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Michael T. Osterholm is an American public-health scientist and a biosecurity and infectious-disease expert, and he wrote Deadliest Enemy: Our War Against Killer Germs. Joe Rogan interviewed Osterholm, who answered questions about the COVID-19 epidemic.
Epidemiology
Epidemiologists deal with the control of diseases. They have two main goals. The first is to prevent. When that is impossible, the second is to minimize disease.
Consequential epidemiology is a weapon that can be used in the war against viruses. It means, by trying to change what could happen with inaction, we can alter the course of history for the better – rather than explain it retrospectively.
The weapons for prevention are: sanitation, including safe water and food, and the removal of human fecies and urine, vaccination, and disinfecting agents. And then there are nonmedical actions, including education, attempts to get the public to change behaviors, public communications, and quarantine. Examples are guidance on sexual habits and multiple-partner activity, so are changing burial practices for Ebola deaths.
Electricity as the Father of Public Health
There are arguments you can make about who deserves to be called the father of public health, but according to Osterholm, it should be Nikola Tesla. The Serbian engineer invented the alternating-current induction motor and widely applying the use of electricity.
The invention of electivity brought breakthroughs in public health and infectious disease control. With electricity and water pumps, safe water supplies can be distributed throughout the world. Electricity also brought refrigeration, the ability to pasteurize milk, vaccine manufacturing, and air conditioning to keep mosquitos out.
In 1900, the average life expectancy in the U.S was forty-eight years. By 2000, it was seventy-seven.
Statistics vs Emotions
Public health science is based on statistics, but people don’t think this way. People think emotionally, especially about things like death and disease. For example, we know that airplanes are safer than automobiles mile for mile traveled, yet those who are afraid of flying do not hesitate to drive their cars.
In a 2015 Ted Talk, Bill Gates said that the most likely thing to kill over 10 million people in the next few decades was not war, but an infectious virus. Part of the reason is that we have invested a lot in nuclear deterrents, but very little in a system to stop an epidemic. We are not ready for the next epidemic.
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Planning is Essential
In public health, you cannot plan for everything, but what we can do is plan for a disaster, for suspension of power, no service, medical emergencies when resources are unavailable.
When everyone is in a pandemic, no one has extra help, food, supplies, or medicine to donate – unless there was enough planning. There is a naïve belief that the kinds of supplies we need (such as N95 respirators) are a click away on the internet, but this is not the case.
The World Bank Pandemic Emergency Financing Facility fund was created to provide global financing for responding to a pandemic, but it will not work for a global emergency, because no amount of money can buy something that doesn’t exist. For example, a pandemic may take its toll on the working population of a city in Asia that produces the N95 respirators.
If a major outbreak hits, we will be on our own. One case of Ebola sent shock waves throughout Dallas, Texas in 2015. What if Dallas and cities all over the world were experiencing thousands of cases at the same time? Despite being an act of nature, a pandemic is closer to war than any other natural disaster. And like a war, there is greater destruction every day, with no opportunity for recovery.
Every time there is a major disease outbreak—Ebola in 2014, MERS in 2015, Zika and yellow fever in 2016—I get calls from media throughout the United States and the world, looking for explanations, guidance, and predictions. I’m generally happy to comply, but I also must admit to a frequent sense of déjà vu in such cases when I think of all the opportunities we’ve had to take proactive measures that might have prevented, and certainly would have mitigated, whatever situation or crisis is currently before us.
Crisis Agenda
The first priority is to confront microbes that cause deadly pandemics. There are two microbial threats that fit this description: influenza (the one respiratory-transmitted infection that can spread around the world with speed and strike with lethal force). The other is a growing number of virulent microbes that are more insidious in transmission, but can have a big impact on the health of humans and animals.
The second priority is to prevent high-impact regional outbreaks, like Ebola, MERS, SARS, and Zika.
The third priority is to prevent the weaponizing of microbes, or the accidental release of a microbe that has been enhanced by scientists to be more easily transmitted, to be more likely to cause death, or to be unpreventable by vaccination.
