How Progress Makes Us Sick--Advances that make life more comfortable can also make it more dangerous
By Geoffrey Cowley NEWSWEEK
May 5 issue — SARS may have dominated the headlines last week, but it wasn’t the only weird disease on the World Health Organization’s radar screen. In central Africa, an outbreak of the dreaded Ebola fever had stretched into its fifth month. In Belgium and the Netherlands, a virulent new strain of avian flu was wiping out entire chicken farms. Dutch farmers recently slaughtered 18 million birds in hopes of stopping the outbreak. Yet the bird flu has spread to several provinces and jumped from poultry to pigs and even people, causing 83 human cases. Most of the infected people have suffered only eye inflammation, but some have developed respiratory illness. One of them, a 57-year-old veterinary surgeon, recently died of pneumonia. “Bird flu virus was... found in the lungs,” according to an April 19 statement from the Dutch Agriculture Ministry, “and no other cause of death could be detected.” Sound familiar? Has the SARS epidemic caused you to change your lifestyle at all? Yes, I've changed my travel plans to avoid SARS-stricken cities Not much, but I bought a protective face mask--just in case Not at all
Vote to see results Has the SARS epidemic caused you to change your lifestyle at all?* 19703 responses Yes, I've changed my travel plans to avoid SARS-stricken cities 21% Not much, but I bought a protective face mask--just in case 5% Not at all 74% Survey results tallied every 60 seconds. Live Votes reflect respondents' views and are not scientifically valid surveys.
SARS. Ebola. Avian flu. The parade of frightening new maladies continues, each one confirming that our species, for all its cleverness, still lives at the mercy of the microbe. It didn’t seem that way 30 years ago—not with smallpox largely defeated, AIDS still undreamed of and medical science evolving at an unprecedented clip. But even as optimists proclaimed victory over the germ, our megacities, factory farms, jet planes and blood banks were opening broad new avenues for infection. The dark side of progress is now unmistakable; many of the advances that have made our lives more comfortable have also made them more dangerous. Some 30 new diseases have cropped up since the mid-1970s—causing tens of millions of deaths—and forgotten scourges have resurfaced with alarming regularity. “Infectious diseases will continue to emerge,” the Institute of Medicine declares in a new report, warning that complacency and inaction could lead to a “catastrophic storm” of contagion. So what’s to be done? As the SARS outbreak has shown, surveillance is critical. By spotting new infections wherever they occur, and working globally to contain them, we can greatly reduce their impact. But is preparedness our ultimate weapon? Do we know enough about the genesis of new diseases to prevent them? Could we avert the next SARS? The next AIDS? What would a reasonable strategy look like?
We don’t hold all the cards in this game. Most new diseases begin when a person catches something from an animal—a transaction shaped by chance or even the weather. When healthy young adults started dying of a SARS-like syndrome in New Mexico 10 years ago, it took health experts several weeks of intensive lab work to identify the culprit. To the scientists’ amazement, it wasn’t a human pathogen at all. It was a novel member of the hantavirus family, a group of rodent viruses that sometimes spread through the air after rats or mice shed them in their urine. The previous outbreaks had occurred in Asia. So why were people dying in New Mexico? Scientists now believe the American mice had harbored the virus all along but had never been populous enough to scatter infectious doses in people’s toolsheds and basements. What changed the equation that year was El Niño. The ocean disturbance caused an unusually warm winter in the Southwest. The mouse population exploded as a result—and the hantavirus got a free ride.
Until someone harnesses the jet stream, such accidents are sure to happen. But quirky weather isn’t the greatest threat we face. As ecologists study the causes of disease emergence, they’re finding that human enterprise is a far more significant force. Almost any activity that disrupts a natural environment can enhance the mobility of disease-causing microbes. Consider what happened in the 1980s, when farmers in Venezuela’s Portuguesa state cleared millions of acres of forest to create cropland. The farms drew as many rats and mice as people, and the rodents introduced a deadly new virus into the region. The so-called Guanarito virus causes fever, shock and hemorrhaging. It infected more than 100 people, leaving a third of them dead.
