A Deadly Outbreak in Africa

In Kenya, an Ebola-like pathogen has infected two Americans. One lies at death's door. With the clock ticking, teams from the CDC, WHO, and Kenyan Ministry of Health rush the scene. What they find in the remote village is beyond their worst fears.

Dr. Peyton Shaw, the CDC's leading epidemiologist, works tirelessly to trace the origin of the pathogen. But with each passing hour, she begins to believe that there is more to this outbreak — that it may be merely the opening act in a conspiracy with far reaching consequences.

Q & A with the Infectiously Interesting A.G. Riddle

Q: Okay, I finished Pandemic a few days ago. I really enjoyed it, but frankly I'm still freaked out. How plausible is a global pandemic? PS: I need you to say not very.

A: First, thanks for supplying both question and answer - that's always incredibly helpful. The good news is that by the time you hear about a global pandemic, you're likely already infected.

Q: Wait. That does not make me feel better.

A: Excellent. Your fear and preparedness may save your life one day.

One of my goals with Pandemic was to raise awareness of just how vulnerable we are to a pandemic in the developed world. I also wanted to showcase the work of epidemiologists and public health workers who put their lives at risk every day. They are the reason we've gone so long without a major pandemic that kills millions. To me, they're the heroes of Pandemic. Sadly, their real-life exploits are rarely reported. Let's face it, if we knew, we'd be even more frightened.

Q: So you're saying this could happen?

A: I would say that I hope it doesn't, but history and statistics are not on our side. Since prehistoric times, we’ve fought a constant battle against infectious diseases. Consider a passage from Dr. Peyton Shaw in the novel (all of the following is factual):

In the third century, the Antonine Plague wiped out a third of Europe’s population. And just when population levels were recovering, the Plague of Justinian in the sixth century killed almost half of all Europeans; up to fifty million people died from what we believe was bubonic plague.

In the 1340s, the Plague once again remade Europe, forever changing the course of world history. At that time, we believe the world population was around 450 million. The Black Death killed at least 75 million. Some estimates go as high as 200 million. Imagine, in the span of four years between twenty and fifty percent of the world population dying.

Europe, because of its large cities, population density, and advanced trade routes, has repeatedly been a hotbed for pandemics. But it is not alone.

The image switched to a picture of Spanish conquistadors meeting indigenous tribes at a shoreline, their wooden ships anchored in a bay behind them.

Consider the New World when Europeans arrived. We’ve heard so much about the plight of native peoples in the present-day United States, but consider the populations of New Spain, present-day Mexico. In 1520, smallpox killed nearly eight million. Twenty-five years later, a mysterious viral hemorrhagic fever killed fifteen million — roughly eighty percent of their population at the time. Imagine that: a mysterious illness killing eight out of every ten people. In America, that would be over 240 million people. It’s unthinkable, but it happened, right here in North America, less than five hundred years ago. We still haven’t identified the pathogen that decimated Mexico in the sixteenth century, but we do know it returned twenty years later, in 1576, following two years of drought. It killed another two million from the already decimated population. To this day, we still have very few clues about what caused that pandemic. Most importantly, we don’t know if or when it will return.

The image changed to a black-and-white photo of a field hospital with rows of iron single beds holding patients covered by wool blankets.

1918. The Spanish Flu. Or, as it’s more recently known, the 1918 Flu Epidemic. Less than one hundred years ago. Estimates are that one in every three people around the world contracted the pathogen. It killed one in five people who fell ill with the disease. As many as fifty million died. We think twenty-five million died in the first six months of the outbreak.

Human history has a repeating theme: we battle pandemics, we lose, we die, it burns itself out, and we rebuild. We always come out the other side stronger. Humanity marches on.

But today, we are more connected than ever before. Our population is four times larger than it was at the time of the last major global pandemic in 1918. We’re more urbanized. We’re disturbing more animal habitats. Most concerning, we are disturbing habitats where reservoir hosts for extremely deadly diseases reside. Fruit bats, rats, squirrels, fowl, and other hosts for zoonotic diseases are coming into contact with humans with greater frequency.

Q: Still not feeling totally reassured here. Give it to me straight: how do I survive when the big one happens?

A: Your best chance of survival is to avoid infection. That may be nearly impossible if the pathogen is airborne and capable of surviving on hard surfaces (fomites) for a meaningful amount of time. It will be even more difficult if you live in an urban area and if those infected are asymptomatic and contagious during the early stages of infection. Carriers could be all around you - for days before you even know the pandemic has begun.

Treatment is an even greater challenge. The novel depicts a new, Ebola-like viral hemorrhagic fever with a high mortality rate. There's no viable treatment. In those scenarios the best healthcare providers can do is to treat secondary infections and provide palliative care. Dehydration is a serious concern.

Tracing the spread and containing the pathogen becomes the key to ending such a pandemic. That's why we see cordon sanitaires established in places where a new disease has been identified.

Our best hope of surviving a pandemic is early identification and a fast, coordinated response from government. The book details some of these early warning systems. GPHIN, for example, monitors data from health agencies as well as social media--Facebook, Twitter, Instagram - and looks for patterns of a new outbreak emerging. It identified SARS and MERS early, saving countless lives.

Q: Let's back up. How does a pandemic get started?

A: Probably with animals.

Q: Like the monkey in the movie Outbreak?

A: It's actually a lot like that. Animals all around us carry viruses and bacteria that don’t harm them, but wreak havoc on our bodies. These zoonotic diseases are a huge problem in the developing world and to a lesser extent everywhere else. Scientists estimate that over 60% of known infectious diseases in people are spread from animals, and 75% of new or emerging infectious diseases in people are spread from animals.

We believe that African fruit bats harbor the Ebola virus--they're natural reservoir hosts. When the fruit bats come into contact with humans (in caves for example), they transmit the Ebola virus; in fact, that’s how we believe many Ebola outbreaks have begun. Field mice harbor hanta-viruses and lassa fever. Black rats, prairie dogs, chipmunks and squirrels are capable of carrying bubonic plague. Ticks carry Rocky Mountain spotted fever. And there’s perhaps the best known example: rabies in raccoons, skunks, foxes and bats. We believe HIV was a zoonotic disease transmitted to humans in the early part of the 20th century, though it has now evolved to become a separate human-only disease.

Q: This is now officially the scariest book interview I’ve ever done. Let’s get back to the story. And you have got to stop scaring me.

Pandemics seem to feature in all of your previous books. How is this novel different?

A: My past novels like The Atlantis Gene, The Atlantis Plague, and Departure take place before and after a massive pandemic. With this new novel, I wanted to take readers inside what a real-life response to a global pandemic might look like, to show the outbreak from the perspective of those infected and those working to stop it.

I spent over two years researching and writing the book. Getting the details as close as fiction would allow was important to me. And of course, my first priority was to tell a good story that makes folks forget about life for a while.