What’s the Difference Between Pandemic, Epidemic and Outbreak?
By Rebecca S.B. Fischer
The coronavirus is on everyone's minds. As an epidemiologist, I find it interesting to hear people using technical terms – like quarantine or super spreader or reproductive number – that my colleagues and I use in our work every day.
But I'm also hearing newscasters and neighbors alike mixing up three important words: outbreak, epidemic and pandemic.
Simply put, the difference between these three scenarios of disease spread is a matter of scale.
Small, but unusual.
By tracking diseases over time and geography, epidemiologists learn to predict how many cases of an illness should normally happen within a defined period of time, place and population. An outbreak is a noticeable, often small, increase over the expected number of cases.
Imagine an unusual spike in the number of children with diarrhea at a daycare. One or two sick kids might be normal in a typical week, but if 15 children in a daycare come down with diarrhea all at once, that is an outbreak.
When a new disease emerges, outbreaks are more noticeable since the anticipated number of illnesses caused by that disease was zero. An example is the cluster of pneumonia cases that sprung up unexpectedly among market-goers in Wuhan, China. Public health officials now know the spike in pneumonia cases there constituted an outbreak of a new type of coronavirus, now named SARS-CoV-2.
As soon as local health authorities detect an outbreak, they start an investigation to determine exactly who is affected and how many have the disease. They use that information to figure out how best to contain the outbreak and prevent additional illness.
Bigger and spreading.
An epidemic is an outbreak over a larger geographic area. When people in places outside of Wuhan began testing positive for infection with SARS-CoV-2 (which causes the disease known as COVID-19), epidemiologists knew the outbreak was spreading, a likely sign that containment efforts were insufficient or came too late. This was not unexpected, given that no treatment or vaccine is yet available. But widespread cases of COVID-19 across China meant that the Wuhan outbreak had grown to an epidemic.
International and out of control.
In the most classical sense, once an epidemic spreads to multiple countries or regions of the world, it is considered a pandemic. However, some epidemiologists classify a situation as a pandemic only once the disease is sustained in some of the newly affected regions through local transmission.
To illustrate, a sick traveler with COVID-19 who returns to the U.S. from China doesn't make a pandemic, but once they infect a few family members or friends, there's some debate. If new local outbreaks ensue, epidemiologists will agree that efforts to control global spread have failed and refer to the emerging situation as a pandemic.
Terms Are Political, Not Just Medical
As of this writing, the World Health Organization classifies the risk of global COVID-19 spread as "very high," the highest level in their risk classification scheme and one step below an official pandemic declaration. This means that the WHO remains hopeful that, by taking aggressive steps now, containment of localized outbreaks may still be possible.
But I and other scientists and public health officials are already calling this a pandemic. The official numbers count an excess of 100,000 cases in almost 100 countries, and community spread has been documented in the U.S. and elsewhere. By the classical definition, it's a pandemic.
A formal declaration of COVID-19 or any other infectious disease as pandemic tells governments, agencies and aid organizations worldwide to shift efforts from containment to mitigation. It has economic, political and societal impacts on a global scale.
Formal declaration needn't incite fear or cause you to stockpile surgical masks. It doesn't mean the virus has become more infectious or more deadly, nor that your personal risk of getting the disease is greater. But it will be a historical event.
Reposted with permission from The Conversation.
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The human body comprises around 60% water.
It's commonly recommended that you drink eight 8-ounce (237-mL) glasses of water per day (the 8×8 rule).
