Global Epidemics

This review offers an overview of several devastating historical epidemics and pandemics. The first pandemic ravaging the Middle East and Ancient Egypt was an unidentified “plague” in the late Bronze Age. The plague of Athens was apparently “only” a local epidemic but with fatal consequences for that ancient democracy. Great empires with well-developed trade routes seem to be very susceptible to rapid and devastating spreads as the Antonine Plague, the Plague of Cyprian and the Justinian Plague testify. The great Medieval plague wave in Europe was absolutely devastating, but for the first time it brought along with it substantial containment measures that are still being successfully used today (e.g. isolation, quarantine) as well as the seeds of the development of a new form of medical theory and practice. The blame game that can be observed in the current COVID-19 pandemic has also been seen in previous epidemics and pandemics. Particularly in the case of syphilis, its origin was ...

This review offers an overview of several devastating historical epidemics and pandemics. The first pandemic ravaging the Middle East and Ancient Egypt was an unidentified “plague” in the late Bronze Age. The plague of Athens was apparently “only” a local epidemic but with fatal consequences for that ancient democracy. Great empires with well-developed trade routes seem to be very susceptible to rapid and devastating spreads as the Antonine Plague, the Plague of Cyprian and the Justinian Plague testify. The great Medieval plague wave in Europe was absolutely devastating, but for the first time it brought along with it substantial containment measures that are still being successfully used today (e.g. isolation, quarantine) as well as the seeds of the development of a new form of medical theory and practice. The blame game that can be observed in the current COVID-19 pandemic has also been seen in previous epidemics and pandemics. Particularly in the case of syphilis, its origin was ...

This essay appears as the Preface to: *Pandemic Disease in the Medieval World: Rethinking the Black Death*, ed. Monica H. Green (Kalamazoo, MI, and Bradford, UK: Arc-Medieval Press, 2015), pp. ix-xx. This is the HARDBOUND edition of essays that first appeared in 2014 in the journal, *The Medieval Globe*. This preface (as well an accompanying index) are new in the book version, which can be purchased from Arc-Medieval Press (ISBN 978-1-942401-00-1).

The *Medieval Globe* volume went to press in Spring of 2014, before the full import of the 2013-2015 West African Ebola outbreak had become clear. By the Fall of 2014, comparisons were being made between what was still an exponentially growing outbreak in West Africa and the greatest pandemic of human history, the Black Death. Many of those comparisons were specious, but they pointed to the real terror that both diseases created, not simply by the swiftness of the mortality they caused, but by the social disruptions they produced. The present essay was an attempt to bring some greater historical analysis to the question of how we think comparatively across time periods and contexts. I welcome further discussion of these questions.

The authors suggest to view the origins of Islam against the background of the 6th century AD Arabian socio-ecological crisis whose model is specified in the paper through the study of cli-matological, seismological, volcanological and epidemiological history of the period. Most so-cio-political systems of the Arabs reacted to the socio-ecological crisis by getting rid of the rig-id supra-tribal political structures (kingdoms and chiefdoms) which started posing a real threat to their very survival. The decades of fighting which led to the destruction of the most of the Arabian kingdoms and chiefdoms (reflected in Ayyam al-`Arab tradition) led to the elabora-tion of some definite "anti-royal" freedom-loving tribal ethos. At the beginning of the 7th cen-tury a tribe which would recognize themselves as subjects of some terrestrial super-tribal polit-ical authority, a "king", risked to lose its honour. However, this seems not to be applicable to the authority of another type, the "celestial" one. At the meantime the early 7th century evi-dences the merging of the Arabian tradition of prophecy and the Arabian Monotheist "Rah-manist" tradition which produced "the Arabian prophetic movement". The Monotheist "Rahmanist" prophets appear to have represented a supratribal authority just of the type many Arab tribes were looking for at this very time, which seems to explain to a certain extent those prophets' political success (including the extreme political success of Muhammad).