History of Germs
There are more microbes in the human gut than there are cells in the entire body, and there are microbes everywhere within us. Yet our personal microbiome is about three pounds of our total body weight. Consider that the total of microbes on earth outweighs all other life forms.
But microbes are not all bad. Some sustain us as healthy humans, animals, and plants.
As a species, we reproduce a human generation roughly every 25 years. Microbes can reproduce every twenty minutes. Compared to us, they are hyper revolutionary.
And to complicate the matter, we are changing the dynamic with pathogens simply through our encounters with them. By visiting rain forests, by concentrating many people together, by breeding millions of pigs and poultry and keeping them in close confines, by overusing antimicrobial drugs, we are forcing microbes to adapt to constant stress – giving them opportunities nature never did.
It is true that we also adapt, but at a much slower rate. If we wipe out a large chunk of microbes, the strain can recover in a day.
Prevention
Public health scientists should determine which infectious disease microbes can rapidly mutate or change their genetic codes to avoid the host’s immune system or vaccines, and can lead to faster transmission, through the respiratory route. That is why influenza viruses are the leading candidates for causing a global pandemic.
If compromised locations are not wealthy nations, there may not be enough incentive to develop a vaccine.
The idea behind vaccines, is that we introduce a dead version of the virus so the body can build up defenses before the real virus hits.
Sometimes, the microbial agent is only the trigger, while the bullet comes from our own bodies. A microbe can induce a powerful response from the immune system that can trigger a cytokine storm.
Cytokines are proteins that tell white blood cells to rush to the site of infection and fight the invaders. But in a cytokine storm, the continual feedback loop between cytokines and the defensive cells can clog airways and shut down organs. This is what may have happened with 1918 flu strain, and why it killed many young, healthy people with robust immune systems.
The most dangerous microbes are those that can change their antigens or component parts quickly through mutations – particularly if they also spread via the respiratory route. The genetic simplicity of microbes and swiftness is difficult to counter. We cannot overwhelm them; they are too vast in number. Our survival depends on outsmarting them.
The Global Supply Chain
The modern world has created a great potential for harm.
Imagine there is a major epidemic in a region of India where many of our drugs come from. Lives will be lost in major cities because critical medications won’t be available.
In June 30, 2014, planes flew 186 million passengers between the US and the rest of the world. These carriers also transported 9.54 million tones of freight. There are more than 150 million tons of freight transported by planes around the world. Every day, up to 60,000 large cargo ships travel the world, moving containers from one continent to another, and with them, many infectious disease vectors such as virus-infected mosquitos and contaminated agricultural products.
The irony is that we have organized the modern world for efficiency, economic development, and enhanced lifestyle, but have made ourselves more susceptible to the effects of infectious disease than we were in 1918. And the more complex and technologically integrated the world becomes, the more vulnerable we will be to devastating the entire system.
Bats
Bats are a type of disease reservoir – a place where pathogens maintain themselves. It is believed that the Marburg filovirus, a cousin of Ebola, lives in fruit bats in Kenya. The reservoirs don’t need to be animals or even alive, it can be a plant, a body of water, or any host which allows the pathogen to multiply.
The Seasonal Virus
The public doesn’t panic over the seasonal virus infection known as flu – the way we have for Ebola and Zika. But the influenza virus causes conditions and consequences ranging from no symptoms to death. In a given year, seasonal flu claims 3,000 to 49,000 lives in the United States. In some years, it kills more people than car accidents. Admittedly, many are among the elderly, or those with weak immunity. But like highway deaths, we seem to have factored in the yearly influenza death toll into our threat matrices, and decided not to worry. Many don’t even bother getting flu shots, even when they are offered at low cost at our local drugstores, and may protect us against the illness in some years.
The 1918 flu was the deadliest single pandemic killer of all time. More people died in six months in 1918-19 than have died from AIDS in thirty five years since the virus was identified in humans.
The effects of the outbreak were so large that the average life expectancy in the US was immediately lowered by more than ten years. The population then was about a third of what it is in 2014.