Influenza Trivia Quiz

The Antonine plague, or the Plague of Galen for the Greek doctor who described it, was the first known pandemic to affect the Roman Empire and occurred in 165-180 AD, with an estimated death toll of 5-10 million. It is unknown exactly what kind of disease was spread; both smallpox and measles have been suggested. The first documented case was Aelius Aristides, an orator, in the then Greek city of Smyrna (now Izmir in Turkey) in 165; although Aristides survived, his health was impacted.

The Antonine plague is thought to have been contracted by Roman soldiers who invaded Seleucia, the capital of the Seleucid Empire, in what is now Iraq. The soldiers brought it back to Rome with them, and the plague ripped its way through the Roman Army; it is also thought to have killed Lucius Verus, one of the co-emperors of Rome, in 169. (The plague was named for Antoninus, the family name of the two emperors.) Crowding and poor sanitation in Roman cities contributed to the spread of disease among the population. The plague also spread to Gaul and the occupied Germanic territories.

The Plague of Justinian was part of a larger pandemic across Europe and Asia that lasted from 541 to approximately 767. It was an outbreak of bubonic plague that occurred in the Sasanian and Byzantine Empires, covering Western Asia (modern day Iran and Turkey), Egypt and the Mediterranean between 541 and 549, reaching as far as Gaul. The estimated death toll is between 15 and 100 million, although this is debated, with some historians arguing that the initial death toll was exaggerated. It was named for Justinian I, the Byzantine Emperor at the time, who contracted the plague in 542 but survived; however, a fifth of the population in the capital of Constantinople (now Istanbul, Turkey) were killed by the disease. Both cities and countryside were badly hit, and the price of grain rocketed as farmers were unable to manage their crops. The Goths, who were at war with Constantinople, also capitalised on the city's weakness, with Totila's Ostrogoth forces beating the Romans at the Battle of Faventia, despite their lower numbers.

One of the first reports came from the historian Procopius from the port of Pelusium, in the east of the Nile Delta, in 541; the disease was thought to have been imported from Egypt to Constantinople by rats who were infected with the disease, hiding in grain stores on Egyptian ships. However, research suggests that the plague came from even further afield, from the Tian Shan mountains on the border between Kyrgyzstan, Kazakhstan and China, as related strains were found there.

The Japanese smallpox epidemic, or Epidemic of the Tenpyo Era, occurred between 735-737, with an estimated death toll of one million, equivalent to one-third of the then Japanese population. It began at the port of Daizaifu, Fukuoka Province, when a fisherman came into contact with a 'barbarian' ship, thought to be from the Kingdom of Silla in what is now Korea, that was riddled with smallpox. Kyushu was badly hit by the disease, and was spread to Nara by government officials passing through Kyushu. Both rich and poor were affected by the plague; rice farmers were badly affected, with deaths and inability to maintain crops leading to poor rice yields and famine.

Although the epidemic eventually died down, it had a catastrophic effect on the Japanese economy and political system, with the four brothers of the powerful Fujiwara clan all succumbing to the plague. In 741, the Emperor Shomu - a devout Buddhist - funded the building of Buddhist temples and sculptures to unify the country through a shared religious experience in the wake of the plague.

The Black Death, an outbreak of bubonic, pneumonic and septicaemic plague, was one of the deadliest epidemics of all time, killing millions of people across Europe, Asia and North Africa. It was the beginning of the second plague pandemic, with outbreaks of bubonic plague occurring around the world over centuries; one example was the Great Plague of London between 1665-1666, with the Great Fire of London having one positive effect of killing the fleas carrying it. The death toll of the Black Death is estimated to be between 75-200 million (equivalent to one to two-thirds of the Eurasian population and one-third of the African population), and is believed to have originated in Crimea, or possibly even further east in what is now Kyrgyzstan. Rats carrying plague-bearing fleas were brought into Europe and North Africa on ships traveling from the Italian port of Genoa; once ashore, it spread from person to person. It was introduced to England from France via the coastal town of Weymouth, Dorset. It also spread rapidly across the Muslim world; pilgrims on the hajj brought the plague into Mecca, while ships from Constantinople brought the plague to Egypt. Cairo in particular was devastated, losing almost half its population, with bodies being dumped in the Nile.

Pollution and crowding in cities, where animals roamed the streets freely and human waste was dumped in the streets, was a major factor contributing to the spread of the disease. Houses of plague victims were marked with crosses on doors, and bodies were buried in mass graves. In many European cities, such as Toulon in France and Barcelona in Spain, Jews were blamed for the spread of the Black Death and accused of poisoning wells; entire Jewish communities were wiped out in Germany.

The Cocolitztli epidemics occurred in New Spain, in what is now Mexico, in the 16th century, with a death toll between 5-15 million. 'Cocoliztli' is the Nahuatl word for pestilence. The worst of these epidemics occurred in 1545. It is thought to have originated in the southern and central highlands of Mexico. The exact cause of the epidemics is unknown, but examination of the teeth of skeletons found in the Oaxaca region, thought to be Mixtec people, suggests it may have been salmonella introduced to the region by Europeans; a severe drought occurring in the region around the same time may have also physically weakened the population's immune response, as well as increasing the number of rodents carrying disease. Another suggested cause is a viral haemorrhagic fever similar to ebola. Spanish colonisers attributed the indigenous people's tendency towards illness to bathing practices or the climate, or even the wrath of G-d.

Indigenous populations were devastated by the disease, with up to a thousand people dying per day in some areas. Aztecs and other indigenous people were forced to live on crowded settlements known as reducciones, where closeness to imported animals increased the risk of disease. The population reduction led to a lack of indigenous labour, which in turn caused food shortages for both indigenous people and the Spanish.

