• Tuesday, May 26, 2020
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An elegy for dying globalization

  • Published at 08:00 pm March 11th, 2020
Public compliance with preventative measures is essential BIGSTOCK

What is the worst case scenario for the coronavirus?

It is time to reflect and to ask ourselves the big question: Are we, the citizens of this planet, as vulnerable -- or more vulnerable -- to another pandemic we witnessed in 1918? 

Public health experts routinely have ranked coronavirus as potentially the most dangerous “emerging,” health threat that humanity may face. A century ago, our grandparents had gone through exactly the same experience. Only, the threat had sprung out of a virus that caused “influenza.”

Earlier this year, upon leaving the office of the chief of the Centres for Disease Control and Prevention, he was asked what had scared him the most -- or what had kept him up at night. His reply was prompt and clear: “The biggest concern is always for the virus pandemic ... (it) really is the worst-case scenario.”

So the tragic events of the last 100 years have exhibited a surprising urgency today -- particularly since the most crucial lessons to be learned from the disaster are yet needed to be absorbed.

To me, this appeared to be like a great tsunami that initially pulls water away from the shore, only to return in a towering, overwhelming surge. 

In August 2018, the affliction resurfaced in Switzerland in a form so virulent that a US Navy intelligence officer, in a report stamped “Secret and Confidential,” warned “the disease now epidemic throughout Switzerland is what is commonly known as the black plague, although it is designated as Spanish sickness and grip.”

Scientists today understand that bird influenza viruses, like human influenza viruses, can also infect hogs, and when a bird virus and a human virus infect the same pig cell, their different genes can be shuffled and exchanged like playing cards, resulting in a new -- perhaps especially lethal -- virus.

We cannot say for certain what had happened in 1918 in Haskell County, US, but we do know that an influenza outbreak struck in January of that year -- an outbreak so severe that, although influenza was not then a “reportable” disease, a local physician named Loring Miner -- a large and imposing man, gruff, a player in local politics, who became a doctor before the acceptance of the germ theory of disease but whose intellectual curiosity had kept him abreast of scientific developments -- went through the trouble of alerting the US Public Health Service. 

The report itself no longer exists, but it stands as the first recorded notice anywhere in the world of unusual influenza activity that year. The local newspaper, the Santa Fe Monitor, has confirmed that something odd was happening around that time: 

Several Haskell men, who had earlier been exposed to influenza, happened to visit Camp Funston, in central Kansas. Days later, on March 4, the first soldier known to have influenza reported ill. 

The huge army base was training men for combat in World War I, and within two weeks, 1,100 soldiers were admitted to the hospital, with thousands more sick in barracks. 38 died. 

Then, infected soldiers likely carried influenza from Funston to other army camps in the States -- 24 of 36 large camps had outbreaks -- sickening tens of thousands, before carrying the disease overseas. Meanwhile, the disease had spread into US civilian communities.

The influenza virus has been known to mutate rapidly, changing enough that the human immune system has difficulty recognizing and attacking it even from one season to the next. 

A pandemic occurs when an entirely new and virulent influenza virus, which the immune system has not previously seen, enters the population and spreads worldwide. 

The 1918 pandemic virus worked by infecting the cells in the upper respiratory tract, transmitting easily, deep inside the lungs, damaging tissue and often leading to viral as well as bacterial pneumonias.

Are we aligned towards a pandemic in which virtually every home would have a victim? 

John M Barry has written in his book about that pandemic, The Great Influenza: “People were already avoiding each other, turning their heads away if they had to talk, isolating themselves. The telephone company in the US had increased the isolation: With 1,800 telephone company operators out, the phone company allowed only emergency calls.”

Sports events were cancelled. Theatres closed. Shaking hands was made illegal in Prescott, Arizona. Philadelphia hurriedly set up six more morgues.

Families put crepe paper on doorways to signal a death inside -- and crepe was everywhere.

Wherever it began, the pandemic lasted just 15 months, but was the deadliest disease outbreak in human history, killing around 50 million people worldwide. An exact global number is unlikely to be determined, given the lack of suitable records in much of the world at that time. 

But it’s clear that the pandemic had killed more people in a year than AIDS has killed in 40 years, more than the bubonic plague killed in a century.

