A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 17: SEARCHING FOR SOLUTIONS
The reused syringe and the blood and plasma systems
Probably the most efficient amplifier was the reused syringe. The Yambuku 1976 Ebola epidemic was grossly amplified by the mission hospital’s use of five syringes on an average of 300-600 patients per day. Numerous microbes have successfully exploited blood banks, transfusions, and plasma markets to amplify their numbers markedly. The dramatic rates of HIV and hepatitis B infection among the world’s population of people with hemophilia offered striking evidence of the rapidity with which the risk for infection by a microbe that infects less than a tenth of the general society can be amplified many times over through multiple transfusions, decimating a whole generation of blood recipients. It seemed reasonable to conclude that an international campaign to provide sterile syringes as needed, and clean up the blood and plasma systems, would go a long way toward eliminating amplification of emerging microbes. Both efforts are feasible: there are no technical roadblocks, nor are the efforts terribly expensive. What is lacking is political will.
A shared medical inhalation device
In hospital and clinical settings there have been outbreaks of a host of diseases in which an invasive device or medical equipment served as an amplifier. A shared medical inhalation device used for prophylactic treatment of HIV-positive men in a Miami outpatient clinic amplified a single MDR-TB infection many times over, leading to a large, lethal outbreak.
Constant recirculation of the same air
Outbreaks of multidrug-resistant bacteria and mycobacteria have also resulted in amplification directly by medical personnel, syringe or devise reuse, device packaging, septic catheters or IV lines, septic surgical procedures, often involving contaminated implants of heart pace-makers, valves, limbs, joints, or other devices, and respiratory assistance equipment. In some cases an entire room – its walls, tables, beds – could be so thoroughly saturated with microbes that the physical setting itself served as an amplifier. The use of air conditioning or recirculation devices in otherwise airtight facilities has served to amplify infections, in such places as an airplane, nursing home, prison, or office building building where constant recirculation of the same air afforded small numbers of microbes enhanced opportunities to infect human beings.
SatelLife
By 1993 eleven developing countries were connected to medical data bases in the wealthy world and to each other, via SatelLife, the brainchild of Nobel Prize winner Dr. Bernard Lown who led the International Physicians for the Prevention of Nuclear War. The Russian government launched a satellite for the program, the NRC Corporation of Japan provided the necessary equipment, and the International Development Research Center of Canada came up with the funds.
Humanity will have to change its perspective
Ultimately, humanity will have to change its perspective on its place in Earth’s ecology if the species hopes to stave off or survive the next plague. Rapid globalization of human niches requires that human beings everywhere on the planet go beyond viewing their neighborhoods, provinces, countries, or hemispheres as the sum total of their personal ecospheres. Microbes and their vectors, recognize none of the artificial boundaries erected by human beings. Theirs is the world of natural limitations: temperature, pH, ultraviolet light, the presence of vulnerable hosts, and mobile vectors.
Mutating and undergoing high-speed natural selection
In the microbial world warfare is a constant. The survival of most organisms necessitates the demise of others. Yeasts secrete antibiotics to ward off attacking bacteria. Viruses invade the bacteria and commandeer their genetic machinery to viral advantage. The most sophisticated of their species have the ability to outwit or manipulate the one microbial sensing system we possess: our immune systems. By sheer force of numbers they overwhelm us. They are evolving rapidly through adapting to changes in their environments by mutating and undergoing high-speed natural selection. Only by appreciating the fine nuances in their ecologies can human beings hope to understand how their actions, on the macro level, affect their micro competitors and predators.
Like the city of Rome in 5 B.C.
The human world was a very optimistic place on September 12, 1978, when the nations’ representatives signed the Declaration of Alma Ata. By the year 2000 all of humanity was supposed to be immunized against infectious diseases, basic health care was to be available to every man, woman, and child regardless of their economic class, race, religion, or place of birth. But as the world approaches the millennium, it seems, from the microbes’ point of view, as if the entire planet, occupied by nearly 6 billion mostly impoverished Homo sapiens, is like the city of Rome in 5 B.C. We have been neglectful of microbes and that is coming back to haunt us. Either we learn to live together or we die together.
Learn to live in a global village that affords the microbes few opportunities
While the human race battles itself, fighting over ever more crowded turf and scarcer resources, the advantage moves to the microbes’ court. They are our predators and they will be victorious if we, Homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities.