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The Coming Plague: Newly Emerging Diseases in a World Out of Balance

Laurie Garrett · 9 HN comments
HN Books has aggregated all Hacker News stories and comments that mention "The Coming Plague: Newly Emerging Diseases in a World Out of Balance" by Laurie Garrett.
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Amazon Summary
The definitive account of epidemics in our time, from the Pulitzer Prize-winning public heath expert Laurie Garrett. A New York Times notable book Unpurified drinking water. Improper use of antibiotics. Local warfare. Massive refugee migration. Changing social and environmental conditions around the world have fostered the spread of new and potentially devastating viruses and diseases—HIV, Lassa, Ebola, and others. Laurie Garrett takes you on a fifty-year journey through the world's battles with microbes and examines the worldwide conditions that have culminated in recurrent outbreaks of newly discovered diseases, epidemics of diseases migrating to new areas, and mutated old diseases that are no longer curable. She argues that it is not too late to take action to prevent the further onslaught of viruses and microbes, and offers possible solutions for a healthier future.
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"Ever since the SARS outbreak of 2002-03, after all, paper after paper and countless popular pieces have warned that, sooner or later, nature would produce the next big SARS."

In 1995 Laurie Garrett warned about how the world could be brought to its knees by another airborne flu-like illness in "The Coming Plague".[1]

The first SARS and avian flu and swine flu, and CJD and mad cow disease were just more warnings that humans were continuing to play russian roulette with the way they were living with an using animals. Virologists knew this and warned about this, but the rest of the world chose to ignore them.

As things return to "normal" for the parts of the world lucky enough to get vaccinated it's likely that we're going to return to sticking our heads in the sand and pretending that this could never happen again, especially if we believe SARS 2 was created by humans instead of being just another natural disease... with probably a bunch more waiting in the wings.

[1] - https://www.amazon.com/Coming-Plague-Emerging-Diseases-Balan...

stavros
> The first SARS and avian flu and swine flu, and CJD and mad cow disease were just more warnings that humans were continuing to play russian roulette with the way they were living with an using animals.

How do we live with and use bats that makes viruses crossing over more likely, though?

Taniwha
Both the Ebola and Marburg viruses both seem to live in bats in Africa and periodically transfer to humans - given it's happening in one place means it's not surprising it happens elsewhere
joejerryronnie
Sure, but does it happen right next to a world renowned Ebola virus research center?
Taniwha
You mean like this one?

https://www.niaid.nih.gov/diseases-conditions/researching-eb...

Where else would you research ebola?

InitialLastName
I would be willing to bet that if Ebola were a frequent issue in a country that had the ability to construct a world-class virus research center, there would be a research center very close to the locations where Ebola had a natural reservoir.

No matter how hard you yell it, correlation is not causation (and even when there is causation, the direction of the causation isn't always obvious).

kian
Wuhan Virology Institute is not located near a natural reservoir.
native_samples
Ebola has in the past escaped from labs.

https://www.cdc.gov/vhf/marburg/index.html

(Marburg virus is a variant of Ebola)

mikem170
There's genetic evidence that the first cases were not from Wuhan [0]:

> Of 23 samples that came from Wuhan, only three were type A, the rest were type B, a version two mutations from A. But in other parts of China, Forster says, initially A was the predominant strain. For instance, of nine genome samples in Guangdong, some 600 miles south of Wuhan, five were A types.

[0] https://www.usnews.com/news/best-countries/articles/2020-05-...

danparsonson
By increasingly moving into their territory and disturbing populations of animals with which we were hitherto not in contact.
voxic11
Wuhan is a very old city. Settled in 1500 BC.
danparsonson
The point is not where the city is, but where its inhabitants (or visiting traders) go in search of natural resources.
lamontcg
Directly via bat guano farming and direct human/bat contact (plus some presence of live bats in wet markets and the workers that need to clean those).

Indirectly via animals like minks/civits being farmed. The bats can occasionally infect those animals, when those zoonotic jumps happen there's then a large bioractor of animals in close contact, resulting in a "serial gain of function" experiment to produce a virus which is adapted to those animals and can spread.

