ISSN 2330-717X

3P’s: Post Pandemic Preparation Advisory – Analysis

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A pandemic, a microbial mediated disaster, is very difficult to tackle. This may had happened because of lack of awareness of management techniques. If it is known, the knowledge was untouched by common people. Once a microbial community has got the taste of human blood, they can return several times until and unless either we have eradicated it from our civilization or we have strengthened our self by vaccination and medical drugs. Every pandemic was accompanied by numerous death casualties. And lockdown enforced for running economical and developments works. In order to carry on with the daily work of the human society, we have to follow certain precaution. To prevent this we have collected some of the basic precaution and constructed some defensive measure and gives stress on creating a bio safety guideline for using common facilities and work of people during such situation. It is very important to suppress the pandemic second stroke or to prevent any mutated strain of previous infectious microbe or a new one. The dedication to follow the precaution should be such that it should become the part of our daily lifestyle and culture, if we want to save our human civilization from microbial dominance.

INTRODUCTION

After encounter of any microbial mediated disaster, cabined captive and confined are the best word to explain our situation. Situation constructed by a cellular entity that has clung with our progress and imbibing the fluid of productivity out of it. It has been confirmed that the COVID-19 will go to be the part of human surrounding for coming years (John Lauerman; 2020 May 02)). Prevention is better than cure. Therefore, just working on antidote, medicine or vaccine will not give the demanding outcome. Hence, it is necessary that we should construct the methods of defense not only against COVID-19 but also for future microbial invasion and to be preparing for pandemic. The world is witnessing rise up of different kind of infectious microbe in the recent past (Table 1) that has created catastrophic changes in human civilization and hence changed the world forever (Stanly Johny; 2020, April 15). From a small road side business to a multinational companies’ no one is unaffected when pandemic occur. The question is: Why such big countries even with well develop facilities can’t handle the pandemic situation successfully? Simply the reason is management with proper systematic and reasonable approach. It has been found that even being highly developed in medical facilities many county lack management and unity of thought. The reason could be different views of different people such as party politics, personal indolence, geographical status, population, personal awareness, and unethical ignorance (Tsion Girma; 2020, April 09; Eleanor Cummins, 2020 March 24) and Alexander Smith and Luke Denne, 2020 March 23). Furthermore, the locus of the infectious microbes country didn’t respond responsibly and hadn’t reported to the world in time for awareness and preparation (AP, 2020 May 04; Tucker Higgins, 2020 May 3). Such hiding creates a big issue and gives rise to a pandemic.

For preventing pandemic extension, ceasing community movement, social distancing, Isolation and quarantine are some of the widely used and working measure that are highly effective in fighting against any pandemic (Morrison, L. G., & Yardley, L. (2009; Wilder-Smith, A., & Freedman, D. O., 2020).But handling the community movement is the most difficult task to prevent community transmission of infection. As it hammers on the health of people, country economy, migrant, business and give rise to poverty and unemployment (Mohammad Ibrar, 2020 May 19; Saroj Chadha, 2020 April 16; Nikhil Inamdar, 2020 May 06). Hence, handling pandemic situation is more difficult than curing pandemic. There is need of a pandemic management acts, fund and agencies like Disaster Management Act, Disaster management fund and Disaster management agencies. Agency would be preventing or reducing the adverse effect of pandemic. Furthermore, not only government or controlling body, there should be changes in the lifestyle rule of every individual. Few decades before during World War 2, the drop of Atomic bomb has been witnessed by the world in Hiroshima and Nagasaki. Specialist had confirmed that life could never be normal again here; no vegetation will grow in the affected area. But today the situation is just opposite. Hiroshima and Nagasaki are flourishing today (Becky Alexis-Martin (2017, 6 August)). It was found that they have molded their lifestyle in such a manner that whatever daily work they do it will have led to reduce the radiation effect a little. From Cooking to nosiness they have created a new life style that has led to construct the lost glory of their land. No doubt that scientific reason for reducing radiation is the way the bomb drop. But that situation photograph will answer that it had not reduce the disaster. 

Hence, for pandemic situation common man has to put his hand in work. Work in such a manner that it will suppress the transmission. There is some critical need for which humans are bound to put their steps outside of their house (Fig.1). Keeping these aspects, we have constructed ten categories of precaution. Hence, our discussion has tried to focus on this category as we have found that these aspects are the critical demanded aspect of modern human life. And a common man cannot live without these facilities.

