Putting the Pandemic in Historical and Epidemiological Perspective

“Annals of Medicine: The Good Doctor” by Michael Specter in The New Yorker, April 20, 2020, https://bit.ly/2KpmZSB

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In this New Yorker article, Michael Specter describes the scientific events that have shaped the career of Dr. Anthony Fauci. Since 1984, he’s been director of the National Institute of Allergy and Infectious Diseases, and he’s currently at the epicenter of the coronavirus crisis. Specter’s article lists some previous epidemics that wreaked havoc through history:

- In 430 BC, Athens was struck by a plague that killed as many as 2/3 of its residents.

- Beginning in 165 AD, smallpox contributed to the downfall of the Roman Empire.

- In the 14th century, the Black Death killed more than half of Europe’s population.

However, by the middle of the 20th century, improvements in antibiotics and sanitary conditions led many scientists to believe it was possible to eradicate, or at least control, infectious diseases. Fauci, who had specialized in this field at the start of his career, worried that he’d chosen an area that was going to become a sideshow.

Then several deadly diseases changed the game. AIDS has killed more than 30 million people, and tuberculosis infects about a quarter of humanity, killing 1.5 million people in 2018 alone. “But the greatest threat that humanity faces, by far,” says Specter, “is a global outbreak of a lethal virus for which no treatment has been found.” And indeed, COVID-19 has forced billions of people into lockdown, and another pandemic like this will inevitably appear – maybe next year, maybe in a decade, maybe in a century.

“We live in evolutionary competition with microbes – bacteria and viruses,” said Nobel Prize-winning molecular biologist Joshua Lederberg. There are countless viruses in animals and humans, most of them harmless. For a virus to pose a worldwide threat, it has to meet three critical conditions:

- It emerges from animals and humans don’t have immunity to it.

- The virus sickens and kills humans (the vast majority of viruses don’t).

- The virus spreads efficiently – e.g., through coughing, sneezing, or handshakes.

For years, Fauci and others have been concerned about a virus that would punch all three tickets – new, deadly, and infectious – and that’s what we have in COVID-19.

For most of human history, a virus with all three characteristics would afflict many people in the community where it emerged, but then stop spreading. But as human mobility increased, pathogens could spread more widely. Nowadays, someone can wake up with an infectious virus in China and fly to America, spreading it intercontinentally the same day. According to one analysis, at least 430,000 people have arrived in the U.S. on direct flights from China since the coronavirus outbreak began.

Lederberg and others have advocated for greatly expanded early-warning systems, particularly in the developing world, as well as stronger measures to respond to microbial threats. Unfortunately their alarm bells were almost completely ignored. In 2004, a year after those recommendations were made, a highly pathogenic form of avian influenza, H5N1, leaped from waterfowl to chickens to humans. This time, the world was lucky – it was deadly but not very contagious. Five years later, a new influenza virus, H1N1, infected nearly a quarter of the global population before vaccines were developed – but again we were lucky: it was highly contagious but not nearly as deadly as most strains of influenza. Dodging the bullet twice fostered complacency and made it more difficult for scientists to create a sense of urgency.

A somewhat hopeful development is that genetic engineering has made it possible to respond to an epidemic much more quickly than in the past. After the COVID-19 outbreak began, it took scientists less than a month to sequence the genome of the virus; by the end of February, the instructions were on the Internet and the virus had been recreated in labs around the world so that scientists could seek treatments and vaccines. The problem is that treatments and vaccines will be virus-specific. Each year scientists try to scope out newly-evolving viruses and create vaccines, but it’s hit-or-miss: in the 2017-18 flu season, the vaccine worked for only about one-third of the people who received it. And scientists are playing whack-a-mole with each new virus. “We keep trying to develop a vaccine for one thing – usually the last one – and it’s a waste of time,” says Fauci. “Every time we get hit, it is always something we didn’t expect.”

Fauci has long advocated for developing a universal influenza vaccine that would provide lasting defense against all strains. “Similar to tetanus,” he said, “a universal flu vaccine probably would be given every ten years. And if you get one that is really universal, you can vaccinate just about everyone in the world.” This would cost hundreds of millions of dollars to develop and test, and to date, that money hasn’t been raised. Perhaps that will change now. “To plan a coherent biological future, rather than simply scramble to contain each new pandemic,” Specter concludes, “will require an entirely new kind of political commitment.”

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10/04/2020 - SB
Fabulous article

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