Deadliest Enemy: Our War Against Killer Germs

by Mark Olshaker

A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. —ATTRIBUTED TO WAYNE GRETZKY

encroachment of natural habitats that have brought animal reservoirs of disease to our doorsteps,

In any pandemic, effective leadership is critical, and the first responsibility of the president or the head of any nation is to offer accurate and up-to-date information, provided by public health experts, not agenda-oriented political operatives.

Consider this sobering statistic: Shortly before the 2009 H1N1 pandemic, CIDRAP undertook a national survey of hospital pharmacists and intensive care and emergency department doctors, as we detailed in chapter 18. The update of that survey identified more than 150 critical lifesaving drugs for all types of diseases frequently used in the United States, without which many patients would die within hours. All of them are generic and many, or their active pharmaceutical ingredients, are manufactured primarily in China or India. At the beginning of the COVID-19 outbreak, sixty-three were already unavailable to pharmacies on short notice or on shortage status under normal conditions—just one example of how vulnerable we are.

As another example, in many healthcare settings, up to 35 percent of nurses are the parents of school-age children, and up to 20 percent of those would have to stay home with their children because they have no childcare alternatives. So, closing schools can have the effect of losing 20 percent of our vital nursing workforce in a time of medical crisis, before we even consider those that we will lose to illness itself.

London School of Hygiene and Tropical Medicine.

without policy, research has nowhere to go.

anal intercourse is much more likely to cause small abrasions and resultant bleeding than vaginal intercourse,

This is an instructive model for the proliferation of other infectious diseases as population growth and “progress” create better roads and more mobility while reducing jungle and forestland. As a result, microbes that may have stayed in their particular niches for centuries or longer are now emerging into far larger problems.

But the key word here is control, just as we do with diabetes and other chronic diseases, not prevent or cure.

The first step in the evolution of ethics is a sense of solidarity with other human beings. —ALBERT SCHWEITZER, MD

“Play for more than you can afford to lose and you learn how to play the game.”

“When you know how to relieve torment and don’t, then you become the tormentor.”

“The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow.”

What we in the public health sphere are always trying to do is replace bad deaths with good deaths; to prevent early and needless death and disease.

We have several important weapons for prevention: sanitation, including safe water and food and the safe removal of human and animal feces and urine; vaccination; and anti-infectives, which can minimize disease, disability, and, potentially, infectiousness.

Today, the John Snow pub, on the corner of Broadwick and Lexington Streets, is a place of pilgrimage for any epidemiologist or public health officer visiting London.

Electricity also brought us refrigeration, the ability to pasteurize milk, vaccine manufacturing, and air conditioning to keep mosquitoes out of our homes and places of work. It revolutionized medical practice through the invention of X-ray and other imaging technology, diagnostic equipment, mechanical ventilators, and more.

With clean water, sewer systems, safer food, pasteurized milk, and vaccines, we made historic advances in eliminating the diseases that killed children, who are particularly vulnerable to the illnesses related to these environmental conditions.

There are only four events that truly have the power to negatively affect the entire planet. One is all-out thermonuclear war. Another is an asteroid striking earth. The third is global climate change. And the fourth is infectious disease.

But to understand the true biologic sense of the power of microbes, we must never forget that we are the ones trying to anticipate and respond to their evolution, not the other way around.

Don’t we adapt too? Of course we do, but you can see how many microbial generations equal one human generation: about 40 million to 1. It would be as if the Grand Canyon were created by high-pressure water cannons in a day rather than by drip-by-drip erosion over many millennia.

Europe suffered a huge depletion of labor, productivity, and social advance in the third decade of the twentieth century, results of the twin devastations of World War I and the 1918 flu pandemic. If we wipe out a correspondingly large chunk of microbes, the strain can recover in about a day.

If we have chicken pox as children, the varicella-zoster virus that caused it can remain latent in the body for decades. Then, when we’re older and our immune system is weaker, it can break out in a form called herpes zoster, causing painful shingles.

Generally, seasonal flu is a remnant of a strain of the flu virus that once caused a pandemic.

So successful was the effort to curtail or eradicate the range of childhood diseases that the public started taking their absence for granted. This, among other things, has given rise to an antivaccine movement, whose members are wary of vaccines, particularly childhood vaccines, believing that they may cause autism, or even the diseases they are supposed to prevent.

While we all applaud corporate social responsibility, we cannot expect it to be a business model.

What we really need is a game-changing influenza vaccine that will target the conserved—or unchanging—features of the influenza viruses that are more likely to cause human influenza pandemics and subsequently seasonal influenza in the following years.

the time when you have to act is when it’s not that clear.”

One of the more interesting passive measures being tested is insecticide-treated wallpaper. Insecticide spraying must be repeated every three or four months, but these wall liners can be effective for three years or more.

I’m worried about the future impact that this program will have. First, given the current level of political support—or lack thereof—for public health–related issues

was following up on hundreds of air passengers who had taken a flight to Minneapolis–Saint Paul from some distant country, only to find out later that a passenger on their flight had active drug-resistant TB and was infected with HIV. He coughed for nine hours on the flight to the Twin Cities.

It may be possible in the not-too-distant future to use CRISPR to create whole new species.

The CDC and three other research groups submitted a paper for publication in the journal Science detailing how they had reconstructed the 1918 H1N1 influenza virus, using virus genes that had been identified in lung samples of patients who died during the 1918 pandemic.

From that information, they were able to re-create the virus and then put it into ferrets (a good animal model for human influenza infection) to understand how easily it could transmit, how it causes illness, and its severity.