1 / 5 SARS: common questions NBC’s Robert Bazell explains the basics about SARS.2 / 5 China says it will set up health network to combat SARSChina says it will spend $500 million to set up a nationwide health network to combat SARS. NBC’s Ned Colt reports from Beijing.3 / 5 SARS: fear in NYIt is an unwelcome effect in Asian neighborhoods, including New York City’s sizeable Chinatown. NBC’s Brian Williams reports.4 / 5 Asia tries to coordinate SARS planChina is ground zero for SARS, especially the capital of Beijing. NBC’s Ned Colt reports from there.5 / 5 Toronto and SARSThe SARS outbreak has devastated business in Toronto, where restaurants are empty and hotel occupancy rates were already down almost 25 percent. NBC’s Don Lemon reports.
Malaysian pig farmers had a similar experience in 1999, after they started pushing back the forest to expand their operations. As barns replaced forestland, displaced fruit bats started living in the rafters, bombarding the pigs’ drinking water with a pathogen now known as the Nipah virus. “The pigs developed an explosive cough that became known as the one-mile cough because you could hear it from so far away,” says Mary Pearl, president of the Wildlife Trust in Palisades, N.Y. The virus soon spread from the pigs to their keepers, causing extreme brain inflammation and killing 40 percent of the affected people. The outbreak ended when Malaysian authorities closed eight farms and slaughtered a million pigs. The point is not that rain forests are dangerous. It’s that blindly rearranging ecosystems can be hazardous to our health—whether we’re in the Amazon Basin or the woods of Connecticut. That’s where Lyme disease emerged, and it, too, is a product of the way we user our land. Borrelia burg-dorferi, the bacterium that causes Lyme, lives in the bodies of deer and white-footed mice, passing between those animals in the heads of biting ticks. People have crossed paths with all these critters for generations, yet the first known case of Lyme disease dates back only to 1975. Why did we suddenly become vulnerable? Richard Ostfeld, an animal ecologist at the Institute of Ecosystem Studies in Millbrook, N.Y., has tied the event to suburban development. In open woodlands, foxes and bobcats keep a lid on the Lyme agent by hunting the mice that carry it. But the predators vanish when developers chop woodlands into subdivisions, and the mice and their ticks proliferate unnaturally. In a recent survey of woodlots in New York, Ostfeld found that infected ticks were some seven times as prevalent on —one- and two-acre lots as they were on lots of 10 to 15 acres. His bottom line: “You’re more likely to get Lyme disease in Scarsdale than the Catskills.” May 5, 2003 Issue Cover: SARS--What You Need to Know • The Mystery of SARS • How Progress Makes Us Sick • Economies on Empty Fortunately, you’re not likely to spread it in either place. Even when a microbe succeeds at leaping from one species to another, the new host is often a dead end. Neither Nipah nor Guanarito can spread from person to person. The hantaviruses have the same problem. And a tick could suck on a Lyme-disease patient all day without getting enough bacteria to infect its next host. The infections we get from primates and pigs are a whole different story. When the Ebola virus jumps from an ape into a person, it often races through a family or a hospital before burning itself out. And HIV is still spreading steadily after three decades of person-to-person transmission. It has infected some 60 million people since crossing over from chimpanzees, and its emergence was no fluke of the weather. We placed ourselves in the path of the virus, we moved it around the world, and we’re well poised to do it again.
