Doomsday 2: No One Knows When the Next Plague Will Come, Only that it Will

Thursday, June 19, 2014
By Paul Martin

Fear the Reaper

By Glen Martin
Berkeley.edu

Editors’ Note: The Summer 2014 issue of California magazine is called “This is the End.” Every day this week: a different catastrophic scenario.

The first confirmed victim was a Vietnamese butcher in Láo Cai. He collapsed suddenly while chopping up pork ribs in his outdoor stall, and died within hours.

Family members said he had been feeling ill for several days,had been coughing constantly for two, but insisted on working. It was a point of pride with him, they said. After several days, they too were stricken, and most died. Then people who had bought meat from the butcher sickened and expired. Then their neighbors succumbed. Then people across the river, down the road, over the next mountain.

The epidemic raged through Láo Cai, and also the neighboring towns of Cao Bang and Thái Nguyên. Before any effective containment strategy could be devised, it had spread to Nanning and Kunming in China, and then it reached Macao—and finally, Hong Kong. And from there, it literally took flight around the world. Within weeks, people were coughing, collapsing, and dying in San Francisco, Sydney, London, and São Paolo.

Virologists and microbiologists analyzed the responsible pathogen and found it was a coronavirus, kin to the SARS microbe that briefly induced global panic before it was contained in 2003. But this coronavirus contained RNA from Influenza C, a virus that infects pigs as well as humans. This new hybrid bug had probably originated on a small farm, incubating in both the farmer and his swine. When the pigs went to market, the new coronavirus was poised to make its debut.

It was stunningly virulent. The “Spanish flu” epidemic of 1918 had a 2 percent direct mortality rate (though many more died from secondary bacterial pneumonia). The 2003 SARS outbreak had a general mortality rate of more than 10 percent, climbing to 50 percent in people middle-aged or older. But this new pathogen had a general mortality rate of 31 percent, hitting 67 percent in people 60 years or older. Normally, virulence works against the rapid spread of a virus; people who are violently ill generally aren’t effective at disease transmission, because they quickly become too sick to walk around and shed microbes in public venues. But this coronavirus had a long incubation period. Many people harbored “subclinical” infections for days or even weeks; they were highly infectious and ambulatory prior to developing full-blown, incapacitating symptoms. In short, the disease was widely dispersed before anyone recognized its existence.

The medical community named the new plague Massive Acute Respiratory Syndrome, or MARS. But as it gained momentum and began killing millions, then tens of millions, it gained a popular, and more sinister moniker: Reaper.

The above scenario is extreme, but is by no means impossible—or even unlikely. In fact, the emergence of pathogens capable of causing global pandemics that kill millions, if not billions, of people is inevitable.

It will be nothing new. We have evolved with viruses and bacteria, many of them lethal. Pandemics have accompanied us from the caves to the skyscrapers, shaping who we are genetically and socially. The bubonic plague, caused by the bacterium Y. pestis, likely contributed to the fall of Rome: The so-called Justinianic Plague raged from the 6th to 8th centuries and killed about 100 million people in lands controlled by the Empire. Similarly, the Y. pestis–driven Black Death wiped out a third or more of Europe’s population in the 14th century and changed the genome of Continental people, selecting for certain genes involved in immune response. In short, most of the living things on the planet are microbiological. To a very real degree, we are mere hosts, living petri dishes for creatures inhabiting the microcosmic world. We cannot stop them. We can only accommodate and sometimes divert them. Moreover, the threat is and will remain imminent. We’ve recently dodged some very near bullets from the microcosmos.

“SARS—that was the big wake-up call,” said Tomás Aragón, an assistant adjunct professor of epidemiology at UC Berkeley’s School of Public Health. “It was completely unexpected. It had 11 percent overall mortality and 50 percent mortality in people over 50. We had no vaccine for it. It was incredibly scary.”

The Rest…HERE

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