Renata Schiavo (2020): Advocacy, community engagement and cross-sectoral collaborations as key strategies during COVID-19 response and beyond. New directions for a new decade. Journal of Communication
in Healthcare: Strategies, Media, and Engagement in Global Health. DOI: 10.1080/17538068.2020.1762983

Beginning in the early 1990s, a new manner of articulating the threat posed by epidemics of infectious diseases took shape. ‘Global health security’ (GHS) emerged as a novel epistemic space as a response to the perceived threats posed by circulations and appearances of ‘global’ diseases. Marked throughout the 2000s by major events both political and pathogenic, GHS has undergone profound changes; from primarily a policy-legal framework to a forum for reconfiguring global health 'action'. This research examines how the problems that emerged in the 1990s are changing since the 2014 West African Ebola crisis and the announcement of new global health security projects and initiatives. How might these transformations constitute a new manner of thinking about, and acting on, epidemics as a ‘global’ problem?
  Contrasting genealogical-archival research with a series of field-based episodes, this dissertation explores how public health experts and technicians worked to define new problems and design the interventions aimed at addressing them. It juxtaposes a historical account of the emergence and transformation of GHS across the 2000s and 2010s against field-based ethnography of GHS during 2016 and 2017. Based on over a year working with a global health non-profit, the text’s episodes attend to day-to-day work that translated diffuse concepts of ‘threat' and ‘risk' into discrete technical practices and projects to mitigate and minimize those threats. Working with experts through the early stages of project development, attention is paid to the relational processes that went into making global health security a workable concept. Together, the episodes illustrate the routines and technical artistry that made GHS into a space not only to reimagine a ‘safer’ or ‘healthier’ world, but to build the means to realize it.
  The text also examines how communities of experts reworked their projects and programs during great destabilizations and disruptions, including both the 2016 US Presidential election as well as an Ebola outbreak in the Democratic Republic of Congo. It explores how global health organizations and experts attempted to better 'prevent, detect, and respond' to public health emergencies after Ebola in 2014. Unpacking various understandings of the ‘global’ in GHS, it examines how experts worked to build novel 'global assemblages’ and reposition ‘reciprocal obligations between nations'. The research looks at novel techniques and technologies designed to ensure a ‘global’ community of healthy nations—ones able to live up to their responsibilities to care for and protect their vulnerable populations.
    In 2014, Ebola set the stage for dramatic changes to global health as new actors and organizations came to understand a pressing need for change. ‘GHS' emerged as a response to these calls for reform and improvement, an urgent effort to improve vulnerable health systems in developing countries. This research explores how GHS and some of its technicians became entangled with these emerging and evolving mix of policies, practices, and possibilities for global health practice.

Dystopian movies are often the product of both creativity and analytics. As a result, they offer thought provoking reflections on how the world might turn into a place of desolation and misfortune if we do not recognize and intervene on the deep-rooted problems affecting our society. The main objective of this book is to raise up the public attention on a series of contemporary global challenges – such as  climate change, lack of vital resources, overpopulation, global pandemics, social inequality, authoritarianism, weapons of mass destruction, artificial intelligence and genetic engineering – by provocatively claiming that the world might soon turn into a dystopia.
#dystopianworld