1. Helps Maximize Physical Performance<p>If you don't stay hydrated, your physical performance can suffer.</p><p>This is particularly important during intense exercise or high heat.</p><p>Dehydration can have <a href="https://www.healthline.com/health/how-to-tell-if-youre-dehydrated" target="_blank">a noticeable effect</a> if you lose as little as 2% of your body's water content. However, it isn't uncommon for athletes to lose as much as 6–10% of their water weight via sweat.</p><p>This can lead to altered body temperature control, reduced motivation, and increased fatigue. It can also make exercise feel much more difficult, both physically and mentally.</p><p>Optimal hydration has been shown to prevent this from happening, and it may even reduce the <a href="https://www.healthline.com/health/oxidative-stress" target="_blank">oxidative stress</a> that occurs during high intensity exercise. This isn't surprising when you consider that muscle is about 80% water.<a href="https://pubmed.ncbi.nlm.nih.gov/19344695" target="_blank"><span></span></a></p><p>If you exercise intensely and tend to sweat, staying hydrated can help you perform at your absolute best.</p><p><strong>Summary</strong></p><p><strong></strong>Losing as little as 2% of your body's water content can significantly impair your physical performance.</p>
2. Significantly Affects Energy Levels and Brain Function<p>Your brain is strongly influenced by your hydration status.</p><p>Studies show that even mild dehydration, such as the loss of 1–3% of body weight, can impair many aspects of brain function.</p><p>In a study in young women, researchers found that fluid loss of 1.4% after exercise impaired both mood and concentration. It also increased the frequency of headaches.</p><p>Many members of this same research team conducted a similar study in young men. They found that fluid loss of 1.6% was detrimental to working memory and increased feelings of anxiety and fatigue.<a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/mild-dehydration-impairs-cognitive-performance-and-mood-of-men/3388AB36B8DF73E844C9AD19271A75BF/core-reader" target="_blank"></a></p><p>A fluid loss of 1–3% equals about 1.5–4.5 pounds (0.5–2 kg) of body weight loss for a person weighing 150 pounds (68 kg). This can easily occur through normal daily activities, let alone during exercise or high heat.</p><p>Many other studies, with subjects ranging from <a href="https://www.healthline.com/health/parenting/signs-of-dehydration-in-toddlers" target="_blank">children</a> to <a href="https://www.healthline.com/health/symptoms-of-dehydration-in-elderly" target="_blank">older adults</a>, have shown that mild dehydration can impair mood, memory, and brain performance.</p><p><strong>Summary</strong></p><p><strong></strong>Mild dehydration (fluid loss of 1–3%) can impair energy levels, impair mood, and lead to major reductions in memory and brain performance.</p>
3. May Help Prevent and Treat Headaches<p>Dehydration can trigger <a href="https://www.healthline.com/health/dehydration-headache" target="_blank">headaches</a> and migraine in some individuals.<span></span></p><p>Research has shown that a headache is one of the most common symptoms of dehydration. For example, a study in 393 people found that 40% of the participants experienced a headache as a result of dehydration.</p><p>What's more, some studies have shown that drinking water can help relieve headaches in those who experience frequent headaches.</p><p>A study in 102 men found that drinking an additional 50.7 ounces (1.5 liters) of water per day resulted in significant improvements on the Migraine-Specific Quality of Life scale, a scoring system for <a href="https://www.healthline.com/health/migraine-symptoms" target="_blank">migraine symptoms</a>.<a href="https://academic.oup.com/fampra/article/29/4/370/492787" target="_blank"></a></p><p>Plus, 47% of the men who drank more water reported headache improvement, while only 25% of the men in the control group reported this effect.<a href="https://academic.oup.com/fampra/article/29/4/370/492787" target="_blank"></a></p><p>However, not all studies agree, and researchers have concluded that because of the lack of high quality studies, more research is needed to confirm how increasing hydration may help improve headache symptoms and decrease headache frequency.<a href="https://pubmed.ncbi.nlm.nih.gov/26200171" target="_blank"></a></p><p><strong>Summary</strong></p><p><strong></strong>Drinking water may help reduce headaches and headache symptoms. However, more high quality research is needed to confirm this potential benefit.</p>
