The pandemic’s most bitter pill
Plagues and disease are familiar villains in human history
The pandemic’s most bitter pill
Plagues and disease are familiar villains in human history
For the crime of spitting in public, New York City officials arrested and fined 144 men on Oct. 4, 1918, during the second — and deadliest — wave of the flu pandemic. Cases had suddenly spiked, and the city’s Department of Health became desperate to curb the spreading disease. With no hope for a vaccine nor a cure, the city posted bulletins imploring people to sneeze into handkerchiefs, avoid crowds, stop spitting, and wash their hands. During the heat of the pandemic, some New Yorkers donned masks.
Yet now, over 100 years later, we’re stuck combating the latest human scourge, the newly emerged coronavirus, in mostly the same ways. (Though perhaps spitting is less of a problem.)
Our eventual savior — similar to combating afflictions like polio and smallpox — will be a vaccine, creating widespread immunity against the virus. Yet developing a new vaccine for this new human contagion will likely mean waiting a long time, at the optimistic best perhaps some time in winter or in 2021, when one of ten promising vaccine candidates might safely work. And any miracle cure, for those severely sickened, is unlikely to come much sooner (there’s still no evidence the touted malaria drug hydroxychloroquine curtails deaths). This may all come as sour news. But it’s not the most bitter news of all for our vulnerable species. The most troubling reality of a sustained pandemic that has killed over 112,000 Americans (as of June 10), shuttered cities, and emptied stadiums, is this isn’t some fluke.
It has long been expected. It’s totally predictable. And an outbreak will happen again.
“The history of humanity is punctuated by pandemics,” said Dr. Richard Gunderman, an M.D. and medical historian at Indiana University. “This is just another chapter in that big volume.”
Seattle police wearing masks during the 1918 flu pandemic.
Courtesy of Everett Collection / Shutterstock
That the incessantly mutating influenza virus, coronaviruses, and plagues have repeatedly broken out in human populations means we should be prepared to promptly quash any novel disease outbreak (see South Korea’s exceptional COVID-19 response). This is especially the case in today’s modern, profoundly connected world. After all, the coronavirus hitched rides to New York City from Europe on planes racing across the Atlantic Ocean at 600 mph. “We knew this was coming,” said Craig Klugman, a medical anthropologist at DePaul University. “Viruses don’t need passports. It’s the golden age for viruses.”
Of course, medicine has progressed dramatically since the 1918 flu pandemic. Doctors work wonders in surgical rooms and beyond, saving the lives of people shot through the head, restarting stopped hearts, and significantly extending the lives of people infected with HIV. But a new viral disease — which hijacks human cells to multiply by the thousands — will have no quick, silver bullet. The fastest vaccine ever approved, for mumps, took four years back in the 1960s. Vaccine investigators today, however, have an unprecedented wealth of information about this new microscopic pathogen, allowing modern labs to create detailed visualizations of the infamous, spiky protein that binds to human cells, letting the virus inside (a vaccine might block these spikes from latching on). Still, any vaccine will have to be rigorously tested. Scientists warn it could take at least eight to 12 months to confidently prove even a promising vaccine works effectively and without causing harm.
Yes, humanity has driven vehicles on the moon, built supercomputers, and eradicated polio — after ensuring the vaccine worked by running a trial on 623,972 U.S. schoolchildren. But we’re simply not in total control on a planet swirling with imperceptible, evolving, microscopic parasites, many of which come from other animals, like the new coronavirus.
“We’re by no means the masters of our fate,” said Gunderman.
We all want to live healthy lives. And with the medical triumphs of the 20th century, we’ve largely come to expect it. Twentieth century physicians, armed with germ theory and soon potent bacteria-killing drugs, could do what previous practitioners couldn’t, explained James Kyung-Jin Lee, the director of the University of California, Irvine Center for Medical Humanities. Doctors became curers of many diseases.
This infused the following narrative into the American mind, said Lee: “Yesterday I was healthy. Today I am sick. But I'll get better tomorrow."
The idea is formally called the “restitution narrative,” meaning the belief that one’s health will be restored by the wonders of modern medicine. It’s certainly an attractive creed. “Who doesn't want to live in a narrative of restitution and health?” asked Lee.
But a microbe that jumped from animals to humans in late 2019 has shaken this expectation.
“We’re now at a point in 2020 when the world has essentially been brought to its knees by this new coronavirus,” said Lee. This narrative isn’t infallible, he emphasized. It’s fragile.
Actors practicing a kiss in Hollywood during a flu epidemic in 1937.