-----ÖZET: Yirminci yüzyıl başından bu yana dünyada respiratuvar virüslerden kaynaklanan beş pandemi gerçekleşmiştir. Bunlardan ilk dördü grip (İnfluenza A) virüslerinden kaynaklanmışken halihazırda sürmekte olan COVID-19 pandemisi bir koronavirüs suşundan ileri gelmiştir. 1918 tarihli “İspanyol gribi” pandemisi dünya genelinde yaklaşık 500 milyon kişiyi kapsamış ve 40–100 milyon ölümle sonuçlanmış olup, bugün respiratuvar viral pandemiler için olabilecek “en kötü senaryo” kabul edilmektedir. Halihazırdaki COVID-19 pandemisi de Aralık 2019’dan bugüne (Nisan 2020), >1,2 milyon vaka ve >60 bin ölümle sürmektedir. Bu pandemide, virüsün türü (yeni ve pandemik bir SARSr-CoV suşu) ve konağın yaşı (>50–60 yaş) temelinde daha yüksek mortaliteli, yeni bir “koronavirüs hastalığı” gözlenmekte olup tıp (başta epidemiyoloji ve halk sağlığı) tarihinde yeni bir sayfa açılmıştır. Yanı sıra, 1918’de olduğu gibi yüz yıl sonra bugün de halen efektif bir anti(korona)viral tedavi bulunmamakta ve bu çaresizliğin klinik, sosyolojik, psikolojik ve makroekonomik sonuçları dünyada ve ilk resmi vakanın 11 Mart’ta kaydedildiği Türkiye’de şimdiden derinden hissedilmektedir. Ayrıca, yine 1918 pandemisinin mortalitenin giderek arttığı üç dalga halinde seyretmiş olduğu gibi, COVID-19 pandemisinde de gelecek haftalarda daha sarsıcı bir epizodun başlaması endişe edilen ihtimaller arasındadır. Bu yazıda katastrofik 1918 pandemisi esnasında yaşananlardan hareketle önümüzdeki COVID-19 sürecinde yaşanabilecek olanlara dair bir mukayese yapmak ve sonuçlar çıkarmak, önümüzdeki risklerin (başta virülansı ve dolayısıyla mortaliteyi artırabilecek bir viral mutasyon) ciddiyetini vurgulamak ve böylece T.C. Sağlık Bakanlığı başta olmak üzere pek çok ulusal ve küresel sağlık otoritesi tarafından çeşitli medya kanalları aracılığıyla yinelenmekte olan sosyal izolasyon çağrısını desteklemek amaçlanmıştır.

-----ABSTRACT: Since the early 20th century, the world has seen five pandemics caused by respiratory viruses. While the first four of these were caused by flu (Influenza A) viruses, the ongoing COVID-19 pandemic is due to a coronavirus strain. Now considered a “worst-case scenario” for respiratory viral pandemics, the “Spanish flu” of 1918 afflicted about 500 million people and resulted in 40–100 million deaths worldwide. Since December 2019 to date (April 2020), the current COVID-19 has been confirmed in >1.2 million cases and >60 thousand deaths around the globe. A new “coronavirus disease,” with a higher mortality based on the type of the virus (a novel, pandemic SARSr-CoV strain) and host age (>50–60 years), has been identified during this global health crisis, opening a new period in the history of medicine, particularly epidemiology and public health. Furthermore, today, one hundred years after 1918, there is still no effective anti(corona)viral treatment, with its clinical, sociological, psychological, and macroeconomic impacts being already felt around the world and in Turkey, where the first official case was reported on 11 March. Also, there is the worrisome possibility that the COVID-19 pandemic may develop into an even more serious problem in the following weeks, similarly to the 1918 pandemic that occurred in three waves marked by increasingly higher mortality. In this study, we aimed to infer from the experience of the catastrophic 1918 pandemic for the rest of the ongoing COVID-19 calamity, highlight the imminent risks (most notably, viral mutation that could result in higher virulence and mortality), and thus support the calls for social isolation, repeated through various mass media by many global and national health authorities, particularly the Turkish Ministry of Health.

Il volume esamina il regime internazionale di controllo delle malattie infettive come disciplinato dal Regolamento sanitario internazionale dell'OMS, analizzando lo stretto rapporto intercorrente tra salute pubblica e diritti umani e tra emergenze sanitarie di rilevanza internazionale e sicurezza. Il volume offre un'analisi giuridica approfondita utile a comprendere anche le risposte fornite dall'OMS e dagli Stati alla pandemia di COVID-19.

