Blood Will Tell: “Crisis In The Red Zone;” One Wonders How Much Longer Humankind Can Continue To Dodge A Lethal/Global Pandemic

Blood Will Tell: “Crisis In The Red Zone;” One Wonders How Much Longer Humankind Can Continue To Dodge A Lethal/Global Pandemic

     Richard Preston, a writer for The New Yorker, and best-selling author of numerous books on infectious diseases, bioterrorism, and the blockbuster best-seller, “The Hot Zone,”  has a new book out, “Crisis In The Red Zone,” which was reviewed by William F. Bynum, “Blood Will Tell,” in the July 24, 2019 edition of the Wall Street Journal. Mr. Bynum’s books include: “The History Of Medicine; A Very Short Introduction,” and with Helen Bynum, “Botanical Sketchbooks.”  I refer you to Mr. Byrum’s review in the July 24 edition of the WSJ, for the full article.
     Mr. Bynum’s opinion up front: Mr. Preston’s new book, “grippingly chronicles another Ebola outbreak, 2014-2016; and, offers a grim forecast [for humankind] for future flare ups.”
     Mr. Brynum begins, “HIV, the human immunodeficiency virus, made its presence felt beginning in 1981, first gradually and dramatically. We know that it “emerged” decades previously, crossing from an animal reservoir to a human host. It then smoldered in isolated individuals before conditions permitted it to spread explosively. HIV has since evolved before our eyes,” he noted, “becoming less aggressive and [but] more insidious, especially in the West; but, it is still a major health problem, no where more than Africa.”
     “Five years before, in 1976, the Ebola virus had already announced its awesome power,” Mr. Byrum wrote. “Initially, the disease was thought to be an outbreak of typhoid, or perhaps an outbreak of Marburg, another emerging virus,” he noted. The episode created local panic, and killed a number of patients, several nuns, and a priest at Yambuku Catholic Mission, in what is now the Democratic Republic of the Congo, but the virus apparently disappeared without causing too much of an international ripple. Not only have Ebola epidemics continued to occur, however, but the World Health Organization has warned that [progressively] worse epidemics are the norm.”
     “Crisis In The Red Zone,” “is Richard Preston’s second book on Ebola,” Mr. Bryum wrote, “The Hot Zone” (1994) “dealt centrally with an outbreak among laboratory monkeys that had come to America via the Philippines and died in a research facility near Washington D.C.” he noted. “The present volume [Mr. Preston’s latest book] highlights the serious epidemic in the western African countries of Sierra Leone, Liberia, and Guinea in 2014-2016, although it includes a fuller account of the 1976 episode than did his first Ebola book. Those who have read other books by Mr. Preston will recognize the narrative devices: date stamped (and often time-stamped) episodes and vivid dialogue,” Mr. Bryum wrote. “He knows his characters and science well and uses a variety of sources, including emails and conversations, to reinforce the immediacy of his account. Not for nothing was he once chosen to complete a novel by [the late] Michael Crichton [author of Jurassic Park & The Andromeda Strain].”
     “In the West Africa epidemic, international agencies were criticized for offering aid that was too little, too late,” Mr. Byrum wrote. “Medical personnel — doctors, nurses, technicians, ambulance drivers — bemoaned the lack of medicines, hospital beds, isolation and diagnostic equipment, intravenous fluids, and the plethora of materials, exotic and mundane that make up the infrastructure of modern medical care. This perceived lethargy in the response is the theme running through Mr. Preston’s story, mostly seen by individuals at the ground level. Though “Crisis In The Red Zone” ranges widely through West Africa, North America, Geneva and elsewhere, its center of gravity is the Kenema Government hospital in Sierra Leone, which felt the brunt of the epidemic.”
     “We know a lot more about the Ebola virus than we did in 1994,” Mr. Byrum notes. “Its genome has been sequenced and the virus classified into different strains, which often differ by a single mutation, but produce distinct mortality rates. The virus’s ultimate animal reservoir is probably the fruit bat, but even this remains uncertain. It is spread primarily through body fluids, especially blood, but virus particles can also be present on the skin. The fear is that a further mutation might fender the virus airborne, like influenza, or the common cold. Were this to happen, it would make the 1918-1919 influenza epidemic, the most serious in history, seem like a stroll in the park.”
One Wonders How Much Longer Humankind Can Continue To Dodge A Lethal/Global Pandemic
     Just like scientists who say we’re overdue for a catastrophic earthquake, so to do virologists, who are constantly on guard for the next super bug/global pandemic. While we have had our share of insidious diseases — HIV, SARS, MERS, Ebola, etc., we really haven’t experienced a significant, lethal, global outbreak since the 1918 ‘Spanish’ flu. But, it isn’t hard to imagine another global pandemic, when we have refugee camps in the war-torn Middle East, or a homeless problem in Los Angeles that has witnessed humans living in their own excrement, along with an infestation of rats.
     In her August 24, 2014 article on the website, AEON, “The Next Pandemic: How Plagues Really Work,” Wendy Orent wrote that “One mysterious, ancient outbreak, the Great Plague of Athens, shows how deadly epidemics unroll in time,” Ms Orent suggests. “The [Athens] Plague, — said to have been caused by typhus, measles, small pox, or Ebola, depending on whom you ask — exploded in Athens in the summer of 430 BCE, during the early days of the Peloponnesian War, an [epic] 27 year struggle between Athens and Sparta over hegemony in the Hellenic world. Pericles, the de facto leader of Athens — who pushed for war, developed a defensive strategy that proved fatal, to him; and, as many as a third of Athenian citizens. He insisted on bringing all citizens — people who lived in towns and the rural areas outside the city — into Athens, leaving the rest of the city-state to be ravaged by the invading Spartans. The Athenian Long Walls ran down to the separate ports of Piraeus and Phaleron, each of which lay about four miles from the city of Athens proper. Thus, sealed off, fronting only on the sea, Athenians could shelter safely Pericles argued, until the Peloponnesian War.”
      “The normal population of the [ancient] city [Athens] was around 150,000. Scholars estimate that 200,000 – 250,000 farmers and townsmen; and, their families, came streaming in, bringing everything they could carry with them — down to the woodwork of their farmhouse walls. But, Pericles made no provision for the newcomers, who were used to their country manors, their quiet towns, their open fields,” Ms. Orent elegantly writes. A few had homes, or relatives within the walls. But, most had no where to go, and huddled in stifling huts, or tents flung up in the narrow spaces between the walls. The crowded encampments were ripe for a virulent infection,” she writes.

