August 26, 2020

In the movie San Andreas: Dwayne Johnson faces the Big One

In California when we talk about “The Big One” we mean only one thing: the overwhelming displacement of the San Andreas Fault that will reshape Southern California. Epidemiologists talk about a different kind of earthquake. When they talk about “The Big One” they mean a sweeping pandemic that will reshape humanity. The sources I’ve seen agree on two things. It’s not a matter of if, but when. And it will probably be the flu.

So I’m curious. Why is a devastating pandemic so inevitable? Why did experts think it would be the flu? And, underlying these questions, is the question that comes up at the beginning of any earthquake: is this the Big One?

The case for a major pandemic is put forth in books like Spillover by David Quammen and Deadliest Enemy by Michael Osterholm and Mark Olshaker. The three arguments I find most convincing are: population growth, increasing contact between humans and animals, and worldwide trade and travel. Let’s look at these one by one:

  1. Population growth: People have been around for a long time, but only recently have there been so many of us. For example, 1900: about 800 million people. 1960: 3 billion. Now: around 7.6 billion. (67-68)
  2. Contact between humans and animals: Several drivers. Humans are continuously moving into new habitats for housing and farming. The populations of animals raised for food like chickens and pigs has risen exponentially, with more people working around them breathing the same air, touching the same surfaces. Plus more wild animals are being brought live into markets to be sold as food.
  3. Travel and trade: Think of the full airplanes bringing people to attend conferences, visit family, take a vacation, and then coming home with hugs and souvenirs. Cruise ships, freighters.

Osterholm adds in broader factors such as climate change and degree of international conflict/coooperation which are relevant variables, certainly, but difficult to measure.

Factor 2 above deals with the source of new pathogenic viruses. A virus in a friendly environment replicates rapidly and carelessly, falling around in the dust and air and excrement of, say, a chicken farm. Once in a while the replication results in a mutation that can multiply in a nearby animal, say a human. Maybe that’s a dead end for that virus. But a virus does nothing but multiply and when enough replications and recombinations enable it to spread from one human to another, the virus has found a new home. Diseases that spread from animals to humans are called zoonotic.

In Spillover, Quammen talks about the spread of disease from animals to people. He stresses that zoonoses come from things we are doing, not things that happen to us. (Consider the three arguments above.) In his opinion, “The Next Big One could very well be flu.” (503). Osterholm thinks so too–he has a whole chapter on how the influenza pandemic will unfold, which sounds eerily familiar these days. In addition, I’ve been watching the Great Courses lectures on infectious diseases given by Barry C. Fox, M.D. from the University of Wisconsin. In the last lecture he goes systematically through pandemic possibilities, and–you guessed it–flu.

Keep in mind that all these sources were written before we had COVID-19. Moreover, we ourselves don’t know whether this pandemic is The Big One. It probably won’t be The Last One, and for all we know The Next One may actually be the flu.

Why is the flu so suited to be the really big pandemic? After all, when we first learned about the coronavirus 8 months ago people found it reassuring to shrug it off and say that it was “just a flu.” So why do the experts take flu seriously?

  1. It has the capacity to spread fast.
  2. It has a short incubation period and high mortality rate. The 1918 flu killed 50 million people.
  3. There is still no universal vaccine and no dependable treatment.
  4. Its high rate of mutation and reassortment produces new subtypes all the time.

For example, Influenza A can mutate its hemagglutinin (H) 16 ways and its neuraminidase (N) 9 ways (do the math), producing new subtypes like H5N1, or bird flu, which emerged in 1997 and has now spread throughout the world via wild birds and chickens. When it infects humans it has a one-third fatality rate, but so far it has not been able to spread from one human to another. (Spillover, 508-509).

Nathan Wolfe, author of The Viral Storm, doesn’t make a specific prediction. Instead he says, “We need resilient systems that don’t assume the next threat will be influenza or SARS or whatever the au courant infectious disease happens to be.” Absolutely.

Every time there’s a sizable earthquake we are reminded to make sure we have water, food, batteries, and a plan in place for next time. Because whether or not it’s The Big One, we know it’s not The Last One.

Today’s Notable Headlines

“12 million have lost employer-sponsored health insurance during pandemic,” CBS News, August 26, 2020. https://www.cbsnews.com/news/health-insurance-coronavirus-pandemic-12-million-lost-employer-sponsored/

“C.D.C. Changes Testing Guidance to Exclude People Without Covid-19 Symptoms, Worrying Experts,” New York Times, August 26, 2020. https://www.nytimes.com/2020/08/25/world/covid-19-coronavirus.html

“Further coronavirus heart impact discovered; new clues to why women fare better than men,” Reuters, August 26, 2020. https://www.reuters.com/article/us-health-coronavirus-science/further-coronavirus-heart-impact-discovered-new-clues-to-why-women-fare-better-than-men-idUSKBN25M2JM


David Quammen, Spillover: Animal Infections and the Next Human Pandemic, W.W.Norton & Co., New York, 2012.

Michael  T. Osterholm and Mark Olshaker, Deadliest Enemy: Our War Against Killer Germs, Little, Brown Spark, New York, 2017. Preface to 2020 on coronavirus,  edition, 2020.

Nathan Wolfe, The Viral Storm: The Dawn of a New Pandemic Age, St. Martin’s Griffin, 2012.

Infectious Disease, Great Courses, Barry C. Fox, M.D.

Why am I doing this?

The coronavirus pandemic will be indelibly written on our memories just as the Great Depression or the Battle of Britain left their mark on past generations. It is my intention to journal the events of these days from three perspectives: as a retired medical technologist, a historian (Ph.D., 2014), and an ordinary person living through an extraordinary crisis.

You are on History’s Edge.

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