fact file SARS virus cases
Number of people affected by the flu-like virus Severe Acute Respiratory Syndrome (SARS) worldwide. As of May 1, 2003 | 1 | 2 | 3 Country Cases* Deaths Recovered China 3,638 170 1,351 Hong Kong 1,600 162 834 Singapore 201 25 143 Canada 147 20 87 Taiwan 89 3 25 Vietnam 63 5 56 USA 54 23 Italy 9 4 Thailand 7 2 5 Germany 7 7 Malaysia 6 2 3| 1 | 2 | 3 Country Cases* Deaths Recovered Britain 6 6 Mongolia 6 3 France 5 1 Philippines 4 2 1 Australia 4 4 Sweden 3 2 Brazil 2 2 Indonesia 2 1 Japan 2 Bulgaria 1 India 1 1| 1 | 2 | 3 Country Cases* Deaths Recovered Ireland 1 1 Kuwait 1 1 Macao 1 Poland 1 Romania 1 1 South Africa 1 South Korea 1 Spain 1 1 Switzerland 1 1
- Includes number of deaths, recoveries and current cases Source: World Health Organization Printable version The human AIDS viruses are descended from simian pathogens known as SIVs. HIV-1 is essentially a chimpanzee virus, while HIV-2 (a rarer and milder bug) comes from the sooty mangabey (a monkey). How did the chimp virus make its way into humans? The best guess is that African hunters contracted it while butchering animals, and then passed it on through sexual contact. Until a few decades ago, that hunting accident would have been a local misfortune, a curse played out in a few rural villages. What turned it into a holocaust was not just a new infectious agent but a proliferation of roads, cities and airports, a breakdown of social traditions, and the advent of blood banking and needle sharing. Those conditions virtually sealed HIV’s success, and they continue to rocket obscure bugs into every corner of the world. “The volume and speed of travel are unprecedented,” says Dr. Mary Wilson of Harvard. “We are interconnected in ways that weren’t true a century ago.”
• Learn more about the disease SARS is only the latest reminder of how powerful those connections can be. The novel coronavirus that causes the syndrome emerged from Guangdong, the same Chinese province that delivers new flu viruses to the world most years. Pigs, ducks, chickens and people live cheek-by-jowl on the district’s primitive farms, exchanging flu and cold germs so rapidly that a single pig can easily incubate human and avian viruses simultaneously. The dual infections can generate hybrids that escape antibodies aimed at the originals, setting off a whole new chain of human infection. The clincher is that these farms sit just a few miles from Guangzhou, a teeming city that mixes people, animals and microbes from the countryside with travelers from around the world. You could hardly design a better system for turning small outbreaks into big ones. For all the fear it has caused, SARS clearly isn’t the big one, at least not in its current incarnation. The coronavirus that causes it is as nasty as any flu virus, but it doesn’t get around very easily. And as University of Louisville evolutionist Paul Ewald points out, an epidemic can’t sustain itself unless each patient infects more than one other person. “If each SARS case were generating even two others,” he says, “we would have seen hundreds of thousands by now.” A doomsday flu virus would approach the virulence of the SARS agent, but it would infect people by the roomful.
Such pandemic flu viruses have emerged in the past, and many experts believe it’s only a matter of time until it happens again. How can we lessen the danger? A long-term strategy would have to include modernizing the world’s farms, improving basic health care and stockpiling vaccines and antiviral drugs. As science illuminates the ecology of infectious disease, it may also inspire wiser, safer approaches to land use and wilderness preservation. Until then, surveillance will be doubly important. The good news is that the forces making microbes so mobile are also making them easier to track. Ten years ago, quick communication was still a problem for many health departments, says Stephen Morse, director of the Center for Public Health Preparedness at Columbia University’s Mailman School of Public Health. “A colleague in Russia had a fax but no fax paper. A colleague in Ghana had telex but no fax. In other places they had a telephone but no telex.” Today even the most remote surveillance stations are tied into the Web-based Program for Monitoring Emerging Diseases. The world’s largest health agencies have created similar systems for sharing scientific research. Such systems are only as good as the openness and good will of their users. If anything good has come of the SARS scare, it is a renewed commitment to those ideals. How far they’ll take us is still anyone’s guess.