November 02, 2005,
On Tuesday, President Bush announced his avian-flu strategy at the National Institutes of Health, raising the flu which has yet to hit our shores to a clear presidential priority. Should it be that? How does it rank in history? How might it? Impossible questions to answer yet, but National Review Online editor Kathryn Lopez picked the brain of historian and science writer John Kelly on Tuesday on the subject anyway. Kelly is author of The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time.
Kathryn Jean Lopez: President Bush is talking "pandemic" as far as the avian flu goes. Is it really that bad?
John Kelly: The avian flu is spreading at a frightening rate. [From Eastern Europe to England to Canada,] the flu is certainly moving closer and closer toward us. However, two things have to be kept in mind in assessing how bad it is: First, the flu virus has not developed the ability to go from human to human, and it's only when the organism develops that potential that it truly becomes dangerous. Secondly, we really don't know how bad the pandemic will be. There have been two major pandemics since the 1918 flu, the last as recently as the late 1960s. And, while they caused a great many deaths, the deaths were primarily among very vulnerable populations the old and the sickly. For most everyone else, the pandemic was like encountering a tsunami in mid-ocean: There was a ripple effect but not much else.
NRO: Would it ever have the possibility of becoming a Black Death-like problem? Aren't we just so far advanced way beyond the threat of falling victim to a disease quite that badly, at least in the West?
Kelly: I have my doubts about whether the avian flu has the killing power to become another Black Death, but I'm also certain there are pathogens out there that do have the biological oomph to cause mortality on the scale of the Black Death. Our advanced public-health system isn't quite as advanced as the public thinks. In 2001, when an epidemic of hoof and mouth disease spun out of control in the English countryside the British government was helpless to contain the outbreak and had to resort to methods that made Britain seem medieval such as burning livestock and pouring gasoline over the roads as a disinfectant for car tires. Modernity is a very fragile thing.
NRO: What can Joe and Jane American do to prevent an avian-flu disaster, based on history?
Kelly: Probably the most effective thing Joe and Jane can do is to convince the Asians to stop living with their animals. It isn't accidental that so many of these viruses and pathogens come out of east Asia and southeast Asia. The countries in these regions are among the last ones in which people still live in close proximity to their animals, and it's very easy for a virus to jump from an animal to a human in such close quarters. One of the most frightening things about controlling the avian-flu epidemic is that it's very hard to get people in many of these countries to change their habits. In the late 1990s Hong Kong authorities stopped the avian-flu cold in its tracks by slaughtering a million and a quarter chickens. But Hong Kong is a wealthy city. The latest outbreaks have occurred in places like Indonesia and Vietnam, which are very poor and whose peoples will not, under almost any circumstances, kill their birds unless they're forced to by direct government authority meaning police or soldiers standing at the house while they kill the animals.
As for what else Joe and Jane can do, probably the best remedy is just to stay generally healthy. Another is to live in a low-population-density area. A pathogen requires a population density of about 400,000 to survive, so people who live in rural areas or have summer homes in rural areas have some protection in that sphere. Another protection assuming the virus does learn to go human to human is not eating or drinking anything that hasn't been sterilized first. There also may come a time, if it got really bad, where you'd consider buying those plastic face masks.
NRO: To what extent does government need to be involved?
Kelly: Among other things, the Black Death gave a big boost to the notion of direct government intervention in everyday life. Public health was born ion the hill towns and seaports of Northern Italy in 1347-48. For the first time there were ordinances about banning certain kinds of travel, stringently enforcing sanitation regulations, and mandating how burials should be conducted all designed to curb the contagion of the plague.
It is very difficult to cope with a major natural disaster without a central authority. (Think of Katrina.) Government is needed to ensure an adequate supply of vaccine, to ensure that the people who need it most are inoculated, to enforce quarantines or restrictions on travel, if that becomes necessary, and to maintain public order in the face if incipient panic, and again if necessary to eradicate infected poultry flocks and to ban or regulate the selling of chicken and other vulnerable avian species. The threat of mass death can't be privatized.
NRO: What are the lessons of history that can be taken from the Black Death right now?
Kelly: The principal lesson is that human beings are capable of coping with just about anything. We have a remarkable resiliency. During the Cold War, the U.S. government commissioned a RAND study to see how the U.S. population would stand up to the effects of all-out thermonuclear war. The only historical event that the RAND researchers could find that mimicked all-out thermonuclear war in both its enormous mortalities and suddenness of onset was the Black Death. Despite 50 and 60-percent death rates in many regions, the RAND researchers found that there was always a group of men and women who came forward to hold society together to make sure the dead were buried, garbage was picked up, that the life of society continued. I am certain that if avian flu ever turned out to be the nightmare it's sometimes depicted as, we would see the same sort of resilience the ability of men and women to carry on, no matter how devastating the circumstances. Humans are the hardiest pathogens on the planet.