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A review by lpm100
The Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laurie Garrett
5.0
Book Review
The Coming Plague
5/5 stars
"A lengthy rampage through infectious diseases and microbial ecology."
*******
Dynamics of the book:
-621 pages/ 17 chapters≈ 37 pps/chapter. (Range per chapter from 17 to 109 pages.)
-1326 references (2.1/page)
-Reading time≈20 hours (the small print and longer pages made this book feel like reading ≈1200 pps)
*******
I would have to say that the book has stood the test of time, because it is replete with resonances to things that are happening in the current times--And in that way, almost every single one of the 621 pages was needful.
17.5% of the length of the book (109 pps) is about HIV/AIDS, and in that way it's a suitably brief recapitulation of Randy Shilts' "And The Band Played On," with some inclusion of germane points that were not even mentioned in his book.
Lots of good thoughts in this book, and it is so long that I will have to try to reduce it to some number of general principles that work forward and backward in time. (And it would have to be that way because there are SO many names and different narrative arcs that it is impossible to keep all of them straight. For this reviewer, at least, the book takes on an impressionistic quality.)
1. When you have a pandemic, it is never the same story twice and that is because the magnitudes of transmissibility, virulence, latency period, amplification and vectors are completely unpredictable.
If you have seen one pandemic, then you have seen one pandemic.
2. Evolution is a zero-sum game, and pathogens are evolving defenses just as fast as/faster than human beings develop antibiotics. And it's always been that way.
3. Antibiotics did not exist from the beginning of time, and they have only been with us for about 3/4 of a century. It remains to be seen who will be the victor in this extremely cyclical war of humans against microbes.
4. It is very difficult to predict the past about a devastating pandemic that has already passed (and a lot of diseases come, go, and re-emerge without a clear explanation).
It is nearly impossible to do predict the future in real time, and anyone who suggests that they know what is going on presently is likely to be a liar just based on statistical arguments. (I'm looking at you here, Anthony Fauci.)
5. Africa (especially) and certain tropical parts of the world are reservoirs for diseases so diverse and particular as to occupy every single niche of human existence. To compare the density of endemic diseases and the experience of local people and dealing with them to the analogous parameters in Western countries is to compare an astrophysicist to a wino.
6. It really is meaningless to ask "What is the origin of these diseases?" (Everybody and their brother has an attitude with China because of the existence of covid-19.) It seems like these diseases blink into existence with no explanation, and then they blink out of existence almost as fast. It is thought that there is some periodicity to viral infections, but no one seems to be able to agree what it is. (15 years? 50 years? 70 years?)
7. "Never let a crisis go to waste." It is not new that an outbreak provides cover to pass a bunch of unrelated/liberal riders to spending bills.
8. Humans and microbes live in an equilibrium, and certain things about microbes can induce changes in human migration/lifestyle. But human migrations/lifestyle changes can also induce changes in microbes.
(Tuberculosis became much more popular as a result of more human contacts during the Industrial Revolution, etc.)
9. The Matthew Effect ( “For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.”) in *full effect*: Poor economic conditions can be fertile ground for exacerbating plagues; poor chumps in Africa cannot manage an economy for any reason (and certainly nothing so trivial as generating own-life saving tools for their own use), and that just makes their disease control even worse.
10. In a lot of ways, disease epidemics are directly proportional to human population density, and diseases are part of a self-correcting system of population control. (The Black death killed so many people that the population density was too low to support leprosy.)
11. Logic is not enough to explain the why and how of a disease/epidemic. Scientists have to generate theories *which have to be subsequently falsified.* (People have thought before that AIDS was: a cancer / autoimmune disease / result of poppers / result of immune system tiredness. Is HLTV causative or just symptomatic?)
Koch's first postulate must be followed, at a minimum.
12. (pps 380-382): Newspapers have absolutely no qualms about printing things that are completely false. (HIV was created to poison the Cuban pig population. Wait! Dioxins cause AIDS. Wait! AIDS was created in South Korea. Wait! It was created by crossing BLV and Vizner virus in an attempt to make cancer.)
13. Healthcare has to be created in every generation. If economic conditions change drastically for the worst, so can national health. (Contrary to popular belief, healthcare is a physical good and not a metaphysical one.)
