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THE COMING PLAGUE by Laurie Garrett

Wednesday, November 26, 2014 @ 07:11 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 17: SEARCHING FOR SOLUTIONS

The largest short-term refugee migration in world history
On April 6, 1994, an airplane was shot down over Rwanda during the final leg of its flight from Tanzania to the Rwandan capital, Kigali. Aboard the plane were the Presidents of Rwanda and Burundi. Three weeks later the carnage following the deaths of the two heads of state was staggering. Long-standing ethnic, economic, political, and cultural hatreds between the two nationalities living in the region, the better-educated Tutsis and the far more numerous and historically less advantaged Hutus, erupted in Rwanda and threatened the stability of neighboring Burundi. By April’s end the United Nations estimated that up to 500,000 civilians had been slaughtered and more than a million had fled their homes in search of safe havens. On April 29 more than a quarter of a million Rwandan refugees poured across the corpse-laden Kagera River into Tanzania during a twenty-five-hour period, making it the largest short-term refugee migration in world history.

People drew water from rivers clogged with rotting corpses
People poured into areas of Tanzania and Uganda that ranked as the most hard-hit rural AIDS centers in the entire world. If populations remained uprooted for weeks or months on end, and refugee poverty promoted prostitution, another explosive surge in the already horrendous AIDS epidemic would ensue. Before that could transpire, however, cholera would come, spread as people drew their water from rivers clogged with rotting corpses. What else lurked in the refugees’ new environs? If a novel epidemic appeared, was the international public health community prepared to handle the crisis? Before it was even noticed, ailing individuals could have traveled to all parts of the globe. In November 1989 Ebola broke out in a primate colony located in Reston Virginia. Fortunately the Reston Ebola outbreak involved a strain that was harmless for Homo sapiens, but it shocked experts into taking the question of readiness very seriously. The failings, weaknesses, and gaps in preparedness were enormous.

The monkeys carried two viruses, one of which was Ebola
On October 21, 1989, one hundred monkeys were shipped from Manila to New York. By December over 50 had died and 300 euthanized to control the epidemic. The monkeys carried two viruses, one of which was Ebola. Panic reigned among the scientists trying to figure out what was causing the monkey die-off. Testing in the Philippines was delayed because of a rebel uprising. Word came of an unusual die-off of monkeys in Philadelphia. Effective March 23, 1990 no more monkeys could come through facilities located in the state of New York without 60 prior days of quarantine outside the United States and an additional 60 days quarantine before commercial sale or research. There were loud calls for a full ban on the importing of wild monkeys.

Disease emergence was inextricably bound to human rights
In 1993 21 million people on earth were living under conditions ideal for microbial emergence: denied governmental representation that might improve their lot; starving; without safe, permanent housing; lacking nearly all forms of basic health care and sanitation. The situation worsened in 1994 as more than two million Rwandans fled their country, most of them ending up in perilous refugee encampments Lacking even the most rudimentary sanitation or safe water supplies. On June 17, 1993, Médecins Sans Frontières filed an official protest with the United Nations Security Council documenting examples in war-torn areas of relief workers being endangered by local military forces, outlaw gangs, or United Nations troops. Civilians were routinely denied access to hospitals and medical care – in some cases hospitals were deliberately targeted by warring forces. Disease emergence was inextricably bound to human rights.

THE COMING PLAGUE by Laurie Garrett

Tuesday, November 25, 2014 @ 06:11 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 16: NATURE AND HOMO SAPIENS

The organism hid in algal scum
During the 1970s Rita Colwell, convinced that the entire oceanic crisis was directly imperiling human health by permitting the emergence of cholera epidemics, showed that the tiny resilient cholera vibrio could live inside of algae, resting encysted in a dormant state for weeks, months, perhaps even years. It was the emergence of cholera in Peru in January 1991 that compelled the World Health Organization and the global medical community to take notice of Colwell’s message. It was discovered that the cholera vibrios could feed on the egg sacs of algae: up to a million vibrios were counted on the surface of a single egg sac. The organism simply hid in algal scum floating atop local ponds, streams, or bays, lurking until an opportune moment arrived for emergence from its dormant state.

