The world faces a pandemic of coronavirus. Compared to 2002-2003, when there was a SARS outbreak, science has leaped forward, but epidemics occur more often, and to stop them harder. Why? Historian of medicine and author of “The Pandemic of the Century: One Hundred Years of Panic, Hysteria, and Hubris” mark Honigsbaum believes that the modern world generates epidemic-like coronavirus. Nash.live translates his column for the publication Time.
“The disaster is actually a thing quite ordinary, writes albert Camus in his novel “the Plague”. – But believe in it with difficulty, even when it collapses on your head. The world has always been a plague, always has been war. And yet, plague and war, usually caught people by surprise.”
Camus wrote about a fictional outbreak of plague in 1948 in the port city of Oran in the Northwest of Algeria. But at a time when the world shudders at the very real emergency situation due to a new coronavirus in the Chinese city of Wuhan, his observations as never appropriate.
Like an emergency on an international scale due to a virus Zeke in 2015, because of the terrifying Ebola outbreak in West Africa a year earlier, or the General panic due to one of the SARS coronavirus in 2002-2003, the pandemic coronavirus once again caught by surprise of physicians the world.
But if the age of pandemics taught us anything, it’s that we may be able to better track threats of pandemics at the same “white spots” of maps, but also tend to forget the lessons of the history of medicine.
The first lesson – epidemics of new infectious diseases seem to spread faster. In the 19th century, cholera and the plague took several years to spread from the epicentres of the outbreak, India and China, to Europe and North America through the trade routes with caravans, horses and ships.
That all changed with the advent of steamships and the expansion of the railway network in Europe. Most likely, the ship that sailed from Japan to Honolulu, in 1900 was brought to the San Francisco plague of rats. A decade earlier the so-called “Russian flu” spread throughout Europe thanks to the steam locomotives. In the end, after four months after the first case in St. Petersburg, in December, 1889, the, “Russian influenza” recorded in Berlin and Hamburg, where he on ocean liners made up of Liverpool, Boston and Buenos Aires.
“Russian flu” has caused two global outbreak in 1892 and 1893, which killed about 1 million people – although the actual losses were probably higher. For comparison, the three waves of the outbreak of “Spanish flu” occurred in a short period between the summer of 1918 and spring of 1919. Pandemic, which coincided with the First world war almost certainly contributed to the rapid movement of American soldiers to the front line in Northern Europe on the landing aircraft.
But really, the game changed international air traffic. Wuhan is located in the center of the Chinese network airlines and is both a domestic and international hub, with more than 100 direct flights to 22 countries around the world. As a result, whereas during the outbreak of SARS in 2002, the coronavirus spread around the world for five months now the world has caught Chinese infection in just four weeks.
Another important lesson of the last outbreak – too dwell on the cause of the disease, we risk missing the broader ecological picture.
70% of new infectious diseases originate from animals. Since the AIDS pandemic in the 1980s, SARS, Ebola and panic due to bird flu in the early 2000s, most outbreaks can be traced to the time of transmission from animals to humans. Some really prevented by good hygiene and regular inspection of the markets of wild animals. But others come from the violation of ecological balance or intervention in the environment, which are usually pathogens. This is especially true of viruses like HIV and Ebola, the natural reservoirs are animals.
In particular, the Ebola epidemic in West African countries is likely to have started with the fact that Guinean children had a lunch of local bats “Lalibela”, which have made a nest in a rotten stump in the middle of the village. Usually bats live in dry savannas at the edge of the forest, but seem to be forced to leave their usual habitat because of climate change and deforestation.
Bats are considered the primary reservoir of the coronavirus. However, the virus is also found in snakes and palm of civet (game, reminiscent of cats, which is very appreciated by the Chinese). The SARS epidemic, most likely, called civet, which is sold in the market in Shenzhen in Southeast China. Flash in Wuhan, most likely, also started with a seafood market. Despite the name, they sold more and wild animals, including crocodiles, snakes and bats.
The third lesson is that Chinese Metropolitan areas and large urban agglomerations in Asia, Africa and South America, create a fertile ground for the spread of new pathogens due to the large crowds in conditions of unsanitary conditions. Sometimes technology changes and our infrastructure is able to reduce the risks posed by the overcrowding for transmission of pathogens to people. So, after the outbreaks of plague in San Francisco in 1901, and Los Angeles in 1924, from households and from enterprises successfully drove out the rats and squirrels carried the plague fleas.
High-rise building and air-conditioning system is also very effective at protecting people from mosquitoes that carry the virus, Zeke and other diseases. But, as it became obvious during the outbreak of SARS, when Hong Kong recorded a large number of infected in an apartment complex in the walled city of Kowloon, our infrastructure can carry new risks of morbidity.
We will, no doubt, help the microbes to occupy new ecological niches and spreading to new places in ways that usually becomes apparent after the fact. Therefore, you should always remember an expression from Bernard Shaw’s “Doctor’s dilemma”:
“The characteristic microbe of any disease may not be the cause but the symptom”.
But perhaps the greatest lesson of the last outbreak was that although scientific knowledge is constantly progressing, it can be disastrous, blinding us in the face of a looming epidemic – the so-called “disease X”.
In the case of SARS we later realized that we are dealing with a new deadly respiratory pathogen, largely due to the belief of the who that the world is on the verge of an epidemic of H5N1 avian influenza – concerns that seemed reasonable after two parks of Hong Kong suddenly started dying ducks, geese and swans.
Almost the same who initially missed the Ebola outbreak in 2014 – not least because of the suspicion of some experts that the virus, which was originally correlated with outbreaks in remote forests of Central Africa, could pose a threat for East Africa – not to mention the big cities of Monrovia, Freetown, new York and Dallas.
In each case, before the tragedy was “known” that Ebola will not reach the big cities, not to mention the city in North America, and coronavirus that causes atypical pneumonia. It was a mistake, because of what the experts were stupid.
This time the good news is that Chinese scientists quickly discovered the new coronavirus. And, despite the initial attempts of the Chinese government to hide the warnings that doctors publish in social networks at the beginning of the outbreak, they quickly deciphered its genome. It inspires hope that we will be able to create a vaccine – what failed during SARS.
However, these efforts definitely do not contribute to misconceptions about the effectiveness of medical masks compared to reasonable measures such as frequent hand washing. Similarly, do not help the message of the “exotic” culinary habits of Chinese people by wild animals or, as one French newspaper, the publication of frightening news about the “*yellow alert”.
The last lesson of the history of medicine – during outbreaks, we should carefully select words to our statements did not rise to xenophobia, Salamina and prejudices – as it happened in the early 1980s, when AIDS was dubbed the “gay plague”. This is especially true of our time – the era of instant digital communications, where misinformation and fakes are spreading faster and wider than any virus.