{"id":"5e9e2aec6cee070006833321","slug":"deadliest-enemy-en","title":"Deadliest Enemy","audio_url":"https://hls.blinkist.io/bibs/5e9e2aec6cee070006833321/5ea2f0126cee070006c2e96a-T1597741594.m4a?Expires=1642554336&Signature=Tj38Sg9TmuzRS4nUME31icuF-GmVGO0AIH5iypilNtwxZgY67Eu6Wfh0Ywa4J4dMFW9yA0oHJfB4~DMvd3s8nTtdBmH34g1VgBR0tmcYkF6J-gk9A-~Sw3bB5XrMnr-KD-pU4n44zlMYVWmY0v1U7mX8l57y5WJ8YndZ~zxfmOsHcaqH4lmYIxF6Ni8cEdS0j0ixFxJN~Fu1DGzKtlZw1Cx4tezJi8QQQcrFrzpZIKaf8~NeLkwgT-QEDH-VGnzbkkZWlUgOSTFP03pkcbKk4YmtCRCEAB0-qxWp1XEvwKpJGYIUT8MRYR1FTI~tJukHkZ5g4K5ROOIYRW-b1nDBJA__&Key-Pair-Id=APKAJXJM6BB7FFZXUB4A","chapters":[{"id":"5ea2f0126cee070006c2e96a","title":"Understanding an epidemic is like solving a puzzle or doing detective work.","text":"

The year is 1981. A team of experts gathers at the Centers for Disease Control and Prevention in Atlanta, also known as the CDC. Together, they’re trying to solve a mystery: Why are young, healthy people in New York and California suddenly experiencing rare diseases like Pneumocystis carinii and Kaposi’s sarcoma?

Of course, now we know the answer. These individuals were among the earliest known victims of HIV. However, at the time, their conditions were an enigma. In order to solve the mystery, the CDC needed to gather more information about the case. They needed an epidemiologist, and Dr. Michael Osterholm was there to help.

The key message here is: Understanding an epidemic is like solving a puzzle or doing detective work.

The goal of epidemiology is to track and trace the spread of diseases so that they may be controlled and prevented. To do this, epidemic specialists must collect as much information as possible about a given case. Who is contracting an illness? Where is it appearing? Are there patterns to be found?

That’s why, back in the early 80s, the first step that Osterholm and the CDC took was something called “case surveillance.” This involved surveying doctors in New York and LA to find similar cases of people presenting with rare diseases. They found a pattern: the victims were most often young, gay men. The men were experiencing conditions that usually only appear in much older individuals.

As the CDC gathered more information, it became possible to start describing the culprit. This is called “case definition.” In this case, the facts emerged quickly. The disease was a retrovirus, one that attacks the immune system. It is spread by blood transfusions and sexual activity. It most likely originated in sub-Saharan Africa. And, most importantly, it was completely new.

For Osterholm, the HIV outbreak was a Black Swan event. This is the term used by epidemiologists to describe unusual occurrences that have a huge impact. And the impact of HIV has been enormous. Within mere decades, the disease has gone from a few hundred cases to infecting an estimated 40 million people. It is no longer a pandemic, but a hyperendemic– a public health problem that won’t go away.

In this case, the work of the CDC’s epidemiologists couldn't overcome the spread of the disease. It did, however, lay the groundwork for future research into prevention and cures. In the next blink, we’ll hear about another case that had better results.

"},{"id":"5ea2f04a6cee070006c2e96b","title":"The roots of an epidemic can be unexpected and complex. ","text":"

It’s every parent’s worst nightmare: having to watch helplessly as your child dies slowly. In the early 1980s, this was the horrific reality facing dozens of families. All across the United States, teenage girls were succumbing to Toxic Shock Syndrome, or TSS. Even worse, no one knew why.

Was an exotic new disease sweeping the country? No, in this case, the cause was much more mundane. In fact, the root cause was being sold in local drug stores and pharmacies.

The key message here is: The roots of an epidemic can be unexpected and complex.

