In a press conference, World Health Organization Director-General Tan Desai said, “Although the prevention of epidemics in many countries has been effective, the spread of new crown epidemics is actually accelerating worldwide, and the darkest hour is far from being reached.” With the epidemic looming, what are the thousands of years of entanglement between humans and microbes? What are the historical precedents? In her nonfiction work The Coming Plague, published back in 1994, American journalist Laurie Garrett noted, “Microbes are mankind’s arch-enemies, and they didn’t go away just because science invented medicine, antibiotics and vaccines.” Later, in his preface to the Chinese edition of the book in 2006, Garrett again emphasized that in the context of globalization, national borders are increasingly difficult to separate people from each other, and that in the event of an epidemic, few countries can remain immune, and that countries must work together to prevent the resurgence of viruses. Garrett’s fears proved to be well-founded, and we are still emboldened and inspired to reread this forward-thinking work in 2020.
Breaking disciplinary boundaries, The Looming Plague is a detailed account in 12 chapters of the multidimensional game that humans have been playing for a century against diseases such as plague, leprosy, smallpox, Bolivian hemorrhagic fever, tuberculosis, Lassa fever, Ebola, swine flu, AIDS, and Legionnaires’ disease. The first six chapters of the book are organized around different diseases individually, while the last six chapters are centered on several hot topics of contemporary scholarship. By depicting representative figures, important events, and environmental backgrounds in the development of each epidemic, combined with extensive data analysis, Garrett brings the often tedious and arduous scientific process to life in the form of a story, while exploring the complex cause-and-effect relationships among various factors under the epidemic. It is easy to see that many infectious disease outbreaks have certain commonalities, the most landmark of which is the human experience of fighting three of the most dangerous germ infections: bacterial infections, AIDS and SARS, which can be said to be the three wake-up calls for humanity by microorganisms. In addition to the evolution of the diseases, Garrett summarizes and reflects on the responses to each of them, and in this light, he presents his recommendations for the future development of public health and his concerns for the fate of humanity.
From a chronological perspective, bacterial infectious diseases such as scarlet fever, meningitis, gonorrhea, cholera, and diphtheria remained fatal to people from the mid-19th century to the early 20th century. Although certain microorganisms were known to be responsible, the theoretical basis and technical means available to scholars at the time were limited to the elimination of germs, and the proven medical value of antibiotics in the 1940s made it easy to cure many of the previously deadly diseases. The discovery of organochlorine chemicals (commonly used to synthesize pesticides and insecticides) in the 1950s led to a blind optimism that would lead to the conquest of the microscopic world and the total eradication of disease. Only a few scientists were concerned about this at the time. In the decades that followed, the ill effects of over-optimism became apparent: excessive spraying of insecticides led to bioconcentration, soil and water pollution, and the misuse of antibiotics led to the discovery of a new, highly drug-resistant tuberculosis bacterium in South Africa in 2006, which in turn led to cancer, genetic lesions, and other problems that are still difficult today.
It is worth noting that Garrett documents the blind confidence and over-optimism that characterized mankind’s triumph over disease. For example, the book mentions that in the first half of the 20th century, the Soviet Union, Eastern Europe and other government departments were convinced that through vaccination, pest control, germ eradication and chemical pharmaceuticals, mankind would eventually usher in a disease-free and brilliant 21st century. The U.S. Departments of Health and Education and Welfare held seminars to discuss the future of public health against the backdrop of increased human control over nature. In retrospect, such slightly comical arguments are in stark contrast to the well-known subsequent reality, adding to the reader’s reading pleasure while serving as a warning to future generations.
Unknown to us, although humans have the absolute upper hand in the game with microorganisms, and the threat of microbial disease no longer exists for the time being, we ignore the technological and cognitive progress, while microorganisms are gradually evolving to adapt to new environments, and the speed of human scientific research is much slower than the speed of microbial change, which is one of the reasons for the recurrence of historical tragedies.
Another nightmare in the history of human infectious disease struggle is AIDS, and to this day mankind has not been able to overcome this death spell. In several chapters, Garrett mentions the history of the discovery of AIDS and reflections on the response, and the future prevention and control situation is one of Garrett’s greatest concerns, which shows its unique position in the history of infectious diseases. Since the first case of AIDS was discovered in the United States in the early 1980s, progress in prevention and control has been extremely difficult, and progress in treatment and drug research has been slow. The virus has spread at a remarkable rate, and while people are still caught in a war of words, the virus has been making its way around the world without moving.
