Contagion: SARS Cov -2 Big Picture:

Authors of the Genesis legend of Adam and Eve, wrote of the expulsion from Eden and rise of knowledge and civilization. Civilization exposed hazards and introduced unnatural mortality to humankind. From Egypt to Mesopotamia, China, and India, cities gave rise an elite oppressors and hoards of the miserable, leading short brutish lives.

We are witnessing the clash of contagion with civilization now in the SARS-Cov-2 virus in Wuhan and New York. The word contagion means proximity, contact, animals to humans, and human to human. Our proud medical technologies fail us. Modernism is as helpless as it was in the London spread Bubonic Plague of the seventeenth century. Indeed moderns of the twenty-first century find ourselves relying on the same pathetic and ancient methods of quarantine and isolation. We lock down people, by political decree, in their apartments, nursing homes and hospitals, the well along with the sick, condemning them to infection and even death, if not to die, to spread infection to others.

Better to recognize that plagues derive from perverse relations between in infection and civilization as experience shows, and to act accordingly. Densely packed cities hasten the spread of illness and cause epidemics. Control of Covid and scourges of the future will depend on dealing with social factors more than technology. We are so fortunate to have a practice epidemic with Corona viruses of limited virulence and lethality which will allow learning and changing behavior in the future.

The first task is to recognize, as has not been emphasized nearly enough, that all human epidemics come from animals, what is called zoonosis. Though Infections spread in different ways, first human cases always cross from animals. Necessary is the proximity of human and animal populations as with bedroom communities encroaching on and crowding deer, in Lyme disease. Zoonosis is magnified by domestication, consumption, and exploitation of animals.

In our travels to China, India, SE Asia S. America, my wife took me to open-air markets. Plumbing, refrigeration, even electricity were often unavailable. Our Viet Nam guide laughed when I told him I eat peanut butter and jelly sandwiches every day at work. Western diets are extremely less diverse compared to S.E. Asian diets. I grew up on a Kosher diet where the whole idea is distinguishing “clean” from “unclean” animals. Now that I’m older, I find a certain amount of adaptational truth in the kosher concept. I saw a kneeling women processing live frogs. She used bare hands to eviscerate pitiful living creatures, throwing the writhing carcasses in a pile with the left hand and abdominal contents into another pile with the right. For all I knew, both piles were on sale for human consumption. People are not starving but consume everything in these markets, tarantulas, beetles, rodents and all their contents.

As for SARS Cov-2, it’s reservoir is bats. Chinese buy and sell pangolins a type of scaly anteater whose flesh might be contaminated by bat droppings. An infected individual with lung disease would be of little consequence. He may survive or not. But phlegm containing virus coughed out into the air, allows rapid contagion with high population density and indoors especially. That is what I mean by a perverse relation of contagion and civilization (cities) leading to plague. At the time of this writing we cannot tell whether SARS Cov-2 will become endemic and seasonal as so many other infections and especially viruses have tended to do in the past.

Long after I finished med school, l had my lightbulb moment with the classic, “Rats, Lice and History” by Hans Zinsser. I was never exposed to infectious disease being about nearness to animals. Severest infections and other diseases were introduced to humans after settling down in dense close populations with animals and larger numbers of humans in proximity. To my teacher’s credit, they had drilled home the point that antibiotics and technology did NOT conquer plagues like T.B. but that crowding, plumbing, education, and humans factors were way more effective in eradicating disease. This is basic.

Jared Diamond, the author of Collapse, and other books of big history, combines scientific and historical trends. In an article cited below, Diamond and co-authors present infectious disease as a continuum of contagion from animals to man along 5 steps.

There is surely a spectrum of infection running from animals to humans. You can take Diamond’s arguments further, drawing a nice continuum of infection along an x-axis. What may partly correlate on the y-axis abscissa is human prevalence of specific viruses. I cite examples of viruses, yet this principle applies to all infectious organisms: Rickettsia, Mycobacteria, spirochetes, bacteria all the helminth parasites start out as zoonoses as well as human spread infections. Some infections, like malaria and Zika type viruses, require arthropod vectors with reservoirs of infection in animals living nearby. The animal:human continuum roughly relates to human prevalence, but other parameters, virulence, case: fatality, may easily be graphed against the animal to human spectrum on their own axes to give a full picture.

