Scary Disease of the Week: Influenza

And so we’ve arrived at the final disease, my choice of the #1 scariest infectious disease out there.

Avian flu, via Wikimedia Commons

#1 is Influenza. We haven’t seen a pandemic flu in North America in a while--long enough to have lost our collective fear of one. The 1950’s saw the last. There are many different influenza viruses, and some have a low fatality rate, less than 2%, and some have a much higher rate, 70%. In most cases, the elderly and children are most vulnerable.

I chose this disease for the pandemic in my thriller in part because most of us hardly think twice about it. The word “flu” doesn’t send us into a tizzy the way “Ebola” does. Some of us get the vaccine, but many do not. We’ve grown used to the annual talk about flu and vaccines and tend to tune it out, despite that this virus kills thousands or tens of thousands times the people as Ebola does every year.

The flu type I chose for my novel Crow Vector, HPAI (Highly Pathogenic Avian Influenza, H5N1), is frightening--not just to me, but to the experts. With a 69% fatality rate right now, even with treatment, and almost no capacity at all to create vaccines for it, if it explodes out of China and starts moving from person to person (rather than only bird to person, as it stands), we are all in deep trouble.

The flu generally kills via filling the lungs with fluid. While it has no brain damage beyond the usually temporary confusion we feel when we have a high fever, going from having to cough several times a day to gasping for air to needing a breathing tube before you die is something I’ve don’t want anyone to have to experience.

Because the killer version of the H5N1 virus has already been manipulated in the lab to make it able to pass easily from person to person, in the 2014 Rotterdam experiments and elsewhere, we know with 100% certainty that it’s weaponizable. Not only is it, those experiments made it clear to anyone with the will and technique exactly how to turn it into a human pandemic. So... yeah. Scary disease indeed.

1950's flu epidemic; patients overwhelming medical system

Obviously, that I thought it most frightening--most realistically frightening--is why I picked it for the novel.

And this concludes my six-part series on scary infectious diseases. Return to Part I to see some runners-up. For me these are the scariest five:

1. Influenza
2. Rabies
3. Hemorrhagic fevers
4. Botulism
5. Cruetzfeldt-Jakobs

Which disease scares you the most? Tell me in comments.

Scary Disease of the Week: Rabies

#2 Rabies. 100% fatal, and it’s a terrible way to die.

Rabies patient, 1959. CDC

Is there a vaccine? Yes. (I’ve had it twice myself.) Does it work? They really don’t know. (It’s not as if they’re going to ask a bunch of people to volunteer to take the vaccine and then infect them with rabies on purpose to make sure it worked. Not with that 100% fatality rate.)

And it certainly scores a full 10 points on my “symptoms involve the brain” scale. Terror, paranoia, and hallucinations are likely to plague you on the way to your inevitable death.

The one saving grace with this disease is its R nought, about 1.2. That is, if you have it, you’ll likely only infect one person, who will perhaps weeks later only infect one, and so on. Therefore, it’s unlikely to burst into pandemic status the way measles or MERS or the flu could. On the other hand, the infection of a group of animals could spread it locally to humans more rapidly. If every squirrel in Ontario, for instance, had it, and if they could pass it to pet cats allowed to run loose, there would be many more human cases as a result.

A diabolical person could manipulate it in the lab to become more pathogenic and then capture, infect, and release those squirrels. Because of the 100% fatality rate (exactly one person has recovered with treatment--though she still has serious and apparently permanent problems with balance--so it’s shy of that by the tiniest fraction of a percent), it’s on most biodefense programs’ list of potential weaponized diseases.

Rabies. Wikimedia Commons

And so we’re down to the final disease next week, my choice of the #1 scariest infectious disease out there.

Scary Disease of the Week: Hemorrhagic Fevers

#3 Viral hemorraghic fevers. Ebola, Marburg, Machupo, RVF, lassa, and a dozen more emerging diseases. If you’re only in your 20’s, expect to see many more discovered in your lifetime. 

