Pandemic

Pandemic: Tracking Contagions from Cholera and Ebola to Beyond by Sonia Shaw

 “Those who cannot learn from history are doomed to repeat it” (paraphrase of George Santayana).[i]

Sonia Shaw’s Pandemic was published in 2016, but reads like it was written in the summer of 2020—it seems prescient. That’s because Shaw knows her history, unlike too many countries who make the same mistakes that killed millions in other pandemics.

Shaw focuses most of her writing on cholera because, unlike other diseases, cholera’s emergence is well documented. Also, the story of cholera has the clues required to understand how other diseases emerge and infect large numbers.

By telling the stories of new pathogens through the lens of a historical pandemic, I could show both how new pathogens emerge and spread, and how a pathogen that had used the same pathways had already caused a pandemic.

Another pandemic is inevitable. Ninety percent of epidemiologists believed a global-recession causing pandemic that kills tens of millions would arrive sometime in the next two generations.

Partly, this sense of an impending pandemic derives from the increasing number of candidate pathogens with the biological capacity to cause one.

Between 1940-2004 more than 300 infectious diseases emerged or reemerged in poluations that had never seen them before; deaths from pathogens rose over 65% in the US alone.  

The way modern societies have handled outbreaks of new diseases so far does not bode well.

Indeed, modern societies responses do not bode well. One reason is because a few political actors beholden to big business irresponsibly raise doubts about measures to slow the spread of a disease.

For example:

• Quarantines were “a most unwarrantable tyranny over the merchant” (New York city newspaper, 1798).
• Business losses from quarantine “calamitous” (physician Daniel Drake).
• “Quarantine is useless and the injury it inflicts on the commercial relations and maritime intercourse of the country is an absolute and uncompensated evil” (British physician Dr. Henry Gaulter, 1833).
• Quarantines are “engines of despotism” (Charles Maclean, Evils of Quarnatine Laws, and Non-Existence of Pestilence Contagion”).

Another reason is that a first reponse from officials is often to deny there is a problem. For example:

• In the 2002 SARS outbreak, China blocked WHO inspectors from visiting their country, and lied about the disease.
• In 2012, Cuba suppressed news of cholera, and in 2000 when dengue fever was reported by a doctor, he was imprisoned for a year.
• Saudi Arabia almost imprisoned a virologist for warning the public about an outbreak. Despite later being credited for having prevented a pandemic, he had to relocate to Egypt.
• In 2010, India investigated and tried to jail Indian scientists who studied and reported on a gene snippet (NDM-1) that could make bacteria antibiotic-resistant superbugs.
• In 1832, the mayor and the board of health of New York City didn’t alert the public about cholera arriving. They even destroyed four months of hospital records.
• In 1911, Naples, Italy was involved in an actual international conspiracy with the US and France to cover up cholera because millions of tourists were expected for the country’s 50^th anniversary. They bribed newspapers, threatened doctors, confiscated cholera education literature, censored telegrams, tapped phones. Even the US Surgeon General failed to warn the public about travel to Italy although he did warn his personal acquaintances not to go.

Also, the bad thing about science is that it’s true whether or not you believe in it–in this case ignoring containment measures will kill you.

During the 1832 cholera epidemic,

…the elite of Paris attended elaborate masquerade parties where, in denial and defiance of cholera’s toll, they danced to “cholera waltzes,” costumed as the ghoulish corpses many would soon become….Cholera killed them so fast they went to their graves still clothed in their costumes.

And it was a messy death.

And they did not just clutch their hearts and crumple to the floor, either; their bowels released uncontrollable floods. Cholera was humiliating, uncivilized, an affront to nineteenth-century sensibilities.

So many died that the government stopped publishing death statistics.

An outbreak also spawns a pandemic of hate. People will find scapegoats to blame.

Scapegoats include 19^th-century physicians and nurses (beaten, murdered when mobs attacked hospitals), monks and friars (in San Francisco 40 monks were stabbed, drowned, and hurled from rooftops). In 1830, Irish immigrants were hired to clear a path for a new railway in Pennsylvania were quarantined, then murdered. Local papers celebrated the mass murders of the “intemperate”– the shattered skulls of the murdered men were unearthed from a mass grave in 2009.

In 1985, Muslims were attacked and killed during one of their pilgramages. In 1890, New York went after Russian Jews and Hungarians. Asians have been attacked for centuries (including 2020), and Jews have been blamed for, well, pretty much everything, but especially plagues and pandemics in the past two millennia.

There are many fascinating chapters in this book. For example, if it wasn’t for cholera we might still be living with several inches of compacted sewage on city streets. New York City cleaned their streets so infrequently that even lifelong elderly residents were surprised to discover the streets actually were cobblestones under the compacted sewage. Living with human waste was so normalized many people actually ate faeces or snorted powdered poop for health benefits (Reformationist Martin Luther ate a spoon of his own faeces every day).

We learn about the evolutionary steps cholera took from a harmless seawater microbe that ate chitin to a deadly human pathogen causing pandemics that are ongoing now (e.g., Haiti). We learn how and why pathogens arose, and that the conditions we’ve created guarantee even more pathogens arising. We learn how private donors are now the biggest donors to global health agencies like WHO. There is no mechanism to hold private donors accountable if their agenda conflicts with a public health agenda (the Ebola outbreak was worsened by a political appointee at WHO).

This book should be one of those books assigned in high schools rather than the typical “life is hard, then everyone dies at the end” books. COVID19 was predictable, and it was preventable if we’d learned the lessons from the past.

Maybe for the next pandemic—and there will certainly be another pathogen that evolves to infect humans—we could stop it before it even begins.

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[i] The original quote is “Those who cannot remember the past are condemned to repeat it.”