Killers On The Loose

It's easy to get smug up here on top of the food chain. But nature finds chilling ways to remind us we're in constant battle with the most patient and opportunistic of foes: microscopic organisms. Witness pneumonic plague in India, flesh-eating strep, antibiotic-resistant tuberculosis in inner-city hospitals. Those are just the most recent gruesome threats.

It's fascinating how virulent organisms emerge and wreak havoc--not least because it usually has as much to do with politics, supposed progress, or even good intentions run amok as with biology, zoology, or virology. What do Idi Amin, super-absorbent tampons, missionary clinic nuns, a conservative U.S. administration, mouse feces on a Navajo reservation, and the building of the Aswan Dam have in common? They're all primary villains, directly or indirectly, in the spread of a slew of lethal epidemics. By reusing needles for vaccinations, for example, those well-intentioned missionaries have helped spread numerous killers, including HIV, in Africa.

Laurie Garrett's new work, The Coming Plague: Newly Emerging Diseases in a World Out of Balance, spells out these episodes in smart and comprehensive fashion. Title notwithstanding, the book is not about some terrifying new threat ready to pounce. Rather, it's an in-depth exploration of how recent epidemics emerged, often with the unwitting assistance of individuals, societies, and governments. It brings us up to date on how research into and battles against such scourges as AIDS, malaria, toxic shock syndrome, Legionnaires' disease, childhood ailments, and lethal African viruses such as Ebola and Marburg are going.

What Garrett does best is reveal the interconnectedness of diseases and the conditions that amplify them. A common problem is governments' almost criminal neglect of public-health surveillance and prevention--and it's not just an issue for the Third World. As Garrett notes, most of the childhood diseases that can be easily prevented by vaccination are on the rise in the U.S. because public-health budgets were decimated during the 1980s and public-health agencies are in disarray. According to Garrett, fewer than 1,500 children contracted measles in the U.S. in 1983. In 1990, 27,000 cases were reported, and 100 children died.

There's no denying that reading The Coming Plague, with more than 600 pages of text and an additional 100 pages of notes, is an endurance test. Garrett loosely drapes her work on the shoulders of a group of "disease cowboys"--international infectious-disease specialists who have traveled the world battling microbes for decades, often at great personal peril. Checking in with the "cowboys" as the book progresses provides a useful structure for exploring how we have learned about epidemics and the similarities among them. But it also means that Garrett jumps back and forth in discussing diseases and includes eclectic, irrelevant detail. That makes it difficult to use The Coming Plague as the kind of reference document that a work of this size and scope should be. It's downright dangerous to skim the book, in fact, because Garrett often fails to foreshadow that she'll be returning to a subject with more current information.

Also beckoning armchair epidemiologists is Richard Preston's far slimmer and more engrossing The Hot Zone. Preston focuses on the incredibly dangerous, or "hot," Ebola virus, an African microbe that kills 9 out of 10 victims by causing bleeding from every orifice and virtually melting down organs. In 1989, monkeys from an importing facility in Reston, Va., began dying of an agent that looked just like Ebola. That set off a top-secret operation by the U.S. Army to seal off and shut down the threat.

The Hot Zone originated as an article in The New Yorker, and it's no surprise a movie was in the works before the book was even published. Preston's opening, set in Africa, is spellbinding. Here is Frenchman Charles Monet, dying of Ebola on an airplane: "His blood is clotting up.... His personality is being wiped away by brain damage.... Tiny spots in his brain are liquefying. The higher functions of consciousness are winking out first...." No wonder that, as the cover blurb attests, Stephen King loves this book.

It soon becomes apparent, however, that Preston has concocted a suspenseful narrative of terrors that mostly prove unfounded. He anoints the people willing to combat these viruses as heroes, then dramatizes their personal challenges rather than exploring bigger, more relevant issues. But nearly every threat a character faces has to be debunked by the end of the book. Preston spends pages leading up to a kitchen-knife wound on the hand of a veterinarian that you think will be significant--but it isn't. He offers a lush description of the crystals, bat dung, and the occasional leopard inhabiting Kenya's fantastic Kitum Cave--then admits that only circumstantial evidence suggests it's the source of the dread virus. Worst of all, he finally reveals that for all the scariness of the Army's hush-hush assault on the "hot zone" (the Reston monkey house), the virus killing the monkeys wasn't Ebola--and was harmless to humans. Obviously, it's a relief that no one died of Ebola in Reston. But hanging a whole book on a triumph over imaginary threats and near-misses works better in fiction. Garrett, by contrast, never exploits her subject or unnecessarily inflames emotions.

The shared topic of these books is crucial for everyone to appreciate. On the one hand, evolution dictates that plagues will never stop, no matter what we do, since organisms constantly mutate. On the other, we know enough about what facilitates infectious disease to prevent a lot of it, especially through vaccination. Alas, in the absence of a crisis, governments grow complacent.

That can expose citizens to grave dangers. In fact, it's critical that governments keep in mind the many facets of infectious disease when evaluating the true cost of poverty, war, development, pirating resources from the rain forests, overcrowded prisons, and politically motivated public-health policies. Consider California voters' recent, overwhelming approval of Proposition 187, a measure that would, among other things, deny all but emergency medical care to illegal immigrants. Such withholding of vaccines er treatment is a virtual prescription for amplifying infectious diseases within the state.

And you? How worried should you be about your and your family's health? Garrett's discussion points to some obvious measures: Stay off the infection superhighways of sexual promiscuity and IV drug abuse. Follow instructions carefully when using antibiotics.

The scope of both books goes so far beyond the individual sphere, though, as to leave one feeling powerless. How can readers in developed nations affect the spread of cholera in the Third World? It's not about sending money or medicines. Absent more stable governments and more effective public-health strategies, they can't. Yet with each outbreak, the chance of the disease crossing borders grows. "While the human race battles itself, fighting over ever more crowded turf and scarcer resources, the advantage moves to the microbes' court," Garrett concludes. And thus dodging a killer microbe that evolves in or gets transported to an air conditioning duct, a city's water supply, or a crowded airplane becomes a matter of fate.