Pandemic- a book review

If you like history, current events, medical science, or just want to be more knowledgeable about why we should be concerned about infections , antibiotic resistance and vaccine phobia, you should read this book.

update July 25, 2020

When I read and reviewed this book almost 4 years ago, I thought it was only for historical interest. I never imagined you and I would live during and hopefully through a pandemic. I now know that assumption was false; this COVID-19 pandemic is not over, and even when it is, it likely will not be the last.

The world has now spent the majority of this year dealing with a COVID-19 pandemic producing grim statistics.

  • Almost 16 million confirmed cases world wide
  • 640,000 deaths worldwide
  • 4 million cases in the United States
  • Close to 150,000 deaths in the United States
source: Johns Hopkins Coronavirus Resource Center

Pandemic by Sonia Shah

Sonia Shah is a science journalist, not a scientist or physician, who has built a career  writing about medical science. She explains the “what”  of her book in the subtitle-

Tracking contagions from cholera, to Ebola, and beyond

And she answers the “why” in the introduction-

“By telling the stories of new pathogens through the lens of a historical pandemic, I could show both how new pathogens emerge and spread, and how a pathogen that had used the same pathways had already caused a pandemic.”

What is a pandemic?

Let me back up and define some terms. (And tell you this post uses affiliate links for your convenience and to fund this blog’s mission)

Pathogen– any disease producing agent, but especially referring to a living  microscopic organism, such as a virus, bacteria, or  parasite; this includes the organisms that cause Lyme disease, Ebola, West Nile, HIV, bird flu, even the common cold

Pandemic– a disease outbreak that spreads throughout a country, continent, or the world, as opposed to an epidemic, which is localized.

map of the world
In a pandemic, an infectious disease may spread all around the world.

With current focus on chronic diseases like heart disease, diabetes, cancer, and dementia, physicians and patients can get lulled into thinking that infectious disease has been conquered and no long a serious medical threat. This book reminded me that is not the case.

Cholera- a historic pandemic

Ms. Shah recounts the history of cholera, which has caused epidemics on every continent except Antarctica, focussing on the epidemics which devastated London, New York City, and more recently Haiti.

Cholera is little known in the United States now, but in the past it has been deadly both here and throughout the world. Cholera, an infection due to a bacteria Vibrio cholerae causes severe uncontrollable diarrhea which quickly renders its victims helpless, dehydrated and critically ill. The bacteria lives in and is spread by contaminated water, but for many years physicians did not know this; and even when some doctors proposed this as the method of spread, others refused to believe it. Thus the opportunity to control it and prevent thousands of deaths was delayed .

bacteria under the microscope
photo of the Vibrio cholera bacteria under a microscope; used courtesy of CDC/ Dr. William A. Clark
How pandemics spread

The author explains how cholera and other infectious diseases cause so much human suffering by detailing “How disease spreads” in these  chapter titles

Locomotion– Humans and pathogens travelling from place to place spreads disease.

Filth-Waste management and in some cases mis-management, leads to contamination of drinking water by human waste.

Crowds-People living in crowded slums creates perfect conditions to spread disease person to person.

Corruption– Public officials and business people who place profit and power above public health.

Blame No one willing to take responsibility for making hard choices, and too willing to blame someone else.

Ms. Shah uses examples from her personal life, like her annual family trips to India to visit relatives who lived in less than clean and sanitary neighborhoods. She also shares her and her sons’ battle with skin infections due to  MRSA, a form of staph (staphylococcal) that is resistant to many antibiotics and can be difficult to eradicate.

Pandemic includes extensive footnotes and a glossary of terms used in the book.

If you like history, current events, medical science, or just want to be more knowledgeable about why we should be concerned about infections , antibiotic resistance and vaccine phobia, you should read this book.

Other resources that address  the risk of global spread of infections.

For a visual lesson on how pandemics occur, watch this video.Warning: it is rather graphic. 

“How Pandemics Spread”
created by Mark Honigsbaum and animated by Patrick Blower 
When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed
by Howard Markel

“Medical historian and pediatrician Howard Markel, author of Quarantine! tells the story of six epidemics that broke out during the two great waves of immigration to the United States—from 1880 through 1924, and from 1965 to the present—and shows how federal legislation closed the gates to newcomers for almost forty-one years out of fear that these new people would alter the social, political, economic, and even genetic face of the nation.”  (quote from Goodreads)

Dr. Larry Brilliant talks pandemics

Lawrence “Larry” Brilliant is an American epidemiologist, technologist, philanthropist, and author, notable for his 1973 – 1976 work with the World Health Organization, helping to successfully eradicate smallpox.