Before 1980, TSS was fairly uncommon. So, when dozens of cases of the deadly condition suddenly appeared within a few months, epidemiologists like Osterholm took notice. And, like always, they began looking for patterns.

The first pattern was obvious. The vast majority of patients were teenage girls. And, even more specifically, a huge percentage of TSS suffers first experienced symptoms within a few days of their period. Clearly, there was a connection between the malady and menstruation. But still, researchers needed more data to nail down the cause.

So, Osterholm and other researchers conducted a “case-control study.” This approach required using a questionnaire to gather detailed information from both TSS victims and “control” groups. These were individuals who were similar to the TSS sufferers but had somehow escaped the disease. By comparing the responses, scientists could identify possible causes.

The results showed that, unlike the control group, most TSS victims used a new style of super-absorbent tampon sold by Procter & Gamble. So it was this specific brand of tampon making the girls sick, right? That’s what many people assumed. However, they were wrong.

Even after the company pulled its products from stores, girls kept falling ill. More studies were conducted. They found that TSS wasn’t caused by Procter & Gamble tampons, but by specific bacteria that loved high-absorbency materials. Every brand of high-absorbency tampon let these bacteria grow, but Procter & Gamble just happened to be the most popular brand.

Finally, with the root cause found, new rules and practices were introduced to limit the harmful material. With these regulations in place, the wave of TSS cases subsided.

To a young Osterholm, this case was particularly instructive. It taught him that solving an epidemic sometimes required a trial and error approach. But hopefully, with some critical thinking, the error part could be minimal.

"},{"id":"5ea2f0646cee070006c2e96c","title":"An infectious disease pandemic is the most likely threat to humanity.","text":"

How do you imagine human civilization ending? Will doomsday come from a big, catastrophic nuclear war? Or will a stray meteor strike the Earth and send humanity packing like the dinosaurs?

While these dramatic events are certainly deadly, they’re also pretty unlikely. Statistically speaking, our modern world won’t end with bang, but with a sneeze.

The key message here is: An infectious disease pandemic is the most likely threat to humanity.

When it comes to disasters, there are only four real scenarios that could endanger humanity on a global scale. The first two, nuclear war and an asteroid strike, get a lot of attention because they are singular events that are easy to understand.

The third threat, climate change, is also receiving more consideration because it spurs large disasters like hurricanes and droughts. The final threat, a worldwide pandemic of a deadly illness, is relatively overlooked.

So, why does the spread of infectious disease pose a unique threat to society? First, unlike an asteroid strike, disease outbreaks are fairly common. A huge asteroid may pass near Earth once every 100 million years, but a plague capable of sweeping a population occurs much more frequently.

And second, unlike other natural disasters, disease outbreaks are not isolated in time or space. For instance, while an earthquake may be cataclysmic, its reach is limited to one geographic area. It also ends after the initial destruction. On the other hand, pandemics can hit multiple areas of the globe all at once. They are also ongoing. As a disease spreads, it can keep dealing out death and disruption for months or years.

A widespread and long-lasting pandemic would be particularly harmful in our contemporary globalized world. Our economy, food supply, and other crucial systems for keeping society running are dependent on world trade and connectivity. Given a wide enough reach, a deadly outbreak could bring these systems to a grinding halt, causing famines and possibly violent conflict.

There are two types of pathogens that are most likely able to set off such a pandemic. The first are viral respiratory infections like influenza which are fairly common and very easy to spread. The second threat is antibiotic-resistant bacteria. Diseases caused by these microbes would be impossible to stop with the medicines we currently have available.

So, while humans have lived alongside viruses and bacteria for millions of years, the potential for this peaceful coexistence to end is always present. And unfortunately, as the next blink shows, the balance is more fragile than ever.

"},{"id":"5ea2f07a6cee070006c2e96d","title":"The modern world is especially vulnerable to a new pandemic.","text":"

1918 was a bad year. All across the globe, people were dying at an unprecedented rate. It didn’t matter if you were young or old, a man or a woman, your life was in danger. No, this tragedy was not the outcome of World War One. The cause of this widespread death was the flu.