Domestic Preparations

During Pandemic, the life of command man is highly affected and he is observed to in vary unsafe condition. Under the house hold scenario, domestic life is very much dynamic for infectious disease transmission. Normal house is not constructed to have optimum distance for family member. If anyone is found to be suspect of infection there are vital chance that the transmission has happened. And, at the time of treatment (isolation) after confirmation is found that the whole family is required to be in quarantine even if they are found negative (7 family members of man who tested positive for corona virus home quarantined in Delhi. (2020 March 6)). In more severe case the families are made to quarantine in some quarantine centre. To be defensive we have to follow certain precautions, such as:

  • Individual should prevent movement in congested area as they can get contaminated by a contamination carrier person unknowingly. There should be restriction in moving from one place to another in order to cease the movement of infectious microbe. As they attach themselves with their host and keep on multiplying. As their host organisms meet another organism of the same kind they can easily attack them. And if the organism or the moving thing is not eligible to be their host they can work as a transporting vehicle for the infectious microbe, if the infected person comes in the vicinity (Chu et al., 2010)). 
  • Follow the rules of self-isolation in house. If a person is healthy or he/she may find any mild symptoms of infection they should undergo self-isolation. If the person is healthy he will be safe from infectious microbe’s carrier and if the person shows any symptoms he/ she will be stopping the chain of infection transmission (Zhang, Q. & Wang, D. 2015).
  • Keep your surrounding clean. Many times, the agent of transmission are either any garbage stuff or any flies of small insect. This could be contaminated by any infectious person. Hence keep your surrounding clean and fresh. Dispose the garbage at right place as prescribed by the management bodies of that area. And use anti pest spy in order to keep flies and pest away from your surroundings (Garbage heaps pose threat of spread of viral infections (2015 July 4))
  • Escape gathering. Meet people only when it’s very necessary and escape unusual gathering. As most of the infectious microbe can be transfer by touch, respiratory or sneezing sputum, air or by sharing of a common goods or products such as food, toys, equipment’s of work or games tools (Al-Tawfiq et al., 2016).
  • Take care of personal and family hygiene. We should try to keep our body clean and focus on cleaning of our residence and the things of regular use such as cloths, furniture flooring and many regular stuff in our house.  Avoid contact with any material which can transfer contamination. Hence, personal hygiene and cleaning will be a shielding system in fighting pandemic kind of situation.
  • Keep your residence clean and sanitised by using proper techniques. Keep your house and home dirt free and wash the floor regularly.
  • Prevent outdoor junk food and eat healthy food only. Junk food will reduce immunity and are the reason of numerous health complications. This will destroy your body first line of defence hence destroying your immune system which is the central tool for healing against an infection (Study (2018 January 13)) 
  • Maintain good psycho social environment around your circle. Humans are social animals. Under lockdown scenario, it’s very hard to meet someone generating feeling of loneliness and make a person depress or create anxiety and many critical mental disorder (Azera Parveen Rahman (2020 April 4)). Use the power of technology to keep connection with friends and family.
  • Perform exercise or yoga. Home workout and yoga are very important in the situation like lockdown as nobody is going for work or walk. Hence, no physical activity this will make people lazy and people start getting overweigh, acquired psychological issues and low confidence. Doing exercise and yoga daily will be fruitful for your metabolism and help in shorting all kind of mental and physical health issues (Gayathri Menon, 2020 April 15))
  • Maintain healthy balance diet to strengthen your immunity. Eating healthy food will give you nutrition. This will not only provide you energy buts also strengthen your immune system to fight against infection microbe (Childs et al., 2019)).

These are some of the basis thing one should take care while handling pandemic kind of situation. But as soon as the state of outbreak comes down, people start showing leniency and give less importance to the precautions. Remember, only a single microbe is enough to start the outbreak again. As people are locked in their privacy for so long start being social more often and initiate public gathering. This results in rise up of pandemic again. And some time the microbe either evolves itself from previously used treatments or they get mutated and create a fresh assault. Hence, there should be domestic post pandemic preparation which prevents further happening of contaminations. Contaminants could attach us in many possible ways. These are by the air (Airborne) which we breath; by the food we take; by the water we drink (Waterborne); by Sputum attachment from the infected person; by body fluid transfer from one person to another; by using the apparatus used by or which has come in the vicinity of infected person; using public services; taking part in gathering and so on.

