Pandemic by Sonia Shah
In the opening minutes of the 2011 movie Contagion a sequence of seemingly everyday acts take on an ominous tone. Paired with the pulsating synthesizer score that adds to the tension, we take a quick trip around the globe, Hong Kong to Tokyo to London to Minneapolis. From the moment business woman Gwyneth Paltrow, with a slight cough, hands over her credit card to the bar tender at Hong Kong airport, we in the audience know we are being asked to take notice of the everyday interactions we all take part in:
the touchpad of the register at the bar,
the bowl of peanuts,
the poles we hang on to on the subway,
the doorhandles that are touched by different hands repeatedly across a day,
the documents we hold onto then share with others,
the elevator call button,
and, most deadly of all the warm embrace of a loved one after a long trip.
By the time Gwyneth is in that embrace with her son we know the jig is up. Less than 10 minutes into the movie she is writhing on the floor, foaming at the mouth and dead pretty soon after, followed by her son, the recipient of that warm embrace. And the world is in the grip of a Pandemic where Gwyneth was ground zero.
What does a movie like Contagion do to help us understand the dangers of diseases we can’t see?. Director Steven Soderbergh’s movie was actually pretty effective in demonstrating how our jet age can allow for the fast moving spread of a disease across the globe before we even know what’s hit us. When my family went to see it at the theater back then, everyone used their coat sleeves to push door handles as we left!
Sonia Shah’s book Pandemic has been on my shelf of aspirational reading for some months. As a news executive I’ve had to make decisions about sending journalists to places that are disease hotspots, most recently when Ebola struck in West Africa. I consider myself knowledgeable but not an expert and I was curious to know what we could learn about our interactions with diseases in the past that might inform our reactions today.
Shah’s book is subtitled: Pandemic: Tracking Contagions from Cholera to Ebola and Beyond. That’s a lot to handle in one book and so the book is uneven. But her engaging story of cholera alone makes this book a worthy read for anyone with an interest in how history can help us understand the spread of diseases and the confluence of events necessary to contain them.
Her historical narrative of the path of the waterborne pathogen vibrio cholerae is absorbing. The toxin in the vibrio, “sucked water and electrolytes out of the body’s tissues and flushed them away with (excreta).” Just a few tiny drops of that waste could pass the vibrio from one person to another. This was a pathogen that lived in the Sundarban wetlands in the Bay of Bengal, and that’s where it was contained. That is, until the arrival of long distance travel. The creation of the East India Company their arrival in India and the expansion of the British Empire in the 18th Century meant that the vibrio could hitch a ride and spread across the globe.
By the 19th century cholera “was one of the fastest-moving, most feared pathogens in the world,” sickening hundreds of millions. By the end of the book she has brought us up to date to the 7th Cholera pandemic currently underway on our planet and along the way she eloquently illustrates how society’s scientific, economic and social challenges stood in the way of combating previous outbreaks through history and still do.
Each chapter dives deep into the mechanisms of each stage that contributes to a pandemic. The Jump, Locomotion, Filth, Crowds, Corruption, Blame, The Cure - a sequence that, unabated, is deadly.
My favorite chapter, Filth, chronicles the development of sanitation systems from ancient Rome to the industrialized western cities of the 19th century. Ancient civilizations including the Romans and Greeks saw a correlation between “separating ourselves from our waste” and “healthful living.” Water was the mechanism by which this occurred.
But sadly, somewhere in the Middle Ages, water was considered a dangerous vector for the bubonic plague and that separation (via water) from waste became a thing of the past. by the 19th Century some of the world’s great cities, New York, London and Paris suffered devastating outbreaks of cholera as a result of their proximity to their waste. New Yorkers, says Shah “immersed themselves so completely in each other’s waste that each likely ingested two teaspoons of fecal matter every day with their food and drink.”
The scientific fight over whether cholera was caused by miasmas or dirty water occupied much of the 19th century. Excreta underfoot was common in most of the cities where waste was emptied into the streets. Even the arrival of the toilet or “water closet” didn’t solve the problem. In London, where the miasma theory held strong, the water closet relieved people of the odor, which they deemed dangerous. They sent their waste directly into the River Thames which ran through the city, but the filth remarkably, ran back upstream twice a day into the intake pipe’s of the city. Cholera inevitably followed.
It wasn’t until “the Great Stink” of 1858 in London, following a drought and a heatwave, that resewering, which diverted London’s waste and gas far downstream through a system of intersecting pipes, that London became cholera free. Even then the miasmaists won out, the endeavor was undertaken to remove the stench from London, not the waste itself.
Tracking cholera is at the heart of the book. But Shah also takes us on a tour of the variety of pathogens that seem to make news every day and the efforts to deal with them in a world where trade and commerce allows the tiniest of viruses to hitch a long ride across the globe and take root. A glance at the daily news reminds us of the alphabet soup of infections we are dealing with, H1N1, SARS, MRSA, MERSA, EBOLA and Shah shines a light on some of the same obstacles today’s disease fighters are up against. For example, the Chinese tried to keep a lid on their 2002 SARS outbreak because of the economic and commercial interests they wanted to protect. Something similar happened in Italy at the turn of the 20th Century during a cholera outbreak which authorities kept secret.
Shah notes “It took nearly a hundred years of deadly cholera pandemics for cities like New York, Paris and London to rise to cholera’s provocations. To do it, they had to remake the way they housed themselves, managed their drinking water and their waste, governed the public’s health, conducted international relations, and understood the science of health and disease.”
The fact that Cholera (transported by Nepalese UN soldiers who had come to Haiti’s aid during the devastating 2010 earthquake) is now firmly entrenched in Haiti in the globe’s 7th Cholera Pandemic highlights the stubbornness of these pathogens and the challenges to governments to alleviate a very manageable disease.
Cholera is a relatively easy disease to prevent or treat but the fact that new outbreaks continue to plague us does not portend well for our ability to take on big challenges from the tiniest of microbes.
Before You Read:
Length: 217 pages
Genre: Non-Fiction, Science
Themes: Basic Science, History, Public Policy
Commitment: Very accessible science book
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