Examples gone viral: Basic Stuff

Rabies is a mammalian disease, and human infection is rare except by the direct bite of an animal, like an unvaccinated rabid dog. Human to human transmission does not occur except in the laboratory. Human prevalence is close to zero.

Ebola viruses were discovered in the 1970s, reservoirs being forest rodents and other mammals consumed by humans. Outbreaks were due to the mishandling of infected fluids by poorly trained medical personnel. The initial Ebola epidemic in the 1976 was in a rural hospital. It ended on its own when the poorly prepared nuns who encountered patient fluids all died, and everyone ran away. Spread was iatrogenic. I was unaware of this remarkable story until hearing of it on Outlook/ BBC. The same can be said for Lassa virus part of a family of rodent-borne Arenaviruses, primarily in Africa and South America. There is generally no human to human spread except via body fluids of these zoonotic diseases.

Slightly along this spectrum of human to human transmission are viruses spread without the aid of their animal reservoirs like HIV. HIV descends from the Cameroon simian virus. It started in forest dwellers consuming primates and other animals. HIV is blood and fluid borne, yet spreads human to human via unhygienic practice, blood contamination, needle re-use or addict needle sharing and sexual transmission. Worldwide prevalence was significantly increased by air travel and other modern technologies. HIV is the prime example of an epidemic starting in the wilds whose spread owes to modernity. By these means, HIV has thus effected non-animal dependent human to human transmission, the next phase on our continuum. A revolution in antiviral pharmacology has helped rescue humans from a more extensive HIV epidemic, yet, education and hygienic practices are more efficient ways of controlling this disease.

Influenza viruses infect birds and pigs. There is still some zoonotic or animal derived spread of flu viruses to humans. The virus has mutated or learned human to human transmission primarily via the respiratory route in coughs and sneezes, like common cold viruses, quite comparable to SARS Cov-2. Indeed other Corona viruses are symptomatically manifest as common cold. Human to human transmission has a life of its own in that again, animal reservoirs in the advanced evolution of infections are no longer required in some of them evolved further along on our spectrum. Sputum is one of the best methods to spreads disease. Prevalence in human populations is high, and novel seasonal virus spreads in temperate climes when people gather indoors. Even with virulence or actual death rates low, infection can be common. Therefore U.S. death rates typically run in the 10s of thousands per year despite the flu vaccine. The 1918 pandemic is thought to have killed between 50 and 100 people worldwide.

Though now spread worldwide, the number of deaths from SARS Cov-2 is still low compared with other infectious diseases. Case fatality rates vary but may be near 1%. We are so lucky to be dealing Corona virus rather than say Ebola. That has not prevented SARS Cov-2 from giving rise to alarmism, panic and hysteria, with near collapse of Western economies. I believe if we don’t change social conditions we are in for far worse in the future.

The original SARS was more virulent, with a mortality rate near 10%. SARS is essential because it gives good insight into Covid-19. The WHO website showed Infections with SARS in 2003 occurred mostly over an approximate 8-12 week period and then quickly died out. No matter what government officials decide to do, I would invite anyone interested to look at how similar were the responses of governments of the past in other epidemics, this one will run its course, all of the intense finger pointing discussions not withstanding, this virus as in all other plagues will have its own finite course, and will end up killing certain numbers of persons. Locking people up will not alter that very much in fact may further spread disease. Technology and ventilators won’t save all that many people.

Still further along our spectrum are epidemic diseases smallpox and measles the latter descending from rinderpest. Rinderpest is eliminated, by a vaccine, as smallpox was eradicated, a proud achievement of health science. These diseases were among the most highly contagious, in and of themselves, truly epidemic and deadly. The measles vaccine has mostly handled the disease in wealthier countries, yet poverty and ignorance continue as barriers to measles eradication, most frustrating, as people are suffering needlessly.