The impact of the pandemic on the US is sobering to contemplate: Some 670,000 Americans had died.

In 1918, medicine had barely become modern; some scientists still believed “miasma” accounted for influenza’s spread. With the advancement of medicine since then, laypeople have become rather complacent about influenza. 

Today we worry about Ebola or Zika or MERS or other exotic pathogens, not a disease often confused with the common cold. 

This is a huge mistake!

For decades, public health experts have been calling for preparations for another “big one” -- yet adequate preparations were never made. Nobody knows if the coronavirus will be a “big one,” for it may still fizzle. 

As of this writing, 31 people are known to have died from it in the US, while thousands routinely die annually from the seasonal flu. But increasingly, experts are saying that we should get ready … just in case.

In 1918, the killings had created their own horrors. Governments aggravated these partly because of the war. For instance, the US military took roughly half of all physicians under 45 -- and most of the best ones.

What proved even more deadly was the government policy toward the truth. When the US entered World War I, President Woodrow Wilson had demanded that “the spirit of ruthless brutality… enter into the very fibre of national life.” 

So he created the Committee on Public Information (CPI), which was inspired by an adviser who wrote: “Truth and falsehood are arbitrary terms … The force of an idea lies in its inspirational value. It matters very little if it is true or false.”

Are we seeing a replay of 1918? This is one question that quietly looms over the minds of citizens around our globe. 

In the New England Journal of Medicine, a publication not associated with alarmism, Bill Gates, who for years has been warning presciently about the danger of pandemics, bluntly cautions that this virus could be a “once-in-a-century pandemic.”

In most disasters, people come together to help each other, as we saw recently when hurricanes Harvey and Irma lashed Florida. 

However, in 1918, without leadership, and coupled with the lack of the truth, human trust in one another just evaporated. And then … people only looked after themselves.

Bill Gates, perhaps the richest philanthropist, has reportedly said: “I hope it’s not that bad, but we should assume that it will be until we know otherwise.” 

That seems very prudent today. While figures are uncertain, the coronavirus may likely kill around 3.4% of those infected; if correct, that would be similar to the lethality of the 1918 flu (it’s also possible that many more people are infected without significant symptoms, which would make the death rate quite a bit lower). 

Another similarity with 1918 that has been noticed is that the US and the world are not really ready for a pandemic.

“We’re amazingly unprepared,” Dr Irwin Redlener, a Columbia University professor and director of the National Centre for Disaster Preparedness, told me.

President Trump exaggerates the threats from a hobbled Iran and he has diverted billions of dollars from the military to build a border wall that smugglers hack apart with $100 saws. 

But he has not been attuned to pandemic threats: In 2018 the White House removed the position on the National Security Council to fight pandemics, while seeking to scale back anti-pandemic work to about 10 countries from 49. Experts had warned at the time that this was dangerously shortsighted.

In Goldsboro, North Carolina, Dan Tonkel had recalled: “We were actually almost afraid to breathe… You were afraid even to go out … The fear was so great people were actually afraid to leave their homes… afraid to talk to one another.” 

In Washington, DC, William Sardo said: “It kept people apart … You had no school life, you had no church life, you had nothing … It completely destroyed all family and community life … The terrifying aspect was when each day dawned you didn’t know whether you would be there when the sun set that day.”

Human fear had emptied places of employment, and emptied cities at the height of the flu pandemic. Shipbuilding workers throughout the northeast were told they were as important to the war effort as soldiers at the front.

Another question which concerns all those whose lives were not spared by the disease. Even though the death toll was historic, most people who were infected by the pandemic virus survived; in the developed world, the overall mortality was about 2%. In the less developed world, mortality was worse. 

In Mexico, estimates of the dead range from 2.3% to 4% of the entire population. Much of Russia and Iran saw 7% of the population die. In the Fiji Islands 14% of the population died -- in 16 days. One-third of the population of Labrador had died. 

In small native villages in Alaska and Gambia, everyone had died, probably because they all got sick simultaneously and no one could provide care, or simply put, could not even give people water, and perhaps because, with so much death around them, those who might have survived did not manage their courage to fight.

