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Pandemic: Tracking Contagions, from Cholera to Ebola and Beyond Hardcover – February 16, 2016
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Praise for Pandemic
"Shah's book should be required reading." ―The New York Review of Books
"The world’s ability to put the lid on pandemics has come a long way since the days when the plague, cholera and smallpox ravaged unchecked. Ms Shah’s book is a superbly written account of how we got here and what might await us." ―The Economist
"[Shah] has succeeded in producing a lively, rigorously researched and highly informative read." ―The Wall Street Journal
“Investigative science journalist Shah (The Fever, 2011) is at it again, and if the words, and beyond, in her latest book’s subtitle don’t grab a reader’s attention, they should . . . Yes, Shah is back and in rare form. And this time it’s personal.”―Donna Chavez, Booklist (starred review)
“Shrewdly articulated . . . thought-provoking and well-documented” ―Nature Microbiology
“[A] grounded, bracingly intelligent study” ―Nature
“Shah proves a disquieting Virgil, guiding us through the hells ruled by [infectious diseases] . . . the power of Shah's account lies in her ability to track simultaneously the multiple dimensions of the public-health crises we are facing.” ―The Chicago Tribune
“In this absorbing, complex, and ominous look at the dangers posed by pathogens in our daily lives, science journalist Shah (The Fever) cautions that there are no easy solutions . . . Shah’s warning is certainly troubling, and this important medical and social history is worthy of attention―and action." ―Publishers Weekly
Praise for The Fever
“An often rollicking read . . . Shah has put together an engrossing cast of doctors, malariologists and historical figures.” ―TIM MORRISON, Time
“Sonia Shah ’s tour-de-force history of malaria will convince you that the real sound track to our collective fate [is] the syncopated whine-slap, whine-slap of man and mosquito duking it out over the eons.” ―ABIGAIL ZUGER , M . D ., The New York Times
“This insightful book explores the human struggle with malaria not just from a scientific angle, which is cogently detailed without being overwhelming, but also from sociological and anthropological perspectives . . . Shah is to be commended.” ―DENNIS ROSEN, The Boston Globe
“The lessons of history should give us pause . . . Many [issues] are brilliantly exposed in Ms. Shah’s book .” ― W. F . B YNUM, The Wall Street Journal
“Meticulously researched and passionately written . . . One of this year ’s most significant science books for the general reader.” ―DAVID WALTON, The Plain Dealer (Cleveland)
“A fascinating history . . . Insightful, even revelatory.” ―WENDY ORENT , The New Republic
About the Author
Sonia Shah is a science journalist and prizewinning author. Her writing on science, politics, and human rights has appeared in The New York Times, The Wall Street Journal, Foreign Affairs, Scientific American, and elsewhere, and she has been featured on Radiolab, Fresh Air, and TED.com, where her talk “Three Reasons We Still Haven’t Gotten Rid of Malaria” has been viewed by more than a million people around the world. Her 2010 book The Fever was long-listed for the Royal Society’s Winton Prize for Science Books.
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A note here before I continue. I am in upper management of a mosquito control district, so I am quite informed about mosquito disease issues that are problematic here in the United States. With that said, some issues with her research include her information on West Nile virus and dengue in Florida.
Her discussion of West Nile virus early in the book is a mixture of fact and conjecture. No one is really sure how West Nile first got started in this country (in Queens, New York), but most experts believe that the most likely scenario was either mosquitoes that hitch hiked aboard commercial airline flights, cargo flights or it was introduced through the illegal trade in rare and exotic birds.
The author makes the claim that the disease had probably been introduced by way of migratory birds along the Atlantic flyway. The big problem is that, while these birds do get together during the summer in the Arctic, their migration routes take them over New York as the mosquitoes that can transmit West Nile (Culex sps.) are heading into winter hibernation. In addition, the birds most susceptible to West Nile are not birds found along this flyway. Birds that summer in the Arctic are geese, ducks, etc. and they are very resistant to this virus. It is pretty uncommon to find the virus in their blood, and if it is, it is at a very low threshold. Crows and other corvids, which are heavily affected y the disease and are the reservoir for it don't winter there and commute south, making this an unlikely method of transmission.
Her treatment of the dengue outbreak in South Florida is also riddled with inaccuracies. Yes, there were a number of abandoned pools in the housing meltdown at about the time of the dengue outbreak. And, swimming pools were allowed to go "green", which means the water turns fetid. Her claim that they are out of sight of mosquito control experts is ludicrous, however. Most mosquito control districts use either images from satellites or aerial photography. The "green" pools stand out like a sore thumb and the districts can them treat them. In addition, neighbors tend to squeal when there is a large influx of mosquitoes.
What makes this a particularly erroneous section, however, is that the species of mosquito that likes to breed in fetid water is the Culex sps., which can transmit West Nile disease and a number of other disease, but cannot transmit dengue. That requires the Aedes sps. which has been present in South Florida (and a lot of the rest of the country) for years. That particular type mosquito hates fetid water and likes to breed in containers, tires and other places where clean rainwater collects. In a roundabout way, the foreclosure crisis may have been to partially to blame, but not because of the swimming pools, but rather because people being evicted tend to leave junk on the property, such as tires, old pots and containers.