     “Physicians and attendants died quickly, and the only people who could care for the sick, were survivors immune to further infection.”

“The infection came from the sea,” Ms. Orent notes, “the portal that Pericles had left open to feed the Athenian people and bring in enough money to keep the war effort alive. The Athenian historian Thucydides tells us that the disease originated in Ethiopia, traveled northward into Egypt, and Libya, moved across the Mediterranean to the island of Lemnos, and on to Athens. ‘There was no record of the disease being so virulent anywhere else, or causing so many deaths as it did in Athens,’ wrote Thucydides; and, we have no reason to doubt him. This is a critical bit of information,” Ms. Orent contends. “It tells us,” she argues, “that The Great Plague evolved: it became much more lethal in the great refuge camp of wartime that Athens had become. Thucydides continued: “People in perfect health, suddenly began to have burning feelings in the head; their eyes became red and inflamed; inside their mouths, there was bleeding from the throat and tongue, and the breath became unnatural and unpleasant. The next symptoms were sneezing and hoarseness of voice, and before long, the pain settled on the chest and was accompanied by coughing. Next, the stomach was affected, with stomach-aches; and, with vomiting of every kind of bile that has been given a name by the medical profession, and this being accompanied by great pain and difficulty. In most cases, there were attacks of ineffectual retching, producing violent spasms; this sometimes ended with this stage of the disease, but sometimes continued long afterwards.”

