On Pandemics

Deadly Diseases from Bubonic Plague to Coronavirus

David Waltner-Toews

• Publisher: Black Inc.
• Year: 2020
• ISBN:
  9781743821602
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

Written by a leading epidemiologist, this engrossing book answers our questions about animal diseases that jump to humans – called zoonoses – including why they have become more common in recent history, and what we can do about them.
Almost all pandemics and epidemics – including SARS, Ebola and now COVID-19 – have been caused by diseases that come to us from animals. In On Pandemics, David Waltner-Toews gathers the latest research to profile dozens of illnesses.
Why do zoonotic diseases jump from animals to humans – and why do some hang around for good? How have governments responded to pandemics and epidemics throughout history, for better or worse? How have climate change, industrialised farming, cultural practices, biodiversity loss and globalisation made these diseases not only possible, but the inevitable outcomes of our modern lifestyles?
Coronaviruses have made bats their home for centuries. Until SARS came along, we didn't know they were there, nor do we know how many other death-dealing viruses might be living undetected in wildlife. On Pandemics examines the increasing impact of animal-borne diseases on our world, and encourages us to re-examine our role in pandemics – for the health of the planet as well as our own survival.

(1)

AN INTRODUCTION TO THE SECOND EDITION

I WROTE THE first edition of this book in the turbulent wake of avian influenza’s spectacular appearance in the late 1990s, and the even more dramatic SARS alarm early in this century. In quite different ways, both diseases awakened fears and memories of the 1918 influenza pandemic, and led to widespread animal slaughtering, airport closings, government panic, mayoral rants, and rock concerts. On the other hand, the pandemic of influenza that swept around the world in 2009 and 2010, first called swine flu, and later given the technical moniker H1N1, evoked measured responses accompanied by widespread skepticism.

In 2020, I am writing this second edition of the book during a global lockdown in response to the explosive spread of SARS-COV-2 (the virus) and COVID-19 (the disease it causes). COVID-19 has now joined the list of pandemics, near-pandemics, and possible pandemics that have long haunted human history. With popular names such as SARS, bird flu, swine flu, Ebola, and bubonic plague, these diseases all have one thing in common: they are zoonoses, diseases that have made the jump from their natural homes in other animals to take up residence in people. Some of them—the influenzas, mostly—took the direct route from chickens or pigs to people. Others, such as Ebola, COVID-19, and SARS, took a more circuitous route from bats, pausing at rest stops in one or two other animals—civets, monkeys, or pangolins, perhaps—before they found their way to humans. Welcome to the twenty-first century.

The eruption and worldwide spread of SARS-COV-2 was, some might assert, predictable, but predictable only in the sense that earthquakes and volcanic eruptions in certain parts of the world are predictable. The Ring of Fire, for instance, home to more than three-quarters of the world’s volcanoes, is a horseshoe-shaped area rimming the Pacific Ocean. We can predict that there will be volcanic eruptions and earthquakes along this rim, but exactly where and when they will occur is uncertain.

There were reports, of course, briefings, warnings about emerging infectious diseases, rumors of chimeric viruses that bore traces of their animal origins. In retrospect the reports should have been heeded; they weren’t just angry jeremiads. They were based on scientific studies and simulations. But there were events other than rogue viruses in a Chinese market that kept us distracted. And in our collective distraction and denial, we were surprised. I could say we shouldn’t have been surprised, but I’ve never found retrospective told-you-sos to be comforting or useful.

Even the most scientifically literate among us might be forgiven our skepticism that an outbreak led by an unstable, albeit crowned, virus, was going to usher in a New Age, or even a Different Age. Some might argue, based on good evidence, that crowned heads have always been somewhat unstable. On the other hand, we wouldn’t be the first to have underestimated the impact of a small event—say, a butterfly flapping its wings in Brazil on storms in Texas. The world is more chaotic, less predictable, than we would like to believe.

Many of the pandemics imagined in movies and novels before 2020 involved apocalyptic scenarios that included people stumbling through garbage-strewn streets, bleeding from all orifices, zombies, billions dead, and bodies in the street. Perhaps a few religious or ideologically obsessed zealots even wished, mostly in secret, for one of those God-save-us pandemics that historian Walter Scheidel announced might provide a sufficiently violent shock to “upend the established order” and “flatten disparities in income and wealth.”

What most literary scenarios did not imagine was an infection that spread rapidly, infected hundreds of thousands, and seemed to kill almost at random. Of course, as with previous pandemics, COVID-19 has tended to kill more older people, and people whose immune systems were already under duress from cancer or diabetes or heart disease. But what has struck many observers, myself included, was how two healthy people in the prime of life could be infected with SARS-COV-2, and one of them, without any reasonable medical explanation, would die, while the other lived. This almost seemed like the random drive-by shootings described by my Colombian colleagues from the 1990s.

