{"id":141,"date":"2020-03-14T22:47:31","date_gmt":"2020-03-14T22:47:31","guid":{"rendered":"http:\/\/www.jacobgrier.com\/blog\/?p=141"},"modified":"2020-03-14T22:53:14","modified_gmt":"2020-03-14T22:53:14","slug":"spillover-revisited","status":"publish","type":"post","link":"https:\/\/www.jacobgrier.com\/blog\/2020\/03\/14\/spillover-revisited\/","title":{"rendered":"Spillover, revisited"},"content":{"rendered":"\n

\u201cYou\u2019re overreacting. Look at how many people die from the flu every year,\u201d my mom said. This was a couple weeks ago, and we were on the phone discussing my plans to visit home. My parents live in Houston, I live in Portland, Oregon, and my annual work trip to SXSW in Austin presented an all too rare opportunity to visit Texas. I was expressing my doubts that the trip was going to happen. There was this new coronavirus, and it sounded serious. <\/p>\n\n\n\n

My mom, like many at the time and some even now, thought the media might be blowing the whole thing out of proportion. She mentioned my own writing, which has often focused on debunking media-driven health panics. Could this be more of the same? At first, it seemed unthinkable to cancel an event as massive as SXSW. Then it began to feel inevitable. Today, the idea that they could have done anything less feels recklessly irresponsible.<\/p>\n\n\n\n

The events I\u2019d been planning for months were called off, but I still had plane tickets and an expensive, non-refundable hotel room. I still had parents who wanted me to visit. I still had a hunger for breakfast tacos and Texas barbecue. But I also had vague yet evocative memories of a book I\u2019d read eight years ago, a book in which ordinary people pick up extraordinary diseases, with often fatal consequences for themselves, their loved ones, and the doctors and nurses who care for them. Transporting my body and its invisible passengers into my parents\u2019 house, where any sneeze, cough, or lick from an affectionate terrier could spread contagion, didn\u2019t feel worth the risk. And so, as my flight departed to Austin, I stayed home revisiting David Quammen\u2019s prescient book, Spillover<\/a><\/em>. <\/p>\n\n\n\n

\"\"<\/a><\/figure><\/div>\n\n\n\n

David Quammen is among a handful of authors whose books I\u2019ll order as soon as they\u2019re announced, regardless of whether I have any previous interest in the subject matter. (Perceptions of man-eating predators? I will \u2013 hopefully \u2013 never be devoured by a bear, but Monster of God<\/a> <\/em>was an engaging read nonetheless.) His 2012 book, Spillover<\/em>, is devoted entirely to infections that make the leap from other animals into humans. In technical parlance, \u201czoonosis.\u201d The list of previous zoonoses is long: AIDS, Ebola, Marburg, rabies, Nipah encephalitis, Lyme disease, too many more to mention. Some, like flu, have become an ever-fluctuating part of our familiar viral landscape. Others, like SARS, flare up, run their course with terrifying intensity, and burn out. Our lives move on. But Quammen\u2019s book wasn\u2019t intended as a curious catalogue of past events. It was a warning. Zoonosis, he cautioned, \u201cis a word of the future, destined for use in the twenty-first century.\u201d Eight years later, that future has arrived.<\/p>\n\n\n\n

Is this new coronavirus the \u201cNext Big One\u201d that epidemiologists have been fearing? If not, it\u2019s certainly big enough, and it\u2019s exposing how unprepared we are for it. Though Spillover <\/em>is too dense to cover fully, here are three points that stood out while re-reading it during the current pandemic.<\/p>\n\n\n\n

\u201cEverything comes from somewhere\u201d<\/strong><\/p>\n\n\n\n

One of the things I appreciate about Quammen\u2019s books is that he situates his topics in evolutionary and ecological contexts. \u201cAlthough infectious disease can seem grisly and dreadful, under ordinary conditions it\u2019s every bit as natural as what lions do to wildebeests and zebras, or what owls do to mice.\u201d We are not separate from nature. We are not even fully human; each of us is an ecological niche unto ourselves, home to uncountable microbes. So is every other creature. Through the long, relentless pressure of evolution, most of these relationships become manageable, sometimes even beneficial. Occasionally these microbes find themselves outside of the reservoir hosts to which they\u2019ve become adapted. And then? A dead end, typically. But also opportunity. Nearly 8 billion opportunities in the case of humans, an efflorescence of new environments packed densely into cities and connected by global travel. And while most of us in wealthier countries rarely come into contact with live animals other than our pets, we interact with them indirectly through farming, trade, and encroachment into wild habitats. \u201cShake a tree,\u201d as Quammen writes, \u201cand things fall out.\u201d<\/p>\n\n\n\n