“Thucydides goes on to describe rashes, delirium, mental confusion and, among the survivors, blackened, dead tissue on the extremities and sometimes blindness. This was a highly transmissible, virulent, systemic disease. Physicians and attendants died quickly, and the only people who could care for the sick — were survivors immune to further infection.”

     Ms. Orent concludes that “the Athenian plague shows how a disease of mild to moderate virulence can heat up in what we can only call a ‘disease factory’ — a place where the sick are trapped together with well, causing infection to spread with wildfire. If the Athenian infection was typhus, the most likely culprit,” Ms. Orent argues, “it would normally be spread by the human body louse and its infected feces. There must have been body lice among the Athenian squatters.” she observes. Usually, just scratching lice bites, thus digging louse feces inadvertently into the skin, causes transmission. But, in crowded conditions, transmission of typhus can be more direct. For instance,” she notes, “in the Serbian prison camps of World War I, where typhus was rampant, transmission through the air – possibly caused by aerosolized louse feces — was known to occur. The right conditions, in other words, can cause the short-term evolution of a louse-borne disease into something explosive.”
     “Looking at epidemics, and pandemics through this evolutionary lens makes it clear that the most important condition necessary for the evolution of virulent, transmissible disease is the existence of a disease factory. Without social conditions that allow the evolution of virulent, transmissible disease, deadly outbreaks are unlikely to emerge,” Ms. Orent says.

     “Deadliness itself, isn’t all that uncommon: SARS, or severe acute respiratory syndrome, which terrorized China in 2002 and 2003, killed ten percent of its victims; Ebola kills 60-90 percent; untreated rabies kills close to 100 percent, as does pneumonic plague, caused by Yersinia pestis, the bacterial agent of The Black Death, the worst pandemic in human history. But, to be both deadly, and efficiently transmissible — requires exacting circumstances,” Ms. Orent observes. Even the Black Death — though to originally have come from Central Asian marmots — must have evolved in a chain of human-to-human transmission, to become as lethally effective as it was.”

“Fighting existing pathogens is more urgent than hunting for possible new ones — less exciting, but more likely to ease real suffering in the world.”

“So, what is wrong with listening to the drumbeat, to the endless calls to protect ourselves against the coming plague — against Ebola from Africa to bird flu from Asia? Is it possible that a huge pandemic could erupt from some as-yet unknown pathogen? Is apocalypse lurking out there, among rats, or monkeys, or bats or flying squirrels, or birds? The Black Death shows that you can never say never: there might be an animal pathogen out there that, under the right circumstances, can evolve and maintain both virulence and transmissibility among humans as well as animals.”

“The Central African Monkey Pox virus (so-called because it was first identified in macaques in 1958) has dangerous attributes: like smallpox virus it is often deadly, and it’s also a ‘sit-and-wait pathogen,’ — highly durable in the outside environment. Yet the evolution of monkey-pox into a human disease such as smallpox seems, at this point, unlikely: some strains of monkey-pox have transmitted from person-to-person for several iterations, but, the chains of transmission have easily been broken; and, the evolutionary processed stops in its tracks,” Ms. Orent wrote.

“Instead, people continue to die of human-adapted disease,” Ms. Orent adds. “Malaria kills more than one million children annually. Tuberculosis, in its ugliest, drug-resistant forms, is well-entrenched worldwide. Polio, despite our noblest efforts, continues to cripple and kill children. Fighting existing pathogens seems more urgent than hunting for possible new ones — less exciting, but more likely to ease real suffering in the world.”

     Ms. Orent ends on this note. “If The Great Plagues Of Athens tells us anything,” she notes, “it is to avoid social conditions that allow pathogens to evolve to great virulence and transmissibility. Preventing disease factories — trench-like warfare conditions, crowded hospitals, enormous refugee camps — is our best protection. While alarmists among us wait for the plague to pounce out of the jungle, it is far more likely to come from inside us, our disease factories, and our social world.”
     Is anyone in Los Angeles listening. RCP,




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