Human folly and pandemics

Book review of Pandemic: Tracking Contagions, From Cholera to Coronaviruses and Beyond

Disclaimer upfront: Pandemic is not an easy read. It’s engagingly written, deeply researched, well-argued, and prescient. It’s funny in a mordant way. It presents intriguing theories and hypotheses, buttressed by science, statistics, and anecdotes. But the subject is ultimately, frightening and depressing.

Sonia Shah examines pandemics as a recurrent phenomenon, and methodically dissects the nature of the beast, the reasons they occur and recur, and the root causes of our inability to deal with them. She outlines the repetitive nature of human folly in dealing with disease. The first edition of Pandemic was published in 2016, and it predicted the advent of Covid-19 with bullseye accuracy.

The chapter headings offer broad hints as to contributory factors. There’s “Locomotion”, which helps localised infections turn into pandemics as infected people move around. Unfort­u­n­ately, globalisation has made this process easy. A doctor in Singapore who examined a SARS patient just returned from China took the disease to Berlin.

The ability to move people and infected material (including air and water) across distances is not new. But it has been greatly amplified by technology. Pandemics spread quicker once maritime technology opened up the oceans and railway networks proliferated. The Spaniards took smallpox to the Americas. Grand projects such as the Grand Erie Canal, which opened up the North American Midwest, also brought cholera. The railways transported cholera from Paris to Rome. Civil aviation had a stunning multiplier effect. The maps of infection clusters in SARS and Covid-19 correlate directly to travel times from large aviation hubs.

There’s a chapter headed “Filth”, which goes hand-in- hand with “Crowds”. Any civilisation leads to urban clustering. Urban conglomerations tend to be over-crowded and insanitary, providing ideal breeding ground for invisible tiny organisms. In addition, there’s battery farming, with pigs, cattle and poultry shoehorned into tiny spaces, with poor manure disposal. Urban clusters in Third World countries are serviced by wet markets where multiple species in close proximity allow viruses and bacteria to jump species and mutate.

One problem here is that bacteria share genes between species by asexual means. This means a drug-resistant bacteria that affects pigs, for example, can not only mutate and jump to humans; it can also share the drug-resistant gene with other bacteria that already affect humans.  

The downsides of things like fast travel, urban crowding, lack of hygiene, and battery farming, need little explication. But we need to understand why they are not dealt with, even when science, urban planners, and politicians, et al, are well aware of them.  

One reason is “Corruption”, which Ms Shah uses broadly to describe the interplay of poor policy initiatives often for venal reasons. This leads to situations where infectious diseases are not tackled even when causes and cures are known. We’ve seen this playing out with Covid-19 with politicians pooh-poohing coronavirus and refusing to take precautions.

Among other things, she points to the clear and present danger posed by the New Delhi superbug, NDM-1, which has been downplayed by successive Indian governments for fear of hurting medical tourism. Shah also describes how drug-resistant MRSA developed and infected her family.

Pandemic: Tracking Contagions, From Cholera to Coronaviruses and Beyond 

Author: Sonia Shah 

Publisher: Harper Collins

Pages: 271

Price: Rs 499

More insidiously, the profit motive means research into malaria has been retarded since the usual victim is dirt-poor. Big Pharma also has little incentive to find new antibiotics. Since resistance rapidly develops to a new antibiotic, the return on research is low. Only three new antibiotics have been released in the last 50 years.

Another factor is “Blame”, of the wrong causes and wrong groups. Tragically, health care workers are often targeted by mobs — we’ve seen this all over in 2020. There are also anti-vaccine zealots, whose conspiracy fantasies are fuelled by incidents like the CIA using a polio vaccine survey as cover for hunting for Osama Bin Laden. In Haiti after the 2010 earthquake, Nepalese Gurkhas who were posted there on UN duty carried the cholera virus. This caused havoc, and as a result, all UN personnel were attacked.

Climate change may also be under-rated as a pandemic enabler. Warmer weather has led to cholera gaining a foothold in Alaska and dengue is now visible in the US. Shah speculates fungi could be the next source of new pandemic diseases. Warm-blooded mammals have an evolutionary advantage because fungi cannot survive in warm blood. But climate change is leading to fungi adapting to higher temperatures.

There are other intriguing hypotheses the book mentions in passing. For example, humans lack a gene for synthesising the sialic acid, Neu5Gc, which other apes and mammals possess. The man who discovered this, Dr Ajit Varki, speculates a pandemic may have wiped out everybody with that gene. Ms Shah also mentions the “suicide gene” hypothesis. Death is caused by “suicide genes” which gradually switch off repair functions. It’s postulated that suicide genes may have evolved as a response to some pandemic.

In sum, this is a great book that will make you think and inform you about many things you ought to know. It may also drive you to despair but it should be a mandatory read. It should be handed out at grocery stores, along with the hand sanitiser and masks.