So, yes, the SARS-COV-2 pandemic was predictable, but as one of my Italian colleagues, in lockdown as I write this, said, “Even in the case of an earthquake, whilst the earth is shaking, the first reaction (seconds or less) is denial: it is impossible, it cannot be true, not here! And even afterward, when you see the ruins, it’s still hard to believe.”

Most of us have been made aware of the ravaged landscapes, lost habitats, and disappearing megafauna that have characterized the past century. We fret about the extinctions of birds and rhinos. We try to save some arthropods, like bees and butterflies, even as we try to kill others, like mosquitoes. Still, even the most conservation-minded among us rarely think about the trillions of viruses, yeasts, fungi, and bacteria for whom these disappearing animals are home, or about where those microfauna might look for new homes once we raze their habitats for mines, cattle ranches, or cities. The diseases described in this book are, in a sense, about microscopic refugees from those lost habitats and disappearing species.

The living things on this planet are one big, dysfunctional extended family of species, in which most bacteria, viruses, and parasites are beneficial and necessary, in which diseases have a useful role in nature, and in which we ourselves have evolved from microbes and are composed of them. I think we—this big family, including the bothersome and wonderful and contradictory human species—can work out our problems with the help of some serious narrative therapy. War, with all its calls to arms, technological weapons, and national pride, its suspension of civil liberties, xenophobia, and collateral damage, is often used as a metaphor for how we should fight disease. But that is too impoverished and small-minded an image. Perhaps politics, the so-called art of the possible, is a better metaphor. War is a last resort.

After millennia of war on the agents of disease and the eradication of some of the worst, we might even find ways of negotiating with them, of accommodating each others’ needs, engaging in minor, stylized skirmishes, with a reasonable, acceptable death toll on all sides. In the twenty-first century, we are discovering that we will have a common future, or none at all. But such a future will require us to educate ourselves in different, more ecologically aware, ways. One of our many tasks is to translate that education into a new version of common sense, a kind of solidarity with other people, and other species, informed by careful attention to this amazing planet we share.

Clinical neurologist Oliver Sacks has argued that we “do not honor our peripheral vision as much as we should.” Sacks was talking about his own individual experience, but some of us have argued that the highly focused-but-disoriented stumbling about of biomedical sciences reflects a collective lack of honoring—indeed, a pathological loss—of peripheral vision.

If epidemiologists of human diseases were more aware of animal diseases, if veterinary epidemiologists spent more time having conversations with public health officials, if economists and politicians were more aware of complex social-ecological webs, if every upstart business guru were more aware of the unintended consequences of disruptive entrepreneurial innovations, if we were as good at paying attention to the world around us as we are to what is just in front of us … then maybe we would not have been so shocked by the appearance of COVID-19. Those are a lot of ifs, none of which can be addressed by any single profession or scientist or politician; peripheral vision in the global sense requires us to watch out for each other. In an overcrowded twenty-first-century world, we are each other’s peripheral vision.

We will all die. That is a normal part of life. Still, there are ways to make our dying more pleasant, less catastrophic, more as if we are among mortal friends. As the poet W.H. Auden once wrote: The slogan of Hell is to eat or be eaten; the slogan of heaven is to eat and be eaten.

If we understand just a little more about the animals we share this planet with and the micro-organisms that they carry around, both those that we eat, and those that will eat us, we might even begin to understand ourselves.

FINALLY, BEFORE WE step into the butterfly-induced tornado of terminology related to outbreaks, epidemics, and pandemics, I should say something about names. If the names of hurricanes are open to criticism, the names of diseases are even more fraught. The task of naming things, whether in upper-class European Latin from the seventeenth century, or in popular culture, is a very human burden. This task is not to be undertaken without careful thought. In some cases, careless naming has led to reckless blowing up of bat caves and slaughtering of civets or dogs. Naming a disease after where it was first found (West Nile, Lagos, Hong Kong, Asian, Russian, Wuhan) might provide useful shorthand for field investigators—or an opportunity for demagogic, xenophobic, and racist rants. A name can hinder the implementation of good public health programs. H1N1 was called swine flu, until several leaders in the Middle East, understandably offended, suggested that it be called the Mexican virus. Virologists settled the matter with a name that sounds like a postal code for an address in another, parallel, world. At other times, after someone, whether thoughtlessly or maliciously, labeled a disease according to ethnicity, sexual orientation (e.g., HIV as a “gay disease”), nationality, or economic status, millions of people have been stigmatized, ostracized, assaulted in the streets, and murdered. In this book I shall, insofar as is possible, use technical scientific names and, where these are not available or are too obtuse, descriptive popular names, such as SARS (severe acute respiratory syndrome).

(2)

THREATS, OUTBREAKS, EPIDEMICS, AND PANDEMICS: A PRIMER

UNTIL A few years ago, many scientists had banished words like “threat” and “danger” from our vocabulary. In an attempt to be more rigorously quantitative and less emotional, we began to write about risks. Our response to danger was called “risk management.” A risk is a threat or a danger that you put into a box. Then you can count boxes, and manage them. The assumption in risk management is that you can quantify danger. This is only partially true.

