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Book Review:
Writers shine light on pandemic
three years before it started

Deadliest Enemy: Our War Against Killer Germs

Michael Osterholm and Mark Olshaker, 2017

In 2017, Michael Osterholm, an infectious disease scientist at the University of Minnesota, and Mark Olshaker, a documentary filmmaker and author of five novels and ten books of non-fiction, published Deadliest Enemy: Our War Against Killer Germs

A piece of their work is most prophetic regarding the coronavirus pandemic that spread around the globe with frightening speed. 

Chapters 18-21 (pp. 254-318) make it obvious that many infectious disease experts and a few philanthropists (Bill Gates most notably) have understood for years that a viral pandemic was a virtual certainty; and that a pandemic is probably the biggest single threat to humanity in the short run, though without climate change's potential for total destruction of most biological species during the next hundred years, or longer. 


These four chapters contain several surprises and warnings which I have yet to hear or read in discussions of COVID-19: 


  • "The reason we need a new vaccine formulation each year is because influenza viruses that are transmitted between humans are unstable and unreliable. They mutate easily as they pass from person to person." (pp. 254-55)

  • "Mutation of influenza viruses usually results in minor changes in the emerging strain that nonetheless require the vaccines to be updated, sometimes annually. ... with re-assortment, major changes occur, resulting in a new virus that can be unlike anything humans have experienced before, and can become the viral strain that starts the next worldwide pandemic."  (p.255)

  • "The first thing to understand about influenza," says John Barry, the author of the definitive account of the 1918 pandemic, The Great Influenza,  is that it's all bird flu; there's no such thing as a naturally occurring human influenza virus. But they can rapidly spread to other species, including domestic birds such as chickens and turkeys, as well as dogs, cats, horses and pigs. Pigs are especially important to inflicting humans with active avian influenza viruses."  "The cells lining their lungs have receptors that match up with both bird and human viruses, so those lungs turn out to be the perfect place for influenza strains "to meet each other" and mix." (pp. 256-57)    

  • As far as pandemic potential is concerned, "the most dangerous places on earth are anywhere people, birds, and swine are crowded close together in large numbers - the food markets of China and southeast Asia for example, or the industrial farms of the American Midwest." (p.257) 

  • The potential of influenza "terrifies epidemiologists," the authors state.  (p.257) "As infectious disease epidemiologists, we all know, that pandemic influenza is the one infectious disease that will happen. It has happened at least thirty times since the sixteenth century and our modern world presents all the ingredients for an imminent return." (p.257)

  • "More people died in a six month period over the fall, winter and spring of 1918-19 than have died from AIDS in the roughly thirty five years since the virus was identified in the human population." (p.259) This is no small claim. Deadliest Enemy asserts that HIV killed 1.2 million persons in 2014 alone, and more than 2 million persons become infected with HIV each year. 

  • The HINI pandemic in 2009 killed about 300,000 people, 80% under the age of 65. (pp.260-61), so it's not as if public health experts and policymakers had not been warned of the potential of a pandemic in recent years. 

  • "We now realize there are two distinctly different patterns of influenza pandemic cases. One is what we saw in 1918 and 2009 pandemics, where severe illness and deaths fall disproportionately on young adults The second is in the 1957 .. and 1968 ...  pandemics where most of the deaths were in the older population, as is the case with seasonal flu." (p.261)   

  • "Even a moderately severe pandemic would impact just about every aspect of our lives." (p.262)  

  • "We must not think of the potential pain and suffering from an influenza epidemic as limited to those who develop infection here in the U.S.. We must realize and plan for the horrible impact a pandemic could have and all the deaths that would occur (around the world) as a result of an acute shortage of lifesaving drugs or medical care." (p.264)

  • "Today, influenza is hyper-evolving, more so than at any other time in the earth's history. The huge number of animals needed to produce our food serves as the amplifying factor for virus transmission ... " The rapid recent expansion of modern confinement agriculture, together with the establishment of many millions of smaller farms around the world, has given influenza viruses every opportunity to find suitable hosts to proliferate in poultry and pigs." (p.264)

  • "In February 2015, the WHO issued a document entitled "Warning Signals from the Volatile World of Influenza Viruses." "This statement summarized thirteen months of increased virus activity .. Just thirteen months later by  March 2016 - the number had grown to hundreds of H5 and H7 outbreaks, involving nine different viruses in thirty-nine countries." ( p.265). 