Sickening at least 336,554 people, killing 3,538
In Peru’s hot summer January – made hotter still by an El Niño event – a Chinese freighter arrived at Callao, Lima’s port city. Bilge water drawn from Asian seas was discharged into the Callao harbor, releasing with it billions of algae that were infected with El Tor cholera. As the El Niño water spread out along the Pacific coast of the continent, carrying with it bilged algae, cholera appeared in one Latin American port after another, sickening at least 336,554 people, killing 3,538, aided by obsolete or nonexistent public water purification systems, inadequate sewage, and airplane travel. Cases reported in the United States involved individuals who boarded flights from Latin America unaware that they were infected, and fell gravely ill either in flight or shortly after landing.

Resistance to eight drugs
The El Tor substrain, Inaba, possessed genes for resistance to eight drugs. More than $200 billion would be spent by Latin American governments by 1995. Once chlorine was introduced into Peruvian water supplies, the 01 strain proved fairly resistant to the chemical. Prior to the Bengal cholera outbreak there were two types of cholera in the world: classic and El Tor. The Bengal cholera appeared to represent a combination of characteristics found in both the El Tor and the classic vibrio. One genetic trait was missing in the new Bengal strain: that which coded for antigens that were usually recognized by the human immune system. Even adults who had survived previous cholera outbreaks appeared to be susceptible to the Bengal strain.

The Big Picture
In 1993 Colwell teamed up with two Cambridge Massachusetts, physicians, Drs. Paul Epstein and Timothy Ford at the Harvard School of Public Health, to try to pull together the Big Picture, an explanation of how global warming, loss of ocean biodiversity, ultraviolet radiation increases, human waste and pollution, algal blooms, and other ecological events joined forces. They theorized how the cholera microbe defecated by a man in Dhaka, for example, got into algae in the Bay of Bengal, lay dormant for months on end, made its way via warm water blooms or ship bilge across thousands of miles of ocean, and killed a person who ate ceviche at a food stand in Lima.

Working to the advantage of microbes
Epstein lobbied scientists working in diverse fields, many of whom had reached the conclusion that changes in global ecology – particularly those caused by warming – were too often working to the advantage of microbes. Robert Shope was convinced that even a minor rise in global temperature could expand the territory of two key mosquito species that could invade population centers such as Tokyo, Rome, and New York, carrying dengue and yellow fever. British experts felt certain that global warming would greatly expand the territory and infectivity ratio of the East African tsetse fly. The same principles held true for the Anopheles mosquitoes and the spread of malaria. A WHO Task Group report in 1990 offered a broader range of expected disease impacts from global warming due to altered wind patterns, changes in humidity and rainfall, and a rise in sea levels that would alter the ecologies of microbes carried by insects and the ecologies of microbe-carrying animals such as monkeys, rats, mice and bats.

International commercial air flights soared
The heightened exposure to ultraviolet light suppressed the human immune response, increasing susceptibility to all microbes. Karl Johnson, Pierre Sureau, Joe McCormick, Peter Piot, and Pat Webb had long ago witnessed the results of human incursion into new niches or alteration of old niches. International commercial air flights soared from 2 million in 1950 to 280 million in 1990. Once microbes reached new locales, increasing human population and urbanization ensured that microbes faced ever-improving statistical odds of being spread from person to person.

The classic wartime opportunists
Between 1980 and 1989 the number of refugees fleeing natural disasters, wars, famine, or oppression increased by 75% every year. By the end of 1992, 17.5 million people were refugees, most of them living in squalor in the world’s poorest countries. Millions of abandoned children roamed the streets of the world’s largest cities, injecting drugs, practicing prostitution, and living on the most dangerous margins of society. Civil war in the horribly overcrowded nation of Rwanda broke into inconceivable carnage during the spring of 1994. When such conflicts occurred in developing countries, they created new opportunities for typhus, cholera, tuberculosis, and measles – the classic wartime opportunists.

THE COMING PLAGUE by Laurie Garrett

Monday, November 24, 2014 @ 07:11 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 16: NATURE AND HOMO SAPIENS

Large numbers of dead seals
In 1987, Siberian fishermen and hunters working around Lake Baikal noticed large numbers of dead seals washing up along the shores of the huge Central Asia lake. Because the Soviet government had long used the country’s lakes as waste dumps, it was first assumed that the seals were victims of some toxic chemicals. With the spring thaw of 1988 came an apparent epidemic of miscarriages among female harbor seals in the North Sea along the coasts of Sweden and Denmark. By August dead seals were even found on the beaches of northern Ireland. Scientists determined that two different viruses were responsible for what seemed to be separate seal epidemics in Lake Baikal and the North Sea. The extraordinary death rates among harbor seals indicated that their immune systems had never previously encountered such a virus. While the seal experts worked on that puzzle, veterinarians in Spain were examining dolphins that were beaching themselves along the Mediterranean coast of Catalonia. – dubbed “dolphin AIDS”. Dutch scientists determined that at least four newly discovered viruses were attacking Europe’s and Central Asia’s marine mammals.