In this recent TED interview, he discusses COVID-19 , how we’re doing so far, where we’re going, and what we should do to get there

a book by Dr. Brilliant

Sometimes Brilliant: The Impossible Adventure of a Spiritual Seeker and Visionary Physician Who Helped Conquer the Worst Disease in History

Exploring the HEART of pandemics

Dr. Aletha
before you leave, take a look at this post

Why COVID-19 and other infections are not “just a virus”

Unless you haven’t listened to any news for the past 8 weeks, you are well aware of the “challenge” the whole world has been confronting over what some do call “just a virus”; and you know that it has caused much critical illness and death, leading to “public” and private anxiety.

Call 911, it’s an emergency! or is it?

To patients, an emergency is any medical condition which 

is new, unexpected, worse than usual, uncontrolled, of unknown origin, not responding to treatment, not going away and interrupts normal life.

However, to physicians and other health care personnel, the definition of an emergency is specific.

An emergent medical condition is one that

  • Threatens life
  • Threatens one or more limbs
  • Threatens vision/hearing/speech/mental function/ function of any major internal organ or organ system
  • Has the potential, if not treated promptly, to cause death or long term and/or permanent harm.
Minutes matter with heart emergencies
Minutes matter with heart emergencies

Some examples of conditions that meet this definition are

  • Acute changes in heart function, like a myocardial infarction (heart attack), arrhythmia (abnormal heart rate or rhythm) or congestive failure (poor pumping capacity)
  • Acute brain conditions including stroke, head trauma, seizure, psychosis
  • Pulmonary (lung) dysfunction including pulmonary embolus (blood clot), severe pneumonia, asthma or COPD
  • Multiple trauma , including large burns or trauma to any major organ
  • Significant changes in components of the blood; for example high blood sugar, low blood potassium, low platelets
  • Severe depression

When should you suspect any of these conditions?

The SYMPTOMS of an emergency  include

  • Shortness of breath, or difficulty breathing, especially if not associated with exertion
  • Uncontrollable bleeding
  • A seizure, especially in a person with no previous diagnosis of seizures
  • Sudden or severe loss or difficulty with vision, hearing , speech, or other functions such as swallowing, thinking, walking, passing urine or stool
  • Fainting, passing out, loss of consciousness
  • Hallucinations, confusion, thoughts or threats of harm to self or others
  • In a pregnant woman- any of the above plus loss of fetal movement

You notice that I did not list PAIN and FEVER. Even though these are symptoms that concern patients the most, BY THEMSELVES they do not define an  emergent condition. However, if they occur with any of the other symptoms, or are severe, then it is reasonable to call it an emergency.

The COVID-19 pandemic presented some unique challenges in emergency room use, I discuss those in this article.

Chest pain must always be taken seriously, even if mild.

Although in persons under 40 years old it is less likely due to a heart attack, there are other life threatening conditions that can occur in this age group. Again, especially if it is associated with any of the other symptoms, it is emergent.

While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; our medical team members took care of the injury right on the clinic site, and he recovered without permanent damage
While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; a local surgeon was working with our medical team , and with their help he sutured the wound at the small rural church where we were holding clinic; his leg has healed well, just a scar to remind us of the adventure.

So assuming it is an emergency, what do you do now? You do not call your doctor’s office or answering service, your mother, your best friend, or post a question on social media (which I have seen done!)

IN AN EMERGENCY  CALL 911!

Helicopters transport of emergency patients can make the difference between life and death.

If it’s not an emergency but is urgent, then the next best options are calling your doctor’s office or going to an urgent care clinic. Posting on social media is still a bad choice. Do you really want your “friends” giving you medical advice about something they know nothing about?

Now, some doctors may disagree with this- but I think it is acceptable to go to an emergency room for problems that are serious but not emergencies. Since an emergency center is staffed 24/7, it should be utilized; there’s no reason to waste our health care resources. And sometimes it may be your only choice- if your doctor’s office is closed or the schedule full, if you are away from home, or you don’t have a primary care physician.

Just be aware if you go to an emergency room instead of an office, clinic or urgent care facility you may

Hospital sign- 5 miles to help.

That brings me to my final point. There are

10 Things to Know Before Your Next Visit to the Emergency Department

that Dr. Kristin Prentiss Ott and I want you to know. She is an emergency physician who knows exactly what an emergency is . In my career I have worked in ERs so I can attest to the accuracy of what she writes. I hope you never need to go to an emergency room, but if you do, keep her advice in mind.

Helicopter landing at a hospital to deliver a critically ill person.

exploring the HEART of emergency medical care

Dr. Aletha