The Age of Plagues

It wasn't that long ago that medicine declared a victory over infectious disease. Now a raft of new and mutating bugs are at the door, and a declining public health system is in no shape to fight them.

The wakeup call came in the early 1980s, when doctors started trading news of an odd condition that was killing healthy young men in New York and San Francisco. By the time anyone realized what was going on, AIDS was out of hand. It took another few years for a few scientists to warn that there might be more epidemics where this one came from.

At first much of the talk was about "tropical diseases" jumping from rainforest monkeys and transported by jet plane; that's the scenario of Outbreak and the main fantasy underlying the current fascination with monster bugs. (A computer technician in California has created a home page for aficionados of the deadly hemorrhagic-fever virus Ebola. He reports tens of thousands of hits so far, and has recently upgraded to make an "Outbreak" site with hyperlinks to documents from all over the world (http://ichiban.objarts.com/outbreak-unreg/index.html).

Then microbiologists took HIV under the microscope, and found that it--at least the strain predominant in the United States and Western Europe--didn't really look much like the monkey viruses from which it was suspected to have come. It was, at the very least, a new mutant. This gave rise to another wave of worry. Most bugs are prone to rearranging their genes; some viruses, like influenza, shape-shift so often a new vaccine has to be concocted every year. So any day, somewhere in the world, an old bug might take on a threatening new form. Influenza, after all, killed between 20 and 40 million in 1918, when a particularly aggressive strain emerged from the mutation soup. Most scientists think the planet is due for another deadly flu epidemic before the end of the century.

It wasn't until recently that a third possibility entered the emerging-infections picture. There is now evidence that HIV may have been around as a human infection for at least several decades. But it never caused an epidemic until the 1970s, when growing numbers of people found themselves crowded together in cities where drugs and prostitution skyrocketed. Perhaps, many scientists now say, the main worry shouldn't be about new bugs, but old ones for which humans are rolling out the red carpet.

No one may ever know which of the three scenarios is the most likely; for that matter, focusing on where the bug came from may mean missing HIV's bigger lessons. No one saw it coming; few took it seriously when it arrived; and over time, what once would have been a horror scenario became a fact of life. "We now have infection rates that are five, 10 times as high as when we were almost panic-stricken as a nation," Osterholm reminds his audience at Bloomington's Decathlon Club. AIDS--not gunshots or cancer--is the leading cause of death among American men 25 to 44. It's killed more than a quarter-million people in the U.S., and in some African and Southeast Asian countries, the HIV infection rate is close to 50 percent. No one even dares to think about what will happen once all those now infected actually get AIDS.

Osterholm knows that, as usual when he brings up these stats, his listeners won't flinch. People may shift in their chairs, raise eyebrows. But in the end, they rest relatively assured in the knowledge that with luck and a few precautions, AIDS will be someone else's disease. He brings up the next slide. "I guarantee you," he says, "that by the time this is over, you will know an emerging infection personally."

As his listeners nibble at dessert, Osterholm points to a picture of a purple football helmet. Back in 1988, he recounts, the Minnesota Vikings went to Miami to get the shit kicked out of them; when they came back, their intestines were still acting up. Eventually the team doctor put in a call to the health department, and the players were found to have shigellosis, one of the oldest diarrheal diseases known to humanity. They'd gotten it not playing football, but eating sandwiches on a Northwest Airlines flight.

The sandwiches, it turned out, were prepared by a large commercial caterer that brought in busloads of temp laborers each morning. Eventually the epidemiologists tracked some of them down. "One woman was crying when we interviewed her," Osterholm says. "She told us that she had been working two shifts every day for two weeks with a bad case of diarrhea because she couldn't pay the rent otherwise for herself and the kids. Of course she had no health insurance. And had this not happened among the football players, we might never have found out about it."

It's impossible to tell how many people got shigellosis from those sandwiches. Osterholm's team guesses it's close to 2000; they've identified hundreds of flights that probably served up the bug that fall. Some passengers have since been confirmed as having had the disease, while others were never tested. For that matter, there are probably sandwiches carrying shigella on an airplane, or at a deli counter, or in an office cafeteria near you right now. And if not sandwiches, then perhaps pizza; or cheesecake; or those baby vegetables in plastic wrap.

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