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World War C – Covid19 and measles

We think of measles as "just" a childhood illness - yet it killed millions in the Americas and Polynesia.

Measles isn’t taken seriously by many people – they think it’s just a childhood illness. It’s true that most people have herd immunity to measles, bought and paid for by all the children who died of it over the centuries. It’s a much worse illness than Covid19 in a virgin field epidemic, where nobody has much resistance to the disease because their immune systems haven’t seen it before.

We are incredibly lucky with Covid19, the sickness caused by SARS-CoV2. No, really, we are. It seems to only kill about 1-2% of people who get it if there’s treatment available.  It doesn’t seem to kill children at all, and young people rarely.

Do you realise how wonderful that is? How gobstoppingly abnormal for a newly human-adapted virgin field pandemic? Seriously?

Compared with epidemic disease in the past – even as recently as the 20th century, for Pete’s sake – that is nothing at all. Zilch. Zero.

A sense of proportion

Now some of you may be mourning the death of someone close to you from Covid19, or you may be vulnerable and frightened of dying of it yourself, so you may not like to read that. I totally understand: statistics talk of 1 or 2% mortality, but if you lose someone that figure is really 100%. If your parent or your spouse or, worst of all, your child is threatened or has been killed by the SARS-CoV2, you certainly don’t care how few children get it, you’re thinking about your own family.

What I’m trying to do here is back off and get a sense of proportion from looking at the history. If you’d rather not do that, you don’t have to read this blog, after all. But if you do choose to read it, you may find some surprising things which may give you a new perspective on the Covid19 pandemic.


This is very far from being the first time humans have been badly affected by a pandemic – the most recent previous example was in 1918 when the Spanish flu killed 50-100 million people over two years or so. But pandemics have been a fact of life ever since we stopped being hunter gatherers and started living in villages with our animals – if not before. There’s a reason for that. Viruses and bacteria could jump from our animals to us in all sorts of ways once we started living so close to them. SARS-CoV2 is the most recent zoonotic infection in a very long line.


For the last seventy years we’ve had a wonderful holiday from major infectious disease pandemics, made possible by hygiene, vaccination and antibiotics and the dark arts of isolation, testing and contact-tracing. It was the first such holiday in the entire history of humans. It couldn’t happen before because we only started to understand what microbes were and how to identify and study them towards the end of the 19th century.

Here is a short account of the history of epidemic disease. I’m going to look at three of the main killers, two viruses and one bacterium – measles, smallpox and plague. I’ll try to give you a picture of how these diseases affected people in ways that, luckily for us, we only have to imagine.


Let’s start with measles, caused by the Rubeola virus. In 2011 the WHO estimated that 158,000 deaths globally were caused by it. It’s now thought to have diverged from a cattle plague called rinderpest some time around the 11th century AD.

This is a disease that I had myself because I was born before the MMR became available. In fact I caught all the traditional childhood diseases and missed about three weeks of school with each one, which was totally normal. Mothers would often send their children round to have tea with children who were getting better from one of these illnesses, so they’d catch it and later be immune – that was called a fever tea. You could call it a primitive attempt at vaccination, if you like because with measles (and mumps and German measles) if you got it once, you generally never got it again. Of course sometimes the children died.

Yes, children died of childhood diseases. Not often, but I think you’ll agree that just one child dying of measles is too many. In the years before the vaccine was developed 3 to 4 million people got it in the USA and of them about 400 to 500 died.


I was about 6 or 7 when I caught measles. I remember having a headache and feeling grumpy and tired and then I found a lot of funny little spots on my chest. I remember my mother was very annoyed with me – she checked on the phone, perhaps to the GP – and then told me to go back to bed because I had measles. She worked from home at something important to do with books, so I suppose she was worried that I’d disrupt her work.

I was too lethargic to disturb her. I had just moved proudly into my new room in the converted attic which had a loo next door and a playroom and instead of a window it had a skylight through which I could see the chimney and the stars – and occasional exciting thunderstorms. I climbed the steep steps to the attic slowly and collapsed into bed.

Later Mummy tried to interest me in oatmeal porridge with chocolate sprinkled on it, a treat from her childhood, but I simply couldn’t eat it although I did try. To this day I can’t stand porridge made with milk.

My eyes hurt

And then my eyes started to hurt. The light seemed like it was spearing my eyeballs and I hid under the duvet where it was darker. Daddy came up the steps and asked how I felt, and I told him that the light was hurting my eyes. He looked at the skylight which had no blind and then went down again.

I woke up later to find he’d come back with a large roll of brown paper which he was sticking over the skylight with tape so that the light didn’t hurt so much. I watched the process and wanted to ask questions but couldn’t find the energy. I didn’t even have the energy to read.

Hotter and hotter

I was already hot and I got steadily hotter. Mummy started taking my temperature regularly – it was a cold glass tube she put under my arm, not in my mouth because  I was too young for that. I might bite it and swallow the mercury which would be bad. She always frowned when she looked at it.

My headache got worse, I felt awful whenever I woke up, which was only to go to the loo.  I remember sitting on the loo with my legs dangling and my whole body shivering.

Horses, lovely white horses…

At some point around this time I got some really exciting dreams. The one I remember is when beautiful white horses galloped out of my head and into my room and I watched them galloping around and tossing their heads. I wasn’t frightened, I felt they were my friends and they looked so lovely.

Maybe that was the crisis, the turning point. Certainly a few days after that, I remember waking up and not feeling hot any more, and I was hungry. Mummy checked my temperature and announced that I could have oatmeal with chocolate as a treat. I managed to choke some down only because I was so hungry and I knew I had to convince her I was better so I could graduate to scrambled eggs.

A day or two after that I was asking questions again, the brown paper came off the skylight and I went back to school a week later.

Cultural memory

I’ve gone into this level of detail only because there is so little cultural memory of what childhood diseases were really like, especially measles. I was a sturdy healthy child with a fine immune system – but even so my parents were worried. I don’t remember if my two little brothers got measles too, and I think my little sister wasn’t born yet. That would have worried them even more, because measles is very very infectious and was a regular killer of babies, even in the 1960s.

The Persian physician Rhazes (860-932AD) wrote the first systematic description of measles and how it differed from smallpox and chickenpox in “The Book of Smallpox and Measles.” Recent work indicates that the measles virus emerged from rinderpest (cattle plague) as a zoonotic disease between 1100 and 1200 AD. It may have broken out earlier as it adapted to people in places where there was a large enough susceptible population (more than 250,000) to sustain an epidemic.

Maurice Hilleman’s measles vaccine is estimated to prevent one million deaths per year.


Measles is an endemic disease, meaning it’s continually present in a community, and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating. In 1529, a measles outbreak in Cuba killed two-thirds of those natives who had previously survived smallpox.

Between roughly 1855 and 2005, measles has been estimated to have killed about 200 million people worldwide. Measles killed 20 percent of Hawaii’s population in the 1850s. In 1875, measles killed over 40,000 Fijians, approximately one-third of the population. In the 19th century, the disease killed 50% of the Andamanese population.

So that’s the illness we think of as a mere childhood illness. It has an infectivity rate of around 12 – Covid19’s is around 2.4. In a virgin field epidemic it has a deathrate of around 30-40% – not the tiddly 3.4-5% that Covid19 is showing at the moment in places with an overstretched hospital system nor even the 14% that is happening in some parts of the world with a particularly susceptible population.

We are lucky, lucky, lucky!

In part 2 I’ll get to grips with smallpox, a truly horrible disease.

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