Pandemic.inddA pandemic is the worst of the worst when it comes to classifying disease spread, it’s not isolated to a single community (an outbreak) and it’s no longer contained within even a single region (an epidemic). No a pandemic involves the world over. Shah tracks the history and science of past pandemics to clarify how plagues can have such a wide impact. Historical evidence, expert analysis and personal anecdote (Shah’s travels to cholera-stricken Haiti) are woven together to illustrate how factors like city crowding and a lack of infrastructure have allowed global sickness to spread. Cholera, responsible for seven pandemics in the last two centuries, is used as a case study. Shah’s underlying argument, focus on preventative measures now, don’t wait until we have to wage war against an unknown entity.

There are a lot of threats on horizon; climate change, nuclear holocaust, rampant consumerism, the automation of jobs, etc… It might just be my bias as a health care practitioner, but the most immediate of theses threats in my mind is contagious disease. We’ve used antibiotics to the point of absolute resistance in more than a few bugs capable of doing much harm and we seem to have little to no interest in changing our ways. The heart of the problem, as she explains, is that “epidemics grow exponentially while our ability to respond proceeds linearly, at best.”

Thanks to alarmist reporting, I’m looking at you Fox News, Americans are terrified that hemorrhagic diseases such as Ebola will “break out” and kill us by the millions. Shah patiently explains that much more common diseases are far more likely to pose threats to us, influenza and cholera in particular. A series of unfortunate mutations in either one could fashion a disease that is not just virulent (contagious) but also highly lethal.

Shah’s account of the role of Christianity in fostering infectious disease for more than a thousand years is very interesting. Anyone familiar with history knows that two thousand years ago the Romans piped clean drinking water to their cities through an elaborate system of aqueducts. Cleanliness was a virtue to them. With the advent of Christianity that all changed. Unlike the Jews and (later) the Muslims, Christian clergy disdained personal hygiene, associating it with Roman polytheism and viewing cleanliness as superstitious. It was common for Catholic priests and the Protestant pastors who succeeded them in some parts to discourage their flocks from bathing. For many centuries, the vast majority of people in Christian lands lived side-by-side with their animals atop pits filled with excrement and cooked with smelly water drawn from contaminated streams or wells.

In Pandemic, Shah describes the role of contemporary trends in making the threat of epidemic disease greater than ever. Five stand out: climate change, continuing urbanization, ever more accessible global transportation, resistance to vaccines, and the encroachment of development on previously virgin lands, especially in sub-Saharan Africa, South and Southeast Asia, and the Amazon. The result is that an increasing number of unknown and unpredictable new tropical diseases is emerging and making their way into more and more crowded cities further and further north on the globe. All the while, diseases previously thought conquered, such as polio and measles, rise up in communities around the globe.

Pandemic: Tracking Contagions, From Cholera to Ebola and Beyond
by Sonia Shah