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The Four Horsemen - Part 2: Pestilence
Across the span of recorded history more humans have died of disease, and especially epidemic and pandemic disease, than any other single cause, war included. We've recently seen the damage done worldwide not by a respiratory virus, but by the misguided response of governments.
COVID will no more go away than will the ineffectual meddling of co-opted scientists and statist bureaucrats. Its next variant, or the one after that, might actually pose a threat to more than just a narrow slice of the unhealthy and immune-compromised, or those denied early effective treatment. And this will happen independent of the ongoing argument about its origins, intent, or spread.
Clearly these concerns did not emerge with COVID-19 in 2020, but outside the narrow field of epidemiology and apart from brief headlines that flare and subside about epidemics of Ebola in Africa, bio labs in Ukraine, monkeypox and other outbreaks, most people in the United States pay little attention to these threats. The skepticism generated by the COVID response should not blind us to real and more dangerous microbial threats that could emerge at any time. A grim tour through those possibilities can be taken in Laurie Garrett's book, The Coming Plague: Newly Emerging Diseases in a World Out of Balance, which was published in 1994, but has aged well and is still highly relevant. None of her warnings, conclusions, or predictions have been refuted.
Biological Warfare Biological warfare is another aspect of the threat. Leaving aside speculation about COVID's origin – because we just don't know – the threat is real. Many nations had robust biological weapons programs for many years, and those like the United States and Russia that have publicly renounced theirs inspire little confidence, for two primary reasons:
- Biological agents, natural or engineered, that were once stockpiled are a forever threat, because we can never be 100% sure they were entirely destroyed. And because of that, government laboratories maintain samples to ensure we have a head start in development of therapeutics or vaccines should they emerge. A stark example is weaponized smallpox, which was stockpiled in quantity by the Soviet Union. Just as with nuclear weapons, rumors of its compromise – shared, sold, or stolen – and maintenance by other nations or terrorist groups have to be taken seriously.
- Biological weapons are the poor man's (or poor nation's) nukes. Their production can be more clandestine, easier, and cheaper than nuclear weapons. Whether pursued as a deterrent or as an offensive, existential threat against hated enemies, they are attractive. They are considered Weapons of Mass Destruction and their widespread use could trigger a nuclear or conventional military response, particularly if the user leaves a "return address." They are particularly attractive to terrorist organizations, especially in the post 9-11 world, understand the value of having no known territorial base.
War games: sinister or necessary? Or both?
Much speculation has arisen recently over simulations of coronavirus and monkeypox outbreaks, that were conducted suspiciously soon before each emerged in the real world. Whether those indicate nefarious conspiracies cannot be proven or disproven, but we might ask how many such simulations are conducted on an ongoing basis, and to what extent all their scenarios are based on real-world threats. Since the SARS-CoV-1 outbreak in 2002-2004, a lethal and highly transmissible coronavirus has been a legitimate concern, and monkeypox is endemic in equatorial Africa and has leaked to the outside world several times since 1970. Should we be surprised that war gaming by governments and health authorities have addressed both?
Another such simulation was "Dark Winter," conducted in 2001, based upon a scenario of simultaneous release of smallpox in several American cities. The outbreak could not be controlled by any means available at the time. With an assumed case-fatality rate of 30% (at least ten times higher than COVID-19) based on historical smallpox epidemiology, the simulation predicted three million cases and one million deaths nationwide by the end of the second month, with no relief in sight. The simulation was terminated at that point. Note that no sudden outbreak of smallpox in the real world followed.
We still have to remain open-minded and alert to the roles and intent of governments and the private sector in actual and imminent public health crises. Our welfare is never the only goal. Political careers and "legacy" of narcissistic elitists, advancement of ideological goals, bureaucratic blame-shifting, an obscenely distorted profit motive, and the corruption and misuse of science all play a role.
But setting all that aside for a moment, because they lie in the realm of politics and can only be addressed through politics, we'll focus on what we'll see at the point of contact, "where the rubber meets the road" – and what we as individuals, families and communities need to know and to do.