In Garrett’s writing, AIDS can be described as a very dramatic virus, the “dystopia” of viruses. Garrett devotes considerable space to detailing the exploration of clinical symptoms and pathological mechanisms of AIDS by different scholars in different periods of time, and by quoting the research reports of Curran and other scholars and digging deeper into the growth experience of individual cases, he truly restores the difficulties of researchers at that time. Garrett’s visually striking portrayal of the various stages of the patient’s physical appearance narrates how a young man in the prime of life is reduced to a frail, dying man just months after the onset of the disease, eventually dying of Pneumocystis carinii pneumonia. This grotesque contrast is dramatic and adds a touch of fiction to the story, as it brings the fear of AIDS to life. Garrett points out that the main reason for the failure to prevent and control AIDS in a timely manner did not come from the technical level; biochemistry was already well established at the time, and it took only two or three years to identify the basic elements of epidemiology, such as disease types and pathways. Even if it was not clear how the pathological mechanism worked, this basic knowledge was enough to cut off some of the transmission routes. The problem is that this new epidemic involves many sensitive factors: sexual orientation, ethics, morality, politics, human rights, equality, race, freedom, religion, and so on. People were often held hostage by public opinion, making it difficult to view the disease objectively, and patients were often discriminated against and ostracized, without access to appropriate treatment. In addition, the globalization trend at the time was beginning to emerge, and the frequent movement of people was like adding fuel to the fire, making the spread of infectious diseases uncontrollable.
It took several generations of scientists to figure out how HIV could kill people, but the corresponding treatment is still being explored, although this catastrophe has highlighted the importance of immunity in reverse. Combined with other studies from the same period, experts generally agree that the human immune system is the strongest armor in the face of an unknown epidemic until a way is found to deal with irreversible damage to the immune system. The establishment of this concept contributed to a certain extent to the concern about “subhealth” and paved the way for the subsequent “fitness fever”. The ideal state of infectious disease prevention and control is to prevent and treat the disease before it happens.
SARS is one of the most far-reaching infectious diseases after the Spanish pandemic, and its outbreak once again pushed the construction of public health to a new height. 2003, SARS attacked, with a high death rate, multiple transmission routes, no specific drugs, widespread susceptibility of the population, a dense urban population and a surge in population movement near the Spring Festival, and a pandemic was slowly approaching.
In the face of disagreement and conflict, the macrocosm and the microcosm seem to have some kind of subtle tacit understanding. Garrett writes in her book, “In the world of microbes, war is constant, and a necessary condition for the survival of most organisms is the death of other organisms.” But she also mentions an interesting phenomenon: “In the world of microbes, there are also rare joint actions, when they pause for infighting to deal with a common enemy. They swap genes, build on their strengths to counter the threat of antibiotics, and thus parasitize more comfortably.” How is this not true of humans? Many disputes were eventually settled by war, and after all the sailing and sinking and pitching, there was still war. from 1971 to 1980, Uganda experienced a military coup, the Ugandan war, a financial deficit, and many other crises. The severe famine that followed caused Ugandans to feed on wild animals such as hippos, elephants, monkeys and antelopes. According to Garrett’s account, it was during this period that there were massive outbreaks of malaria, leprosy, tuberculosis, cholera, measles, black fever, Ebola, Marburg, Congo hemorrhagic fever, and other epidemics with African hosts in Uganda. In 1978, the Alma-Ata Declaration, which redefined “health” and included it as a fundamental human right, was born at a meeting of 130 health ministers of the WHO. In the old days, containing virulent infectious diseases was a bloody affair, basically waiting for all the sick and diseased animals to die, unless they miraculously healed themselves. Each tragic pandemic was a bloodbath to emphasize the importance of “win-win cooperation and joint prevention and control”.
SARS swept through the world, not only giving a blow to the 21st century and forcing people to look back at the blood and tears of those who were almost forgotten, but SARS is also the first coronavirus that is globally prevalent and is an infectious disease that has the ability to affect countries in important areas such as politics, economy and diplomacy. According to past experience, in the face of unknown diseases, there is no specific drug, and cutting off the transmission chain through geo-isolation is still the most effective means of prevention and control. However, this is undoubtedly a major test for cross-sector and cross-cultural cooperation.
Hegel once predicted, “The only lesson mankind learns from history is that mankind never learns from history.” Back to the present time, when we look at the global rampage of the New Coronavirus, we cannot help but feel sad: the epidemic knows no borders, life is not important, the virus does not know human feelings, and science does not know the world. The concept of a community of human destiny is also being challenged. We may seek to position ourselves in the “community” or be forced to distance ourselves from it, but it is urgent that we need to reconstruct our understanding of the epidemic, simply because no one can be a winner in the silent battlefield of the microcosm, and the approaching epidemic has sounded the global alarm, and the bell It is a long shot.