4. May Help Relieve Constipation<p><a href="https://www.healthline.com/health/constipation" target="_blank">Constipation</a> is a common problem that's characterized by infrequent bowel movements and difficulty passing stool.</p><p>Increasing fluid intake is often recommended as a part of the treatment protocol, and there's some evidence to back this up.</p><p>Low water consumption appears to be a risk factor for constipation in both younger and older individuals.</p><p>Increasing hydration may help decrease constipation.</p><p><a href="https://www.healthline.com/nutrition/mineral-water-benefits" target="_blank">Mineral water</a> may be a particularly beneficial beverage for those with constipation.</p><p>Studies have shown that mineral water that's rich in magnesium and sodium improves bowel movement frequency and consistency in people with constipation.<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334415" target="_blank"></a></p><p><strong>Summary</strong></p><p><strong></strong>Drinking plenty of water may help prevent and relieve constipation, especially in people who generally don't drink enough water.</p>
5. May Help Treat Kidney Stones<p>Urinary stones are painful clumps of mineral crystal that form in the urinary system.</p><p>The most common form is <a href="https://www.healthline.com/health/kidney-stones" target="_blank">kidney stones</a>, which form in the kidneys.</p><p>There's limited evidence that water intake can help prevent recurrence in people who have previously gotten kidney stones.<a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004292.pub3/full" target="_blank"></a></p><p>Higher fluid intake increases the volume of urine passing through the kidneys. This dilutes the concentration of minerals, so they're less likely to crystallize and form clumps.</p><p>Water may also help prevent the initial formation of stones, but studies are required to confirm this.</p><p><strong>Summary</strong></p><p><strong></strong>Increased water intake appears to decrease the risk of kidney stone formation.</p>
6. Helps Prevent Hangovers<p>A hangover refers to the unpleasant symptoms experienced after drinking <a href="https://www.healthline.com/nutrition/alcohol-good-or-bad" target="_blank">alcohol</a>.</p><p>Alcohol is a diuretic, so it makes you lose more water than you take in. This can lead to dehydration.</p><p>Although dehydration isn't the main cause of hangovers, it can cause symptoms like thirst, fatigue, headache, and dry mouth.</p><p>Good ways <a href="https://www.healthline.com/nutrition/7-ways-to-prevent-a-hangover" target="_blank">to reduce hangovers</a> are to drink a glass of water between drinks and have at least one big glass of water before going to bed.</p><p><strong>Summary</strong></p><p><strong></strong>Hangovers are partly caused by dehydration, and drinking water can help reduce some of the main symptoms of hangovers.</p>
7. Can Aid Weight Loss<p>Drinking plenty of water can help you <a href="https://www.healthline.com/nutrition/how-to-lose-weight-as-fast-as-possible/" target="_blank">lose weight</a>.</p><p>This is because water can increase satiety and boost your metabolic rate.</p><p>Some evidence suggests that increasing water intake can promote weight loss by slightly increasing your metabolism, which can increase the number of calories you burn on a daily basis.</p><p>A 2013 study in 50 young women with overweight demonstrated that drinking an additional 16.9 ounces (500 mL) of water 3 times per day before meals for 8 weeks led to significant reductions in body weight and body fat compared with their pre-study measurements.</p><p>The timing is important too. Drinking water half an hour before meals is the most effective. It can make you feel more full so that you <a href="https://www.healthline.com/nutrition/35-ways-to-cut-calories" target="_blank">eat fewer calories</a>.</p><p>In one study, dieters who drank 16.9 ounces (0.5 liters) of water before meals lost 44% more weight over a period of 12 weeks than dieters who didn't drink water before meals.</p>
The Bottom Line<p>Even mild dehydration can affect you mentally and physically.</p><p>Make sure that you <a href="https://www.healthline.com/nutrition/how-much-water-should-you-drink-per-day" target="_blank">get enough water each day</a>, whether your personal goal is 64 ounces (1.9 liters) or a different amount. It's one of the best things you can do for your overall health.</p>
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Since even moderate-intensity workouts offer a slew of benefits, walking is a good choice for people looking to stay healthy.