Epidemiologists sometimes define an epidemic as more cases than they would expect, or as “unusually high rates.” But measuring this isn’t as simple as it sounds. We can ask, first of all, whether in our case numbers we are counting people exposed to a virus (and who may be test-positive), people who have been infected but don’t show any clinical disease, people who are clinically ill, or people who die. We might, if we are the World Bank and are worried about economic impacts, try to calculate disability-adjusted life years; that is, how many years of economically productive life are lost. This means that the younger you are when you get sick, the greater the impact (assuming you are economically productive).

Once we decide who and what to count, we are faced with another set of questions. What are we referring to when we say “expected” or “usual”? That is relatively easy, at least from a scientific point of view. The expected or usual numbers are those we’ve seen over the past few decades. Even if the numbers of cases are unexpected or unusual, however, we need to ask: Are we dealing with a disease that is important?

How do we assess importance? Is it a scientific decision? Are authorities more hesitant to use the loaded word “pandemic” for some diseases, preferring to speak of a “global epidemic” of AIDS or “high rates” of malaria or diarrhea in certain parts of the world? If so, why is that? Do some diseases so radically and explicitly expose global economic inequities that the wealthy owners of global institutions would prefer to focus on those that more directly threaten Europe and North America and for which a technical, money-making fix is more likely to be found? Hey, I’m a curious epidemiologist. I’m just asking. The truth is that although words like “outbreak,” “epidemic,” and “pandemic” have a scientific ring to them, and some grounding in science, their use is very political.

Now, after decades of quantitative risk management, in the new age of emerging infectious diseases such as bird flu, SARS, Ebola virus disease, and COVID-19, we seem to be back in a jungle of threats and dangers. If SARS-COV-2 has taught us anything at all, it’s that even our best quantitative, scientific measurements cannot give us all the answers we want.

Before we dive into what we mean by a pandemic—that equivalent to the man-eating lion in the dark forest—let me begin the definition with something smaller, at least in terms of numbers: an outbreak. An outbreak occurs when a relatively small group of people or animals or plants gets sick, as when everyone gets sick after eating a warm potato salad on a sunny day. The source of an outbreak can usually be traced to one particular event or exposure.

The next step up from an outbreak is an epidemic, which is like an outbreak, only huger. The word “epidemic” goes at least as far back as Homer, in about the eighth century BC. Homer used it to refer to someone in his or her own country, as differentiated from a traveler. It had connotations of “indigenous” or “endemic.” Hippocrates, in 430 BC, gave it a medical slant, referring to physical syndromes (illnesses) that occurred in particular places and times. After the discovery of bacteria in the nineteenth century, people began to use the term to refer to specific diseases, as in epidemics of cholera. More recently, the word has been used to refer to more cases than expected, both of very specific diseases, such as hemolytic uremic syndrome caused by E. coli O157:H7, and general syndromes, such as obesity.

This brings us back to the question of expectations. Every year, we expect a certain number of cases of say, influenza A. When we get more than we expect, or we are faced with a new variation of the same old thing, we call it an epidemic. Some diseases, such as West Nile virus disease and Lyme disease, start as epidemics. They surprise us. But after a few years, we get used to them, and we think of them as troublesome, tiresome, endemic. They now belong here, wherever that “here” may be. The words we use to describe these disease patterns are both descriptive and a way to catch—or divert—our attention. Why, some might ask, are there more cases than we expect? How and why have our expectations changed?

Multi-country out...

Table of contents

• Cover Page
• Title Page
• Copyright
• Dedication
• Contents
• 1 An Introduction to the Second Edition
• 2 Threats, Outbreaks, Epidemics, and Pandemics: A Primer
• 3 Zoonoses and Diseases People Get from Other Animals
• 4 Plagues, Rats, and the Perfection of Fleas
• 5 Lyme, with a Twist
• 6 Biting Flies, Kissing Bugs, and Sleeping Sickness
• 7 Western Equine Encephalitis, Television, and Air Conditioning
• 8 West Nile Virus and the St. Louis Blues
• 9 The Chickens Fight Back, with Ducks
• 10 Queens of the South: Nipah, SARS-COV, and SARS-COV-2
• 11 Rats, Bats, and Monkeys: Lassa, Ebola, and Marburg
• 12 Splashing through Rat Piss: Leptospires and Hantaviruses
• 13 All the Rage
• 14 Abortion in the Sandbox and Other Pet Problems
• 15 Poker Players’ Pneumonia
• 16 Bang’s Disease and the White Plague
• 17 Dog Parasites in the Land of the Gods
• 18 Stories for the InterPandemic
• Selected Readings
• Acknowledgments for the Second Edition
• Index
• Back Cover