The 1918 flu was the worst in modern history. By the end of the epidemic, an estimated 100 million people died of the disease. It is a horrifying statistic. The frightening truth is that an even more devastating wave of illness could be just around the corner.

The key message here is: The modern world is especially vulnerable to a new pandemic.

Infectious diseases require certain conditions to emerge and spread. Harmful pathogens are most likely to thrive when there are large, interconnected groups of people and animals. This allows a disease to easily jump from one population to another. 10,000 years ago, when people lived in small communities, a disease could only spread so far and so fast. Today, just the opposite is true.

In the past century, both human and animal populations have exploded. In 1900, there were less than 2 billion people; now there are nearly 8 billion. In 1960, there were an estimated 3 billion chickens. Now, that number is 20 billion. As each of these living organisms is a potential host or vector of infectious disease, the chance of a new deadly strain emerging has grown exponentially.

Furthermore, life on Earth is more interconnected than ever. Two centuries ago, traveling great distances took months or years. Now with air travel and global trade, humans and animals, and any diseases they may carry, can cross the globe in a matter of hours. With eight million people taking flights each day, that represents a huge number of potential disease transmissions.

These conditions present serious risks. One person could contract a novel illness at a factory farm in the Midwest, and within a few days, it could be killing whole communities on the other side of the world.

Our best defenses against such an outbreak are vigilance and vaccines. Properly and diligently used, vaccines can immunize entire populations from even common illnesses. Within the 20th century alone, diseases like whooping cough, smallpox, and measles, have been greatly reduced.

Continuing to support and fund vaccine research and deployment could mean the difference between a brief outbreak and a global pandemic. If we continue to use our resources wisely, we may even see the end of three of the world’s most common maladies: tuberculosis, malaria, and HIV.

Still, scientific developments could be dangerous as well, as we’ll see in the next blink.

"},{"id":"5ea2f0986cee070006c2e96e","title":"New biomedical technologies could create the next horrific pandemic.","text":"

Imagine a strain of flu so deadly that nearly 70% of cases result in death. Pretty terrifying, right? Well, if you’re a bird, it already exists. It’s called H5N1 influenza. And, in 2011, scientists created a version of this virus that could easily infect ferrets.

Of course, these researchers were trying to find ways to prevent H5N1 from ever becoming transmissible between humans. However, many scientists are increasingly wary of this type of research, since it could easily fall into the wrong hands.

The key message here is: New biomedical technologies could create the next horrific pandemic.

The tools and techniques of the life sciences have grown at an astounding rate. One major advancement is CRISPR, a technology that allows scientists to directly “edit” DNA sequences. With CRISPR, it’s possible to cheaply and easily create genetic mutations that give microbes new functions and abilities.

Such research could create new life-saving breakthroughs in medicine. However, it can also be used to create deadly new pathogens. This tension between potential positive and negative applications is why CRISPR research is sometimes called “dual-use research of concern.”

How concerned should we be? Well, in 2016, the US Senate Armed Services Committee named gene editing a “global danger.” This is because biological warfare– that is, intentionally creating or releasing deadly pathogens– can be especially hard to prevent, contain, and recover from.

Scientists have speculated about the many potential forms biological warfare could take. One especially frightening scenario could be the development of genetically modified smallpox. With a little time, a bad actor could modify this already grisly disease to be even more contagious and resistant to treatment. If released, the virus could infect huge swathes of the population before people even displayed symptoms. By the time doctors recognized what was happening, it would already be too late.

Another threat comes from anthrax. This toxic-producing microbe is easy to grow in labs and even easier to spread in powdered form. Studies show that a small plane releasing just 200 pounds of anthrax spores could kill up to three million people.

Governments have already done some work to prepare for such a catastrophe. The US has modeled various disaster scenarios and developed “medical countermeasures” such as vaccine stockpiles and emergency treatment plans. However, it’s not enough. A 2015 report from the Department of Homeland Security puts it succinctly, “There is no comprehensive national strategic plan for biodefense.”