This article discusses national and local strategies for confronting COVID-19 pandemic. The analysis sheds light on how societal context, institutional arrangements, knowledge culture, and technology deployment manifest in national responses to the pandemic. Discussion describes country cases from East and South East Asia, on the one hand, and from Europe and Asia-Pacific, on the other. The overall impression is that Asian cases reflect proactivity and diligence, while Western responses are reactive and more often than not slightly delayed. Both country groups include successes, while the overwhelming majority of global benchmarks are Asian. As the management of COVID-19 crisis is essentially a multi-level governance issue, discussion about national strategies is supplemented with a glance at the role of cities. The COVID-19-related urban challenges revolve around increased interest in urban safety, creative approaches to and the uses of urban space, the rise of digital urban platforms, and deeper insights on citizen engagement.

This review offers an overview of several devastating historical epidemics and pandemics. The first pandemic ravaging the Middle East and Ancient Egypt was an unidentified "plague" in the late Bronze Age. The plague of Athens was apparently "only" a local epidemic but with fatal consequences for that ancient democracy. Great empires with well-developed trade routes seem to be very susceptible to rapid and devastating spreads as the Antonine Plague, the Plague of Cyprian and the Justinian Plague testify. The great Medieval plague wave in Europe was absolutely devastating, but for the first time it brought along with it substantial containment measures that are still being successfully used today (e.g. isolation, quarantine) as well as the seeds of the development of a new form of medical theory and practice. The blame game that can be observed in the current COVID-19 pandemic has also been seen in previous epidemics and pandemics. Particularly in the case of syphilis, its origin was often attributed to foreign countries. Finally, the paper comparatively stresses the historical importance of an early implementation of a lockdown-based approach as an effective form of controlling epidemic spreads. Riassunto. Le epidemie e le pandemie nella storia dell'umanità e la maniera tenuta dai governi nel gestirle. Una review dall'Età del Bronzo alla prima Età moderna Questa rassegna offre una panoramica su diverse devastanti epidemie e pandemie nella storia. La prima pandemia che ha devastato il Medio Oriente e l'antico Egitto è stata una "peste" non ancora identificata alla fine dell'Età del Bronzo. La Peste di Atene fu apparentemente "solo" un'epidemia locale, ma con conseguenze fatali per l'antica democrazia. Grandi imperi con vie commerciali ben sviluppate sembrano essere molto suscettibili alla rapida e devastante diffusione epidemica, come testimoniano la Peste Antonina, la Peste di Cipriano e la Peste di Giustiniano. La grande ondata epidemica di peste nell'Europa medievale si è rivelata assolutamente devastante, ma per la prima volta ha portato con sé sostanziali misure di contenimento che ancora oggi vengono utilizzate con successo (ad es. isolamento, quarantena) e lo sviluppo di una nuova forma di teoria e pratica medica. Il gioco dell'incolparsi vicendevolmente che si può osservare nell'attuale pandemia di COVID-19 può, inoltre, essere osservato anche nelle precedenti epidemie e pandemie. In particolare nel caso della sifilide, l'origine del morbo era spesso attribuita a nazioni straniere. L'articolo, infine, sottolinea in maniera comparativa l'importanza storica dell'applicazione precoce di un approccio basato sul confinamento quale forma di di efficace forma di controllo delle diffusioni epidemiche.

The COVID19 crisis of early 2020 reveals some of the key features of contemporary globalization processes. It is driven by global mobility patterns, and control over these patterns is the central tool for containing the epidemic. The crisis also changes in nature when it crosses scales.

In the past decade and a half, the findings of molecular microbiology have effected a transformation in our understanding the Black Death and its history. The question 'What was it?' has been decisively resolved in favor of the pathogen Yersinia pestis. Microbiological research has also been decisive in pointing toward the Tibetan-Qinghai Plateau as the probable site of the organism's geographic origin and, more tentatively, in suggesting some chronological parameters in which key phases of that evolution occurred. 

These developments have laid out a challenge for medievalists, who now need to test whether these new biological narratives can better inform our understandings of the Black Death (1346-1353) and the Second Plague Pandemic more broadly defined.  It also lays out a challenge for anyone who wants to apply knowledge of the Black Death to the understanding of contemporary epidemics and (re)emerging diseases.