From a microbe\u2019s eye view, we humans are high-risk, high-reward. They may infect our bodies and ravage us so thoroughly that they are unable to spread, their path blocked by human response strategies or their own excessive virulence. That\u2019s the Ebola story, so far: a handful outbreaks, extremely high fatality rates, but ultimately, containment. In other conditions, the microbe may take hold and find itself capable of transmitting from host to host indefinitely, keeping the humans it infects alive long enough to spread it to others. That\u2019s HIV, a virus that jumped from the blood of other primates to a person. The circumstances are contingent; it might have happened lots of times, eventually fizzling out. It only had to break through once. (In actuality, it probably succeeded multiple times<\/a>.) <\/p>\n\n\n\n

You don\u2019t have to slaughter a chimp or eat a bat for\nzoonosis to happen. Disease could spring from racehorses (Hendra), pigs and\nchickens (swine and avian flu), domesticated goats (Q Fever), cattle (\u201cmad cow\u201d),\nparrots (psittacosis), ticks (Lyme disease), or Old Yeller (rabies). Reasonable\nsteps can be taken to prevent spillover, and the present epidemic will likely\nresult in some reflection on how to do so, but there\u2019s no way to stop it\nentirely. The next disease is out there, uncharted. The question is how to\nprepare for it.<\/p>\n\n\n\n

SARS should have prepared us<\/strong><\/p>\n\n\n\n

Eight years after first reading Spillover<\/em>, there were a few specific cases described within it that lingered in my memory. The Australian horse trainer who came down with Hendra. The Dutch tourist who picked up Marburg during a ten-minute venture into a Ugandan cave. And most relevant to the current epidemic, the \u201csuperspreaders\u201d who inadvertently transmitted SARS far beyond its initial entry into the human population. <\/p>\n\n\n\n

A surprising number of these cases can be traced to a single\nhotel in Hong Kong, where a professor from Guangzhou arrived for a wedding. He\u2019d\nbeen ill two weeks before, then felt well enough to travel. At the hotel, he\nfelt sick again. He stayed on the ninth floor. So did a seventy-eight-year-old\ngrandmother from Toronto, who overlapped with him for one night. So did a young\nwoman from Singapore. Within a few weeks, the professor had died. The\ngrandmother died, too, after flying the virus back to Canada, where it killed thirty-one.\nThe young woman returned to Singapore. She survived, but her mother, father,\nuncle, and pastor did not. A woman infected by the grandmother brought SARS to the\nPhilippines; a man infected by the young woman took it to Germany. In the end,\nSARS infected 8,098 people and took the lives of 774.<\/p>\n\n\n\n

This web of infections, vaguely remembered, is what was on my mind as I contemplated my forthcoming trip to Texas. The United States had restricted travel from China, but the new coronavirus was already here. Never mind the Chinese; I fit the profile of a superspreader. I\u2019d just been to New York, cramming onto subways, squeezing into airplanes, massing at the rails of the Staten Island Ferry as we passed the Statue of Liberty. Then back to Portland, where I went to bars and restaurants, played soccer. And then? To Austin, where I would interact with thousands of other travelers who had non-refundable tickets? And on to the home of my parents, who are in their sixties? No, thank you. Better to stay in Oregon reading popular science books.<\/p>\n\n\n\n

Another thing about SARS: It was also caused by a coronavirus, SARS-CoV, namesake for the virus you’re currently worried about, SARS-CoV-2. As frightening as the original SARS outbreak was, its spread was limited. Perhaps that\u2019s part of why some people are downplaying risks now. We\u2019ve had outbreaks like this before, and they weren\u2019t that bad in the scheme of things. That\u2019s the wrong way to think about it. A better question to ask is, \u201cUnder what conditions could SARS have been much, much worse?\u201d<\/p>\n\n\n\n

The fortunate thing about SARS is that the infected typically endured recognizable symptoms before they became highly contagious. That made it possible to contain it. \u201cThis was an enormously consequential factor in the SARS episode \u2013 not just lucky but salvational,\u201d writes Quammen. For some other viruses, such as the flu, infectiousness can precede symptoms; that\u2019s part of why they spread so easily. So, what\u2019s scarier than SARS? SARS that spreads like the flu. <\/p>\n\n\n\n

That\u2019s not exactly what we\u2019re facing now, but there are similarities<\/a>. Toward the end of Spillover<\/em>, Quammen recounts an interview with epidemiologist Donald S. Burke, who had given a lecture back in 1997 on the groups of viruses most likely to lead to the next pandemic. Coronaviruses stood out as a probable candidate even then, given their propensities toward infecting animals and rapidly evolving. The genomes of coronaviruses are encoded in error-prone RNA. That means they mutate often; they adapt, they evolve, the replicate in huge numbers. We were warned about this before SARS. SARS proved that the danger was real. Less than two decades after the initial SARS outbreak, the danger is here.<\/p>\n\n\n\n

