Past Plagues Are Prologue

Disease is a fascinating study, a microbiological commentary and defensive mechanism to the stresses placed on our socio-economic environment.

Given the Avian Flu situation here in SE Asia, I thought I’d dig up an article by Andrew Nikiforuk. It’s a well-written piece geared at the Toronto policymakers in response to the SARS scare several years ago. But in light of recent announcements by WHO on the possible pandemic Avian Flu presents, the editorial still bears relevance.

Past Plagues are Prologue by Andrew Nikiforuk

edited 10 Feb 2010: since the above link no longer works, here it is re-posted:

Epidemics always teach us something, says author ANDREW NIKIFORUK. One SARS lesson is that we’re too dependent on hospitals – which can be scary places

Toronto Globe and Mail Saturday, Apr. 26, 2003

When you learn that epidemic disease exists in a country, do not go there; but if it breaks out in the country where you are, do not leave. –Mohammed

Epidemics, one of the real constants of human history, are pretty rude teachers. SARS, a small virus with a big stick, is a task master complete with quarantines, travel advisories and foreign devils. But it also comes with some surprising messages — and they are not the ones you are hearing from the itinerant professional vandals at the World Health Organization or the TV news.

The first lesson might bruise Ontario egos. Plague historians generally agree that spectacular die-offs are rare events. The biggest global killer this century was the influenza epidemic of 1918. It probably buried anywhere between 40 million and 100 million people. It flooded their lungs with water and poured on pneumonia. It quieted entire aboriginal villages and terrified prairie folk into bundling the sick onto trains, a kind of moving quarantine.

The ill generally got off dead. In the end more than 50,000 Canadians died of influenza in a single year. Now, that was an epidemic.

In contrast, SARS is a modest grave-digger, in the last two months burying 18 Canadians and more than 200 Asians. Hundreds more have been sick and thousands have been quarantined. Now, having a new cold virus running amuck that can superinfect people with an untreatable pneumonia is definitely bad news. So this virus is definitely worth containing.

But SARS is not the plague of Athens (“No one expected to live to be brought to trial for his offenses,” wrote Thucydides). It is not the Black Death (which dispatched nearly a quarter of Europe and Arabia). Nor does it behave anything like smallpox. That mass murderer burnt away the faces, eyes and internal organs of nearly 100-million aboriginals in one century.

But as epidemics have repeatedly illustrated, a microbe doesn’t have to be big to be bad. Polio never killed a lot of children but its paralyzing abilities made it legendary. It also targeted the squeaky-clean classes. So we all remember polio.

But Ontario needs to take its pulse again. SARS is a nasty molecule, not an insurmountable mountain. Thanks to global trade, global health organizations and the global media, the death of 16 people in one month can take on the weight of one thousand in one week. (If a virus with 10 genes can unsettle Canada’s industrial heartland, just imagine what a bioterror attack might do!)

Epidemics are always about trade, politics and fear. In 1881, Egypt clamped a tight quarantine on British ships coming from cholera-infected Bombay, and for good reason. But the move infuriated free-traders in England. So the Empire shelled Alexandria and occupied Egypt. In our own century, China didn’t want to say
much about SARS because it feared an imperial-like cannonade on its trade and tourism. But it got one anyway — and so did Toronto by the virtue of international travel. Globalization works that way:

Whether ugly or just plain inconvenient, epidemics always tell us something about the way we live. The Black Death, for example, was an unabashed commentary on overpopulation, undernutrition and peasant architecture (rat-friendly thatched roofs). Tuberculosis is always a signal of much homelessness. Cholera wags a finger at water quality. AIDS reminded us that sex is never safe and that promiscuity has biological consequences. (Syphilis gave us the same message, but as we developed treatments, we forgot it.)

The 19th-century bacteria watcher Rudolf Virchow correctly called disease “life under altered conditions.” He noted that epidemics acted like grand warnings that told statesmen that a “disturbance has taken place in the development of his people.”

So what social disturbance is SARS illuminating? I’m no expert, but I’d wager something is seriously out of sync in Guangdong province, a place trying to move from the 18th century to the 21st in a hurry. Its waters are putrid and its air is as smokey as 19th-century London. The capital, Guangzhou, is home to millions of migrant workers who sleep on the streets like homeless Cree in Winnipeg. Tellingly, the 1968 Hong Kong flu pandemic started in Guangdong. Microbes recognize an opportunity when they see one.

But SARS is also highlighting another disturbance: the shoddy state of infection control in our hospitals. For starters, the virus has been a lazy opportunist that has largely dined on sick hospital patients. As a
result, about 30 per cent of the infected are hospital workers. In fact most of Ontario’s cases can all be traced back to one hospital. Here in Canada, SARS is a hospital-acquired infection.

This is not an accident. Many ancient and recent epidemics, including Ebola, have marked hospitals as formidable disease spreaders.

Why? Hospitals, like nursing homes, are microbial feedlots.

Thanks to medical cost-cutters and promiscuous antibiotic use, hospital infection control isn’t what it used to be. As such, Canadians generally now have a one-in-10 chance (according to Health Canada) of acquiring an unwanted infection whenever they visit an acute-care hospital. The rate at which patients pick up woeful infections has increased by 36 per cent in the last two decades.

Hospital-acquired infections now kill hundreds of Canadians and more than 100,000 Americans every year — and with barely a headline. With the exception of animal feedlots and daycare centres, no institution has done a better job of spreading antibiotic-resistant bacteria to the greater community than hospitals.

Unsanitary facilities, unwashed hands and unsanitary instruments account for most of these preventable deaths. SARS is a another reminder that if you are not deathly sick, a hospital visit just might change your prognosis.

Epidemics always do a good job of exposing these and other vulnerabilities. SARS, for example, has underscored the sorry state of Toronto’s political leadership as well as the short-sightedness of emergency response plans that assume health-care systems won’t get overloaded during an epidemic. It also illuminates the hopelessly complicated nature of a just-in-time-economy that makes no allowance for hazard. Nature doesn’t make that kind of mistake.

SARS does not spell the end of Toronto or world trade. But it is an economic upside-down mess for the golden horseshoe. China has a true epidemic to worry about. A blazing economy there has altered the conditions of life so rapidly that SARS won’t be China’s only biological export.

But, like all epidemics, SARS will soon pass on. It could get uglier, but I suspect it will just take up residence as a another chronic nuisance.

In a strange way, the message of every epidemic is proverbial: Wash your hands and love your children. Life is a gift and a gamble.

Andrew Nikiforuk is the Calgary-based author of The Fourth Horseman: A Short History of Plagues, Scourges and Emerging Viruses.

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