Every factory farm is a stochastic virus research laboratory that isn't even BSL-1 trained.

pessimizer
It might have been bats this time, next time it might be chickens.
aliasEli
I does not have to be an immediate infection from bats to humans. With both SARS and MERS an intermediate host transmitted it to humans.
pjc50
> especially if we believe SARS 2 was created by humans instead of being just another natural disease

Here's the thing: if we knew the answer definitively to the lab-leak question, how would it change the pandemic response? The things we need to do to combat the virus remain the same.

GekkePrutser
For the current pandemic yes, but we could start banning all gain of function research to make another one less likely. And increase lab safety measures.
pmoriarty
Since virtually every disease comes from nature and not from labs, the thing that would really make a big difference is stopping encroaching on animal habitats and distancing ourselves from animals (including stopping the eating of animals).. not to mention massive increases in funding to virology and way better pandemic planning.
simonh
That's not necessarily the best response even in that case. We know for a fact that animal to human transmission happens, and that it will happen again. I don't know the ins and outs but it's possible that gain of function research could be crucial in preventing or fighting future natural outbreaks. That's a judgement that we should consider carefully.

If you're fighting a shooting war and you have an explosion in a munitions factory, you don't necessarily decide to stop making munitions, or perhaps even that type of munition because it's too dangerous. You make a judgement that balances the risks.

baja_blast
I 100% disagree, GoF research produces viruses as natural as selective breeding. The conditions that researchers expose various animals and humanized mice to infect each other would never happen in nature. This type of research only produces did not help predict the current pandemic, nor did it help with the fight against it, but it may have caused it!

Virologists competing with each other on who can produce the most infectious virus does not make us safer. Pursing research to prove that small pox can indeed mutate to be infectious via airborne aerosols is reckless, it creates a super charged version of a virus that never evolved naturally despite being a common disease for millennia.

forcry
>If you're fighting a shooting war and you have an explosion in a munitions factory, you don't necessarily decide to stop making munitions

What an apt analogy!

dv_dt
Except that munitions don’t self replicate. It’s more like deciding to do munitions research specifically in enemy territory where the research could be taken an used against you on any security breach.
dTal
Except the gain-of-function research specifically targeting covid-like viruses did not help us prepare or respond to the current pandemic one bit. On that basis alone we should suspend this research. It's not worth the risk.
thomaslord
I'm not familiar with the specifics of gain-of-function research, but on its face this comment sounds a lot like "we haven't developed a vaccine for COVID yet, so we should ban trying to develop a vaccine" would've sounded a few months before the vaccines came out.

In scientific research particularly, not having seen results yet doesn't mean we should abandon the research. If gain-of-function research is supposed to help us gain a better understanding of viruses and we're likely to see more pandemic-worthy viruses like SARS and SARS-CoV-2 arise naturally, I think any ban should be considered very carefully.

baja_blast
Except creating vaccines does not have the risk of producing a novel extremely dangerous virus that could kill millions worldwide
accurrent
Governments really need to start getting their shit together and stop blaming each other for their own mishandling (this will never happen I know). There is no point in trying to blame each other or cook up new regulations (enforcing regulation, particularly international regulation is just never going to happen). Quite frankly,most governments should seriously start considering how they will defend their citizens against biological threats. This means governments should do the following:

1. Build vaccine manufacturing capabilities. These are as important as other aspects of physical armed force defense. Every country should try to have their own facility given how vaccine supplies are being weaponised by certain powers.

2. Build up hospital capacity and make healthcare affordable. Train more doctors and nurses. In particular nurses are very important and generally require less training, so I would focus on building up a reserve of nurses. Pandemics will only get worse with our aging population. Our beds:human ratio is terrible even in the most advanced countries.

3. Invest in R&D towards breakthrough technologies in testing. There are currently tests like Breathonix's breathe based test that can detect a covid infection in 2 minutes with pretty decent sensitivity.

4. Build a medical reserves corps. This would be a group of citizens who voluntarily are trained in basic first aid.

5. Build more oxygen plants/equip hospitals and ambulances with oxygen concentrators.

6. Conduct drills like the Army does that simulate such an emergency. Practice emergency buying. Keep your medical corps on their toes.

7. Make sure every god damn citizen has a bank account so you can transfer emergency funds into the account in the event of a major economic disruption.