Ebola outbreaks. Zach Orecchio via wikimedia commons

These diseases get a lot of press, and they seem to be #1 on most people's list of scary disease, despite the infections being rare. I suspect it’s the image of bleeding profusely (which doesn’t often happen, and not exactly the way it’s often fictionally presented), particularly from the eyes, that hits our “fear button.” The horrible part of the disease to me is the pain. As the organs are attacked and become spongy, there is reportedly terrible abdominal pain associated with that. You have a fever, you’re weak and sick, the whites of your eyes may get a few red streaks, but the pain in your gut is what pins you to the bed.

The fatality rates on these diseases range from a low of less than 5% to a high of 70%--similar to the range of flu fatality rates. Zaire Ebola (EBOV) has one of the highest mortality rates. The R nought--how many people get infected by one sick person--isn’t that bad, actually, particularly not in the countries where my readers live. The infections spreading more than that in Africa is related to funeral practices there. Nearly half the people who have died of it are health care workers, and of the rest, half are the women family members who traditionally prepare bodies for burial. If scientists can convince people to forgo their typical burial practices with the dead bodies, the R nought for Ebola drops to near 1. Viral hemorrhagic fevers can also be passed sexually, after recovery, for three to five months.

To be weaponized, you’d want to increase that aspect of the disease, making is pass more easily from person to person. Currently, with Ebola, sneezing pigs can infect people easily but sneezing people cannot. It wouldn't take much time in a lab to change that fact. Everything else about any one of these diseases is bad enough, but were you a terrorist, you’d want it to move easily through the air so that one sick person infected many. If you could change the most deadly hemorrhagic fever virus so that it had measles’s skill at jumping from person to person, you’d have a terrible weapon indeed.  

Lassa virus

Stay tuned for scary diseases of the week #2 and #1. Can you guess what they are?

Scary Disease of the Week: Botulism

A series of blog posts upon the occasion of the release of my pandemic thriller Crow Vector.

#4 Botulism.

Clostridium botulinum from Wikipedia

Until I researched various weaponizable diseases for my novel 41 Days, I didn’t know how bad this was. Now I have something new to be terrified of!

It isn’t new, of course. As a child I was told about it. Home-canned foods are the most frequent source in industrialized nations, though there is wound botulism too and rare cases of inhalation botulism with lab workers. Certain sorts of health-food eating make it more likely you’ll get this disease: home fermented foods, non-pasteurized fruit juices, and the like have never been proven by science to do you any good, and if you’re dead from botulism, they definitely didn’t do you any good.

It’s not transmissible in the same sense all of the other scary diseases I chose are. It’s from a bacteria, but it’s not the bacteria itself that infects you and directly makes you ill, as with the plague. It’s a waste product of the bacteria produced in anaerobic conditions that gets you: the botulism toxin.

The disease qualifies as scary because of how sick it makes you: blurred vision is often the earliest symptom, then nausea, vomiting, increasingly painful cramps, seizures, paralysis of the face, and eventually the paralysis spreads downward to your chest so that you can’t breathe.

In the 21st century, there are treatments, and as a result not even 5% of people with it will die in places like Canada and Australia and the U.S. But where people don’t have access to those treatment or are too poor to afford them, it's 50% of people: also scary. For my prepper fans who believe that one day a SHTF scenario actually will come to pass, I’m betting you’re not going to have a lot of botulism antitoxin on hand, so you’re back up to the 50% fatality rate in those circumstances. And you'll probably be canning food at home so be at increased risk anyway.

Furthermore, it is weaponizable, which also kicked up its scariness score to put it at #4 on my list. USAMRIID and other biodefense labs around the world think this is important enough that they are working on defenses against that possibility.

Stay tuned for scary diseases of the week #3, #2, and #1

Scary disease of the week: Creutzfeldt–Jakob

#5 on my countdown of terrifying diseases.

Creutzfeldt–Jakob disease. It’s rare, but it’s here--here meaning in the US, Canada, England, and Australia, where most of my readers reside.

It’s a prion disease. Prions are not amoebas, not viruses, not fungi, not bacteria, those being the usual agents that cause diseases. They’re something else, not even a form of life, and we can’t do a blessed thing about them yet.

It’s fatal. There’s no vaccine. There’s no treatment beyond pain pills and sedatives.

