The Alphabet Soup of Epidemic Death

It doesn’t mean you’re a hypochondriac if you read things like “The Coming Plague,” “The Hot Zone”, ”Flu” and “Pale Horse, Pale Rider.” But once you’ve read enough of them you may become paranoid, persuaded the natural world is out to get you.

Well, it is. The latest cause for alarm? MERS. That’s Middle East Respiratory Syndrome. Let’s be honest, anything other than gyros that’s labeled Middle Eastern automatically causes feelings of anxiety.

When you learn that MERS can be caught from camels it doesn’t sound that worrisome. How many camels do you run into? But then you recall all those other diseases that came from monkeys, pigs, rats, deer, prairie dogs and you don’t spend much time with any of them either. Unfortunately, bacteria and viruses have a nasty habit of making the leap from other species to us. Think AIDS, Ebola, and various plagues.

And now we come to the reason MERS is in the news. So far MERS has been rather narrowly confined to Saudi Arabia and a few other neighboring countries, hence the name. But annually millions of Muslim pilgrims travel to Mecca. Fear of MERS kept the 2013 tally down to only 1.4 million from 188 countries.

Epidemiologists have warned the Saudis that they aren’t doing enough to prevent the spread, but in a scenario familiar from low-rent creep shows they have been ignored until too late, which would be now. Because cases have begun to appear as far off as Malaysia and the Philippines. In each case they have been traced to a recent visitor to the Mideast. In the Malaysian case, the victim had contact with camels. In the other case, a nurse from the Philippines flew home after a stint in the United Arab Emirates.

So far the disease has seemed to be relatively difficult to contract. There have been only 243 confirmed cases since it was first identified in 2012. That’s the good news. The bad news? MERS is really deadly if you do get it. The great 1918 influenza pandemic killed between 10 and 20 percent of those infected. Worldwide as many as 100 million people may have died. By contrast, MERS seems to kill as many as 40 percent of its victims.

Even worse news, it seems possible it s heating up. Over 25 percent of all new cases have been reported in the last month. And an easier to contract strain might be indicated by a cluster of cases in hospitals in Jeddah, Saudi Arabia, the gateway to Mecca whose airport was designed to handle 2 million travelers during the annual Hajj. Since March 15 there have been 50 cases there, 9 fatal. Beware the Ides of March indeed.

When I mentioned this latest scary bug to someone, they sad, “Oh yeah, my daughter had MERSA.”

I said, “No, this is not a drug resistant thing. It is a respiratory thing.”

“Oh,” she said, “You mean SARS.”

We eventually sorted out that this was something new, but the confusion itself was a reminder that the potential plague bugs seem to be coming more and more frequently. MERS, MERSA, SARS, VISA, VERSA, MDR-TB. Stop me when you’re spooked enough.

Some lessons are obvious. From epidemic diseases there is nowhere to hide. Boccaccio’s refugees from plague could escape to a secluded villa, but thanks to international air travel nowhere is safe. We are all only a day’s flight away from the latest epidemic.

A second corollary is we are all in this together. The Jeddah airport has a separate terminal for Saudi royals but does anyone believe that will confer immunity? Thirty years ago a restrictive country club for the white elite of a small southern city was shocked to find itself the epicenter in a hepatitis outbreak. It was eventually traced to a minimum wage black kitchen worker who unwittingly made the 19th Hole refreshments unsafe to eat. Therefore I repeat: we are all in this sort of thing together.

The risks we confront require the strongest measures to ensure that all children be vaccinated against diseases we can prevent. The Wellcome Trust, a British charitable organization, compiled data on death in the 20th century. Worldwide, 5.2 billion people died in the last century. Many were from natural causes. Almost 20 percent were from violence perpetrated by men against men. But over 30 percent , 1.7 billion, were due to deaths from infectious diseases – 400 million from smallpox, 100 million from measles, 38 million from whooping cough.

Those and many others can now be prevented if people will only get their shots and the required boosters. Yet the anti-government, anti-science and/or religious beliefs of a few can endanger the lives of the many. Refusing to be vaccinated should be a crime, probably punishable by quarantine.

The promiscuous use of antibiotics by physicians and, even more alarmingly, in livestock must be restricted to slow the development of drug resistant superbugs that threaten to turn back the public health gains of the last hundred years.

Our universal vulnerability argues strongly for generous spending for medical research and public health. Yet we live in an era when tax cuts for the wealthy and budget cuts for health and safety are the new orthodoxy. Those who think their own comfort comes before the safety of the community might recall the medieval motif of the Totentanz, the Dance of Death, in which men were graphically reminded that death carries off all indiscriminately – the pope, the pauper, the prince, the serf. The businessman and the congressman, too.

It is as true now as it was then. The difference is, today we are armed with science which at least gives us a fighting chance. Those who would never consider cutting defense spending seem to have no problem cutting spending for medical research even though our lives may depend on it. Gentlemen, “never send to know for whom the bell tolls. It tolls for thee.” We forget it at our peril.

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