In 1918, just six years after “The Scarlet Plague” was published in
London Magazine, the deadly Spanish flu pandemic struck humanity. (The disease got its name not because it originated in Spain but simply because reporters were free to describe its dread effects there. In order to maintain morale, wartime censors suppressed early reports of the illness in the nations fighting World War I. At the time, therefore, it seemed as if neutral Spain had been particularly badly affected.) The H1N1 influenza virus circulating in the period January 1918 to December 1920 infected half a billion people around the globe and killed as many as 100 million people—five percent of the human population. Flu deaths far exceeded the number killed in four years of battle. The disease struck everywhere, from the Arctic to isolated islands in the Pacific. In some communities the impact was so terrible survivors decided it would be best to never talk about it—to pretend, as it were, that this grim event had simply not happened.
Spanish flu was merely the most recent of large-scale pandemics; infectious disease has attacked humankind throughout history. Bubonic plague has been responsible for the most notable pandemics. The first recorded outbreak was the Plague of Justinian (541–542), which struck the Byzantine Empire. Historians estimate that 25 million people died of the plague—less than the number of fatalities caused by Spanish flu, but the total population was much smaller back in Roman times. The Plague of Justinian killed about 13% of the world’s population. The plague returned over the following two centuries, killing a further 25 million people.
The second major outbreak of plague began with the Black Death in 1347. The disease made numerous returns over the following three centuries. The Black Death was one of the most devastating events in human history: it killed between 75 and 200 million people. The dead were placed in ditches and then isolated; in some towns and villages there weren’t enough living to bury the dead. (Figure
shows an example of a plague pit.) The world population did not recover to pre-Black Death levels until the seventeenth century. Many historians argue that the devastation unleashed by this pandemic had a significant impact on the course of European history: the labour shortages it caused accelerated several economic, social, and technical developments, and might even have helped introduce the Renaissance.
These are believed to be the skulls and bones of people who succumbed to the plague, although usually in such cases skeletons are found in some semblance of order. The bodies of these unfortunates were dumped in a brick-built pit (Credit: Wellcome Collection gallery)
So we know pandemics occur. It’s entirely possible—even probable—that a destructive flu pandemic will strike again. And it’s not hard to imagine how a mutation in one of the viral hemorrhagic fevers—Ebola, say, or the Marburg virus—could lead to a disease causing widespread suffering. Therefore the basic premise of “The Scarlet Plague” is not unrealistic. But Jack London was writing more than a century ago. Although elements of his story were prescient (for example, he guessed a global population of eight billion people by 2010—not bad), science and technology have advanced to a level he could scarcely have imagined. Suppose a disease such as the scarlet plague did break out, and let’s assume it was as lethal as, say, Spanish flu. Would our modern civilization collapse in the way London suggests?
This is not an easy question to answer.
On the one hand, as I write, the world population is about 7.6 billion. A large fraction of the population is mobile to an extent that would have astonished Jack London. In the past, disease travelled from continent to continent at the speed of sailing boats. Nowadays, if people develop a disease in Beijing, say, they can carry it to Berlin within hours. This combination of a large pool of people in which disease can develop with the rapid, large-scale movement of people mean infections can be transmitted more efficiently than ever before. Furthermore, the threats posed by viruses and bacteria are always evolving. The flu virus, for example, changes constantly. One type of change is a gradual “drift” in genetic make-up that leads, over time, to a virus our immune system fails to recognise even if we have previously been exposed to a similar virus. (This is one of the reasons why flu vaccine effectiveness is so hit-and-miss: the vaccine must be reformulated every year, based on an informed guess about which strains are likely to cause most suffering in the coming year.) Another type of change is an abrupt “shift” in genetic make-up, caused by a random mutation. When this happens, the possibility of a pandemic occurs: most people will possess no immune protection against the new virus. In short, if the microbial world is our enemy then we face a crafty foe. We might well choose to think of microbes as a threat to our civilisation.