Worst of all, it’s not a good way to go. Because it in effect rots the brain, you have several stages of increasing dementia, hallucinations, muscle spasms, burning nerve pain, and eventually your brain won’t be able to tell you to breathe or swallow, which is what usually kills you.

Sometimes it comes from a genetic mutation. You can get it from eating animals that have it. (Don’t eat brains of any animal. I don’t care if you love their taste. Don’t risk it.) Cannibalism can spread it, so, er, avoid that too, in case you indulge right now. And you can get it from transfusions and transplants. Blood, transplanted corneas, and human growth hormone from infected people have spread it.

(Aside: my favorite discovery from my research for these posts was this line in Wikipedia: “In the U.S., the FDA has banned import of any donor sperm, motivated by a risk of Creutzfeldt–Jakob disease, inhibiting the once popular import of Scandinavian sperm.” Apparently, there was a Scandinavian sperm fad here that I totally missed???? Anyway...)

Stay tuned for Scary Diseases of the Week #4, 3, 2, and 1.

Scary disease of the week: introduction

Wikimedia commons

In my new novel, I make fun of “scary disease of the month reporting,” and yet here I am succumbing to the urge to do the same thing in this blog. Let me get that confession out of the way, and let me also remind both you and me that what kills people most is heart disease, COPD (both made much worse by smoking), diarrhea (in developing countries), and complications of diabetes. Among infection diseases, malaria is the biggest killer, but it’s not a disease that many of my readers have to think about. (It occurred naturally in Australia, particularly in the north, but y’all have worked hard to eradicate it.)

But even though the numbers give us that list, for some reason, it’s the emerging infectious diseases that capture our attention and frighten us. The blog posts in the following week pick five diseases that scare me plenty.

What makes a disease scary to me?

• It’s kills most of those who get it. Over a 50% fatality rate gets my attention
• On the way to killing me, it hurts me a lot or gives me dementia or nerve pain or other brain damage
• It’s out there, already near me, or could easily be
• There’s no way to prevent getting it
• Or it mutates so easily that the prevention currently available quits working
• There are no or treatments that work or the ones that do are limited in supply and expensive
• Its infection rate (called R0 or R nought, in epidemiology) is high, moving easily from sick Sue over there to healthy me
• A very bad person could use it in an act of bioterrorism

So here’s a rating chart I devised for my own use. I assigned points in every category from 1-10 to be as fair as possible in choosing my top five.

Those diseases that kill 100% got a 10, 70% got a 7, and so on. I went with the fatality rates with treatment in industrialized nations rather than its true fatality rate. As measles R nought runs around 20, most are under 10 so I gave it it’s median R nought score (if, on average, one sick person infects 4 others, it got a 4). “Crazify” is my neologism indicating the sort of torturous brain damage that scares me at least as much as physical pain and far more than bleeding out the eye sockets does. You might not feel the same about this issue, but that’s nightmare fuel to me. Imagine being paranoid, hallucinating, and demented, on top of the coughing or diarrhea. "It’s here!" means it is here in North America, something we could in fact catch right now. Usually that means it’s also in Australia and England, though not always. In one case, England has it worse than North America.

Diseases that are plenty scary but didn’t make my top five:

MERS. Terrible disease, a killer, no vaccine, but it’s still rare. You pretty much have to be in Saudi Arabia to get this and hang out with camels, or be a health care worker treating such people. It may be weaponizable though. Stay tuned to see what natural mutations and a spread to additional mammals might do to this one in your lifetime.

Measles. Worldwide, it’s a terrible killer, and the #1 easiest disease to pass along (it has the highest R nought). However, this disease is easily preventable with a vaccine. If you don’t vaccinate your children, there is no simple treatment and they have a good chance of dying. If enough people refuse to vaccinate, it’ll burst into epidemic status again in the developed world. 400 children die per day of it around the world as is. Enough people stop vaccinating, and that could jump to 4,000 or 40,000.

Smallpox. A nasty disease, very contagious, about 40% fatal, but except for some samples in labs, gone from the planet. This is not a promise on my part that some idiot won’t take those lab samples and start a pandemic again.