Hence in order to work safe in post pandemic environment we must change our life style in such a manner that it should become the part of our culture and tradition. Some of the changes that we can create are: Construction of house as per bio safety precautions; house should include a good ventilation system. The plastering, flooring, paint and varnish material should have anti-microbial. The part of house which involves continuous touching of many people should be caring either antimicrobial or it should have microbes or dust repellent properties. The water supply system weather should have a proper check mechanism. Cleaning and Sanitising agents should be customize by using different appropriate strength of chemical sanitising agents. House should be made by using greenhouse techniques.

Entertainment Zone

In pandemic situation people should only look after most important things of their life. No doubt, entertainment industries play an important role in economics of any countries but suffer a lot. But after pandemic condition it is not at all advice to open this facility due to fear of second outbreak of the infectious microbe with double strength. It may happen that in second out break the microbe rise up with evolve potential against previously use treatment. But, to boost economy it is necessary to open this facility. Initially they may start with low population but some of the important measures to prevent the community transmission they can use are: Use of good ventilation system; Use of air curtains; transparent shield box in theatre or multiplex for individual person; Multiple air curtain at the entry gate; Air sanitization spray at the entry; Maintain entry and exit traffic; Show of products should be in such a way that it should promote social distancing; Use of hydrophobic cloths by the management staffs; Use of hydrophobic spray on the chair, sofa, wall and table of the theatre and it should be sanitized by chemical agent after every show; Air sanitization of hall after every show; Dust filter should be install in order to block microbe adheres ion moment; Use of anti-sneezing, cough and corticosteroids fluid in hall air to prevent sneezing, cough, and itching situation; Proper dress for cook and working staff customize by using personal protective kit material; There should be restriction in the customer population and Implementation of UV sanitation system.

Sports complex

World sports are not only a department of fitness building but also an important aspect of business. Lots of earning and employment is created through sports. Moreover, after the innovation in the information broadcasting system like internet, television and radio, sports facility has contributed hard labour in entertainment industries hence plays an essential role in the country’s economy. The system also ceased at the time of pandemic. Hence, it is necessary to look after its working after the pandemic situation to promote the sports industries that do not promote community transmission. We can start the sports industries by allowing only players to play in the stadium; No live audience in the stadium; Allow live broadcasting and internet streaming system; Routing check-up of the players; Use of advance camera management system in the stadium; No crowed or fans should be allowed except players and working staff with proper protection should be allowed and Implementation of UV sanitation system for indoor games.

Gymnasiums

Health is wealth and for an ideal body health it is necessary to eat good food. Exercise is must to use nutrient which increases the rate of nutrient absorptions. Gymnasiums have become an important aspect in today’s life for good physical activity. This facility is also closed during the time of pandemic as gym involve sharing of body building equipment, bathrooms, toilet, space and lockers. This increases the great possibility of infection’s transmission. Moreover, during the time of high level of physical activity, sweat is produced in large amount that promote attachment of microbes. Many time body immune system excrete out the infectious antigen (pathogens) by the mode of sweat leading to community transmission. Furthermore physical activity involves excessive respiration leading to spread of sputum. There is a big chance that they can promote infectious outbreak. Hence, a different level of management should be carried out to re-established this facility including allowing of less population at a time; More space between equipment’s and proper ventilation system. Air conditioner should be installed. More equipment should be installed in order to prevent sharing. Before sharing Equipment (touch/ grabbing area) should be sanitized by using fast action sanitizing agents. Non-sticky and hydrophobic material is used on the touching and grabbing part of equipment and use of hydrophobic spray. Participants should use to prevent touching of face, participant should use antiperspirant and anti-itching lotions. In order to carry out with spa facilities gym should either construct a big area with proper privacy and social distance or they should stop these facilities. Proper sanitization is done after every batch leave. Chamber air is fully replaced by ventilation system after every batch session and Implementation of UV sanitation system.

