Millions of people died as a result of this pandemic, including approximately 10,000 troops in British service, which attracted European attention.

[1] At festival times, pilgrims frequently contracted the disease there and carried it back to other parts of India on their returns, where it would spread, then subside.

[6] Some epidemiologists and medical historians have suggested that it spread globally through a Hindu pilgrimage, the Kumbh Mela, on the upper Ganges River.

[4] In March 1820, the disease was identified in Siam, in May 1820 it had spread as far as Bangkok and Manila; in July the outbreak torched Vietnam; in spring of 1821 it reached Java, Oman, and Anhai in China; in 1822 it was found in Japan, in the Persian Gulf, in Baghdad, in Syria, and in the Transcaucasus; and in 1823 cholera reached Astrakhan, Zanzibar, and Mauritius.

[4] According to economic history professor Donato Gómez-Diaz, "[advances] in commercial exchange and navigation contributed to cholera’s dispersion.

"[5] Navy and merchant ships carried people with the disease to the shores of the Indian Ocean, from Africa to Indonesia, and north to China and Japan.

[4] Hindu pilgrims spread cholera within the subcontinent, as had happened many times previously, and British forces carried it overland to Nepal and Afghanistan.

[14] However, this report was certainly an overestimation as David Arnold writes: "The death toll in 1817–21 was undoubtedly great, but there is no evidence to suggest that it was as uniformly high as Moreau de Jonnès presumed.

[...] Statistics collected by James Jameson for the Bengal Medical Board showed mortality in excess of 10,000 in several districts.

[18] Speaking about the anti-Asian sentiment that rose after the outbreak, British historian David Arnold wrote that "the Indian origins of cholera and its almost global dissemination from Bengal made the disease a convenient symbol for much that the west feared or despised about a society so different from its own".

[18] Medical professionals of the time were also noted for relying on moral judgments and generalizations of Indian people on pilgrimages.

[18] The sanitary commissioner of Bengal, David Smith, wrote that "the human mind can scarcely sink lower than it has done in connection with the appalling degeneration of idol-worship at Pooree".

[8] This movement of the virus in the rivers of Russia allowed cholera to reach England by 1832,[19] and the Americas shortly afterward.

[8] The bacterium also was theorized to have spread into England from British soldiers returning home after tours of duty in India, many of them serving in the Bombay Army which was stationed where the pandemic broke out.

[20] Special deputations from the west traveled to Russia to observe the Russian response and formulate a plan to deal with these pocketed outbreaks.