PANDEMIC: Tracking Contagions, from Cholera to Ebola and Beyond

Nonfiction

Looking for the next epidemic

PANDEMIC:
Tracking Contagions, from Cholera to Ebola and Beyond
By Sonia Shah
288 pp. Picador

Reviewed by Lynne M. Hinkey

From the bubonic plague to HIV/AIDS, contagious diseases have loomed large in human history, and influenced human evolution, behavior, and culture. They intrigue us in the way a train wreck does, leaving us wondering how it could happen and fearful lest it happen to us. But, surprisingly, most of us have very little understanding of how these diseases start, spread, or even factual information on how great – or small – a threat any one of these might be to us. We tend to overreact to distant, vague threats, like Ebola, but brush off as inconsequential the more familiar and likely threat of Lyme disease.  Pandemic explores the human health, economic, social, and even that specific psychological phenomenon of potentially deadly infectious disease.

Using the well-documented and understood mechanisms of cholera’s spread as a baseline for comparing and understanding the spread of new and emerging diseases, author Sonia Shah traces the route the next wave of pathogens may likely take to go from harmless microbe to the global human health crisis.

Shah’s interest in the epidemiology of infectious disease is both personal and professional. As a science journalist, she has written extensively on malaria. In 2010, her own family was affected by MRSA (methicillin-resistant Staphylococcus aureus) and the H1N1 virus. Within months of those personal brushes with emerging diseases, she was witness to the devastating cholera outbreak in Haiti.  She suspected the appearance, in such quick succession, of this multitude of new pathogens might not be random, but part of a “larger, global phenomenon.” Pandemic is her resulting attempt identify and explain the factors that will play a role in developing the next worldwide epidemic.

Basing her approach on microbiologist Rita Colwell’s “Cholera Paradigm” – the idea that cholera’s history can provide all the clues we need to understand other emerging diseases, Shah uses this as the lens through which to tell the stories of emerging human pathogens. Each chapter traces one critical factor involved in cholera’s spread and relates how that could play out with regard to emerging pathogens. Various chapters explain how once innocuous environmental or animal pathogens can cross the species barrier to infect humans, how they move and spread geographically, their reservoirs and sources, the effect of urbanization, and host-pathogen interactions. Other chapters examine the social, economic, political, and psychological drivers that come into play in their containment or spread. 

In this ambitious tour of the most likely suspects that could emerge as the next pandemic, Shah visits “the slums of Port-au-Prince, the wet markets of south China, and the surgical wards of New Delhi, in search of the birth-places of pathogens old and new.” The contemporary trends she identifies that make the threat of epidemic disease greater than ever include: climate change, continuing urbanization, ever more accessible global transportation, genetic resistance to vaccines, and the encroachment of development on previously virgin lands, especially in sub-Saharan Africa, South and Southeast Asia, and the Amazon.

The details of cholera and other disease signs and symptoms are graphically and accurately presented, driving home the message that even this disease that we know so much about isn’t something to be nonchalant about. The most profound moments come with the realization that the 200-year old story of cholera’s spread has been replayed time and again in the intervening decades, and is clearly being repeated today. The similarity of the situation the medical community found themselves in with the 1832 New York City outbreak to that of scientists today is only too obvious. In a public bulletin issued then by a group of leading physicians, they condemn the municipality (which they called the “Corporation”) for “valuing dollars and cents above the lives of the community.”

This no doubt has led them so pertinaciously to deny the existence of Cholera in this city – even after the fact was established by the united testimony of the whole Profession...We appeal to the good sense of our Citizens whether there can be any apology for the criminal neglect of the Corporation, in relation to the distresses of the thousands who are now crying out to us for aid...

The echoes of the past in today’s environmental and human health debates are chilling. 

There is much to recommend this book to anyone interested in decoding the sometimes sensationalized news stories of diseases like Ebola or West Nile virus. Should action be taken to protect ourselves from each and every threat we hear or see in the news? What are the true risks, and what are reasonable measures to take? The best portions of Pandemic illuminate and elucidate how our preconceived notions, biases, and fears can lead us to ignore evidence to the contrary and take actions that enhance, rather than control, bad situations. The opportunities to learn from past mistakes are many.

Pandemic is a fascinating and thorough look into the history, evolution and spread of epidemics. The balance of the biological with the social forces that influence their spread gives a more thorough picture than the biology alone of why their rise and spread is so very difficult to predict with any certainty. That we, as a society, have the ability to properly cooperate and act in the best interest of human health, is made clear. Whether we will choose to do so remains to be seen.

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Lynne Hinkey uses experiences from her years living in the Caribbean to infuse her novels with a bit of tropical magic, from the siren call of the islands, to the terror and hysteria caused by the mysterious chupacabra. Visit Lynne at www.lynnehinkey.com