If some country loses experience treating a disease (physicians / other practitioners do retire and die), they have to learn how to do it all over again and the process may not be smooth / informed by experience several generations back. (The US had to learn how to treat tuberculosis all over again after it resurfaced in New York during the AIDS/drug epidemic.)
14. 56 million Indians are estimated to have died from disease when Europeans arrived to the New World. (p.589).
Second order questions:
1. Given that microbes outnumber human beings by at least a billion to one, AND that they evolve much faster than human beings (175,316.4x faster, as calculated the generation time ratio)... Isn't it's bit quixotic to think that human beings really are going to get the upper hand without living in space suits?
Also, the author talks quite a bit about overpopulation of the Earth. (Along with sundry other environmental Chicken Little type ruminations.)
If you have new diseases auto-generate generate in response to human population levels that are too high and that lowers the human population..... Isn't that the way that things are supposed to be working? (At least, if you believe in blind evolution.)
Africa is expected to have more people than India and China combined in the next 50 years ...... Given that they're having trouble even supporting the number of people that already exist, is it really such a bad idea for that population to be thinned out a little bit?
Or a lot?
2. Many governments have demonstrated themselves to be notably inept in the face of a pandemic. (If we had forgotten the way that they dealt with HIV, we were reminded several decades later with COVID. In some cases, with the same idiots. Fauci, again.)
So, it is a given that governments do not learn from past mistakes... So what does anybody think will be the thing that they learned long ago that they will apply to the next crisis? (I'm not holding out much hope, based on their track record in present times as well as past cases in this book.)
3. People are predicting huge population growth in Africa, but I wonder: what will be the next nightmarish disease that stops that from happening?
4. It is known that being too clean can cause autoimmune problems and children; the question is: "Just how dirty do you let the children get?"
5. A lot of these things are beyond anyone's control: movements of refugee populations are great ways to generate/propagate diseases. I just don't think that the world is going to lapse into political stability just because of disease control arguments.
6. If you don't believe in the Curse of Cham, does the position of black people in this book on disease chip away at that belief?
If you are agnostic, does it push you over the edge? (Governments in all of these violent/ low-cognitive-ability-African countries create the instability that facilitates disease spreading, then are unable to mount a public health response, then deny that there are gay people on the continent, then deny that HIV-->AIDS, then when it does cause AIDS it's a biological germ created by white people to shrink the number of black people.)
How can that many people be that stupid by accident? And through that many steps?
7.Just because of the nature of various pathogens, the next epidemic is just around the corner. Do you live your life in fear, or do you just be aware that epidemics spontaneously generate all the time?
Verdict: RECOMMENDED. Worth the time and worth the price.
New vocab:
Doughboy
Sylvatic cycle
Biological hemorrhagic fever.
Marburg virus.
Brazilian meningitis.
Lassa fever
Panzootic
Permissive host (p.165. things like pigs carry huge numbers of diseases of their own and also other animals).
iatrogenic
Yaws
ascariasis
Nosocomial infection
Koch's postulates
Sporulation
Parastatal
Bacteremia
Virulence factor
The Coming Plague
5/5 stars
"A lengthy rampage through infectious diseases and microbial ecology."
*******
Dynamics of the book:
-621 pages/ 17 chapters≈ 37 pps/chapter. (Range per chapter from 17 to 109 pages.)
-1326 references (2.1/page)
-Reading time≈20 hours (the small print and longer pages made this book feel like reading ≈1200 pps)
*******
I would have to say that the book has stood the test of time, because it is replete with resonances to things that are happening in the current times--And in that way, almost every single one of the 621 pages was needful.
17.5% of the length of the book (109 pps) is about HIV/AIDS, and in that way it's a suitably brief recapitulation of Randy Shilts' "And The Band Played On," with some inclusion of germane points that were not even mentioned in his book.
Lots of good thoughts in this book, and it is so long that I will have to try to reduce it to some number of general principles that work forward and backward in time. (And it would have to be that way because there are SO many names and different narrative arcs that it is impossible to keep all of them straight. For this reviewer, at least, the book takes on an impressionistic quality.)
1. When you have a pandemic, it is never the same story twice and that is because the magnitudes of transmissibility, virulence, latency period, amplification and vectors are completely unpredictable.
If you have seen one pandemic, then you have seen one pandemic.