Industries

An industry is a sector that produces goods or related services where numerous people work as labour. Majority of theses worker and labours possess low financial status. Therefore, closing the industrial work will be very problematic for such employees. Hence, proper consideration should be given keeping with environmental condition such as an epidemic. Generally, the industrial work is done in collaboration of every worker of the industry. Hence, this socialization and collaboration may promote infection transmission. Therefore, there should be a new guideline precaution for industries and safety rule book. Some of the basic guidelines are; Movement of individual inside the industry only after full body sanitation. Compulsory air and chemical sterilization of the work space. Showering and bathing area should be constructed. Bath should be compulsory before and after work. A special safety cloth should be given that not only provide safety from work mistake but also have the capability of infection protection. Provide workers a clean clothing and footwear that is used only at work. Regular hand washing Used clean utensils for tasting food. Mess facility should be properly managed with bio safety precautions. Mess staff should proper sterilization of kitchen and sitting area. Keeping clean hair and covered it or tied back. Ventilation should be installed should be proved in all space were workers are working. Pollution should be managed properly as it may promote weakening of immune system of workers. Use hydrophobic spray on all wall and utensils.  Compulsory use of gloves, face mask, faces shield and goggles by every employee and Implementation of U.V sanitation system.

Institutions

An institute is an organisational body created for study and learning such as school, college and coaching centre involve mass gathering of students and faculties. This mass gathering promotes community transmission in the situation like epidemic. Generally, it is recommended to shut down all the learning institution. But caring it out for a long period could be problematic as it can have ceased the process of learning – the only ways of student self-development. The development of each individual is the development of mankind. Moreover, teaching and learning institution has come up as big source of economy and a source of mass employments. Hence, institution should be customised in such a way to carry on distribution of knowledge without being affected by pandemic. Certain precaution every institution should have to adopt to prevent communicable disease. 

Staff settlement should be observed properly. Mini cabin is constructed in all staff room. Staff traffic at working place by creating proper one-way pathway. Medical testing for the peoples who migrate the place and a good ventilation system should be installed in all room.

Hostel Mess should implement food room delivery facility or parcel system. Library maintenance system include book sanitization system; Virtual library. Sanitization of computer lab should be done. Use of light projected key board and wearable mouse.

Curtain should be made up of hydrophobic stain resistance material, or curtain should not be used. Individual bench system adopted for every student. Mini transparent cabin should be constructed or partition should be done by using transparent material. Student movement should be monitored strictly. No gathering should be promoted. No sharing of teaching stationary. Face shield, mask, goggles and gloves should be compulsory and Implementation of UV sanitation system. Sick students, teachers and other staff should not come to school

Schools should enforce regular hand washing with safe water and soap, alcohol rub/hand sanitizer or chlorine solution and, at a minimum, daily disinfection and cleaning of school surfaces.  Schools should provide water, sanitation and waste management facilities and follow environmental cleaning and decontamination procedures. Beginning and end of the school day be staggered; cancelling assemblies, sports games and other events that create crowded conditions; Use of online/e-learning strategies.  Assigning reading and exercises for home study. Radio, podcast or television broadcasts academic content.

Workplace 

Employment is the basic need of any human being that needs/ promotes mass gathering. In many company employees don’t have their personal cabin. Moreover, movement of employee is also a critical aspect to monitor. We can’t neglect the importance of employment in situation like pandemic where demand of goods is high. Hence, it’s very difficult to close the system for a long period of time. Therefore, safety precaution should be taken to protect employee from disease. 

Staff traffic should be managed properly; Mini cabin should be allotted to every staff member; online transfer of money should be done and individual working equipment kit should be provided. Ventilation in all room should be provided; Work place should adopt greenhouse technology;  Prevent group gathering during eating; Curtain should be made up of hydrophobic stain resistance; Use of light projected keyboard / air mouse; Face shield, mask, goggles and gloves should be compulsory and Implementation of UV sanitation system.

Public Transportation System

Transportation is one of the key modes of development as it connects different village, cities, states and countries with one another. It helps in movement for work as well as for transportation of goods from one place to another. But, the level of facilities of public transportation is not optimum to match the rise in population creating a huge crowd. This crowding promotes interaction of people by the choice of uncomfortable adjustment. Neither it’s good for normal situation nor for the situation like epidemic. Mass gathering and collision promotes transmission of body fluid causing any silence infectious microbe to pump up. This happening can worst the situation of pandemic. Some precaution is needed to handle this situation.

For Road Ways

Proper traffic rules should be followed to reduce traffic hence gathering. Traffic management equipment is installed in the big congested road. Use of helmet within built ventilation system or just a proper helmet is also a good masking for face. No spitting is allowed on road even if the person is driving. Car, bus and heavy vehicles should be properly enclosed by windows, with proper A.C filters. 

Traffic police and police perform the duty for traffic management and checking of vehicles for unwanted products. Therefore, they have to meet a lot of people every day. Proper security clothe with bio safety measures should be tailored for them. Fever and basic symptoms of travellers should be checked before journey. Proper use of face mask or face shield, gloves and goggles should be compulsory.