  •  "Remember, when pigs get infected with influenza viruses, they rarely show many symptoms, but they can become infected with both avian and human influenza viruses simultaneously, and their lungs provide an ideal mixing bowl."  .. in terms of what could happen, it's just as matter of time.  (p. 266- 267)

The book contains a fictional scenario regarding a killer virus that originates in China ( Shanghai, not Wuhan) and spreads around the world, eventually killing 360 million of the world's population.  In that story, the second wave returns in late September. During the second wave, food shortages occur, the unemployment rate reaches 22% ; "morgues are overflowing with bodies .." This part of Deadliest Enemy reads like a dystopian novel, a warning what multiple episodes of a pandemic can do to social institutions and social order. The authors comment that "The preceding scenario is fictional but far from fanciful." (p.283)   


Regarding vaccines


  • Most influenza vaccine, even with improvements in manufacturing techniques takes six to eight months to produce ..." " ... flu vaccine is one of the poorest performing vaccines in our medical armamentarium." (p.287)

  • Flu vaccines work around 50% of the time in protecting young adults. (p.288) The authors assert that public health experts often overestimate the effectiveness of influenza vaccines and become angry when their claims are challenged. (p.288) Some studies indicate that it's better not to be vaccinated every year. (p.289)  Policymakers who believe that yearly influenza vaccines are 70-80% effective have seen no reason to make a large public investment in developing an effective generic influenza vaccine. (p.290)

  • The authors quote an infectious disease expert who has advised governments regarding an influenza pandemic : "It is a high probability, low frequency threat. So it will happen; that is a given.The variables are when and how severe, and ... how prepared mankind will be to respond." Our most dangerous adversary is ... everywhere man and animal live in close proximity. " (p.292)


Being prepared


In 2017, the authors advocated for an initiative on the scale of World War II Manhattan Project which developed the atomic bomb to create and test an effective generic influenza vaccine; of course, their recommendation was ignored. The authors estimate that the cost of developing a vaccine which would prevent an influenza pandemic at one billion per year for 7-10 years .(p.301)  


The authors recommend a military level of preparedness in an ongoing war against infectious disease threats, including personnel in place ready to act: "public health epidemiologists, physicians, nurses veterinarians, sanitarians, statisticians, surveillance technicians, field workers, lab personnel and the support positions they need," and what would amount to a Department of Infectious Disease modeled on the Defense Department.  "As far as leadership, "... traditional public health professionals will (not) be able to lead us out of our current infectious disease complacency. We have to have people who an see - and foresee -- the big picture. .. They have to motivate governments and the public to support the Crisis Agenda ... " (pp. 316-317)


Finally, "we shouldn't have to wait for something to happen before we react. The dots are there to be connected. When we .. were surprised by Zika, we shouldn't have been. When .. we were surprised by Ebola, we shouldn't have been. And we shouldn't be surprised if tomorrow's crisis is caused by Mayara virus, Nipah, Rift Valley fever or a new coronavirus. ... Because we've had the warning and we have the solutions; we just need to act on them. (p.318)  


I heard an interview with Michael Osterholm a few weeks ago on NPR. Osterholm said that everything he predicted in Deadliest Enemy regarding an influenza pandemic applies to the coronavirus pandemic.The fictional scenario in Deadliest Enemy imagines a virus that kills young people and pregnant women in large numbers, while coronavirus seems to target the elderly and those with underlying health conditions. Both influenza and coronavirus are respiratory viruses with somewhat different rates of transmission, but they are transmitted in a similar way.   


The most important message of Deadliest Enemy is that the risk of a pandemic will not be greatly reduced as long as the world's population engages in meat production on a vast scale. The question of the country where COVID-19 originated is less important than that it probably originated in a meat market,  just as the Spanish flu probably originated on pig farms in Haskell, Kansas, according to John Barry. I have yet to see a single news story, or any expert other than Michael Osterholm, emphasize the relationship between food animals, birds and pandemics.    

© Dee Wilson

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