How to Rock Your Walk<p>Walking isn't just fun and healthy. It's accessible.</p><p>"Walking is cheap," says Dr. John Paul H. Rue, a sports medicine doctor at <a href="https://mdmercy.com/" target="_blank">Mercy Medical Center in Baltimore</a>. "You can do it anywhere at any time; [it] requires little to no special equipment and has many of the same cardio benefits as running or other more intense workouts."</p><p>Want to up your walking game? Try the tips below.</p>
Use Hand Weights<p>Cardio and strength training can go hand-in-hand when you add weights to your walk.</p><p>A <a href="https://journals.lww.com/acsm-msse/Fulltext/2019/03000/Associations_of_Resistance_Exercise_with.14.aspx" target="_blank">2019 study</a> found that weight training is good for your heart, and <a href="https://www.mayoclinicproceedings.org/article/S0025-6196(17)30167-2/abstract" target="_blank">research</a> shows it reduces the risk of developing a <a href="https://www.healthline.com/health/nutrition-metabolism-disorders" target="_blank">metabolic disorder</a> by 17 percent. People with metabolic disorders have a higher chance of being diagnosed with high cholesterol, high blood pressure, and diabetes.</p><p>Rue suggests not carrying weights for your entire walk.</p><p>"Hand weights can give you an added level of energy burning, but you have to be careful with these because carrying [them] over a long period of time or while walking could actually lead to some overuse injuries," he says.</p>
Make It a Circuit<p>As another option, consider doing a circuit. First, put a pair of dumbbells on your lawn or somewhere in your home. Walk around the block once, then stop and do some bicep curls and tricep lifts before walking around the block again.</p><p>Rue recommends <a href="https://www.healthline.com/health/exercise-fitness/running-with-weights" target="_blank">avoiding ankle weights</a> during cardio workouts, as they force you to use your quadriceps rather than hamstrings. They can also cause muscle imbalance, according to the <a href="https://www.health.harvard.edu/staying-healthy/wearable-weights-how-they-can-help-or-hurt" target="_blank">Harvard Health Letter</a>.</p>
Find a Fitness Trail<p>Strength training isn't limited to weights. You can get stronger by <a href="https://www.healthline.com/health/bodyweight-workout" target="_blank">simply using your body</a>.</p><p>Often found at parks, fitness trails are obstacle courses with equipment for pullups, pushups, rowing, and stretches to build upper and lower body strength.</p><p>Try searching "fitness trails near me" online, checking out your local parks and recreation website, or calling the municipal office to <a href="https://calisthenics-parks.com/" target="_blank">find one</a>.</p>
Recruit a Friend<p>People who workout together stay healthy together.</p><p><a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0584-3" target="_blank">One study</a> showed that older adults who exercised with a group improved or maintained their functional health and enjoyed their lives more.</p><p>Enlist the help of a walking buddy with a regimen you aspire to have. If you don't know anyone in your area, apps like <a href="https://www.strava.com/" target="_blank">Strava</a> have social networking features so you can get support from fellow exercisers.</p>
Try Meditation<p>According to the <a href="https://www.nccih.nih.gov/research/statistics/nhis/2017" target="_blank">2017 National Health Interview Survey</a>, published by the National Institutes of Health, meditation is on the rise, and for good reason.</p><p>Researchers <a href="https://pubmed.ncbi.nlm.nih.gov/29616846/" target="_blank">found</a> that mind-body relaxation practices can regulate inflammation, <a href="https://www.healthline.com/health/biological-rhythms" target="_blank">circadian rhythms</a>, and <a href="https://www.healthline.com/health/glucose" target="_blank">glucose</a> metabolism, as well as lower <a href="https://www.healthline.com/health/high-blood-pressure-hypertension" target="_blank">blood pressure</a>.</p><p>"Any form of exercise can be turned into a meditation of some type, either by the surroundings you are walking in, like a park or trail, or by blocking out the outside world with music on your headphones," Rue says.</p><p>You can also play a podcast or download an app like <a href="https://www.headspace.com/headspace-meditation-app" target="_blank">Headspace</a> that has a library of guided meditations to practice while you walk.</p>