Naegleria fowleri, or the the brain-eating amoeba. Almost always fatal, not treatable, it scores high in my scary-brain-damage scale, and it’s here in North America, but you can’t catch it from the guy next to you on the bus. Not weaponizable and easily filtered out of city water supplies. But “brain-eating amoeba” isn’t a particularly comforting name, is it? (shudder)

Q Fever (Coxiella). I addressed this one in my novel 41 Days. It doesn’t kill now but it has a super-clever cellular trick that means if it ever was turned fatal by a terrorist manipulating the virus, or by Nature mutating it, it could be a real problem. All viruses are difficult or impossible to treat, and this one is no exception.

HIV. A killer, to be sure, but preventable and increasingly treatable (not curable, and the treatments have nasty side effects, but treatable). It is not potentially a pandemic, for it is already a pandemic. Pretty awful, but not awful enough to make it into the top five for me.

Pneumonic plague. Weaponizable and particular scary because you could wander around infecting others for a week before you got sick, scoring the maximum on the R nought scale, this can’t make the grade because it’s bacterial and almost any antibiotic will cure it...so far. (insert scary music cue) Get an antibiotic-resistant form of this one going, and we will have bad trouble.

Next week: Disease #5 on my personal list of scary infectious diseases for humans.

Pandemics and overpopulation

Does the idea of ebola terrify you? Hanta? Zika? AIDS? Do you ever stay up nights wondering if  100% fatal rabies might one day mutate so that it can be spread by a sneeze?

Do you ever wonder what is going on that so many new diseases have seemed to pop out of nowhere?

It may surprise you to know that scientists know very well why this is happening.

First, to get this out of the way, it IS happening. Unlike a public perception that there are more earthquakes than ever (there are not), which is driven largely by having more forms of media to see reports on them, this event is real. More and more deadly pathogens are appearing all the time and jumping to humans...and killing some of us.

Why?

In the end, it all comes down to one factor, human overpopulation.

Habitat loss, climate change, and the eating of new sources of wild meat to survive all contribute. Habitats become smaller and migration routes are cut off, stranding species or pushing them into more contact with humans. The animals themselves, stressed by habitat loss have greater susceptibility to disease. Furthermore, when you put several different sorts of mammals--including humans--close together, diseases can more easily jump across species and mutate with the jump.

Animals that once controlled insects that carry diseases, like mosquitoes or ticks, are being driven to extinction. We might not have known that some little critter kept us safe from a terrible disease, but it did, and generally we only find this is so when it is too late to regain the animal population needed to help us.

Add to this accidental transfer of animal and insect life via international shipping (container shipping is an ecological disaster all by itself), as we in the US, Canada, and Australia import cheap goods from China, and you have a disaster that has been in the making for decades. You think it's scary now? It's just at its beginning. If you’re young, you’re going to be hearing about literally hundreds more killer diseases like Ebola before you die--hopefully of old age, rather than of one of these.

The solutions in the short term are complex. Many brilliant people are working at them.

The personal solutions you could implement are simple to list, even though it’s nearly impossible to convince people to implement them. I know I risk offending you by being blunt, but I will be blunt.

• don’t have more than two children. We all play a part in overpopulation--or its sensible control. If you dearly want a big family, adopt children 3-X.
• don’t buy goods from other countries. “Shop locally” ends up being the right answer not just for the economic health of your community and nation, but for the protection of yourself and your children from emerging disease
• educate yourself about products that cause the worst environmental degradation, and don’t buy them. Two simple changes that you could begin with as you shop next at the grocery store: Eat chicken and domestically farmed fish, rather than beef and pork. Avoid all products with “palm oil” as an ingredient

This isn’t merely some liberal hippie-dippie concept, to save endangered species and shop locally and think about overpopulation and not be wasteful of energy. As a species, we’ve been committing collective suicide. And, as individuals, we can stop doing so.

I hope you never have to look down at a hospital bed and see your child or grandchild die of something like West Nile, but if you do, and you are calling out to God “Why?”...the first place you need to look is in the mirror. Did you do everything you could at a personal level to stop the mounting disaster from happening? Or did you roll your eyes and turn away?