8. Estimate the financial impact and provide backup options for people who work in the service industry. If you were an air hostess for instance, you would have some basic training in medical emergency handling. In the event of a pandemic, your income source will be hurt. However, the government would definitely be scrambling for nurses and contact tracers. These are jobs that could be taken up temporarily during the duration of the pandemic.

9. Work on technolgies and training for deployment of field hospitals.

None of these actions should change irregardless of whether the vaccine is a lab leak or not a lab leak.

AlgorithmicTime
The big problem was GOVERNMENT, though.

Seriously, the mRNA vaccines were created in a few days once the seriousness of the virus was realized. And then held up for 9 months of testing because the government wouldn't allow challenge trials. We could have been vaccinating people a few months into the pandemic and instead we waited nearly a year to roll out the vaccine at scale.

morpheos137
The biggest thing that made the pandemic so bad outside of china was large fractions of the population not taking it seriously. That said this pandemic was objectively not that bad by historical standards.
taeric
I want to believe this. With how varied the level of reaction was in the states, coupled with how spread the impact was, I'm not sure we can say just yet.

Even the places that were heralded as amazing are starting to fall. I see Vietnam is on a rise now. Thailand? Who is left?

MomoXenosaga
The US was a major source of anti vaccination FUD. And while in the US vaccination is stalling because of "muh freedom" EU governments developed an app that stops unvaccinated people from entering restaurants and airplanes. The latest 3D chess move was letting children get the jab without their parents permission. I was seriously worried about our civilization for a moment but sanity prevailed. We will be at 90% soon.
Dma54rhs
What is this app you're talking about that won't let me visit restaurants or fly in EU? Either you're on purpose spreading misinformation or think whatever happens in your geographic location x is what is happening everywhere aka you're narrow minded.

Edit: ok, you're an arrogant yank, which explains it. Whatever you read about the mystical EU on reddit is 9 times out of 10 total bs.

forcry
> "muh freedom"

Freedom is costly. A lot of people died, and I mean, really, "A LOT", and I am talking people at the prime of their lives, for freedoms that we enjoy all over the world.

"muh freedom" indeed.

jpeloquin
As a blame-free explanation of why SARS-CoV-2 become so widespread, I think the parent comment is basically correct. From [0], "SARS, caused by a respiratory-tract virus, also failed [to become a pandemic], although it came close to causing a pandemic after its emergence in late 2002. It killed almost 800 people worldwide, but was rapidly stopped mainly because infected people developed symptoms quickly." In contrast, Covid-19 spreads pre-symptomatically, and infections are frequently mild or asymptomatic. The test-trace-isolate containment strategy, such that it was, relied on people acting in response to symptoms. People without symptoms can't do that, and if someone has what feels like a normal cold they're just not very likely to take special precautions, at least early on when the disease is rare and there's still a chance of containment. The pandemic response we prepare for next time needs to compensate for this, such as by adopting proactive disease surveillance or increasing efforts in other areas.

As for the pandemic not being that bad, we did get lucky in a couple ways: it was possible to rapidly develop many vaccines, and the mortality rate was relatively low. Covid, disturbingly, was sort of the least bad version of a global pandemic, at least compared to the alternative scenarios outlined in warnings (e.g., [0]) over the past several decades.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2002527/

accurrent
Actually, I would see this as a shifting of blame from the government's perspective. Anyone who runs a government should know that legislation will be broken. People will not comply with orders. Thus the government should implement extremely simple and transparent legislation - something that most governments tend not to do. This legislation should be possible to enforce. One of the best ways to gain empathy is to involve citizens in the process. Rather than blame the citizens, start by thanking those who do follow orders. Involve citizens in the process. I'm sure we could have used a lot more contact tracers and swabbers during the pandemic, how about training unemployed citizens and using them for this task?

