Blog | Wednesday, June 26, 2013

Pandemics, and humans as 'part of the main'

Life is stressful enough without anticipating the next great pandemic. There is the inevitable turmoil in the Middle East, North Korea's nuclear program, cancer-causing genes, the risk of calling your organization something that will make the IRS go through your underwear drawer, and doubts about the right amount of salt to eat. Really, that ought to be enough! We just don't need pandemic influenza or a new coronavirus to keep our adrenal glands stimulated.

But need them or not, folks, they are out there. And since we do, perennially, have plenty to worry about, it won't help much to add new worries to the list. But it might help a whole lot if we skipped worry altogether, and went directly to work. It might help a whole lot if forewarned produced collective responses that led more reliably toward forearmed. The basic requirement here, other than the allocation of some resources to support public health, is a willingness to think of ourselves in a context larger than ourselves. We'll come back to that.

First, a brief orientation to two of the more imminent threats about which we should not worry, but for which we should prepare.

The first is a new variant of avian influenza, H7N9. We have been fussing about pandemic flu for some years now, and have watched bird flu and swine flu contenders come and go without recent global catastrophe. That's great, and let's hope the trend continues, but dodging bullets for a while should not cause anyone to think that bullets are reliably innocuous. Only one needs to hit you.

The new flu strain has thus far infected only relatively few people, and only in isolated areas in China. But the mortality rate appears very high. The virus is different enough from recent flu strains that our immune systems would likely be caught largely unprepared by it were it to circulate globally. Those are the hallmarks of a pandemic threat. It doesn't mean this is the bullet we won't dodge; it just means it could be.

The coronavirus in the Persian Gulf seems to be a new infection in humans. Like the current avian flu strain, it has infected few people, and only in one part of the world. But it, too, has thus far killed a high percentage of those infected. I was in commentary on these topics, some of which has recently graced the pages of the New York Times, has placed an emphasis on inter-species transmission of germs. As noted, the new flu strain is avian, meaning it incubates in birds, poultry specifically in this case, before humans get involved.

The coronavirus, which has thus far infected fewer than 100 in the Persian Gulf region, but killed 55% of those infected, almost certainly originates in animals as well. A variety of bat is a prominent suspect at present.

The transmission of pathogens from animals to humans, either directly or through the intermediacy of other animals, produces zoonoses: human diseases of animal origin. Most of the great outbreaks of the modern era involve this mechanism. It is almost certainly true of HIV, and we know it to be true of influenza, including the infamous pandemic of 1918.

Various factors contribute to this risk. An ever-growing human population, our crowding into the last few enclaves of wild species, is an important issue, discussed too seldom and addressed too feebly. Our various assaults on the planet and climate are forces favoring genetic change in all species struggling to adapt, and in some cases, those adaptations may come at our peril. If nothing else, climate change invites the spread of microbes to areas from which cooler temperatures once barred them.

The world is ever smaller. Flu strains incubating in China can be in New York or Los Angeles or Washington, D.C., in the span of a day. This is a world in which an incurable bacterial disease, spread by a tiny insect native to Asia, decimates the citrus crop in Florida.

The concept that we, the planet, and all other species are in this together has a name: One Health. The One Health movement emphasizes the need to monitor the places where people and wild and domestic animals interact as potential sites of new human perils, and the need to manage ecosystems in ways that preserve their native health and balance. The movement, catalyzed a decade ago in large part by my friend and colleague, veterinarian Dr. Steve Osofsky, and his colleagues at the Wildlife Conservation Society, also emphasizes the importance of critical support for public health, including surveillance for emerging diseases, because we can either pay a bit now, or pay dearly later. And there is, of course, attention to the relentless growth of the human population as well.

We speak as if humans are somehow separate from all else: There is natural, and "man-made." But we are, inescapably, part of the main. We can pretend we are not all in this together. We can pretend there is us, and them. We can pretend that what we do to the planet will not come back to haunt us. We can pretend that there is space on earth for continued growth of the human population. We can pretend that the ills of other species are not our problem.

But reality is asserting itself ever more ominously. The only real defense we have against the looming perils is an end to all the pretense. For there is just one health, and there is just one game, and everyone's skin is in it.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.