I’ll be blogging about diseases for a month or two, in conjunction with the release of my new pandemic thriller, Crow Vector. I’ve read thousands of pages in research for writing it, and I have a good deal of scary stuff to tell you about.

Crow Vector now available for pre-order

The disease they’ve been preparing for...the pandemic they’ve been dreading.

A mystery disease strikes a family in New Jersey. Epidemiologist Glenn Stevens is assigned to lead the investigation. People are dying, drowning in fluid filling their lungs, and no medical treatment can save them.

As the fatalities skyrocket and each of his attempts to halt the spread of the disease fails, Glenn knows that the world will soon be in terrible trouble. The lab rushes to identify the pathogen, and Glenn gets shocking news: this is no natural disease mutation.

Someone is out there, working in the shadows, a man who plans to make the already dire situation even worse. Now it is Glenn’s job to find him and stop him.

The clock is ticking. And a billion lives hang in the balance.

Research on emerging epidemic diseases

I am writing a novel about a pandemic, and the research for it has been fascinating and terrifying.

As people continue to overpopulate the Earth, we come into contact with animals who have been harboring diseases for possibly thousands of years, but those diseases might do the hosts no or little harm. But when we catch these diseases, they can kill us. (In a few cases, like cholera, what we see as a pathogen had a beneficial effect to its host.) People are afraid of bioterrorism...but the truth is, we don't need to be afraid of a "them" giving us diseases, for we are doing pretty darned well at doing that to ourselves.

For instance, with Machupo, a South American hemorrhagic fever, it was cutting down forests to plant monoculture farms (monoculture, the planting of a single crop, exacerbates this problem everywhere) to sell in town, when the traditional ways they made a living were taken from them. This put people in contact with mice who carried the disease and who found their way into villages they'd never before visited. The act of the morning sweeping of the home, which sends pulverized mouse droppings into the air, can infect people.With some diseases, when that infected person goes to town, he passes it on to a dozen other people, and eventually an infected person will get on an airplane, and the disease can move around the globe in a day.

It's happening in the U.S. and Australia too, so we can't think it's some sort of thing that only occurs in South America or Africa. Our own overpopulation is putting us close to animals that carry "new" diseases. (New to us, at least.) As we drive more delicate birds to extinction, opportunist birds like crows, robins, pigeons (here in North America) take over, and their droppings or saliva get on our things. We might wash our car or mow our yard and get the disease. Or a mosquito might bite a crow and bite us, and now we're ill. West Nile Virus is such a disease, carried in some crows.

You hear people sneering and saying, "Why should I care about the extinction of some damned owl?" So here's another reason to care. Because we're finding out more and more that some of these endangered animals controlled a pest, or kept an infected species in balance. So for those who can only think selfishly, that's why you'd care. Because you don't want to die by drowning in your own fluids, or crapping yourself to the point of dehydrating yourself to death, or by bleeding out of your eyeballs, which could well be the eventual punishment for such a cavalier attitude about the balance of nature.

Why should you care about saving the wetlands? Same reason. It provides a home for species that might be controlling a disease we don't even yet know is out there. When you're watching a grandchild die of one of those diseases, and you learn this is the case, might you not feel ashamed of your sneering about "save the wetlands" campaigns? (Probably not, I fear. People who do a lot of sneering at good works tend to never look in the mirror and admit wrongdoing and responsibility for their own tragedies.)

Mother Nature is full of dangers, but that's no reason to hate Nature and try to wreck eons-long balances she has developed. To save ourselves, and our children, we need to tread more carefully. We need to begin by practicing zero population growth, personally. For those who can afford to eat organic, local food grown at farms that produce several crops, that ameliorates the problem, too. Factory and feedlot meats, with the antibiotic overuse, contribute to antibiotic resistance to bacterial disease, so if you can afford antibiotic-free meat, buy that.

And when the day comes--and I guarantee you it will--that a killer pandemic is sweeping across the land, and the CDC (or the equivalent in your nation) says, "Stay home. Wear a mask. Wash your hands," do that, and without whining.

And think long and hard before you get on an airplane. If it's for a vacation, I'll bet you there are pleasant places to visit within driving distance, where the only diseases you are breathing in are the ones your family might already have.