The probability of genetic exchange is very great
Algae, the oldest living family of creatures on earth, can, in times of environmental stress or food shortages, encyst themselves in a protective coating, go dormant, and drop into hiding for extended periods. Rita Colwell of the University of Maryland had devoted years to the study of microorganisms in Maryland’s Chesapeake Bay, where she discovered that viruses were seasonal, increasing as the bay warmed to a billion viruses per milliliter, outnumbering algae and bacteria. Colwell saw viral intrusion occurring, as human and animal waste washed into the bay, carrying with it a variety of pathogens, with the probability of genetic exchange very great. Hepatitis, Norwalk virus, polio, and a host of other microbes were turning up in shell fish in the world’s coastal waters, particularly around dump sites. Strange microbes appeared that burned through the shells of mollusks, killed off salmon, and made lobsters lose their sense of direction. A single gram of typical feces contains one billion viruses. Ocean pollution due to raw sewage, fertilizers, pesticides, and other chemical waste was increasing steadily, producing tremendous changes in coastal marine ecospheres.

Only viruses remained to keep blooms in check
Algae blooms increased in frequency and size worldwide throughout the four post-World War II decades, growing so rapidly that they blocked all oxygen and sunlight for the creatures swimming below, suffocating fish, marine plants, and mollusks. There was evidence that the additional load of ultraviolet light making its way through the ozone layer was driving a higher mutation rate in sea surface organisms, favoring microorganisms. Jan Post, a marine biologist at the World Bank, when announcing the release of the Bank’s 1993 report on the condition of the seas, stated: “The ocean today has become an overexploited resource and mankind’s ultimate cesspool, the last destination for all pollution.” The overall diversity of the marine ecosphere was declining at a rapid rate. A feedback loop of oceanic imbalance was in place. As the populations of plankton/algae eaters declined, only viruses remained to keep blooms in check.

THE COMING PLAGUE by Laurie Garrett

Sunday, November 23, 2014 @ 10:11 PM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 16: NATURE AND HOMO SAPIENS

The microbes were winning
That humanity had grossly underestimated the microbes was no longer, as the world approached the 21st century, a matter of doubt. The microbes were winning. Arguments among scientists focused on the whys, hows, and whens of an acknowledged threat.

Something had to give
The extraordinary, rapid growth of the Homo sapiens population, coupled with its voracious appetite for planetary dominance and resource consumption, had put every measurable biological and chemical system on earth in a state of imbalance. With nearly 6 billion human beings already crowded onto a planet in 1994 that had been occupied by fewer than 1.5 billion a century earlier, something had to give. That “something” was Nature – all observable biological systems other than Homo sapiens and their domesticated fellow animals. The bulk of human population growth would be in the poorest nations on earth. By the 1990s it was already obvious that the countries that were experiencing the most radical population growths were those confronting the most rapid environmental degradations and worst scales of human suffering.

The pace of the loss was staggering
At Harvard University, Dr. E. O. Wilson was one of the leaders of a worldwide effort to catalog the world’s species and protect as much of the planet’s diversity as possible, estimating that there were 1.4 million known species of terrestrial flora, fauna, and microorganisms on earth in 1992, and perhaps 98.6 million yet to be identified, most of which were living in the world’s rain forests. There the plentiful supply of rain, tropical sunlight, and nutrient-rich soil bred such striking diversity that Wilson found 43 different species of ants living on a single tree in the Amazon. The pace of the loss was staggering – on the order, by UN estimates, of 4.75 million acres annually.

Lyme disease
When ecospheres are severely stressed, certain species of flaura and forna that are best suited to adapt to the changed conditions quickly dominate. Both deforestation and deforestation can give rise to microbial emergence. Such was the case in 1975-76 in the Atlantic seaside town of Lyme, Connecticut where 51 residents came down with what looked like rheumatoid arthritis, dubbed Lyme disease. By 1990 it had surfaced in all 50 states and parts of Western Europe. Most Lyme sufferers lived in wooded areas that were inhabited by common North American feral animals: deer, squirrels, chipmunks, and the like.

