It's Worse than Forty Fights

Pandemic: Tracking Contagions, from Cholera to Ebola and Beyond - Sonia Shah

The author takes cholera, an acute diarrheal illness, as her starting point because, like the bubonic plague, influenza, smallpox, HIV and you-know, it has caused pandemics. Writing this book in 2017 – i.e., before our first-hand experience - she points out in the recent past we have seen over 300 infectious pathogens emerge or re-emerge, like ebola, dengue fever, middle east respiratory syndrome, and – surprise! - novel coronaviruses.

Cholera really messes us people up by drawing fluid out of us. We dehydrate to death. About 1 in 10 people whom cholera sickens will develop the severe symptoms of watery diarrhea, vomiting, and leg cramps. In these people, the rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours. As in the 1918 influenza, a person can be fine in the morning and dead by the evening. If not treated right away, it will kill half the people who catch it.  Cholera caused seven pandemics in the 19^th and 20^th centuries.

How does a microbe become a pathogen that causes pandemics? When we enter wildlife habitats, we come into contact with novel viruses. The viruses jump into our bodies where they become pathogenic. The history of cholera illustrates this path. A marine bacterium, it lived peacefully in estuaries, swamps and wetlands, perfect to grow alongside planktons. When these environments were disturbed in India in the 19^th century, people had contact with the cholera in the environment. People using modern transport – ships, canals, trains – then spread it all over the world.

We are still invading wild habitat with farms, mines, and suburban development. Deforestation in West Africa lead directly to an outbreak of ebola in 2014. We have lost diverse bird species in North America because of loss of habitat. Robins and crows have taken over. Unfortunately they are efficient carriers of West Nile virus. In 1999 in New York City, we had the first big outbreak when it spilled over into humans. The loss of opossum and chipmunks, who eat the ticks that try to feed of them, due to suburbanization has lead to the increase of tick-borne diseases like Lyme disease.

Modern transportation increases the risk of pandemics. The Erie Canal, in fact, helped spread cholera by connecting waterways into a highway of infection. In the 19^th century prosperous cities like New York City and Paris had no sewage system. So cholera entered the ground water and made thousands of people sick. Her narrative of the filth of New York City in the 1830s beggars description. Though I have no idea how such a thing can be measured, historians claim that the average New Yorker of the time ingested about two teaspoons of fecal matter.

A day.

The crowding of modern urbanization too helps spread epidemics. In the 1830s the crowding in cities created a huge sanitary crisis. People coming off the land to New York City just used their traditional pooping practices. Cesspools and outhouses were untreated and there were no rules as to how they were cleaned or maintained. Cholera exploded over and over again in New York City. Terrible things happened in the early 1830s as mobs went crazy against Irish workers and doctors were stoned in the street. But the rich and powerful lobbied against measures to combat cholera.

What do we do to contain these outbreaks? Before vaccines and medications were developed to deal with infectious disease, we changed land use policies, dam construction, housing practices, and moved rural people out of poverty. People put screens on their windows. Cities had campaigns to get people to mop up or drain standing water so malaria mosquitoes could not breed.

But from around 1940 when drugs were developed the establishment went over to a biomedical model of fighting contagion.  We figured we would throw drugs at diseases to make them go away when people got sick. But vaccines are not sufficient. Dengue fever broke out in Florida because the foreclosure crisis had lead to many abandoned houses which meant swimming pools and gardens filled with standing water. They become giant breeding grounds for mosquitoes which spread dengue. The biomedical approach failed and now dengue fever in endemic in Florida.

So now we are looking a growth of new pathogens, spreading quickly, untreatable diseases. Most of human beings will live in cities in about 10 years. Millions will live in slums in impoverished parts of the world. Ebola will tear through cities with millions of people. Zika will take advantage of huge populations in dense conditions too.

The author says we need to engage in political and social causes for pandemics. Reading this book’s dark predictions about the future is scary, especially in light of our recent sad bitter experience and how it contributed to our environment filled with our otherwise smart relatives, co-workers, and neighbors that “believe in” the “plandemic hidden agendas” and “rushed through vaccines” on account of they did “their own research.”