At the present time in the US, when we need wise, scientifically informed leadership, we find ourselves with a president with little credibility and an antagonistic relationship with scientists. 

It doesn’t help that during the Ebola crisis of 2014, Trump was one of the most fiery critics of evidence-driven policies that had actually succeeded in ending the outbreak.

Sorry to say to my readers that the US is also vulnerable because of long-standing deficiencies in their health care system. They are the only major rich country without universal health insurance and paid sick leave, and maintain fewer doctors per capita than their peer countries.

Consider a Florida man, Osmel Martinez Azcue, who returned from China and found himself becoming sick. As The Miami Herald reported, he might normally have gone to a drugstore and bought over-the-counter flu medicine. 

But because of the risk of coronavirus, he did the responsible thing and sought medical attention: He went to a hospital for testing. In the end, it turned out not to be coronavirus -- but he was billed $3,270.

We must ensure that no one is deterred from seeking help by the costs. The White House and Congress should immediately establish a system to ensure that patients need not pay for coronavirus testing and treatment. 

We should also ensure paid sick leave. Do we really want to go to a restaurant where a coughing, sneezing food preparer still goes to work out of financial need?

William A Haseltine, president of a think-tank called Access Health International, shared his views privately that a vaccine might take at least six to eight months to develop and test -- some other estimates are longer -- and this should involve an immediate federal investment through Project BioShield. 

We also need better diagnostics and treatment as well as more ventilators to keep people alive.

Dr Peter Jay Hotez, an expert on global health at Baylor University, has emphasized the need to support front-line health workers and keep them from becoming infected.

“If we see a situation in the US like we saw in Wuhan -- more than 1,000 cases among hospital workers and five or six deaths -- it’s game over,” he said. “Health workers lose confidence, and things start to fall apart.”

We may also have to think about reducing occasions when people are crowded together; that may mean more people working from home to avoid offices, buses and subways. 

It may mean avoiding sports events, school assemblies, parties and even unnecessary visits to crowded doctor’s offices -- this is the time to develop what we know as “telemedicine.” 

Not surprisingly, our experts can’t answer the questions that we all have, but say that we will get through better if we make preparations while relying on science and evidence rather than on muddled political leaders trying to talk up markets or score political points.

Why did so many young adults die in the flu? As it happens, young adults have the strongest immune systems, which attack the virus with every weapon possible -- including chemicals called cytokines and other microbe-fighting toxins -- and the battlefield was the lung. 

These “cytokine storms” further damage the patient’s own tissue. The destruction, according to the noted influenza expert Edwin Kilbourne, resembled nothing as much as the lesions from breathing poison gas.

Then there are the less glamourous measures, known as non-pharmaceutical interventions: Hand-washing, telecommuting, covering coughs, staying home when sick instead of going to work and, if the pandemic is severe enough, widespread school closings and possibly more extreme controls. 

The hope is that “layering” such actions one atop another will reduce the impact of an outbreak on public health and on resources in today’s just-in-time economy. But the effectiveness of such interventions will depend on public compliance, and the public will have to trust what it is being told.

That is why, I personally like to believe that the most important lesson from 1918 we have learned is: “Tell the truth.” 

Though that idea is incorporated into every preparedness plan that is imagined, its actual implementation may depend on the character and leadership of the people in charge, when such a crisis erupts.

The legendary Joshua Lederberg, a geneticist and Nobel Prize laureate, once said that in the struggle against new diseases, “it’s our wits versus their genes.” 

If we want our wits to triumph, we will need to think clearly, prepare for the worst, and do better. Let us hope so!

The looming pandemic of coronavirus may likely defeat human efforts of long term survival. Today’s world economy works primarily due to “globalization,” which connects people through economy, finance, technology, and production around our planet. 

In the event that the virus succeeds, this would mark the end of globalization, along with its benefits. Like the domino effect, economies around the globe would fail. This will put a stop to human travel, and progress.

Due to possible shut down of affected countries with high industrial production, their connections with markets and centres will also die down. This would lead to a horrible global recession. Can we say for certain, where this phenomenon may trigger human migration -- towards better or worse

Nazarul Islam is an educator based in Chicago.

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