The bacteria were transmitted to people by a tick
In 1982, Dr. Allen Steere discovered that Lyme patients were infected with a previously little-studied spirochete bacterium, Borrelia burgdorferi, showing that many of the dreadful symptoms of the disease were the result of the immune system’s protracted battles with the microbe. The Borrelia bacteria were transmitted to people by a tick, Ixodes dammini. While the tick was happy to feed on Homo sapiens, its preferred lunch was deer blood but getting rid of the deer in a region didn’t eliminate Lyme disease.

Deer, dogs, humans, rodents, and birds carried the insects
The ubiquitous northeastern mouse Peromyscus leucopus was the natural reservoir for the B. burgdorferi bacterium that caused Lyme disease. The mice passed their B. burgdorferi on to the ticks. The two species, rodent and insect, shared the ecology of low scrub brush where the deer grazed, picking up the ticks, which, while feeding on deer blood, passed on the bacteria. Because there were no predators around to keep the deer populations in check, they stepped into suburban front yards where they came in contact with cats and dogs. The territory inhabited by the tick expanded at a steady and rapid rate as deer, pet dogs, humans, rodents, and even some birds carried the insects from the initial outbreak sites. Their invasion, and the epidemic they spawned were new.

THE COING PLAGUE by Laurie Garrett

Friday, November 21, 2014 @ 05:11 AM
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A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 14: THIRDWORLDIZATION

No Peace Dividend appeared
With the fall of the Berlin Wall politicians all over the world spoke of a Peace Dividend. The world had surplus cash and long-neglected social programs could be subsidized. But no Peace Dividend appeared. Overnight the former Cold War multitrillion-dollar spending became a latter-day Marshall Plan for reconstruction of the ex-communist world. Ten billion dollars shifted from coffers in Bonn to national bank vaults in Moscow in a single day. And that was just one of many West-to-East transfers. By 1991 the Soviet Union no longer existed. AIDS was overshadowed by history and the microbe spread, unfettered by any serious efforts on the part of human beings to limit its modes of transmission. In March 1993 special counsel to President Boris Yeltsin, Dr. A. V. Yablokov, addressed the grave state of the Russian people’s health in a speech before the nation’s Security Council. The primary cause of Russia’s massive excess death burden was suicide, which rose by 20% between 1991 and 1992. In 1976 the numbers of diphtheria cases in the U.S.S.R. approached zero. But in 1990 it reemerged. When the Iron Curtain was lifted, it revealed the Third World status of the old communist regimes, and conditions only worsened amid infrastructural chaos, with countless opportunities for the further emergence of not only HIV but all manner of microbes.

The wealthy nations of North America and Western Europe
The process was occurring during the 1980s and the early 1990s inside the wealthy nations of North America and Western Europe as well. Health economists tallied up the costs of diseases that were preventable through diet, exercise, cessation of tobacco or illicit drug use, elimination of alcoholism, and the like, concluding that personal health decisions were no longer the exclusive purview of individual choice. Smokers cost the rest of society billions of dollars. So did alcoholics. And fat people. Dr. John Knowles, president of the Rockfeller Foundation said: “… one man’s freedom in health is another man’s shackle in taxes and insurance premiums. I believe that a right to health should be replaced by the idea of an individual moral obligation to preserve one’s own health – a public duty if you will.”

New York City – 30,000 AIDS orphans by the end of 1994
New York City alone would have more than 30,000 AIDS orphans by the end of 1994, Newark over 10,000. Just as AIDS was exhausting the extended-family networks in much of Africa, so it was taxing the social support systems in America’s poorest communities. As the virus found its way into communities of poverty, the burden on urban public hospitals was critical as the United States had no system of national health care. By 1990 an estimated 37 million Americans were without any form of either public or private health insurance. Another 43 million Americans were either chronically uninsured or underinsured. By the end of 1993 more than 25 million Americans were hungry, consuming inadequate amounts of food. Complacent after decades of perceived victories over microbes, positioned as the runt sibling to curative medicine and fiscally pared to the bone by successive rounds of budget cuts in all layers of government, public health in 1990 was a mere shadow of its former self.