Bug Out

An Interview with Laurie Garrett

Today we have a rampant yellow fever epidemic in Brazil and in several other places in the world. Cases are now turning up in Sao Paulo and Rio de Janeiro. Why? For one thing, people have gotten lax about vaccinations -- just look at the anti-vaccine movement that's made a huge comeback and has caused surges in measles, mumps, and whooping cough all over the United States and much of the rest of the developed world with its ridiculous hocus-pocus. The vaccination rate for yellow fever has similarly dropped off. Two, the vaccine's so cheap that nobody wants to bother to make it. And finally, the virus could always hide in monkeys, and that's what we're now seeing: the Amazon region plagued by what's known as sylvatic yellow fever. It's coming from the monkeys via mosquitoes to people.

But here’s the final kicker: it is urbanizing. This is something we never saw before. This is why the Ebola epidemic in 2017 was so hideous: it was an urban epidemic for the first time in human history. We don't know what an antibiotic-resistant scourge would look like in the modern world. We can only draw so many assumptions from what we know it was like in the 1920's and 1930's when the world population was an incremental piece of what it is today. When most people lived in rural areas, not urban. When a visit to the family doctor was a rare experience -- and when you did go, you went to some little guy's shop with a shingle hanging out on the street.

Today when someone gets sick they go to a waiting room with their sick child and sit there for 16 hours surrounded by another 100 or 200 people. They then get into a facility that is operating at hyperspeed with sometimes marginal forms of hospital hygiene. And if they're really sick and they get hospitalized, they're going into a facility where infection control is very, very difficult to maintain, especially if the people on the ward are under highly stressed conditions like advanced cancer or pneumonia or are in post-op ICU or neonatal ICU. These are all places where we see outbreaks of drug-resistant bacteria now. We see them go screaming through a ward. One by one every patient -- boom, boom, boom, boom, down the line. The infection is often carried on the hands of well-intentioned doctors and nurses. We now know it can be on their coat, it can be in their shoes. It's almost impossible to completely scour your body free of salmonella, of methicillin-resistant Staphylococcus aureus, of streptococcus, of Enterococcus faecalis.

These are really hard bugs to get rid of. They exist in the environment because they have acquired the capacity to latch onto any surface. If there's so much as a molecule of H2O around they can live there. We don't know what it means to be talking about the spread of bacterial disease in the modern age of air conditioning and of people living in giant towers and cities where you can't even open your windows. In the 1930's nobody had air conditioning and nobody lived and worked in offices and buildings where they shared the air space of every single other person in the entire building. What we see now is an increase in Legionnaires' disease, for example, which is really an air-conditioning disease. We see more and more our air-conditioning systems themselves become giant bacterial biofilms with disease scourges spreading through the system.

So to answer your question, you would have to set your baseline assumptions of how commonly bacterial disease spread with fatal outcome. Let's just stick with fatal. We won't even talk about people who got crippled like my aunt or rendered deaf or blind because of bacterial infection. You could look at how people lived and what the rate of transmission was in the 1930's, but then you’d have to add in all these factors to reflect 21st century living: increased human population, antibiotics in our food and water, social interactions on the subway or on airplanes, and on and on and on. As you can see, it's an almost impossible calculus to make.

Love this content? Then you'll love our inaugural live event, The Octavian Forum. The Forum will be held at Sotheby's on October 17th 2017. Click here to learn more.