Pandemic: Tracking Contagions, from Cholera to Ebola and Beyond by Sonia Shah
With the Zika virus dominating the news, there is no more apropos time for Sonia Shah’s Pandemic to appear. Unfortunately, Zika is just the latest in a lengthening list of epidemics and pandemics that have appeared in the last 50 years. Cholera, H5N1, Ebola, MRSA, AIDS, bubonic plague, and SARS are just a few of the more than 300 infectious diseases new or reborn in that period.
Shah knows her subject and tells the story in an understandable and chilling manner. She is a science journalist whose work has appeared in the New York Times and Scientific American, on Fresh Air and TED Talks. She is the author of The Fever, an award-winning account that tracks the rise and effects of malaria across the world.
Shah also knows pandemics from a personal level. Ready to leave Haiti after studying its massive cholera outbreak, she was about to board an airplane when access was denied. A man who had already boarded had an explosive choleric attack that required his removal from the plane and for it to be thoroughly disinfected. Had the attack waited until the plane was airborne, everyone would have been infected and the passengers would have carried the infection to the United States. She also follows the course of MRSA in her family from a scrape on a son’s knee, its recurrence in him, and her subsequent infection.
Early on, Shah leads the reader through some basic terminology and statistical information crucial to explain how an animal microbe might make the jump into humans and further into a pandemic killer. She distinguishes between an epidemic, a regional outbreak, and a pandemic, which might be country or world-wide. She reports that 90% of epidemiologists believe that “cholera’s child,” (i.e., a new pandemic) will happen within just two generations. It will sicken one billion and kill 165 million, triggering a recession that may cost $3 trillion. Between 1980 – 2000 pathogen deaths rose 60%; HIV accounted for 38% of those deaths.
“Microbes,” she writes, “become pathogens by following the avenues we pave for them, and these avenues follow particular routes.” Most originate in the bodies of animals then we provide the conditions to incubate and spread disease. Deforestation pushes animals and humans into closer contact. Urban sprawl and population density creates too much waste in too little space and results in disease. First ships, now airplanes hasten the spread of infections across the world.
The example of the conditions which resulted in New York City after the 1845 influx of Irish immigrants graphically illustrates how conditions led to cholera and death. Crowded conditions (over 200,000 per square mile), damp housing, and fecal-filled water created conditions that bred an epidemic that gained strength “like a hurricane hovering over warm water.” One doctor said the water so commonly caused diarrhea that it could be considered a cure for constipation.
Shah cites the rise of commercial hog (up 2,000%) and chicken (up 30,000%) as prime examples of the nexus between conditions and humans. These farms produce 13 times more waste than humans, and the waste is poured into lagoons, often unlined and too shallow, and sprayed onto crop fields. Eastern North Carolina reaped the whirlwind in 1999 when two hurricanes struck one behind the other. Massive flooding caused 25 million gallons of waste to pour into rivers resulting in fish kills and 9% of wells becoming polluted with fecal coliform bacteria.
All is not doom and gloom, however. The conditions that spawn the pathogens that produce pandemics can be ameliorated and often prevented. People in malaria-prone countries can sleep under mosquito nets. There are a variety of means to provide clean water. Housing can be improved. More research must be done to identify and track diseases. But nothing will work until each of us understands how a pathogen spreads and reacts with thoughtful action rather than the knee jerk reaction that Ebola caused, for example.
Sonia Shah’s well-researched and clearly written book is a good start to creating thoughtful action. What’s more, you will understand why your mama told you to wash your hands.