"},{"id":"5ea2f0ac6cee070006c2e96f","title":"A new global pandemic could erupt at any time from anywhere.","text":"

It’s finally spring and a young boy is playing near a hollow tree in southeastern Guinea. Above him, bats nest in the branches. A few months later, Ebola, a rare and fatal virus, is burning its way through local communities. Within months, more than 10,000 people die from hemorrhagic fever.

This is the story of the 2014 Ebola outbreak. It is the most extensive outbreak since the disease was first discovered in 1976. And, as bad as this crisis was, it could have been much, much worse.

The key message here is: A new global pandemic could erupt at any time from anywhere.

Ebola is a gruesome disease thought to be hosted by fruit bats. Infections begin with fevers and end with internal bleeding and organ failure. In the past, the virus only emerged in small, isolated outbreaks in the Congo. However, changing population patterns provided the disease access to a larger pool of victims.

Fortunately, two factors prevented the 2014 epidemic from becoming a global pandemic. First, Ebola is not very contagious. It’s only spread through direct contact and only after infected people begin showing symptoms. This quality, plus the dedicated containment work of thousands of doctors, helped curb the spread of the disease before it got out of hand.

However, things could have gone much differently. The disease could have mutated and become airborne like a cold. Or, it could have spread into Africa’s population of migratory agricultural workers. If either of these chance events occured, the disease could have reached every corner of the planet.

Often, it’s a mix of luck and hard work that keep pandemics at bay. For instance, remember MERS? This coronavirus, officially called Middle Eastern Respiratory Syndrome, posed a grave threat to the global community when it first emerged in Saudi Arabia back in 2012. People were right to take it seriously. The new virus had a mortality rate of 40%.

To stop its growth, epidemiologists carefully tracked the spread of the disease and doctors enforced strict containment measures to get it under control. Still, in 2015, years after the initial outbreak, it emerged again in South Korea. Medical professionals had to go to heroic lengths to prevent more widespread infections.

Currently, both Ebola and MERS are contained. But the viruses still exist in fruit bats and camels. They could re-emerge at any time. Governments should heavily fund research into preventive vaccines. Unfortunately, as the next blink shows, the search for a cure could take a long time.

"},{"id":"5ea2f0c46cee070006c2e970","title":"Mosquito-borne diseases remain a serious and growing public health issue.","text":"

A faint buzz, a light pinch, and, a few hours later, a red, itchy bump. For many people in the northern hemisphere mosquito bites are mere seasonal annoyance. At worst, these airborne pests are just a mildly irritating part of a backyard barbeque.

However, for the vast number of people in warmer climates, a mosquito bite can be the harbinger of serious illness and even death. As the climate continues to warm, the threat posed by these blood-sucking pests will only grow.

The key message here is: Mosquito-borne diseases remain a serious and growing public health issue.

There are more than 3,000 species of mosquitoes around the world. This type of flying insect is best known for its annoying habit of biting humans in order to suck their blood. The majority of mosquito bites are harmless. Yet a small number of mosquitoes can be truly dangerous to humans.

Certain species of mosquitoes, such as Aedes aegypti, can operate as disease vectors for deadly illnesses such as dengue fever, yellow fever, West Nile virus, and chikungunya. A vector is an organism that can harbor and transmit a pathogen to another organism. In the case of aegypti, the danger comes from the bites. When one of these mosquitoes bites a human, they inject anticoagulant saliva that transmits any disease it might be carrying.

Scientists recognized that mosquitoes transmit diseases more than 100 years ago. Since then, governments and health organizations have worked to eradicate disease-spreading varieties with pesticides and vaccination programs. Unfortunately, the human population has boomed in tropical regions of the world and human waste, such as plastic containers, have created fertile breeding ground for species like aegypti.

Now, about four billion people live in high-risk zones. As a result, outbreaks of potentially fatal mosquito-borne viruses have been on the rise and appearing in new locations. For instance, the chikungunya virus, once found only in Africa, has infected thousands in India, Myanmar, and Thailand.

