Plague

☣ On Friday, my face tried to kill me by oozing out of all of my orifices at once so I couldn’t breathe. Even my salivary glands went into overdrive, which is atypical of common colds. I had to position myself so that I drooled into a towel. I slept through most of that phase. Well, slept poorly.

Yesterday, the oozing stopped, but last night the incessant coughing portion of this cold started. I may have delayed it for a couple of hours with some Robitussin. As is common, I cough less when upright, and a shower and some hot tea helped clear my sinuses at least enough to score some sleep.

Curiously, Bill Gates has been talking recently and raising concern about the potential of a pandemic or bioterror attack. Gates has been in save-the-world mode for a while, and his efforts to modernize our sewage and water processing have been — for me — one of the rays of hope for the future that cut through the pervasive darkness. So when he raises a concern, I want to know what that’s about.

Could Gates be seeing something I’m not? Or this is the same old (yet still completely valid) set of infectious disease concerns we’ve had in the last half-century? I still don’t know.

When it comes to bioterror, we’ve been depending on the same strokes of luck that keep nuclear terror at bay. Specifically, biologists, like nuclear scientists, often have enough perspective to decide that a plan to massacre people by the millions is too terrible to consider as a valid means to further any cause.

The good news is that our modern system of centralized disease control is amazingly robust. When we look at modern epidemics of infectious diseases, the casualties are in the thousands whereas historical epidemics killed by the millions. There’s a conspicuous contrast from before the HIV epidemic and after.

Of course, this is also to say our disease control mechanisms could be better (and perhaps a touch less politicized). HIV started in the 60s and was allowed to accelerate due to a lack of concern for that gays and druggies disease. HIV remains exhibit A in my argument that we need to treat all infectious diseases as if they’re problematic, even when they only seem to affect people we don’t like, or are spread through activities we don’t like. (Yes, I’m still resentful. Why do you ask?)

Unless industrialized nations are back to making bioterror agents by the silo (Which they are curiously inclined to do) the bigger threat right now comes from treatment-resistant bacterial strains. There’s practically nothing for diseases like XDR-TB (Extensively Drug Resistant Tuberculosis). For now, we estimate 40,000 cases throughout the world, across 100 countries. but treatment efforts are underfunded much like HIV was, so we aren’t detecting and tracking them as well as we could. An XDR-TB outbreak could easily become a runaway pandemic and turn into the plague of the century. Of course, it’ll start with poor brown people in unindustrialized nations, so the people who control health funding aren’t keen to prioritize it.

Then there’s TDR-TB (Totally Drug Resistant Tuberculosis) which is out there, we think. The problem is, TDR-TB has only appeared (if it has at all) in regions in which the tests are not as conclusive as they are in US or European hospitals, and we’ve yet to secure a sample of the strain(s) in our Tuberculosis strain banks So, in this case, it’s a literal specter, a monster we’d like to attribute to testing errors and anomalies, but could be the supergerm we’ve been expecting since Polio.

The other worry is that these super-resistant bacterium strains imply that strains of other species can also become XDR or TDR. We still get about 800 cases a year of bubonic plague. Where there’s modern medical care, it’s rarely a problem as we have an extensive battery of antibiotics to treat it. We see about 150 plague deaths a year, largely due to cases being too far removed from industrialized resources, e.g. deep in the African wilds. Still, an XDR black death is perfectly feasible if (we hope) unlikely. If one were to bloom into an epidemic, the Black Death would be as unstoppable as it was in 14th century Europe.

Civilization as we know it would be doomed.

Update! Rockefeller University has been studying this specific problem, and has been meddling with Cas9, the enzyme that allows bacteria strains to resist antibiotics. (Coincidentally, it looks like a key) By modding the enzyme, they can key (heh!) the antibiotic to specifically target the resistant strain (and kill it, where other antibiotics fail!).

This is all still experimental and still requires a lab to custom-build a new antibiotic for each strain, but science marches forward. Take that, global pandemic risk!

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