This inaugural issue of The Medieval Globe brings together scholars from many disciplines, to begin to assess how new work in the genetics, entomology, and epidemiology of Yersinia pestis, as well as new insights from archeological research, can combine with humanistic methods to allow a rethinking of the Second Plague Pandemic and its historical significance. The contributors collectively demonstrate that this phenomenon was geographically broad, chronologically deep, and ecologically complex: that it likely involved most of Eurasia and North Africa (and possibly parts beyond); that it likely extended from the 13th to the 19th centuries; and that it almost certainly involved many more intermediate hosts than the rats normally considered in plague histories. They also demonstrate that humanistic analysis has never been more crucial to reconstructing the history of the impact of this disease: genetics may be uniquely qualified to trace the history of the pathogen, but the insights of history—both traditional modes (political, religious, cultural) and newer ones (environmental, climatic, post-colonial)— allow us to see how a single-celled organism became a force shaping nearly half the globe.

This issue serves as a state-of-the-field summation for medievalists and for researchers studying the world’s most lethal diseases and their modern implications. It will also provide a methodological model for global historians of any period. It is available open-access at the following link: http://scholarworks.wmich.edu/medieval_globe/1/.

The following link leads to the video of a symposium that was held at the University of Illinois in January 2015 to discuss the implications of the volume:
https://mediaspace.illinois.edu/media/The+Black+Death+and+BeyondA+New+Research+at+the+Intersection+of+Science+and+the+Humanities/1_g1tg61l5.

This volume investigates the multifaceted SHAPES (socio-historic, artistic, political, and ecological significance) of global disease. It challenges conventional views of infection and transmission by associating epidemics with ideologies and their accompanying institutions. It argues that the physical threat of epidemics is irrevocably linked to culture, economic resources, social class, and power. Epidemics involve both the infected and non-infected, affect the local and global, and they expose control and neglect. This book provides a radical collaborative approach, drawing contributors from closely related and vastly distant fields in the search for innovative ways to address human suffering, and to find real solutions that may determine whether people live or die. Such an approach is needed within an increasingly interconnected world where both pathological diseases and health behaviors are infectious. Experts from fifteen diverse disciplines in the natural sciences, social sciences, and arts and humanities present case studies from across the world and time, demonstrating the uniqueness of each disease and epidemic in its place, but also the shared experiences that span human life and death. In order to identify, measure and control epidemics, we must understand epidemics more as long biosocial processes than abrupt events in nature or culture. Such methodology examines the meaning we attach to epidemics, as well as their material reality, and provides a more complete understanding of how epidemics shape and are shaped.

Films illustrate 2 ways that epidemics can affect societies: fear leading to a breakdown in sociability and fear stimulating preservation of tightly held social norms. The first response is often informed by concern over perceived moral failings within society, the second response by the application of arbitrary or excessive controls from outside the community.

Despite the wide applaud about social media’s capacity to allow public participation in content creation and circulation, they do not automatically ensure open and transparent communication because of institutional and cultural constraints. Our study of the use of social media during the H1N1 flu epidemic in the U.S. and China demonstrates that governmental apparatuses may use social media tools for one-way dissemination of risk decisions and policies or limited two-way risk communication. In contrast, the general public may circumvent the institutional control of risk information through extra-institutional participatory risk communication to find out truths about the emerging risks