The dengue outbreak was likely caused by a lot of factors, including weather, but also by the arrival of infected people into the South Florida region. Dengue is endemic in numerous Caribbean islands, as well as most of Central and South America. If visitors to the country that were infected with dengue came in the right numbers, the disease would flourish.
Finally, she chastises the scientific community for not searching for new diseases more quickly. And while that may sound valid, remember that there are thousands, if not millions, of diseases living in animals around the world that have not spread to humans. The majority of time spent looking for new diseases in a given area is spent looking for diseases known to be transmitted to man and to cause death and disablement A good example would be the Zika virus now making the news. This was first identified decades ago in Africa, but it never caused any harm to humans, so it was ignored. It was only when it started to appear in South America that humans became seriously impacted. Now it is on the watch list and testing is being done to locate it.
Overall, I think she tried to write a valid book, but entered into areas where she had no expertise and failed to consult specialists in those fields. It is one thing to read papers on disease, but another to talk to someone who works with it day in and day out. An expert can give you the consesnus science pretty quickly, but you need to read a lot of different papers to find a good mix of information.
My recommendation would be to pass this over. There are other, better books out there, and given the problems found by me and others with expertise, it makes me question all of the science in the book..
A balanced view of contagious disease
Thanks to alarmist reporting, Americans are terrified that hemorrhagic diseases such as Ebola will “break out” and kill us by the millions. Shah patiently explains that much more common diseases are far more likely to pose threats to us, influenza and cholera in particular. A series of unfortunate mutations in either one could fashion a disease that is not just virulent (contagious) but also highly lethal. Today, for example, influenza kills only a small proportion of its victims. We tend to regard it more as a nuisance for most of us, a threat only to those who are most vulnerable. However, the “Spanish flu” (the H1N1 virus) that broke out in the final days of World War I infected up to 500 million people (between a fifth and a third of the world’s population) and killed between 50 and 100 million. Epidemiologists live in fear that H1N1 or one of the countless other varieties of influenza incubating in Southern China could put on a repeat performance — or worse. Cholera poses a similar threat.
Sanitation, Hippocratic medicine, and Christianity
One of the most fascinating passages in Pandemic is Shah’s account of the role of Christianity in fostering infectious disease for more than a thousand years.
History shows us that two thousand years ago the Romans piped clean drinking water to their cities through an elaborate system of aqueducts and made public baths available to one and all. Cleanliness was a virtue to them. That all began to change with the advent of Christianity a few centuries into the Common Era. Unlike the Jews and (later) the Muslims, Christian clergy disdained personal hygiene, associating it with Roman polytheism and viewing cleanliness as superstitious. It was common for Catholic priests and the Protestant pastors who succeeded them in some parts to discourage their flocks from bathing. For many centuries, the vast majority of people in Christian lands lived side-by-side with their animals atop pits filled with excrement and cooked with smelly water drawn from contaminated streams or wells.
When disease struck, as it did with increasing frequency as population grew and gravitated toward the cities, the physicians who purported to combat it were in the thrall of the Hippocratic school of medicine, which attributed all disease to an imbalance in the four “humors” within the body and in external factors that exacerbated it. For example, cholera, which sickened hundreds of millions through the centuries and killed half of them, was blamed on the inhalation of what the ancient physician Galen termed “miasmas” (offensive smells). The nineteenth-century physicians who practiced medical “science” based on these beliefs “increased [cholera’s] death toll from 50 to 70 percent.” Though the germ theory of disease was first proposed in the sixteenth century, it wasn’t until three centuries later, on the cusp of the twentieth century, that practicing physicians began to accept the role of microorganisms in causing disease.
Meanwhile, progress toward improved sanitation and the availability of clean drinking water was even slower. As Shah explains in chilling detail, the construction of London’s sewer system was not prompted because public health officials understood that water used for drinking and washing was dangerously contaminated. The reason they proposed the effort was that they thought it was essential to pipe all the smelly sewage into the Thames, the source of the city’s drinking water! Only in the twentieth century did it become common for municipalities to regard drinkable water as a necessity of life.
Why is contagious disease more of a threat today than ever before?
In Pandemic, Shah describes the role of contemporary trends in making the threat of epidemic disease greater than ever. Five stand out: climate change, continuing urbanization, ever more accessible global transportation, resistance to vaccines, and the encroachment of development on previously virgin lands, especially in sub-Saharan Africa, South and Southeast Asia, and the Amazon. The result is that an increasing number of unknown and unpredictable new tropical diseases is emerging and making their way into more and more crowded cities further and further north on the globe. All the while, diseases previously thought conquered, such as polio and measles, rise up in communities around the globe.
About the author
The daughter of Indian immigrants, Sonia Shah is an American investigative journalist who has reported from around the world, principally on corporate power and gender inequality. Pandemic is her sixth book. Though her parents are both physicians and she lives with a molecular biologist, it appears that the impetus for writing this book came from a painful personal experience with MRSA (methicillin-resistant Staphylococcus aureus), which she contracted from her son. Shah describes her eye-opening experience at length in Pandemic.
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