January 28th, 2020
by Jane M. Orient, M.D.
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Clusters of a dozen or so deaths may get nonstop “if-it-bleeds-it-leads” press coverage. But the lack of preparedness for the really, really big threats may be met with virtual radio silence—until panic breaks out.
The worst, possibly existential, threat is the stealthy, invisible one that multiplies exponentially—in the accurate sense of the term: 400 cases today, 800 tomorrow, then 1600, 3200, 6400, 128000, 256000, 512000, and 1.024 million after only eight doubling times. Biological threats proliferate—until they run out of susceptible victims.
In 1918, the great influenza pandemic killed as many people in 11 months as the medieval Black Death did in 4 years. Ultimately, at least 50 million may have perished. Young healthy people, especially young soldiers headed off to the front in World War I, succumbed quickly. To avoid interfering with the war effort, the U.S. government denied and covered up the threat, preventing the implementation of public health measures.
Since then, the world has gotten smaller. A virus that jumps the species barrier from animals to humans in a meat market in China can cross the Pacific in hours. And despite the expenditure of $80 billion on a National Biologic Defense, the U.S. is arguably no better prepared than it was in 1918, state Steven Hatfill, M.D., and coauthors in their new book Three Seconds until Midnight.
As in1918, we lack a vaccine or wonder drugs, but must rely on non-pharmaceutical interventions (NPI), and on public health authorities to track and try to contain the spread of infection. More
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