Imagno / Getty Images)
Many of us alive today, particularly in the U.S., are too young to fully grasp this fragility. We haven’t lived through a pandemic event that threatens everyone. “We haven’t experienced a pre-vaccine virus with this high level of mortality circulating in the community in a long time,” explained Sara Keller, an infectious disease expert and assistant professor of medicine at Johns Hopkins Medicine. “And this is what it looks like.”
This is the worst pandemic in a century. Large scale societal lockdowns obscure the severity of the current outbreak, as research shows that extreme social distancing interventions in the U.S., China, South Korea, Italy, Iran, and France averted over half a billion coronavirus infections. The deadly 1968 flu, also novel like this coronavirus, killed 100,000 Americans, a number easily eclipsed by this current pandemic — which is still only in its first wave.
A new plague or scourge was going to knock us back into reality, eventually.
“In a modern society we have expected science to solve our problems and we’ve expected to have happy lives,” said DePaul University’s Klugman. “But that's not the norm in human history. Plagues and disease are a huge part of human history.”
"Scene of the plague in Florence in 1348 described by Boccaccio"
Baldassarre Calamai | DEA PICTURE LIBRARY
Smallpox, eradicated by a vaccine, killed on average three of every 10 infected people and for over one thousand years spread around the globe, including, tragically, from the Old World to the Americas. The Black Plague, infamous for its unsightly buboes, killed half of Londoners in 1349, though outbreaks of the plague in London struck nearly 40 times over some 300 years. Globally, the 1889-1890 flu killed 1 million people. The 1957-1958 flu killed 1 million people. The 1968 flu killed 1 million people.
And just since 2000, humanity has contended with outbreaks of SARS (also a coronavirus), MERS, the H1N1 flu, Ebola, Zika, and now an especially insidious microbe, the latest coronavirus.
This coronavirus (along with SARS, MERS, Ebola, and Zika) is part of a particularly troubling pattern. It leaped from animals to humans at the end of 2019. And today, some 75 percent of emerging infectious diseases in humans come from other animals, called "zoonotic diseases." We might think highly of our big-brained species, but we’re still an animal species, which means we're capable of catching diseases from other creatures.
"Lots of viruses are out there,” Rebecca Dutch, a virologist at the University of Kentucky College of Medicine, told Mashable after an infected New York zookeeper passed the coronavirus to tigers at the Bronx Zoo in April. "The question is, when will it enter the human population?"
Soon enough. Spillover between species is inevitable. Humans spend a lot of time around animals. We raise cattle, pigs, and other hoofed creatures by the millions, encroach animal habitats, and trade wild animals, often illegally.
“We sometimes think of ourselves as the masters of nature,” said Indiana University’s Gunderman. “But we’re in it, not above it.”
It’s conceivable that by year’s end, or sometime in 2021, researchers may develop an effective cure or vaccine. Ten vaccines have already made it to human trials, and there are 123 other vaccine candidates, as of June 2, 2020. Billions of dollars are being poured into rapidly finding a solution, including nearly $10 billion from Congress to develop, make, and distribute 300 million doses to Americans — at “warp speed” — by January 2021. (Up to a whopping $1.2 billion may be provided to the drug company AstraZeneca, to test and potentially develop a much-publicized vaccine from an Oxford University laboratory, which produced encouraging results in rhesus macaques; six vaccinated monkeys didn’t get sick when infected with the coronavirus. Next comes a big test involving 30,000 Americans this summer, in addition to trials in other countries.)
“We should have a lot of confidence in medicine,” said Edward Shorter, a professor of the history of medicine at the University of Toronto. He emphasized that vaccines eradicated polio and therapeutic drugs allow people with HIV to live longer, healthier lives. “Those were solved with a massive application of science,” Shorter said.
Shorter is “absolutely confident” a coronavirus vaccine will be developed, perhaps within a year. The other option is finding a drug that cures nearly everyone sickened with COVID-19. But, that would mean making “an almost perfect drug” that amounts to a “miracle treatment,” wrote Bill Gates, who has so far pledged millions to coronavirus drug and vaccine development. A vaccine is the best way out of this scourge.
“I really want a treatment,” said Johns Hopkins’ Keller. “But what I really want more is a vaccine.”
Frozen flu strains at the Vaccine Research Center at the National Institutes of Health.
Carolyn Kaster / AP / Shutterstock
A flu ward at Camp Funston, Kansas, in 1918.
Courtesy of Everett Collection / Shutterstock
Yet whether a vaccine can arrive by 2021 remains a daunting scientific challenge.