Worse still, as more people are infected, the viruses can mutate to become more deadly. This is the case with Zika. Once a rare and mild illness, this virus spread to South America in 2015 where it infected more than a million people.

Scientists are working hard to slow the spread of these diseases. One possible solution could be modifying mosquito populations so they cannot work as vectors. However, even modern science has its limits. We’ll take a look at one of these emerging issues in the next blink.

"},{"id":"5ea2f0df6cee070006c2e971","title":"Microbes resistant to antibiotics are a budding problem we can’t ignore.","text":"

Let’s say you’re not feeling well. You’ve got a sore throat, a fever, and maybe a bit of a headache, too. It’s probably just a mild case of strep. Just take a couple doses of antibiotics and you’ll be back on your feet. No problem.

But what if you took the usual pills and you didn’t get any better? What if the medicine wasn’t strong enough and you just got worse? In the near future, this could be a common scenario.

Here’s the key message: Microbes resistant to antibiotics are a budding problem we can’t ignore.

Antibiotics is a catch-all category for a range of substances which can kill or slow the growth of harmful bacteria. Some of these chemicals, such as penicillin, occur naturally. Others, like sulfonamides, are fully synthetic. Since the 1930s and 40s, both types have been used to fight off a range of diseases and infections such as tuberculosis and staphylococcus.

For many decades, these medicines have been very good at their job. After the discovery of antibiotics, diseases that were once considered a death sentence, such as pneumonia and typhoid fever, became much more treatable. However, this may not remain true due to the rise of antibiotic-resistant strains.

The microbes that cause disease and sickness are constantly evolving. And, unfortunately, some are evolving to become resistant to currently existing antibiotics. This is inevitable. The problem is, the more we prescribe antibiotics – and we prescribe a lot of them – the faster new, even more robust bacteria will emerge.

This is already happening. Take the example of streptococcus pneumoniae, the bacterium that causes pneumonia. Studies suggest that up to 40% of existing strains of this microbe have developed resistance to common antibiotics. Another rising threat is MRSA, a harmful bacterium that has become resistant to methicillin. This strain is responsible for more deaths each year than AIDS.

This problem can’t be stopped, but it can be slowed. First, doctors can cut back on unnecessary antibiotic prescriptions. Second, governments can tightly regulate the widespread use of livestock antibiotics in industrial agriculture. And finally, drug companies can put more resources toward discovering novel antibiotic types.

Without these changes, we could be going back to a time where common colds are deadly and surgeries are far riskier due to the possibility of infections. However, these precautions won’t save us from another looming threat: viral influenza.

"},{"id":"5ea2f0fb6cee070006c2e972","title":"Influenza presents the most acute risk for causing a global pandemic.","text":"

Here is a hypothetical situation. You turn on the TV one day to find a breaking news alert: a new strain of flu has been identified in China. According to doctors, it kills 30 to 40% of patients who catch it. Hospitals are overrun with victims. Cases have already appeared on three continents. The World Health Organization is declaring a global emergency.

Sounds like the plot of a disaster movie, doesn’t it? Sadly, this fiction could easily become a reality.

The key message here is: Influenza presents the most acute risk for causing a global pandemic.

By now, most people are familiar with the seasonal flu caused by the influenza virus. In most cases, it only causes mild symptoms. Yet each year it kills around 40,000 people in the United States alone. In especially bad years, like 1918, the virus can be much more deadly.

This variable fatality rate is caused by genetic mutations. Influenza usually lives in populations of birds, pigs, and other domesticated animals. Within these organisms, the virus can slowly change over time, a process called genetic drift. Or, it can change rapidly by swapping DNA with related viruses. This process is called genetic reassortment.

Either way, each year new strains of the flu emerge. Scientists identify new strains based on their surface proteins, hemagglutinin (HA) and neuraminidase (NA). So far, researchers have cataloged eighteen different varieties of HA subtypes and eleven NA subtypes. In total, that makes for nearly 200 possible virus combinations. The deadly 1918 flu was an H1N1 virus. The common strain in 1968’s pandemic was H3N2.