Much has already been written on this most recent EVD outbreak—evaluating and dissecting the contributions and failings of the various role-players involved, and considering what can be done differently in future. This article will contribute to this important and ongoing debate and will specifically focus on the international, operational, and national legal frameworks in terms of which large-scale health crises like that of Ebola play out. It will be argued that the very culture and architecture of this transnational legal and operational framework for public health emergencies is isolated from the national realities in which it operates and merely offers a hierarchical authority of what legally ought to be done, with little regard to what is actually necessary and possible on the ground. In considering the most recent Ebola outbreak, and juxtaposing it with the Severe Acute Respiratory Syndrome (“SARS”) outbreak of 2003, it will be shown that a more nuanced transnational legal understanding of public health emergencies is indeed needed—a holistic approach that goes beyond biomedical/scientific and legalistic confines in dealing with disease outbreak and control. It is again important to emphasise here, for the sake of clarity, that this article is exclusively focused on the transnational legal and operational framework in which public health emergencies play out. International humanitarian responses, general public health considerations, as well as other national systemic considerations—like those relating to health systems—although important, will not be considered here.
A brief interlude on the methodology of this article also deserves a place here. As already indicated above, much literature exists on the Ebola outbreak, and with the attention now shifting to the Zika virus, it is important to further distinguish the contribution of this article. This article utilises a primarily transdisciplinary lens in narrating the rise and fall of two notable epidemics of the modern world. A variety of sources, from different disciplines and bases, are used in presenting an easily accessible text that recounts key themes of both epidemics—highlighting similarities and differences, and raising important questions for the future. As with most narrative research methodologies, reliance is also placed on newspaper articles in constructing an account of how the two epidemics played out, each in its own particular time and space.  The disease narrative ultimately presented in this article, therefore simultaneously serve as a chronicle of the two epidemics, while also reflecting why a more nuanced transnational legal understanding of public health emergencies is indeed needed.
To facilitate this discussion and analysis, the content of this article is divided into four parts. First, in Part II, the lifecycle of two epidemics will be considered, Ebola, and the 2003 SARS outbreak. Considering these two outbreaks and the international legal responses thereto provides a valuable lens through which the multiple layers of disease outbreaks and control from the past to the present can be observed. In Part III, this paper provides an overview of the international legal and operational framework for public health emergencies, confined to references and examples from the two outbreaks selected for and discussed in Part II. Part IV considers the national legal responses of those countries most affected by the recent Ebola outbreak and the 2003 SARS outbreak. Part V discusses the question of whether to quarantine or not. Part VI discusses lessons to be learned, and why knowledge production beyond disciplinary confines is necessary. And finally, Part VII of this article concludes with a critical analysis of two observed failings of the current international legal and operational framework for public health emergencies. In considering the shortcomings of the current framework it will be argued that a more holistic approach to disease control is required that looks beyond disciplinary confines.

Na začiatku 30. rokov 19. storočia zasiahla Uhorsko epidémia cholery. Pôvodnou oblasťou jej výskytu bola India, kde v pravidelných cykloch hubila miestne obyvateľstvo. V roku 1824 vôbec prvýkrát prenikla do Ruska. Trvalo niekoľko rokov, kým sa nákaza dostala do Európy. Napriek ochranným opatreniam prenikla v roku 1831 cez Halič a Karpaty do Uhorska-tým sa v uhorských dejinách začala prvá epidémia cholery. Samozrejme, neobišla ani územie dnešného Slovenska. Jeho západnú časť zasiahla už v lete 1831 a výrazne ovplyvnila život miestneho obyvateľstva. Platilo to i o obyvateľstve Červenokamenského panstva.

Throughout history, religious beliefs have been a primary way of understanding the experience of epidemic disease. This article offers a pan-historical and cross-cultural analysis of such interactions. The first section examines common structures and assumptions of religious explanatory models. These are characteristically twofold , nominating both supernatural causal agents and particular human actions that have set these forces in motion. A society's identification of the behaviors that would prompt the infliction of mass suffering and death upon an entire people reveals a great deal about the values and world view of that culture. Most revolve around definitions of the sacred, which could be polluted, profaned or neglected by deliberate or inadvertent actions, and acceptable standards of moral behavior. Defensive strategies vary according to the nature of the supernatural agency held responsible, from one or more angry gods to offended ancestors, hungry ghosts or hostile demons. The final section investigates the extent to which religion may be helpful or harmful in shaping responses to epidemics, including the present global pandemic of Covid-19.