With any new virus, researchers must identify which antibodies (protective proteins in blood that, for example, can block viruses from binding to human cells) stop the virus from infecting someone. After making a vaccine and testing it, scientists must then draw people’s blood to see if the vaccine worked and caused the immune system to make the right antibodies or immune response. And, critically, scientists must ensure the vaccine doesn’t cause serious, unintended harm.
“Then, it has to be produced,” Keller said. The nation will be ravenous for immunity (at least most of us will be). “Who gets the first doses?” she asked.
This all means we must be patient. Things might not go swimmingly over the next year. That’s part of science.
“We need patience,” said Michael Kinch, the director of the Center for Drug Discovery at Washington University in St. Louis. “We are all so impatient to get back to some degree of normalcy, and we have to recognize that’s not going to happen anytime soon.”
“We might get lucky,” he acknowledged. “There is that hope. But we shouldn't count on it.”
Some misplaced hopes, for miracle treatments, have abounded over the past few months. First there was the malaria drug hydroxychloroquine, recklessly promoted by President Donald Trump and billionaire Elon Musk, The World Health Organization is still studying hydroxychloroquine to understand if it’s helpful, or harmful. Then came the experimental drug remdesivir (not created specifically for the new coronavirus), which in research showed that people hospitalized with COVID-19 recovered four days earlier than those who didn’t take the drug. Dr. Anthony Fauci, the head of the National Institutes of Allergy and Infectious Diseases, called this “good news” and emphasized it could “open the door” to cures.
That’s terrific. But remdesivir itself isn’t nearly a knockout drug. People who took it still lay sick in hospital beds for an average of 11 days. “It’s not like you take this medication and you’re all better right away,” said Johns Hopkins’ Keller. “It’s not going to be some miracle cure.”
So, take it from experts who know infectious diseases best. It’s unknown when we’ll have a cure or vaccine. But we're not helpless pawns in the coronavirus battle. We can adapt. We can and should wear masks. We can avoid irresponsible gatherings, the type that invite the spread of coronavirus. We’ll need to do this for an uncertain, but sustained length of time.
“We have to prepare for the long haul,” said Kinch.
Wild medical discoveries that change the course of history — namely penicillin — can happen. “But those are rare,” emphasized DePaul University's Klugman. “Science does not work that way. It works that way in Star Trek. But that's not the real world. Science is slow. Science is methodical.”
And with all the well-publicized successes in the medical world — like artificial hearts and surgeries to separate the skulls of conjoined twins — society is still rife with anguish well into the 21st century. “Fuck Cancer” shirts have become popular for a reason.
“We cling to narratives of triumph, medical heroism, and restitution,” said Lee, of the University of California, Irvine. “And there is reason to celebrate. But there is suffering every single day. To not acknowledge that is to not paint the whole picture.”
Humanity has not nearly conquered infectious disease. Though “...the belief that infectious diseases had been successfully overcome was pervasive in biomedical circles — including among a Nobel Laureate, medical Dean, and other thought leaders — from as early as 1948, and extending all the way into the mid-1980s,” medical experts concluded in 2013.
That belief has been squashed. Tuberculosis, which Gunderman calls “the scourge of mankind,” has become resistant to some of our drugs. The respiratory disease kills 1.5 million people each year. HIV, which still has no vaccine, has killed around 32 million people, and infected 1.7 million people globally in 2019. In 2018, there were 228 million cases of malaria.
“Anyone who pronounced the death of infectious disease is certainly way off base,” said Gunderman.
A new one is here. And it’s not unprecedented. “We need to recognize that humans are periodically thrust into situations like this,” Gunderman said. And like past scourges, there probably won't be any miracles, nor quick solutions. Perhaps, however, this pandemic will stoke robust federal efforts to contain the next insidious virus before it races through the population.
“To talk about a post-pandemic world is naive,” said Gunderman.
Coronavirus particles from an infected patient.
National Institute of Allergy and Infectious Diseases, NIH
-
Reporter
Mark Kaufman
-
Editor
Nandita Raghuram
-
Top Image Credit
National Institute of Allergy and Infectious Diseases
"bitter" - Google News
June 11, 2020 at 04:33PM
https://ift.tt/30vnSCw
The most bitter part of the pandemic - Mashable
"bitter" - Google News
https://ift.tt/3bZFysT
https://ift.tt/2KSpWvj
Bagikan Berita Ini
0 Response to "The most bitter part of the pandemic - Mashable"
Post a Comment