Viruses and bacteria and parasites, oh my!

When I started reading “Pandemic” I was skeptical about whether it could teach me anything new, I’ve treated patients with Malaria, HIV, Brucella and Leishmania (although I have yet to encounter Cholera) and many more exotic pathogens, but was pleasantly surprised at how much there is to be gleamed from this short yet dense book. “Outbreaks are inevitable, but pandemics are optional”, this may seem like an odd proposition, but throughout her book, Shah shows how it is human agency and institutions that help spread disease and what’s worse, often prevent proper treatment.

In 1918 the Spanish flu killed 50 million people, more than the war. Smallpox in conservative estimates killed over a billion people until it was eradicated (the only human disease ever to be fully eradicated, the last case of Variola major in the 1970’s). TB kills around 2 million people annually, Malaria kills nearly half a mill, annually, Schistosomas cause blindness and cancer in millions. And there are many more (it’s like pokemon but horrible). Most of these pathogens and most pandemics come originally from zoonotic disease, TB from pigs, Measles from cows, Influenza from fowls, Cholera from crustaceans, HIV from primeapes (no, not from sexual congress, something much more intimate, from consuming their flesh). This is where Shah starts, she goes to China to visit open markets where one can purchase exotic animals for their meat. Stuffed together in tight quarters are animals that would never share habitats in the wild, forced to mingle and then their flesh consumed by humans. This gives viruses an incredible evolutionary breeding ground to swap and mix genetic material and mutate into forms that can easily jump species and hosts.

From there global trade routes can spread disease anywhere, cholera which is transmitted via fecal-oral route was transmitted via spice trade routes, both on land and on sea. When a disease like that reaches an urban setting, the human constructions allow pandemics to thrive. Shallow water wells, improper waste management, eroding bedrocks that kept re-spreading the bacteria in the water.

The saddest part is reading how human behavior, especially greed, racism and ignorance help strengthen the pandemics. Cholera was considered an “Asiatic” disease and when it hit Paris in 1832 it hit hard! The city was completely unprepared for it and tens of thousands died. Cholera kills fast, there is a famous story of aristocrats sitting down for dinner and proclaimed dead by dessert.  There are sadly many tales like this, some quite recent.

This is a remarkable book, fun to read and educational I suspect to both physicians and laypeople. It should also be noted that it serves as a potent reminder that humans do not have to stand passively against the onslaught of viruses, bacteria and parasites, there is much that can be done. Vaccination programs, proper infrastructure investment, global health care, sustainable ecological conservation and a commitment to global public health that all to sadly is exactly what is lacking today in many parts of the world. This may seem like a lot, but in the end not only will it be the moral thing to do, saving lives and preventing misery, it will be the most cost effective thing to do, nothing destroys an economy quite like an epidemic.