What we do now matters<\/strong><\/p>\n\n\n\n

I\u2019m not writing this post to sound fatalistic. Yes, zoonoses are to some degree inevitable (though we can alter practices to prevent them). Yes, a bad one has arrived. But there\u2019s a reason there are nearly eight billion of us: We are smart and we can change our behavior in light of new information. Toward the end of his book, Quammen considers how much that matters. \u201c[Individual] effort, individual discernment, individual choice can have huge effects in averting the catastrophes that might otherwise sweep through a herd.\u201d<\/p>\n\n\n\n

Here in the United States, we\u2019ve squandered our early opportunities to prevent the spread of this new coronavirus. Due to a lack of testing, we\u2019re not even sure how many people have been infected. What happens next depends on a multitude of factors: how deadly the virus turns out to be, how many people get it (especially in vulnerable populations), and whether our hospital systems are able to deliver care without being overwhelmed by new patients. Under the rosiest estimates, deaths will be in the hundreds or thousands. If things don\u2019t go well? Hundreds of<\/em> thousands. If this goes very badly? More than a million<\/a>.<\/p>\n\n\n\n

The worst-case scenarios are not inevitable. But they are plausible. They are realistic. You should take them seriously. Even now, I feel like many people I talk to or interact with online are still complacent about how rapidly things can change. Here are the two points I think cannot be emphasized enough:<\/p>\n\n\n\n

First, this is not something that only happens over there,\nor to other people. It\u2019s not just the flu. You need to be thinking of this as\nsomething that could very well take the life of someone you care about.<\/p>\n\n\n\n

Second, think about what you, as an individual, can do to prevent the worst-case scenarios from happening. Don\u2019t be a superspreader. Try not to be a mediumspreader, either. Cancel your trip, cancel your events, cancel your parties. Work from home, if you can. Practice social distancing. How extreme? Honestly, I can\u2019t tell you, but do think about it. If you\u2019re reading this on your phone while waiting in line to get into a crowded bar, you\u2019re doing it wrong.<\/p>\n\n\n\n

What\u2019s next?<\/strong><\/p>\n\n\n\n

What\u2019s next, when the worst of this is over? I don\u2019t mean next for this virus, or even for diseases generally. I mean what other disasters have we been warned about that many of us blithely ignore? That\u2019s another thing I think about reading Spillover<\/em> now. There\u2019s climate change, obviously, which could spiral out in all sorts of terrible ways. Living in the Pacific Northwest, something more specific comes to mind: the other Next Big One, the earthquake and tsunami that will likely be triggered by the next great shift in the Cascadia subduction zone.<\/p>\n\n\n\n

When Americans think of destructive earthquakes, we generally think of the San Andreas Faultline because it\u2019s the most active. Due to all that activity, the cities along it are prepared. Little earthquakes and big earthquakes happen with too much frequency to ignore. The Cascadia subduction zone is different. Until fairly recently, scientists didn’t even recognize it as seismically active. That stillness belied a more frightening truth: The pressure is building up. Rather than releasing it gradually and actively, like the San Andreas, the CSZ releases it all at once in massively destructive megaquakes. <\/p>\n\n\n\n

Based on current estimates, these megaquakes occur about every 243 years. The last one has been dated precisely to January of 1700. That\u2019s\u2026 320 years ago. You get the picture. I won\u2019t go into detail here, but you can read grim predictions of what\u2019s coming. Outside<\/em> magazine<\/a> devoted a feature to it in 2011. The New Yorker<\/em><\/a> in 2015. Vice<\/a><\/em> in 2016. The narrative structures differ but the basic story is always the same. The megaquake is coming and it\u2019s going to be very, very bad.<\/p>\n\n\n\n

Like many people living in the region, I read these stories when they were published. And like many of us, I haven\u2019t done enough to prepare. There\u2019s a suggestive parallel to COVID-19. Places with recent experience of respiratory disease outbreaks, particularly in Asia, knew to take it seriously and had plans in place for dealing with it. It\u2019s similar to how cities that experience minor earthquakes are more prepared for the big ones. In the case of the Cascadia subduction zone, we are not the places prepared for coronavirus like Taiwan or Hong Kong or Taiwan. We’re Italy or the US. If you live in the Pacific Northwest and are currently lamenting the hardship of missing events or scrambling to find toilet paper because of the current epidemic, start thinking about what you can do now to be ready for the next disaster. We can\u2019t say nobody warned us.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cYou\u2019re overreacting. Look at how many people die from the flu every year,\u201d my mom said. This was a couple weeks ago, and we were on the phone discussing my plans to visit home. My parents live in Houston, I live in Portland, Oregon, and my annual work trip to SXSW in Austin presented an […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-141","post","type-post","status-publish","format-standard","hentry","category-uncategorized","post-preview"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/posts\/141","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/comments?post=141"}],"version-history":[{"count":5,"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/posts\/141\/revisions"}],"predecessor-version":[{"id":148,"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/posts\/141\/revisions\/148"}],"wp:attachment":[{"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/media?parent=141"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/categories?post=141"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.jacobgrier.com\/blog\/wp-json\/wp\/v2\/tags?post=141"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}