On the other hand, our understanding of medicine in general and of public health in particular are vastly more advanced than in London’s day. Furthermore, information can travel even more quickly than people. These advances help mitigate the threat of pandemic disease. Consider, for example, the case of SARS. Between November 2002 and July 2003, a viral disease causing flu-like symptoms caused 774 deaths in China and neighbouring countries. The disease, which was given the name Severe Acute Respiratory Syndrome (SARS for short) was new and it was dangerous—it had a 9.6% fatality rate. There was no vaccine against SARS; there isn’t one now. Nevertheless, the dire threat posed to our civilisation by SARS did not materialise. The rapid response of public health authorities, at national and international level, broke the chain of transmission. Since 2004, no case of SARS has been reported anywhere in the world.
Or consider the case of the swine flu outbreak of 2009. A new strain of the H1N1 virus (see Fig.
) began circulating and, since H1N1 caused the dreadful Spanish flu pandemic, it’s no surprise that individuals and organisations were worried. Fortunately, the virus that caused swine flu was about one hundred times less lethal than the 1918 virus. Even if that had not been the case, I suspect the outcome of the 2009 pandemic would have been less severe than what happened in 1918. For one thing, doctors could prescribe antiviral medicines—the antivirals weren’t hugely successful, but they were better than nothing. More importantly, the public health response was rapid. My own university was soon covered with posters explaining how to slow the transmission of the disease. Some of those posters are still to be found; they are fading, now, but they still provide basic but effective hygiene advice. Furthermore, although it turned out not to be needed, organisations developed business continuity plans. In my own university, these continuity plans involved teaching online if a pandemic caused students to stay away from lecture theatres. (In 1665, the University of Cambridge closed down because of pandemic. In this case it was a precaution against the Great Plague, the last major outbreak of bubonic plague in England. Cambridge was unable to offer online learning back in 1665, but that turned out not to be a hindrance for Isaac Newton. During enforced private study at his home in Woolsthorpe he developed optics, calculus, and the law of universal gravitation!)
A transmission electron micrograph (see Chapter
) of the H1N1 influenza virus, which was responsible for the 2009 swine flu outbreak. An H1N1 virus caused the much more deadly Spanish flu outbreak of 1918 (Credit: C.S. Goldsmith and A. Balish, Centers for Disease Control and Prevention) 11
I’m writing this almost exactly one hundred years after the doctors observed the first cases of Spanish flu. For an entire century, humans have managed to avoid a widespread outbreak of contagious disease. So it’s tempting to conclude that although technological developments might promote a pandemic they also provide us with tools to help prevent a pandemic. It’s comforting to suppose that our science, technology, and medicine will avert the disaster envisaged in “The Scarlet Plague”.
Our knowledge might well save us. But only a fool would be complacent.
Humanity faces a growing threat from bacteria—a self-inflicted threat we could ward off if people would only act rationally. The menace stems from the misuse of our most effective weapon against bacteria.
People are naturally enamoured of antibiotics. Patients demand, and often receive, antibiotics as a treatment for colds, sore throats, earaches… even in cases where doctors know antibiotics won’t work. Antibiotics are used in crop production, as pesticides, or to treat disease in plants. Antibiotics are given to animals as freely as they are given to humans—vets use them to treat disease while farmers use them to promote growth. We live in a world awash with antibiotics. The problem? Well, in order to survive in this antibiotic-filled environment bacteria have evolved resistance. Some bacteria are now resistant to all known antibiotics.
A world without effective antibiotics is a terrifying prospect. Many routine medical interventions we now take for granted—appendix operations, hip replacements, transplant surgery—would be dangerous: patients might survive the knife but succumb to infection. We’d face the same risks people faced before 1928, when Alexander Fleming discovered penicillin. Worse, though, is that possibility of pandemic.
Consider the plague. The disease is caused by the bacterium
Yersinia pestis. When this pestilence stalked our ancestors the prognosis was poor for anyone infected: chances were high the sufferer would die a horrible death. Antibiotics changed the story. The plague infects people to this day, but nowadays if patients are given streptomycin quickly enough then the chances are high they’ll survive. So if a strain of Yersinia pestis evolves resistance to all antibiotics then doctors—and, more to the point, patients—will be in trouble. It’s a similar story with many other infectious diseases.
Science and medicine might have provided us with tools to help prevent a pandemic, but we’re letting one of our best tools get rusty.