This Article challenges the conventional understanding that international crises are limited to instances of direct physical violence. Instead, it argues that the disproportionate distribution of infectious diseases like Ebola is a form of structural violence that warrants international intervention. In the field of global public health, structural violence is a concept used to describe health inequities and to draw attention to the differential risks for infection in the Global South, and among those already infected, for adverse consequences including death, injury, and illness. This Article clarifies how the concept of structural violence can be operationalized in law. It illustrates the ways in which actors can facilitate conditions for structural violence by analyzing the international public health and peace and security regimes.

This Article has several important contributions. First, the way international actors conceptualize crises should be expanded beyond merely addressing direct physical violence, but to also include remedying structural violence. Additionally, this study indicates that the complicated relationship between infectious diseases and conflict deserves more robust attention and resources. Moreover, this study examines the limits of the law governing international responsibility and concludes that shared international responsibility norms should be developed to assist in expanding the tools available for the protection of human rights. Lastly, this Article finds that the burgeoning field of international disaster law holds promise for responding to the challenges posed by infectious diseases like Ebola and the alleviation of large-scale human suffering caused by such diseases.

Global epidemics have been always coupled with the phenomenon, reported on an international level, of the so-called responsibility gaps deriving from failure to achieve the minimum punishability thresholds as provided by the domestic legal systems, which are often inadequate for this purpose.
While in the past epidemics related emergencies affected other parts of the world, now the Italian legal system, because of the health-care crisis caused by covid-19, is called upon identifying any contagion responsibilities by implementing its own law enforcement measures (especially Sections 438 and 452 of the Criminal Code), which have been seldom applied due to the fact that epidemic outbreaks have occurred only rarely and, therefore, are characterized by an uncertain scope of application.
As we will try to argue, the spread of covid-19 in Italy has highlighted a certain gap between the provisions of the Criminal Code — as interpreted to date — and today’s epidemiology, which requires a new approach to some elements related to the case in point, notably the reinstatement of the category of offenders, a differentiation of negligent liability levels also within the healthcare domain and the compatibility of the crime with any omissive conduct (as recognized by the latest case-law) now appear to be necessary steps in order to bring «regulatory reality» back to «factual reality».
Finally, this essay aims to include the «new» individual contagion responsibility, thus outlined, within the context of the so-called web of causation of the epidemics and, conversely, into the common but differentiated responsibility system (CBDR) of international origin, which currently seems to be the most efficient way to attribute any criminal liability in a healthcare crisis.

Tibetan physicians’ response to the novel coronavirus outbreak and its entry onto the Tibetan plateau demonstrates a newly emerging public face of Tibetan medicine in contemporary times that is characterized by a sense of confidence, professionalism, and rigor in stark contrast to decades earlier. This Hot Spots piece provides a lens into the novel set of conditions facilitating physicians to engage this global health crisis and positioning them to re-awaken tradition.

Epidemic outbreaks threaten jurisdictions beyond domestic boundaries and affect diverse societal interests. How to properly handle them therefore becomes an issue of interest for all stakeholders and individuals. The two current approaches to handling them are called risk analysis and risk governance. Risk analysis is the classical model while risk governance is only emerging. What might risk governance contribute to risk analysis? The recent Ebola Virus Disease (EVD) outbreak presents an opportunity for answering this question. The central argument is that because the EVD outbreak affects jurisdictions beyond domestic boundaries and diverse societal interests, it should be handled through risk governance. An empirical investigation of the adaptive and integrative model of Klinke and Renn (2012) shows that risk governance might contribute new inputs into risk analysis in EVD handling. At the moment, the prevailing EVD handling approach substantially shows elements of risk analysis but lacks the basic elements of risk governance at the domestic level. At the global level, the prevailing approach fully incorporates the elements of risk analysis but not fully those of risk governance. Applying the Klinke and Renn model to augment risk analysis might upgrade the prevailing approach to risk handling, making risk handling outcomes more suitable for stakeholders and individuals. Although the analysis excludes the adaptive aspect and the risk communication, evaluation, monitoring and control elements, it shows the model could make risk analysis more integrative and incorporate risk handling variables more accurately.