Do Fartlek Walks<p>Typically used in running, fartlek intervals alternate periods of increased and decreased speed. These are <a href="https://www.healthline.com/nutrition/benefits-of-hiit" target="_blank">high-intensity interval training (HIIT)</a> workouts, which allow exercisers to accomplish more in less time.</p><p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154075" target="_blank">One study</a> showed that 10-minute interval training improved <a href="https://www.healthline.com/health/metabolic-syndrome" target="_blank">cardiometabolic</a> health, or lowered the risk of heart disease, stroke, and diabetes, just as well as working out at a continuous pace for 50 minutes.</p><p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0111489" target="_blank">Research</a> also shows that HIIT workouts increase muscle <a href="https://www.healthline.com/health/fast-twitch-muscles" target="_blank">oxidative</a> capacity, or the ability to use oxygen. To do a fartlek walk, try walking at an increased pace for 3 minutes, slow down for 2 minutes, and repeat.</p>
Gradually Increase Pace<p>A faster walking pace is associated with a lower risk of <a href="https://www.healthline.com/health/copd" target="_blank">chronic obstructive pulmonary disease (COPD)</a> and respiratory diseases, according to a <a href="https://pubmed.ncbi.nlm.nih.gov/30303933/" target="_blank">2019 study</a>.</p><p>Still, it's best not to go from a stroll to an Olympic-worthy power walk in a day. Instead, increase your pace gradually to prevent injury.</p><p>"Start by walking at a brisk pace for about 10 minutes per day, 3 to 5 days per week," Rue says. "Once you've done this for a few weeks, increase your time by 5 to 10 minutes per day until you get to 30 minutes."</p>
Add Stairs<p>You've likely heard that taking the stairs instead of an elevator is a way to add more movement into your daily routine. It's also a way to step up your walking. Stair climbing has been shown to <a href="https://www.sciencedirect.com/science/article/pii/S2211335519301123?via%3Dihub" target="_blank">decrease the risk of mortality</a> and can easily add a bit more challenge to your walk.</p><p>If you don't have stairs in your home, you can often find them outside a local municipal building, train station, or at a high school stadium.</p>
Is Your Walk a True Cardio Workout?<p>Not all walks are equal. A walk that's too leisurely may not provide enough burn to qualify as cardio. To see if you're getting a good workout, try to <a href="https://www.healthline.com/health/how-to-check-heart-rate" target="_blank">measure your heart rate</a> using a monitor.</p><p>"A target goal for a good walking workout heart rate is about 50 to 70 percent of your maximum heart rate," Rue says, adding that maximum heart rate is <a href="https://www.healthline.com/health/fitness-exercise/fat-burning-heart-rate" target="_blank">typically calculated</a> by 220 beats per minute minus your age.</p><p>You can also monitor how easily you can carry on a conversation while you walk to gauge your heart rate.</p><p>"If you can walk and carry on a normal conversation, that's probably a lower intensity walk," says Rue. "If you are slightly breathless but can still have a conversation, that's probably a moderate workout. If you are out of breath and can't talk normally, that's a vigorous workout."</p>
Takeaway<p>By shaking up your routine, you can add excitement to your workout and reap even more rewards than a basic walk provides. Increasing the pace and intensity of a workout will make it more effective.</p><p>Simply pick your favorite variation to add some spice to your next walk.</p>
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Summer and fall are great seasons to enjoy the outdoors. But if you're already spending extra time outside because of the COVID-19 pandemic, you may be out of ideas on how to make fresh-air activities feel special. Here are a few suggestions to keep both adults and children entertained and educated in the months ahead, many of which can be done from the comfort of one's home or backyard.