mongolia6.9
116🇵🇱 Poland6.8
117🇰🇷 South Korea6.8
118🇳🇦 Namibia6.7
119🇹🇲 Turkmenistan6.7
120🇯🇵 Japan6.6
121🇰🇿 Kazakhstan6.6
122🇰🇬 Kyrgyzstan6.6
123🇹🇯 Tajikistan6.6
124🇧🇮 Burundi6.5
125🇪🇷 Eritrea6.5
126🇪🇪 Estonia6.5
127🇷🇴 Romania6.5
128🇷🇼 Rwanda6.5
129🇸🇴 Somalia6.5
130🇸🇸 South Sudan6.5
131🇦🇺 Australia6.4
132🇬🇷 Greece6.4
133🇮🇹 Italy6.4
134🇸🇻 El Salvador6.3
135🇮🇲 Isle of Man6.3
136🇬🇧 United Kingdom6.3
137🇱🇦 Laos6.2
138🇲🇨 Monaco6.2
139🇳🇿 New Zealand6.2
140🇫🇮 Finland6.1
141🇱🇮 Liechtenstein6.1
142🇲🇰 North Macedonia6.1
143🇻🇳 Vietnam6.1
144🇱🇻 Latvia5.9
145🇱🇺 Luxembourg5.9
146🇨🇫 Central African Republic5.8
147🇹🇩 Chad5.8
148🇨🇩 Democratic Republic of Congo5.8
149🇱🇹 Lithuania5.8
150🇸🇰 Slovakia5.8
151🇬🇪 Georgia5.7
152🇦🇲 Armenia5.6
153🇦🇿 Azerbaijan5.6
154🇧🇾 Belarus5.6
155🇲🇩 Moldova5.6
156🇷🇺 Russia5.6
157🇺🇦 Ukraine5.6
158🇧🇴 Bolivia5.5
159🇨🇲 Cameroon5.5
160🇨🇬 Congo5.5
161🇬🇶 Equatorial Guinea5.5
162🇬🇦 Gabon5.5
163🇮🇸 Iceland5.5
164🇸🇹 Sao Tome and Principe5.5
165🇦🇷 Argentina5.4
166🇾🇪 Yemen5.4
167🇩🇰 Denmark5.3
168🇫🇷 France5.3
169🇧🇼 Botswana5.3
170🇳🇪 Niger5.2
171🇭🇳 Honduras5.1
172🇪🇹 Ethiopia5.0
173🇸🇪 Sweden5.0
174🇭🇷 Croatia4.8
175🇵🇪 Peru4.8
176🇦🇴 Angola4.6
177🇦🇹 Austria4.6
178🇸🇿 Eswatini4.6
179🇱🇸 Lesotho4.6
180🇲🇬 Madagascar4.6
181🇨🇭 Switzerland4.6
182🇺🇬 Uganda4.6
183🇳🇱 Netherlands4.5
184🇪🇨 Ecuador4.4
185🇦🇼 Aruba4.3
186🇰🇪 Kenya4.0
187🇫🇴 Faroe Islands3.8
188🇧🇪 Belgium3.6
189🇳🇬 Nigeria3.6
190🇳🇴 Norway3.6
191🇬🇱 Greenland3.3
192🇲🇿 Mozambique3.3
193🇸🇳 Senegal3.1
194🇮🇪 Ireland3.0
195🇬🇭 Ghana2.6
196🇧🇫 Burkina Faso2.1
197🇨🇻 Cape Verde2.1
198🇨🇮 Cote d'Ivoire2.1
199🇬🇳 Guinea2.1
200🇬🇼 Guinea-Bissau2.1
201🇱🇷 Liberia2.1
202🇲🇱 Mali2.1
203🇲🇷 Mauritania2.1
204🇸🇱 Sierra Leone2.1
205🇹🇬 Togo2.1
206🇿🇼 Zimbabwe2.1
207🇬🇲 Gambia1.9
208🇧🇯 Benin1.1

The situation in Pakistan is currently not expected to improve in the near future. By 2045, the country is estimated to have 62 million people suffering from diabetes due to numerous reasons including malnutrition.

This chronic disease has also reached alarming levels in many Oceanic island countries and territories, including French Polynesia, New Caledonia, and American Samoa. Each has a diabetic prevalence above 20%, with reasons ranging from malnutrition to obesity.

Meanwhile, African nations like Benin and The Gambia recorded the lowest prevalence of diabetes in the world. In 2021, African countries had a combined total of 23.6 million adults with diabetes, less than 2% of the continent’s population. However, this number is predicted to double to 55 million by 2045.

Most Diabetic Countries in Absolute Terms

In China, diabetes was prevalent in 10.6% of the nation’s adult population in 2021. While this only puts the country in 60th place in terms of prevalence rate, this is equivalent to roughly 140 million adults with diabetes because of the country’s large population.

Similarly, India’s 9.6% prevalence of diabetes equaled 77 million adults suffering from the disease in the country, more than double the number of Pakistan’s diabetic citizens.

A similar story follows in the Americas, where Mexico has the highest adult prevalence of diabetes at 16.9% or 14.1 million people. Though the U.S. has a lower rate at 10.7%, its higher population gives it an estimated 32.2 million adults with diabetes.

Breaking down diabetes rates by country highlights that this a global health challenge. To address the growing burden of diabetes, we need to focus on prevention, early detection, and management of diabetes.

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