For Railways

Rules should be created to manage public traffic for maintaining social distance on the station platform, ticket counter, waiting rooms and inside the train as well. A special emergency isolation coach should be added in every train to isolate any suspect of infection immediately. Distance between every seat should be managed and small cabin cover installed for every birth (seat). Railway staff and railway security force should be trained for handling any contamination problem during journey. Cleaning and sensitization should be carried out regularly on platform as well as inside train after every journey. 

For Airways

Fever and basic symptoms of travellers should be checked before journey. Travellers must wear proper face mask or face shield, gloves and goggles. Traffic should be monitored on airport.  Airport and airlines staff should be trained for handling travellers suspected for contamination. An isolation cabin should be installed inside the aeroplane and an isolation centre inside airport. Cleaning and sensitization should be carried out regularly at on airport as well as inside aeroplane after every journey.

Mall and Marts Grocery and Other Shops

Retailing includes selling goods or services to the final customers for personal use. People are highly depended on retail shops for their daily needs. As entire countries came under the quarantine orders and consumers around the world start to avoid human contact, retailers are mess up to adapt with this changing customer climate. In future every shop needs to write a board outside the shop so that peoples entering the shop should read and come with the advised precaution.

The malls should implement temperature screening of customers at entry point and allow only one person into the mall for shopping at a time to avoid any physical touch with others. Retail malls like D Mart, Metro are issuing coloured token which are fully sanitized to the customers. They will alert the customers with time limit by making announcements frequently about time slots to the customers to reduce overflow at the cash counters. Packing the loose commodities like flours, sugar, cereals etc., with different quantity sizes to avoid the human touch. Banks issued Wi-Fi enabled microchip cards for the transactions of money. Smart Dome looks like a dome security camera typically seen in many stores. However, it operates much differently. Upon detecting people in the monitored area, it announces a message “For your safety, please maintain at least six feet of social distance.”  If possible, try to re-organize staff which can move from in-store to for example e-commerce assistance. The biohazard warning sign and restricted access/authorized personnel sign must be displayed at the entrance. They should start online shopping and home delivery facility.

Events

Corona virus has severely impacted event planners across the globe. In addition to the scale and type of the event, they are considering numerous other factors, e.g., the density of the crowd, how will the attendees interacting with each other, and from where they will be travelling. As the world recovers from the current crisis, clients start to hold events again, identifying and reducing risk in the post-Corona virus period will be vital to ensure safety, reputation, financial viability. There is need for an integrated and formalized risk management process as well as the new risks and associated contingencies that are likely to be and the new norm for events in the near future. Event organisers should agree with the public health authority on how participants and the local population will be kept informed about the health situation, key developments, and any relevant advice and recommended actions; Increasing the number of, and access to, hand washing stations; cleanliness of the facilities, including the restrooms and food service areas; Close contact with other attendees should be prohibited; Consider filing a Notice of Circumstances, especially if a renewal is fast-approaching and be prepared to implement government guidelines. Tracking the health and travel histories of participant coming to event should be strongly considered; Companies should also consider requiring checking temperatures and highlight the importance of health to the people coming to the event.

Conclusion

Pandemic are really the torches enemy of any organism’s civilization that hasn’t learnt how to pardon any one. If we will not upgrade our defence mechanism or attacking skills, someday our civilization may get defeat as it happens with Rome. We have to keep assurance double sure and keep on doubling it by the change in interaction of biodiversity. Hence, we should focus on our skill that can save us from infectious microbe’s attack. We should not only upgrade our medical and research field but we should starts implementing it in our civilization daily life. 

When we see an enemy we can judge its strength and weakness. But the situation become worst if the enemy is invisible to common eye. Therefore, we should follow the precautions very -very strictly. We should not forget that we human being exists because we love to interact and being social with one another. But this kind of communicable disease situation can destroy our culture of friendship and collaboration, which are some of the root pillars of being human. Therefore, we are not just fighting with a disease or an organism to save our life but also fighting to save the base of the human civilization. 

 The basic aspect of precaution must be taken seriously by every person if they want to save their life and their civilization. There should be a collective effort from visionaries to increase the precision. No doubt, microbes are part of our life, but, we have ignored their power under the desire of prosperity and greed of powerful reality. They are in such dominating condition that they have acquired the power to attend forever dominancy. Hence, post pandemic preparations are our only hope in order to be defensive and in order to be prepared for the future invasion. Therefore, every precaution is followed very careful as assurance is better than being sorry.

