A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 16: NATURE AND HOMO SAPIENS
The organism hid in algal scum
During the 1970s Rita Colwell, convinced that the entire oceanic crisis was directly imperiling human health by permitting the emergence of cholera epidemics, showed that the tiny resilient cholera vibrio could live inside of algae, resting encysted in a dormant state for weeks, months, perhaps even years. It was the emergence of cholera in Peru in January 1991 that compelled the World Health Organization and the global medical community to take notice of Colwell’s message. It was discovered that the cholera vibrios could feed on the egg sacs of algae: up to a million vibrios were counted on the surface of a single egg sac. The organism simply hid in algal scum floating atop local ponds, streams, or bays, lurking until an opportune moment arrived for emergence from its dormant state.
Sickening at least 336,554 people, killing 3,538
In Peru’s hot summer January – made hotter still by an El Niño event – a Chinese freighter arrived at Callao, Lima’s port city. Bilge water drawn from Asian seas was discharged into the Callao harbor, releasing with it billions of algae that were infected with El Tor cholera. As the El Niño water spread out along the Pacific coast of the continent, carrying with it bilged algae, cholera appeared in one Latin American port after another, sickening at least 336,554 people, killing 3,538, aided by obsolete or nonexistent public water purification systems, inadequate sewage, and airplane travel. Cases reported in the United States involved individuals who boarded flights from Latin America unaware that they were infected, and fell gravely ill either in flight or shortly after landing.
Resistance to eight drugs
The El Tor substrain, Inaba, possessed genes for resistance to eight drugs. More than $200 billion would be spent by Latin American governments by 1995. Once chlorine was introduced into Peruvian water supplies, the 01 strain proved fairly resistant to the chemical. Prior to the Bengal cholera outbreak there were two types of cholera in the world: classic and El Tor. The Bengal cholera appeared to represent a combination of characteristics found in both the El Tor and the classic vibrio. One genetic trait was missing in the new Bengal strain: that which coded for antigens that were usually recognized by the human immune system. Even adults who had survived previous cholera outbreaks appeared to be susceptible to the Bengal strain.
The Big Picture
In 1993 Colwell teamed up with two Cambridge Massachusetts, physicians, Drs. Paul Epstein and Timothy Ford at the Harvard School of Public Health, to try to pull together the Big Picture, an explanation of how global warming, loss of ocean biodiversity, ultraviolet radiation increases, human waste and pollution, algal blooms, and other ecological events joined forces. They theorized how the cholera microbe defecated by a man in Dhaka, for example, got into algae in the Bay of Bengal, lay dormant for months on end, made its way via warm water blooms or ship bilge across thousands of miles of ocean, and killed a person who ate ceviche at a food stand in Lima.
Working to the advantage of microbes
Epstein lobbied scientists working in diverse fields, many of whom had reached the conclusion that changes in global ecology – particularly those caused by warming – were too often working to the advantage of microbes. Robert Shope was convinced that even a minor rise in global temperature could expand the territory of two key mosquito species that could invade population centers such as Tokyo, Rome, and New York, carrying dengue and yellow fever. British experts felt certain that global warming would greatly expand the territory and infectivity ratio of the East African tsetse fly. The same principles held true for the Anopheles mosquitoes and the spread of malaria. A WHO Task Group report in 1990 offered a broader range of expected disease impacts from global warming due to altered wind patterns, changes in humidity and rainfall, and a rise in sea levels that would alter the ecologies of microbes carried by insects and the ecologies of microbe-carrying animals such as monkeys, rats, mice and bats.
International commercial air flights soared
The heightened exposure to ultraviolet light suppressed the human immune response, increasing susceptibility to all microbes. Karl Johnson, Pierre Sureau, Joe McCormick, Peter Piot, and Pat Webb had long ago witnessed the results of human incursion into new niches or alteration of old niches. International commercial air flights soared from 2 million in 1950 to 280 million in 1990. Once microbes reached new locales, increasing human population and urbanization ensured that microbes faced ever-improving statistical odds of being spread from person to person.
The classic wartime opportunists
Between 1980 and 1989 the number of refugees fleeing natural disasters, wars, famine, or oppression increased by 75% every year. By the end of 1992, 17.5 million people were refugees, most of them living in squalor in the world’s poorest countries. Millions of abandoned children roamed the streets of the world’s largest cities, injecting drugs, practicing prostitution, and living on the most dangerous margins of society. Civil war in the horribly overcrowded nation of Rwanda broke into inconceivable carnage during the spring of 1994. When such conflicts occurred in developing countries, they created new opportunities for typhus, cholera, tuberculosis, and measles – the classic wartime opportunists.