Today, more humans and animals live together in close quarters all around the globe. Thus, influenza is mutating faster than ever. Scientists are particularly worried about two different strains detected in China, H5N1 and H7N9. These strains have a much higher mortality rate than previous flus. At the moment, they cannot spread from human to human. However, it’s only a matter of time before new mutations make this possible.

If a more contagious H5N1 strain does evolve, the world will be in trouble. Because the flu is airborne, that is, transmissible by coughs and breath, it moves through human populations very quickly. Even if the disease causes severe symptoms in just a small percent of victims, it would still overwhelm the capacity of our health systems.

This is a pretty grim prospect. But don’t lose hope yet. In the next blink, you’ll learn what we can do to prevent the next big pandemic.

"},{"id":"5ea2f1176cee070006c2e973","title":"Aggressive collective action can prevent the onslaught of deadly pandemics.","text":"

Killer strains of influenza. Antibiotic-resistant bacteria. Bioterrorism. At this point, it may seem like there is a devastating cataclysm looming just around the corner. With all these threats, it’s easy to feel hopeless or cynical about humanity’s future.

But don’t despair just yet. While infectious diseases will never be eradicated, the world can take steps to mitigate the chances of a worst-case scenario.

The key message here is: Aggressive collective action can prevent the onslaught of deadly pandemics.

The best way for humanity to ward off a future plague is to anticipate threats and take bold steps to prevent outbreaks. For example, we already know that influenza is the most likely suspect for the next global pandemic. We also know that our current vaccine technology requires a new flu vaccine to be created each year. And, even more troubling, some years that vaccine is only 10 to 40 percent effective.

This can be fixed. With proper funding and support, scientists can develop, test, and stockpile a new generation of vaccines that will be more effective against more strains than our current supply. It won’t be cheap, though. Currently, we spend about $40 million on flu vaccine research worldwide. In order to be properly prepared, governments and industry should be spending closer to $1 billion.

Pathogens don’t recognize borders. Thus, truly preventing pandemics will take a huge amount of international cooperation. To battle global warming, the UN assembled the Intergovernmental Panel on Climate Change. This organization helps coordinate and monitor climate change efforts all around the world. World leaders need to establish and fund similar organizations for infectious diseases.

There should be international organizations to cover every threat. One curbing the growth of antibiotic-resistant microbes, another reining in disease vectors like the aegypti mosquito, and yet another ensuring that potentially dangerous biotechnology doesn’t fall into the wrong hands.

Finally, it is imperative to recognize that all life on earth is interconnected. Preventing human pandemics means also looking after other animal species. Public health organizations should adopt what’s been called a One Health perspective. This approach recognizes that tackling infectious disease requires looking at how human and animal populations interact.

All this may seem like a huge task, but it’s not impossible. The human race has pulled off great feats before. Preparing for and preventing future pandemics should be one of humanity’s top priorities. After all, the stakes are extremely high.

"},{"id":"5ea2f12f6cee070006c2e974","title":"Final summary","text":"

The key message in these blinks:

Infectious diseases have always been part of life; however, the world is more vulnerable to a global pandemic than ever before. Our growing human and animal populations, interconnected global economy, and ability to synthesize new microbes all make the emergence and spread of novel fatal diseases a real possibility. However, we can curb this threat by properly funding the research and development of new vaccines and international cooperation efforts.

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What to read next: Rules of Contagion by Adam Kucharski

You just learned how the science of epidemiology can help us predict and prevent the next global pandemic. Next, learn how the same principles can be applied to other fields of study with Rules of Contagion (2020)

This book-in-blinks explores how and why things go viral. Learn what epidemiology, network theory, and psychology can teach us about the transmission of ideas, fads, habits, and more. Using diverse examples such as gun violence to urban legends, Rules of Contagion illuminates the hidden mechanics trends of all types.

"}]}

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