*About the authors: Rajan Keshri, Harpreet Kaur and Dr Gursharan Singh Kainth, Guru Arjan Dev Institute of Development Studies

References

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Table 1: – Name of pandemics and their basic information.

S. NoPandemicYear of RecognitionPlaceSymptomsPathogen NameNumber of Death Reported
1.Chikungunya1952southern Tanzaniaviral disease that causes fever and severe joint painChikungunya virus (CHIKV)31,496
2.Cholera1817Jessore, Indiaacute diarrhoeal infectionbacterium Vibrio cholerae21 000 to 143 000 each year
3.Crimean-Congo haemorrhagic fever1944 Congoviral haemorrhagic fevertick-borne virus (Nairovirus) 
4.Ebola virus disease1976remote villages in Central Africa, near tropical rainforestshaemorrhagic feverEbola virus2014, 11,315
5.Hendra virus infection1994Brisbane suburb of Hendra, Australiamild influenza-like illness to fatal respiratory or neurological diseaseHendra virus14 of 21 horse die and 157 humans infected
6.Influenza (pandemic, seasonal, zoonotic)1918-1919Europe from Southeast AsiaFever or feeling feverish/chills. cough. sore throat. runny or stuffy nose. muscle or body aches; Headaches. fatigue (tiredness)H1N1 virus with genes of avian origin50 to 100 million people
7.Lassa fever1969Nigeriaacute viral haemorrhagic illness Lassa virus5000 
8.Marburg virus disease1967Marburg and Frankfurt in Germany, and in Belgrade, Serbiahaemorrhagic feverMarburg virus475
9.Meningitis1805Geneva stiff neck, high fever, sensitivity to light, confusion, headaches and vomitingNeisseria meningitides. There are 12 serogroups of N. meningitidis that have been identified, 6 of which (A, B, C, W, X and Y) can cause epidemics.100,000
10MERS-CoV2012Saudi Arabia  fever, cough and shortness of breath nausea, vomiting and diarrhoea.Middle East respiratory syndrome coronavirus850
11.Monkeypox1970 Democratic Republic of Congo fever, an extensive characteristic rash and usually swollen lymph nodesMonkeypox virusUp to 10%
12.Nipah virus infection1999Malaysiafever, headaches, myalgia, vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitisNipah virus209
13.Novel corona virus (2019-nCoV)2019ChinaMost common symptoms: Fever; dry cough; tiredness Less common symptoms: aches and pains; sore throat, diarrhoea; conjunctivitis; headache; loss of taste or smell a rash on skin, or discoloration of fingers or toes Serious symptoms: difficulty breathing or shortness of breath; chest pain or pressure loss of speech or movementNovel corona virus362,200
14.Plaguemid-1300sEurope and AsiaFever and chills. Extreme weakness. Abdominal pain, diarrhea and vomiting. Bleeding from your mouth, nose or rectum, or under your skin. Shock. Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose. Yersinia pestis
25 million people
15.Rift Valley fever1931Rift Valley of Kenya sub-Saharan Africamild flu-like illness to severe haemorrhagic feverArbovirus
16.SARS2009ChinaFever, dry cough, headache, muscle aches and difficulty breathingSARS-CoV770
17.Smallpox3rd centuryIndia and ChinaSudden onset of high fever which may be recurrent; malaise (general feeling of unwellness); widespread skin rash – flat spots which change into raised bumps then firm fluid filled blisters which then scab (see image) severe headache; backache. abdominal pain; vomiting and .diarrhoea.variola, vaccinia, cowpox, and monkeypox300–500 million
18.Tularaemia1900-2000United Statesa skin ulcer at the point of contact with the infected animal or at the site of a bite. swollen lymph nodes near the skin ulcer (most often in the armpit or groin) severe headaches; a fever; chills and fatigue. bacterium Francisella tularensis
19.Yellow fever 3,000 B.CAfricafever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomitingFlavivirus30,000 deaths
20.Zika virus disease1947Africa to Asiaa rash; itching all over the body;  a high temperature; a headache; joint pain (with possible swelling, mainly in the smaller joints of the hands and feet); muscle pain; red eyes (conjunctivitis) and lower back pain.Zika virusZero

(Pandemic epidemic diseases (N.D.) World Health organization. Retrieved from https://www.who.int/emergencies/diseases/en)

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