Define the threat
For us as laymen, the gist of it is that there are many lethal microbes (defined by their case fatality rate, the number of infected people expected to die of primary or secondary causes due to their infection), that are highly transmissible between humans and have a long latency period. Latency is critical; it means that the disease is contagious, but not obvious or symptomatic, for days or weeks after an individual is infected. A long latency period, especially in today's world, means that a person exposed and infected can board an aircraft, travel across the world, and spread his disease to many others before he even realizes he is sick. Epidemiologists have lost some credibility in the COVID era, but they understand these dynamics very well and have protected us against potential threats by their vigilance and extraordinary efforts many times in the last century.
An interesting hypothetical treatment of such an outbreak was published in the Kansas City Star on June 21, 2006, at the height of an earlier episode of fear about H5N1. Parts may seem a bit less hypothetical to us now, three and a half years after the emergence of COVID. Reproduced here from the newspaper's archives:| Kansas City Star June 21, 2006 What if the killer strain hit KC? DARRYL LEVINGS DAVE HELLING BIRD FLU A futuristic scenario blending fact and fiction: The following story is in the genre of science fiction -- call it "health fiction." No one knows whether the H5N1 bird flu virus will even get here, or how dangerous it will be if it does. But experts lay odds that we'll battle this scary bug sooner or later. Does this tale seem exaggerated? Let's all hope so. Check the facts as the story unfolds and decide for yourself. |
| Just how dread morphed into disaster in Kansas City may never be fully known. Did the H5N1 virus arrive on a plane from Seattle, the first U.S. city to declare an emergency? Some blame a returning duck hunter who bagged his limit on the infected Pacific flyway. He lived, but both his children were among the first to perish in the pandemic. But that's just one theory. The human-to-human form of the dreaded bird flu, first breaking out in Indonesia, had been sweeping across Asia. It could have been in the lungs of a GI passing through Kansas City International Airport from some Pacific base. Whenever death stepped off that airliner in that horrible winter of 2006, we weren't ready. How could anyone be? Before it was over, 10,000 Kansas City area victims were stacked in morgues, refrigerator trucks and even an ice rink. A half-million of us will remember forever the way our lungs filled and our fevers climbed. Social order broke down, people fought for nonexistent drugs, and for a frightening week hunger actually wormed into our lives. FACTS:
In June 2007, we might look back and say: Where were the vaccines? Researchers had prayed they'd have some time to tinker with their vaccines once the human-to-human mutation emerged, but prayers are not always answered. Despite the billions Washington poured into labs, only about 4 million unusually large vaccine doses were ready before the outbreak. Ultimately, it meant only 2 million people got adequate protection against H5N1's deadly power. FACTS:
As it spread, authorities tried to isolate it, but it soon was as pointless as throwing water on a campfire amid a forest fire. Many of us had been spreading the virus for days before even feeling sick. And we later realized many doctors missed the first alarms because the virus attached itself to cells deep in our lungs, not our upper respiratory systems. Thinking the disease was still comfortably distant, we made our usual hundred-mile hops to visit grandmother or cheer at an away football game. Even without a quarantine, movement in and out of Kansas City soon became a trickle. Motorists were wary of trying to go far with uncertain supplies of fuel on the interstates. The airlines took yet another huge hit. Who wanted to climb into a tube with re-circulated air? And to keep essential flights in the air during the absenteeism, the feds ordered our air controllers out of KCI to beef up larger hubs in Chicago and Denver. We quickly realized there'd be little federal help. Everyone across the country was up to their eyeballs in sick people and collapsed systems in the following weeks. FACTS:
The U.S. health services had hoped to have most health and emergency workers across the county vaccinated in time. That didn't happen, either. Triage centers were set up, with masked nurses directing the wheezing, staggering victims into different lines. At one point, a nurse turned to a friend and said, "I've got it, too; I've got to lie down." The second nurse escorted her inside, turned and started walking. "Hey," a doctor in the hallway called, "Where are you going?" She didn't turn around, just kept walking. Doctors, nurses, emergency workers, all saw their ranks riddled, leaving fewer and fewer to deal with the desperately sick. Later, we would learn that many medical personnel didn't even show up. FACTS:
By January, the halls of hospitals were churning with chaos and terror, filled gurneys everywhere, some patients on the floor. A nurse wept as she directed body bags to a refrigerated truck behind Children's Mercy. Briefed for weeks, even doctors were shocked at the rapid deterioration of their patients. Ventilators were switched from patient to patient as exhausted staff tried to get at least a little oxygen to some. Medicines for those not sick with flu also were scarce because of shaky distribution. The only good news was that because of our medical resources, the mortality rate was nowhere near the 54 percent experienced in Asia before the big breakout. FACTS:
The flu knocked out a third of the local police force in the first weeks. Strip malls were trashed; some looting occurred. Riots engulfed two clinics when word reached the rear of the line that no more medicines were left. A man holding a Glock 9mm with one hand and a little girl in the other burst into the ER of the University of Kansas Hospital screaming for medicine for his "babies." One Leawood doctor was found shot; later investigation found he had been selling Tamiflu for $300 but was robbed by one of his customers. In at least two cases, jittery gas station clerks shot innocent men coming in with surgical masks over their faces. That was just the first wave. FACTS:
Too much faith, it's now clear, was put into the antivirals. Tamiflu was one of the few drugs not compromised by overseas farmers indiscriminately using antivirals to save their poultry flocks, only to give the bug a chance to develop resistance. Governments rushed to place orders, production was ramped up, but only about 20 million of the 10-pill treatments were ready by late 2006 before distribution collapsed. Desperate parents tried the Web or underground dealers but bought fakes. At least one strain of the flu quickly became resistant to Tamiflu and ripped into the United States more virulent than ever. FACTS:
It was a mild winter, fortunately, but you might have thought we were buried by the deepest blizzard. The social life of the city went dark. Theaters were empty; the Chiefs games were canceled (they couldn't field a team, anyway). Christmas was a grim affair, with many homes dealing with grief. Families searching for some normalcy could be seen driving through the quiet Plaza (the lights blazed away as usual), but shopping was just a whimper of its old self. We missed Christmas services, of course. Churches were closed; even funerals were banned. The morgues were filled. Mass graves were dug in Swope Park and other open areas until later interments. The Times Square ball dropped, and no one gave a damn. And then the second wave hit. It was the worst and in a heart-rending repeat of the 1918 Spanish flu, seemed to seek out our young. Their lungs filled with shocking rapidity. In some of the children, before autopsies were abandoned, the cause of death was brain infections. For a while, covered bodies lay in rows on the ice of a Johnson County rink, two of them young boys who had played hockey there just weeks before, The Star reported. The whole city felt like the Pied Piper had paid a visit. Our children disappeared from view. Once Christmas vacation was over, schools remained closed, daycares locked up. Frightened parents stayed home, kept their kids inside, whether fevered or not. Time Warner anticipated this and set up an automated way to load tapes into a satellite system to keep Cartoon Network on the air, no matter how many technicians got sick. Call it a SpongeBob blessing to parents stuck at home with stir-crazy kids. FACTS:
The first panic buying had stripped the shelves. Store chains shut some stores and consolidated supplies at locations watched over by National Guard troops. For a couple of days, we had brownouts as power sources sputtered. Some weeks the work force was decimated. In January, many companies told all their employees to stay home. A few tried to telecommute, but that made hardly a dent in the vast absenteeism that brought the economy wheezing to a near halt for nearly a month. FACTS:
White, unmarked refrigeration trucks, the kind that once delivered produce to the City Market, now could be seen on residential streets, making pickups of the saddest kind. Even for the lucky ones, life got much more complicated, grim. The city smelled with the halt of trash pickup. Streets were piled with snow a couple times, but that didn't bother the thin traffic as much as the unrepaired traffic lights. Plumbers? Impossible to find. Until they ran out of patties or pizza dough, some drive-in food outlets saw lines stretch for blocks. Walk-in restaurants didn't reopen until March. There were no lines at the chicken joints, however. People were suddenly terrified of poultry, despite the fact that the disease isn't carried by cooked meat. Tyson filed for emergency Chapter 11, its upbeat advertising campaign ignored and its poultry barns emptied by the flu. The virus also ripped through hog operations; they say people 10 miles away were gagging from the smell of the hog houses in north Missouri. So beef prices soared as feedlots and slaughterhouses suffered absenteeism and couldn't keep up with demand. But for some, just getting the money to buy scarce milk was a problem. ATMs weren't filled, the reduced staffs at some payroll offices were unable to get the checks cut. FACTS:
The second wave had peaked by February, and the third came through in March. Most who came down with it by then had only mild cases. Some experts said we'd be fighting different strains for a year or more. Fortunately, it seemed to burn itself out in less than a year. Churches opened for mass memorials. When Easter got here on April 8, services about resurrection had tearful meaning; the holes left in the pews by the disease were filled with those who needed new inspiration, renewed hope. We needed it. A wave of depression, post-traumatic stress, had set in. Suicides began taking up space in the morgues. By then, however, priorities in the workplace had been well established; crucial supplies were coming in regularly. We learned we could do without some things, such as imports from China, where the work force had been riddled much worse than ours. Schools began to reopen on accelerated schedules, and kids were bitterly disappointed by the curtailed summer vacation. The Super Bowl was finally played on a May Sunday. Folks began shaking hands again. And Stroud's reopened. Copyright 2006 The Kansas City Star Co. |
The above scenario is not unreasonable, and is useful as a baseline for what we and our communities might face, and what we might do to prepare. Its underlying and unfortunately rational assumptions include a case fatality rate for H5N1 of 20%, many times higher than COVID-19, but only two-thirds that of naturally occurring smallpox and less than half that of Ebola and related hemorrhagic fevers.
Frame the problem
Much more could be said about preparation and response – and we will have more to say in future articles – but there are at least four primary considerations:
- Isolation. It is unfortunately likely that any highly transmissible disease will spread faster than it can be contained by measures that the government or the public will be willing to take, in time. A suspension of air travel, and of overland travel enforced at state lines if not within states, would have immediate and catastrophic effects on our economy. They would probably face widespread noncompliance, given the current low level of trust between the public and governments at all levels. And it may only take one leak-through to spark uncontrollable contagion within any community. You may not be able to control anything beyond the boundaries of your property, at best. If you are in a remote rural community, there might be a possibility of effective cooperation between neighbors and local authorities – after everyone's out of state relatives and friends arrive, that is. . . The question for an individual or family is whether you are prepared physically, psychologically, and emotionally to cut off outside human contact? To do so for any extended period of time, you would need a level of self-sufficiency beyond what most other "worst-case" preparedness scenarios call for.
- Second-order effects. As we discuss elsewhere in regard to food shortages and other possible long-term crises, both rational concerns and irrational fears are likely to result in dangerous behaviors. Densely-populated areas, large or small, are likely to see surges of evacuation by the frightened or unprepared. Not only will many evacuees be more at risk than if they stayed prudently isolated (and well-supplied) at home, but they will also impact rural areas they pass through or stop in. The Kansas City Star scenario touches upon another broad second-order impact: what will happen in communities large or small, when 40% of the police, firefighters, trash collectors, utility and sewage plant operators don't show up for work because they or their immediate family are seriously ill? If garbage accumulates and water and sewage systems are compromised, humanity's old enemies cholera and typhus could re-emerge.
- Medical preparedness. Understand the spectrum of disease threats and keep your antennae up regarding new threats as they appear. Preventive and therapeutic supplements and medications, both broad-based and specific, need to be kept on-hand, current and effective well before any swiftly emerging crisis. Shop now; avoid the rush. For example, although it's not a pandemic scenario, consider how the availability of potassium iodide, a well-known and inexpensive protective treatment for those potentially exposed to radioactive fallout, fell quickly to zero after media speculation that the Ukraine war might escalate to a nuclear exchange. How would you respond to other illnesses or injuries when health care facilities are filled beyond capacity in a true pandemic – and are primary loci for infection? In those circumstances, a common belief across the less-developed world could find new adherents in America: hospitals are where you go to die.
- Ruthlessness: Talk about "radioactive", this is a subject we are all deeply uncomfortable with but cannot ignore. Who will you aid? Who will you support? How would you interact with good but less-prepared people during a true high-lethality pandemic? Do not put off these challenging questions or assume you'll just "cross that bridge when you come to it." Weigh the best, most compassionate, and most realistic answers available to you.