One of the lesser-known epidemics in this quiz, the Persian Plague occurred between 1772 and 1773 and was an outbreak of bubonic plague in the Persian Empire, with a death toll of approximately two million. It is believed to have started in Baghdad in the winter of 1772, before spreading to Basra (in modern-day Iraq) and Bahrain in 1773, and eastwards to Bombay in India. Basra was badly affected, with a death toll of 250,000. Quarantine measures were introduced around the Gulf region, which ultimately contained the disease, though there was an outbreak of plague in the Iraqi city of Mosul in 1798.

The third plague pandemic was an outbreak of bubonic plague that began in Yunnan in China, and spread to Europe, Africa, the Americas and even Australia, thanks to global trade and disease-carrying rats stowed away on ships. It is also one of the longest-lasting pandemics in this quiz, lasting from 1855 to 1960. India, under the British Raj at the time, and China were the countries most badly hit by the pandemic, with death tolls of 10 million in India and two million in China, while the remaining global death toll was 3 million overall. By 1950, the global plague had died down, though there were still outbreaks in Europe.

The population explosion in China contributed to the spread of disease, with Han Chinese migrating to Yunnan because of its local minerals. The opium trade may also have played a part. One major outbreak during the pandemic occurred in Hong Kong - a British-controlled area - in 1894, after a hospital clerk returned from Canton while carrying the disease, and the plague became endemic there until 1929. Other British-controlled areas in India and South Africa enforced quarantine measures, but many of the locals were suspicious or even frightened of the western medical practices, such as floating plague victims on boats in Hong Kong. In India, the military exacerbated the problem by forcing healthy people into quarantine camps, or evicting plague victims from their homes and burning them down.

The First World War and the Spanish flu were two of the biggest killers of the 1910s; there was some overlap as the first documented cases of Spanish flu occurred in March 1918, and the war ended eight months later. The estimated death toll is 25-50 million, though other estimates range between 17 and 100 million. Despite the misnomer of 'Spanish' flu, the first cases were in the US, at Camp Funston in Kansas; Spain, a neutral country at the time, was not subject to press censorship like countries involved in the war and was able to publish death tolls, and was subsequently thought to be the epicentre of the virus. In the first wave, US troops coming from Camp Funston brought the disease into Europe, where it spread from the UK and France to Eastern Europe, and then into Africa and Asia. There were three further waves, with the second wave in 1918 being the deadliest.

Spanish flu, like swine flu many decades later, was caused by the H1N1 influenza A virus. Unlike other types of flu, however, the Spanish flu had a high death toll among young adults. The second wave also brought complications of bacterial pneumonia. Poor hygiene, unusually wet weather and overcrowding in hospitals were major factors in the spread of the disease, along with global travel; not just ships, which harboured plagues in early epidemics, but road, rail and air as well. Island countries such as Iceland and Australia imposed quarantine measures to stop the spread of disease. Social distancing and the wearing of cloth face masks were also introduced as anti-disease measures.

The Asian flu pandemic, caused by the influenza A H2N2 virus, occurred between 1957 and 1958 and had a death toll of 1-4 million. It was the first global pandemic to occur since the formation of the World Health Organisation in 1947. The disease was dubbed the 'Asian flu' due to originating in Guizhou, China; it spread rapidly to Hong Kong and Singapore which, unlike mainland China, was a member of the WHO. By May 1957, it had spread to Japan, Taiwan, the Philippines, Indonesia and mainland Southeast Asia, and reached the UK in June. US sailors brought the disease from Asia into the US, where the first wave mainly affected children returning to school; the second wave, which was more pronounced among the elderly population, was deadlier.

Thanks to advances in global healthcare, the death toll was lower than the Spanish flu of four decades ago. American microbiologist Maurice Hilleman was among the first to recognise the new strain. He and his team developed a vaccine that was trialled and rapidly distributed in 1957, and helped to contain the spread of disease, as did antibiotics, which were not available at the time of the Spanish flu. Hilleman was awarded a Distinguished Service Medal by the US military, as the vaccine was thought to have saved thousands of lives.

The COVID-19 pandemic was one of the greatest pandemics of the 21st century, originating in Guangzhou in China and spreading rapidly across the globe. It started in China at the end of 2019, thought to be caused by bats at wet markets in Wuhan. It began to spread rapidly across the world at the beginning of 2020; the reported death toll by 2023 was 6 million, though estimated death tolls are thought to be higher. By the spring of 2020, many countries were in lockdown, with some initiating stricter containment measures than others and people only being allowed out for essential shopping or work. Many jobs furloughed their workers or even laid them off, while others initiated work-from-home policies. The wearing of face masks, social distancing and hand washing were encouraged as preventive measures; supermarkets in the UK had antibacterial gel dispensers for incoming customers, and it was not uncommon in the summer of 2021 to see people queueing outside shops, as only a few were let in at a time.

COVID-19 caused a devastating impact not only on global health, but on the global economy, with businesses losing money and many being forced to close; the entertainment industry also suffered, due to bands having to cancel tours and venues losing money, and sports being temporarily stopped or played in empty stadiums. Supply chain disruptions - worsened in the UK due to Brexit - and panic buying caused food shortages, and the UK also experienced a shortage of labour in some sectors when foreign workers returned to their home countries. Social media also played a huge role in the spread of misinformation about the virus; even though vaccines were introduced (I participated in a clinical trial for one!), many people were hesitant to take them for various reasons. Lockdowns were lifted around the world in 2021 and 2022, and as of May 2023, the WHO considered COVID-19 to no longer be a public health emergency.