A história da atuação e do cuidado médico é também a história de perdas humanas com impactos institucionais de largo aspecto. No presente texto, proponho uma olhada reflexiva para eventos de contexto epidêmico ocorridos no passado, com foco na medicina paranaense (Brasil). É um convite para olharmos também para a categoria de profissionais da saúde que atuam na linha de frente de combate ao atual coronavírus.

The history of medical practice and care is also the history of human losses with wide-ranging institutional impacts. In the present text, I propose a reflective look at events of epidemic context that occurred in the past, focusing on the medicine of Paraná (Brazil). It is an invitation to also look at the category of health professionals who work on the front lines of combating the current coronavirus.

Background: To inform researchers about the methodology and results of epidemic estimation studies performed for COVID-19 epidemic in Iran, we aimed to perform a rapid review. Methods: We searched for and included published articles, preprint manuscripts and reports that estimated numbers of cumulative or daily deaths or cases of COVID-19 in Iran. We found 131 studies and included 29 of them. Results: The included studies provided outputs for a total of 84 study-model/scenario combinations. Sixteen studies used 3-4 compartmental disease models. At the end of month two of the epidemic (2020-04-19), the lowest (and highest) values of predictions were 1,777 (388,951) for cumulative deaths, 20,588 (2,310,161) for cumulative cases, and at the end of month four (2020-06-20), were 3,590 (1,819,392) for cumulative deaths, and 144, 305 (4,266,964) for cumulative cases. Highest estimates of cumulative deaths (and cases) for latest date available in 2020 were 418,834 on 2020-12-19 (and 41,475,792 on 2020-12-31). Model estimates predict an ominous course of epidemic progress in Iran. Increase in percent population using masks from the current situation to 95% might prevent 26,790 additional deaths (95% confidence interval 19,925-35,208) by the end of year 2020. Conclusions: Meticulousness and degree of details reported for disease modeling and statistical methods used in the included studies varied widely. Greater heterogeneity was observed regarding the results of predicted outcomes. Consideration of minimum and preferred reporting items in epidemic estimation studies might better inform future revisions of the available models and new models to be developed. Not accounting for under-reporting drives the models' results misleading.

Epidemics are the result of the actions of multiple actors, which necessitates a comprehensive allocation of responsibility. However, the traditional framework for responsibility, as well as the emerging norm of the responsibility to protect, are inadequate for addressing epidemics. Both perpetuate the fallacy that states can, on their own, cope with the increased incidence of epidemics and fail to adequately allocate responsibility.

Given these limitations, this Article argues for a new vision of responsibility. It develops the theory underlying the norm of common but differentiated responsibility and makes the case for expansion of this framework to the challenges posed by highly-infectious diseases. This Article articulates the distinctive normative bases for differentiating responsibilities based on need, culpability, and capacity. The framework developed herein better distributes responsibility and is less state-centric than rival norms. It accounts for structural inequality in ways that other frameworks do not. Further, it does not reify the false hierarchy between civil and political rights and economic and social rights that exists in other frameworks. It recognizes and accounts for the significant role of non-state actors and provides a basis for holding such actors responsible, as opposed to the non-attribution of responsibility that exists.

There is reason for cautious optimism about the prospects of success of this framework. First, it is consistent with theoretical and existing foundations of law where responsibility is tethered to an actor’s conduct and relationship to the harm through culpability. However, the framework does not treat the culpability model as a legal straitjacket and envisions a broad understanding of causation—direct, indirect, and historical. Additionally, the framework differentiates based on capacity, which is derived from human rights and global public health law. It also draws on extralegal incentives, building on moral and political conceptualizations of responsibility towards those in need. The common but differentiated responsibility framework is likely to gain approval and assist rapidly with the battle against epidemics. In fact, elements of it are already reflected in state practice. In sum, the theoretical framework developed in this Article serves not only to provide useful guidance to actors in the face of epidemics but also to shift extant conceptualizations of responsibility in significant ways.