I live in Singapore where due to our size and wealth we have been able to manage the pandemic, arguably better than most countries. Its not only the fact that Singapore enforces legislation that helped us. There are many instances where legislation has been broken, and not all cases will be prosecuted. But one thing that worked well is the government treated us well. The moment they announced a "circuit breaker" (not lockdown cause that sounds scary) the government accompanied that with multiple payouts through the year to ensure people have basic sustenance. Further, the prime minister thanked us for complying with orders rather than picking on the few that did not comply with orders. Also we lived though SARS, and every now and then get scares from the Avian Flu so pandemic response is something we have lready been conditioned bu.

morpheos137
My point was not to assign blame but rather observe that the difference in the way the popuations reacted. Western populations likely did not take the pandemic as seriously as say China or Japan because of mixed messages from government, conspiratorial thinking, and exceptionalism.

For conspiratorial thinking have a look at godlikeproductions.com

countless threads about virus fake, virus harmless, masks don't work, vaccines kill. I am confident that godlikeproductions.com has killed far more people via covid than gab or parler did through "insurrection" or racism. And yet cloudflare continues to provide services to godlikeproductions.com It is almost as if they don't care as long as those dying are not san francisco elites.

accurrent
True. But I don't think its only the populations. We have had a few clowns in Singapore who have expressed similar opinions. Yes, many of them have been prosecuted and charged for not complying, but I'm sure there are some who still have weird ideas about covid being a hoax or the vaccines being untrustworthy. (In fact we have had a lot of trouble convincing the older population to vaccinate some of them think the government approved American vaccines are too experimental)

Japan honestly has done a terrible job managing the epidemic if compared with the rest of East Asia. It cannot be clubbed with China. In China we do not actually know the amount of compliance as that data is not available to us. I know of at least one protest held in Wuhan during the lockdown. https://www.bloomberg.com/news/articles/2020-04-10/wuhan-ren...

Right now I enjoy reading The Coming Plague https://www.amazon.com/Coming-Plague-Emerging-Diseases-Balan... Written 1995, but incredibly actual. Shows that most of epidemics are function of political will and economy and vice versa.
I read The Coming Plague in the 90s: https://www.amazon.com/Coming-Plague-Emerging-Diseases-Balan...

These aren't hard predictions.

If you are interested in reading more about diseases that have seen recent emergence (or rather, emergent diagnosis[1]), The Coming Plague[2] by Laurie Garrett, ISBN 0140250913, is a good read. It details the modern origin cases that led to the characterization of a number of diseases, including Marburg, Ebola, Legionnaires' Disease, and Lassa fever. It also talks about their epidemiology and the optimism of the mid-20th century for eradication of things like malaria, as well as the resulting challenges. The book reads like a thriller because the scientists involved are heroic and colorful, and have stories worth telling.

1. http://www.sciencemag.org/content/338/6108/750.full

2. http://www.amazon.com/The-Coming-Plague-Emerging-Diseases/dp...

The first sentence is (at least to me) obviously untrue -- their have been people clearly and publicly saying this is a serious problem since at least the mid-90's. The book "The Coming Plague" came out in 1995, and discusses almost this exact scenario: http://www.amazon.com/The-Coming-Plague-Emerging-Diseases/dp...

There is little spending on public health issues, crumbling infrastructure, and, due to ease of travel and overcrowding, diseases spread faster then ever before.

They were rural and burned themselves out once people stopped visiting the hospitals where they were transmitted through shared needles.

This is a great book that covers many early outbreaks: http://www.amazon.com/The-Coming-Plague-Emerging-Diseases/dp...

One of the factors that keeps Ebola from causing massive epidemics and pandemics is it's rapid mortality rate. It kills people relatively fast and consistently, so outbreaks often burn themselves out.

https://en.wikipedia.org/wiki/Ebola_virus_disease#Epidemiolo...

If you're curious, The Coming Plague is a very interesting book that covers many hemorrhagic fevers like Ebola: http://www.amazon.com/The-Coming-Plague-Emerging-Diseases/dp...

timr
It doesn't kill people faster than a flight to a major international airport. That's all that matters.
marvin
Most previous outbreaks have been in rural areas, though. So depending mainly on the mortality for containment doesn't sound like the most prudent strategy.

The incubation period of Ebola virus can be quite long (more than two weeks) which is more than enough time to spread the disease geographically far. EVD/EHF is also contagious during the incubation period when no symptoms are present.

There's a lot of info in the book "The Coming Plague" about the initial reaction to the disease GRID, which would later become AIDS.

http://www.amazon.com/The-Coming-Plague-Emerging-Diseases/dp...

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