Black death, Spanish flu, or something along the lines of the scarlet plague—another pandemic will surely happen eventually. When it comes, though, we’ll at least have the comfort of knowing the pandemic agent won’t be
trying to kill us. Some bacteria and viruses cause us harm, but that’s just a byproduct of their life cycle. It’s nothing personal. As mentioned in Chapter , however, advances in biotechnology will soon permit a group or even an individual to 2 design a microbial agent that’s intended to kill. The terrorist, or perhaps merely the misogynist, will have the ability to target disease at specific groups—males, females, the pre-pubescent, those possessing too much or too little skin melanin. And an engineered pandemic could be designed to kill more effectively than the natural variety.
Consider the West African Ebola epidemic of 2013–2016. According to official statistics the virus caused 11,310 deaths. This was a shocking outbreak, of course, but in some ways the virus killed too effectively for its own good. Symptoms became obvious between 2 and 21 days after exposure to the virus, and this led to a method of containment and control. Anyone who was in contact with a patient was tracked for 21 days; communities were made aware of risk factors and preventative measures; and quarantines were put in place. Roughly 900 days after the first case was diagnosed, the epidemic was over. But the single-minded bioterrorist could
engineer an infectious agent in such a way that obvious countermeasures would be ineffective. The agent, for example, might be airborne and easily transmitted through the simple act of breathing. It might establish itself in its host whilst producing no symptoms. After a long latency period it could be “switched on”—and death would follow for all those infected.
SF writers have long imagined something along these lines. In a 1982 novel, for example, Frank Herbert’s titular “white plague” was designed by a molecular biologist. The biologist, driven insane by the death of his wife and children in a car bomb, desires revenge—so he develops a deadly plague, which is carried by men but kills only women. In his 1997 novel
The Cobra Event, Richard Preston has an antagonist called Archimedes release a genetically engineered virus (called “Cobra”)—a fusion of the common cold and smallpox viruses—which results in a horrifying disease called brainpox. (Preston is the author of the non-fiction book The Hot Zone, which gives a well written account of the viral haemorrhagic fevers.) In Paulo Bacigalupi’s award-winning 2009 novel The Windup Girl, large corporations release bioengineered plagues that attack crops—a lucrative activity if you possess plague-resistant seeds.
White plague, Cobra, bioengineered attack genes… these nightmares remain science fictional. The knowledge and techniques needed to realise them don’t exist yet. But, as described in the commentary to the previous chapter, the rate of progress in biotechnology is astounding. In a few years there’ll be research labs possessing the knowledge necessary to create a deadly life form from scratch; a few years later those same techniques will be available to undergraduates.
Such technology is so dangerous it presents an existential risk. Should we not therefore police it, in the same way we police other existential risks? After all, the world has managed to avoid a nuclear catastrophe by cooperating at the international level to limit the spread of the technology that permits the construction of hydrogen bombs. Unfortunately, nuclear non-proliferation techniques won’t work in the case of bioterrorism. The construction of a nuclear arsenal can’t easily be hidden from view—the resources of a nation state are required to build a hydrogen bomb—and so the activity can in principle be monitored. But one day soon a small terrorist cell working quietly in a garden shed might be able to engineer a virus using only a few test tubes. How could society possibly police that situation? The human race can survive natural pandemics: there have been many in our past and there’ll be more in our future. But could humanity survive an
If a pandemic, natural or artificial, did wipe out humanity, what might Earth be like without us? Following London, it’s interesting to speculate. Many of our buildings would likely soon vanish under the onslaught of wind, rain, and vegetation; roads would crack and bridges would collapse; a few constructions—the Channel Tunnel, for example—might last much longer. But eventually, most traces of humanity’s time on this planet would be erased. Perhaps after a few tens of millions of years—the same sort of timescale separating us from the dinosaurs—evolution might produce another intelligent species. Would all traces of the achievements we so value be dissolved by the passage of time? Or would such a species be able to find evidence that humans once walked the Earth?
If some future intelligence was indeed able to infer the existence of a bipedal creature, which chose to dig up fossilized carbon and transform it into plastics and a source of power, then we’d surely seem bizarre to them. But would we seem as bizarre as the creatures depicted in Chapter