The best example of primarily human virus family left to us from older primates but with humans at least as long as the rise of agriculture, is the Herpes family of viruses. These include Herpes I, II, and III (VZV) and IV (EB mononucleosis virus). Herpes viruses are so universally prevalent that enterprising anthropologists use Herpes genomes to trace migrations in human populations. Herpes, a near-universal symbiote, may be considered part of yours and my personal identity, like our dogs, or better mitochondria. Mitochondria got their start as cellular invaders but became part of every cell. Herpesviruses live inside us. They occasionally cause mild personal outbreaks, mostly auto-infections. It seems likely Herpes viruses are providing us some service we aren’t aware of, like gut flora, we also tolerate, but occasionally cause disease. Herpes viruses are by no means unique as being part of us, HPV, JC virus and others certainly fall into the same category.

Here’s a remarkable fact: DNA relics of old virus infections make up more of own genes than all the genes in our individual cells that make our own proteins. Viruses R Us. Don’t believe me? Check it out. So all infectious organisms are arrayed on a continuum from fierce invaders of other animals to eventually being part of us. Viruses now gone, bequeathed useful genes in all our own cells. Indeed enterprising doctors use viruses to give suffering patients beneficial genes.

We have covered a lot of ground, from Eden to civilization from diseases primarily in animals through zoonosis right through to viruses now part of us. Infection “becomes” us, meaning infection is us, and it enhances us.

By 2100 the world’s largest cities will house 10s of millions of people. This is a formula not only for plagues but future dystopia. Some predict Lagos, Nigeria, at 88M, to become the most populous in the world. All top 20 cities will be in what is currently considered developing world in Africa and Asia, none of these in China, interestingly enough. You many object to high population densities and misery indexes on ethical grounds, but miserable conditions are very much a demographic time bomb, prelude to the social and infectious dystopia. The way to prevent future pandemics of virulent organisms is in lavishing effort on crowded conditions, high surveillance, teaching public health knowledge, hygiene, and separation of humans and animals, especially rodents, and other mammals, adequate attention to women children and birth control. Asian and African cultures are not going to make these advancements without Western help, care, and lovingkindness.

Breaking the Link between society and epidemics:
For those who care, I’ve boiled practical lessons to the following:

Strategies to Prevent Pandemics:
Isolate Humans from animals, wild and domesticated.
Hygiene and cleanliness, diet, and sexual practices.
Decrease human population density and misery index.
Avoid dense human venues.
Eliminate unnecessary travel.
Quarantines, Vaccines Meds and masks, pills: – Our last line of defense for epidemics unleashed but not the most effective.

I advocate looking at infectious outbreaks in historical and future contexts. Covid-19 is a practice plague. If we are smart, Covid-19 arms us for plagues to come. With the next contagion it’s best to listen not to politicians but epidemiologist historians. Antibiotics, vaccines, and other technology won’t of themselves, save us. It’s worth repeating that Enlightened medicine weds technology to compassion. Do not panic. Consider yourself a sophisticated city person? Remember that you are part of Nature’s wisdom, and Nature lives in you.

-Written Mid March – Time of the Covid Panic

Bibliography:

Wolfe ND, Dunavan CP, Diamond J. ORIGINS OF MAJOR HUMAN INFECTIOUS DISEASES. In: Institute of Medicine (U.S.). Improving Food Safety Through a One Health Approach: Workshop Summary. Washington (D.C.): National Academies Press (U.S.); 2012. A16. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114494/

2. Reperant LA, Moesker FM, Osterhaus ADME. Influenza: From Zoonosis to Pandemic ERG Open Res. 2016 Jan;2(1):00013-2016. Published online 2016 Mar 11. doi:10.1183/23120541.00013-2016 PMCID:PMC5005146. ONU/d:27730163

3. See: visualcapitalist.com: The Top 20 Megacities by 2100 by Jeff Desjardins pub July 16, 2018, also Mapped: World’s Top Cities in 2035 by Iman Ghosh published Oct 18, 2019.