The Shape of Plagues to Come
Twenty-First Century Plague: The Story of SARS. Thomas
Abraham. viii + 165 pp. Johns Hopkins University Press, 2005 (first
published by Hong Kong University Press in 2004). $24.95.
Many of us have a romanticized view of the living world as a
peaceable kingdom in which only the occasional excesses of Homo
sapiens disturb the balance. But, as Thomas Abraham makes clear
in Twenty-First Century Plague, the reality is less benign.
We, the more than six billion people on this planet, who represent
the single largest threat to the world's biological diversity and to
Earth's capacity to self-regulate and self-correct, are, ironically,
ourselves threatened: We're a vast and vulnerable target for
transmissible diseases, low-hanging fruit for any infectious agent
able to invade a human host.
For most of our history as a species, we have lived in small,
nomadic and relatively isolated assemblages spread thinly on the
ground. Yet in the past 600 years (only 30 generations), and
particularly in the past 200 years, the human population has
increased dramatically in size and density; never before have so
many lived in sedentary agglomerations. Combine that trend with the
speed and ubiquity of travel over long distances and with the vast
global inequities in the distribution of primary and preventive
health care, and you have the makings of an epidemiological perfect storm.
Twenty-First Century Plague is a ringside account of the
world's recent encounter with the emerging infectious disease SARS
(severe acute respiratory syndrome). Engagingly written by an
accomplished journalist, the book traces the spread through the
human population of a relatively obscure coronavirus, one that
previously had infected only animals such as palm civets and ferret
badgers. The epidemic began in Guandong Province in China in the
fall of 2002 and spread swiftly around the world, infecting more
than 8,000 people by the following summer and killing nearly 1 in 10
of them. As the book makes clear, the SARS outbreak was chilling,
not so much because of the number of afflicted
individuals—which comes nowhere near the toll of HIV or
previous influenza outbreaks—but because of what it revealed
about our ability to respond to new infectious agents.
How did we do? The verdict is, at best, mixed.
Maddening political, personal and institutional obstacles prevented
the sharing of critical information; Abraham is at his best
describing the human hurdles to an effective response. In an era in
which information could circle the world within seconds, the SARS
virus initially outraced vital knowledge about treatment and
control. Doctors in Guandong quickly developed basic containment
procedures against the spread of SARS, but that information was not
conveyed even to health workers struggling with the virus elsewhere
in China, let alone to those in the rest of the world. The
authorities in the affected countries lost valuable time worrying
about the effects that news of the local outbreak might have on
their economies and on their personal, national and political
reputations. Abraham, who has a keen reporter's eye, moves beyond
the press releases extolling international collaboration and
preparedness to expose the dissembling and the politicking.
But he also finds a number of heroes: the country doctors and health
workers who rushed into affected areas knowing full well that the
virus had already infected and killed some of their coworkers; the
epidemiologists who traced an outbreak in Hong Kong; the scientists
who managed to identify the virus within weeks of the first reported
case outside China. Many laboratories coordinated their efforts so
that the sequencing of SARS could be completed by mid-April 2003.
The epidemic flamed out, first in Vietnam and eventually around the
world, and by early July the World Health Organization declared it contained.
In retrospect, this new disease was checked relatively quickly. The
success can be attributed in part to the national and international
agencies charged with detecting and responding to outbreaks, which
reacted courageously but inconsistently. Their efforts were
frequently obstructed by individuals and ministries outside the
health system. But we also caught a lucky, and unusual, break: SARS,
although potentially lethal, is not highly transmissible.
Abraham rightly urges us to demand that the lessons gleaned from the
SARS outbreak be incorporated into plans for epidemic surveillance
and response. We can be virtually certain that the system will be
tested again and again—not by deliberate acts of bioterrorism,
where most of our attention is currently focused, but by emerging
diseases. Scientists around the world are keeping a wary eye on a
new strain of bird influenza capable of moving from its avian hosts
into the human population. Other less well-known infectious agents
are making similar tentative excursions into our species, probing
for weaknesses in our immune defenses. SARS may presage new and more
dangerous battles in the long evolutionary struggle between Homo
sapiens and its pathogens. Somewhere on the planet, a new
organism is evolving to exploit six billion specimens of ready prey.