Jan 28 2020
Given the continued spread of the Wuhan coronavirus, we urgently reached out to John Barry, author of the award-winning New York Times best-seller The Great Influenza: The Epic Story of the Deadliest Plague in History.
Two years ago, we interviewed John about the expected implications should a pandemic of similar scale break out in today world. Little did we realize at the time how quickly his insights would prove relevant.
John was the only non-scientist to serve on the US government’s Infectious Disease Board of Experts and has served on advisory boards for MIT’s Center for Engineering System Fundamentals and the Johns Hopkins Bloomberg School of Public Health. He has consulted on influenza preparedness and response to national security entities, the George W. Bush and Obama White Houses, state governments, and the private sector.
John remains quite concerned at how the world’s readiness for a pandemic is woefully lacking, exacerbated by the hyper-connectedness of our modern society (i.e., the ease and speed with with people can travel):
An often-overlooked part of the damage a virulent pandemic can do is its impact on supply chains and the economy.
If you’ve got 20 to 30% of your air traffic controllers sick at the same time, what’s that going to do to your economy?
Most of the power plants in the United States are still coal powered. They get their coal, most of them, from Wyoming. You see these enormous trains – that’s a highly skilled position, the engineers who move those trains which are a mile and a half long. Suppose they’re out. You’re not going to have power in many of the power plants.
These are things that we don’t automatically think of as relating to a pandemic. Even a mild one that makes a lot of people sick without killing them will wreak an economic impact.
In terms of the health care system, practically all of the antibiotics are imported. If you interrupt those supply chains then you start getting people dying from diseases that are unrelated to influenza that they would otherwise survive. We had a small example of that with saline solutions bags which were produced in Puerto Rico. Because of the hurricane, Puerto Rico was no longer producing them; so we had tremendous shortages in those bages after the hurricane. Other suppliers worldwide have picked up the slack, so that’s not a problem today.
But in a pandemic, you’re going to have supply chain issues like that simultaneously all over the world.
So you’re not going to be able to call on any reserve, anywhere, because everybody’s going to be in the same situation whether you talk about hypodermic needles or plastic gloves — any of that stuff. The supply chain issues in a moderate pandemic are a real problem. If you’ve got a severe pandemic, the hospitals can’t cope. There are many fewer hospital beds per capita than there used to be because everything has gotten more efficient. In this past year’s bad influenza season, many, many hospitals around the country were so overwhelmed they all but closed their emergency rooms and weren’t talking any more patients for any reason.
There’s just no slack in the system. What efficiency does is eliminate as much as possible what’s considered waste, but that waste is slack. And when you have a surge in something, you need that slack to take care of the surge. If I were grading generously I would give us a D in terms of overall preparedness. If we had a universal influenza vaccine, maybe we’d be relatively okay, but we don’t.
And while good data is scarce in these early days, what we do know so far about the coronavirus does not encourage him. If the virus is indeed as contagious as suspected, he sees no hope of containing it before it becomes widespread:
Understanding the incubation period is very, very important.
The critical question is: Can you infect someone else when you’ve been infected but don’t have any symptoms?
The Chinese have made statements that they think that’s the case. If that’s in fact true, then there’s no chance of controlling this.
Exacerbating things, when facing an influenza pandemic, you have to sustain anything that you’re doing to be successfully preventive. And that’s extremely difficult for a public health official to get the public to do; sustaining the right behaviour.
Unless you get in the habit of washing your hands all the time — and do it constantly, three, four, five days after you start doing it — you’re going to get tired of it. But that kind of behaviour has to be sustained to be effective.
I guess I’m a pessimist when it comes to changing human behaviour, even something as simple as handwashing — and good luck trying to prevent people from touching their mouth or eyes.
Even the “good” masks, like N95 respirators, have to be fitted almost perfectly for them to be effective. And they’re uncomfortable.
So for those who get sick, just stay home. It’s that simple.
That runs counter to American culture; you’re supposed to tough it out — you’re sick, you go into work. But in this case, that’s not useful. Employers should emphasize that to their employees:
If you’re sick, stay home.
Click the play button below to listen to Chris’ interview with John Barry (43m:34s).