When I was in graduate school, four things happened at almost the same time (probably within a three year time frame, but who’s counting?) 1) The publication of The Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laurie Garrett (well, and my reading of the book); 2) the cultural phenomenon of “hot zone” movies and books, of which the most memorable is probably Outbreak starting Dustin Hoffman; and 3) the realization that a good part of the archaeology I was doing in the Congo was of villages that had been abandoned because a plague of some kind came along and killed enough people that everyone moved elsewhere, which is apparently a tradition in that area; and 4) the Zaire Ebola outbreak in Kikwit. Since I had been working in the area, I got involved, in a minor way, with some of the Ebola research, and I produced evidence for a model for the virus jumping from fuit bats to humans that turned out to be exactly what had happened about ten years later when the West African Ebola epidemic occurred.
This combination of things got me interested in both epidemiology and immunology, and I’ve been studying it (and teaching the topics) since then.
Do you remember the H1N1 pandemic of 2009? Compared to our current pandemic, it was minor. But it wasn’t nothing. There were a half million lab-confirmed cases, which is probably a fairly small percent of acutal cases, with the real number being up to 1.4 billion. The estimated death toll was well over a quarter of a million. My memories of that pandemic are sharp, because my son was born right in the middle of it. The Maternity Ward was on lock down. But, the vaccine was around and nobody in our extended family actually got sick.
Also at that time, epidemiologists and other infectious disease experts were doing a lot of talking-head work, and among them, was Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. (See for example: H1N1 could overwhelm U.S. in the next two months).
I remember at the time, or probably a year or two later, Osterholm was on a talk show with two or three other experts, including one who had written a recent definitive history of the 1918 pandemic. At one point, each of the experts had a chance to opine about the next version of such a pandemic. Interestingly, they were all fairly up beat. We have, after all, vaccines, something not really developed in 1918. And great doctors and medical ablities and stuff. There really can’t be another pandemic like 1918.
Then, Osterholm spoke. He said this: The next pandemic may be worse than 1918. It will be harder, not easier, to deal with. Yes, we will have a vaccine for the next pandemic virus, but it will take at least a year, maybe a couple of years, to get it. The virus will not wait. It will ravage our population. There will be, plain and simple, a major pandemic with no vaccine for it, for a very long time, many months at least. Meanwhile, the virus will be worse than 1918, because in 1918 we had far more hospital beds per person than we do now. Basic nursing, in a hospital, will be what will save lives, more so than fancy medical stuff.
We have transformed our medical system today to one in which people spend very little time in hospitals, and hospital stays have become something for the very sick or the very rich. Note that the first thing sane US states did (the ones run by Democratic governors, and a couple of others) when Covid-19 emerged was to figure out how to build out hospital capacity at lighting speed. That was because of Osterholm and a few of his colleagues, and their predictions of what would happen. The response plan was already in place, and has been for years. Something like this state level response was also in place at the federal level, until the Trump Crime Family dismantled it early in Trump’s term.
A bunch of smart people had studied past epidemics and pandemics. A bunch of smart people had studied epidemiology and immunology, and viruses. A bunch of smart people described what a pandemic would look like. All you had to do was to be one of the few people who happened, by chance or circumstance, to have read that literature and listened to those individuals, to remain today pretty much unsurprised by everything that has happened over the last year, and that will happen over the next year. Nobody knew the timing, but this one corner of science and public health knew this would happen, and what it would look like.
One thing none of these smart people expected was that the US would be taken over by a nefarious anti-science political party (Republicans) that would set us back decades in our ability to manage a pandemic, just when the big pandemic came along.
And, there is one other unexpected surprise, and this is surprisingly little talked about. The vaccines that are now being distributed are nothing like vaccines have ever been before. In fact, they only barely fit the definition of a vaccine. Vaccination normally involves introducing substances into the body that cause an immune reaction that doesn’t make you sick, or not too sick, but that cause the adaptive immune system to prepare for a future infection by a specific pathogen. The new RNA technology does not do that. Rather, it programs a few thousand cells in your body to produce a molecule that is the substance that causes the immune system to react. The vaccine factory is in your cells.
That is new.