2. Evolution is a zero-sum game, and pathogens are evolving defenses just as fast as/faster than human beings develop antibiotics. And it's always been that way.
3. Antibiotics did not exist from the beginning of time, and they have only been with us for about 3/4 of a century. It remains to be seen who will be the victor in this extremely cyclical war of humans against microbes.
4. It is very difficult to predict the past about a devastating pandemic that has already passed (and a lot of diseases come, go, and re-emerge without a clear explanation).
It is nearly impossible to do predict the future in real time, and anyone who suggests that they know what is going on presently is likely to be a liar just based on statistical arguments. (I'm looking at you here, Anthony Fauci.)
5. Africa (especially) and certain tropical parts of the world are reservoirs for diseases so diverse and particular as to occupy every single niche of human existence. To compare the density of endemic diseases and the experience of local people and dealing with them to the analogous parameters in Western countries is to compare an astrophysicist to a wino.
6. It really is meaningless to ask "What is the origin of these diseases?" (Everybody and their brother has an attitude with China because of the existence of covid-19.) It seems like these diseases blink into existence with no explanation, and then they blink out of existence almost as fast. It is thought that there is some periodicity to viral infections, but no one seems to be able to agree what it is. (15 years? 50 years? 70 years?)
7. "Never let a crisis go to waste." It is not new that an outbreak provides cover to pass a bunch of unrelated/liberal riders to spending bills.
8. Humans and microbes live in an equilibrium, and certain things about microbes can induce changes in human migration/lifestyle. But human migrations/lifestyle changes can also induce changes in microbes.
(Tuberculosis became much more popular as a result of more human contacts during the Industrial Revolution, etc.)
9. The Matthew Effect ( “For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.”) in *full effect*: Poor economic conditions can be fertile ground for exacerbating plagues; poor chumps in Africa cannot manage an economy for any reason (and certainly nothing so trivial as generating own-life saving tools for their own use), and that just makes their disease control even worse.
10. In a lot of ways, disease epidemics are directly proportional to human population density, and diseases are part of a self-correcting system of population control. (The Black death killed so many people that the population density was too low to support leprosy.)
11. Logic is not enough to explain the why and how of a disease/epidemic. Scientists have to generate theories *which have to be subsequently falsified.* (People have thought before that AIDS was: a cancer / autoimmune disease / result of poppers / result of immune system tiredness. Is HLTV causative or just symptomatic?)
Koch's first postulate must be followed, at a minimum.
12. (pps 380-382): Newspapers have absolutely no qualms about printing things that are completely false. (HIV was created to poison the Cuban pig population. Wait! Dioxins cause AIDS. Wait! AIDS was created in South Korea. Wait! It was created by crossing BLV and Vizner virus in an attempt to make cancer.)
13. Healthcare has to be created in every generation. If economic conditions change drastically for the worst, so can national health. (Contrary to popular belief, healthcare is a physical good and not a metaphysical one.)
If some country loses experience treating a disease (physicians / other practitioners do retire and die), they have to learn how to do it all over again and the process may not be smooth / informed by experience several generations back. (The US had to learn how to treat tuberculosis all over again after it resurfaced in New York during the AIDS/drug epidemic.)
14. 56 million Indians are estimated to have died from disease when Europeans arrived to the New World. (p.589).
Second order questions:
1. Given that microbes outnumber human beings by at least a billion to one, AND that they evolve much faster than human beings (175,316.4x faster, as calculated the generation time ratio)... Isn't it's bit quixotic to think that human beings really are going to get the upper hand without living in space suits?
Also, the author talks quite a bit about overpopulation of the Earth. (Along with sundry other environmental Chicken Little type ruminations.)
If you have new diseases auto-generate generate in response to human population levels that are too high and that lowers the human population..... Isn't that the way that things are supposed to be working? (At least, if you believe in blind evolution.)
Africa is expected to have more people than India and China combined in the next 50 years ...... Given that they're having trouble even supporting the number of people that already exist, is it really such a bad idea for that population to be thinned out a little bit?
Or a lot?
2. Many governments have demonstrated themselves to be notably inept in the face of a pandemic. (If we had forgotten the way that they dealt with HIV, we were reminded several decades later with COVID. In some cases, with the same idiots. Fauci, again.)
So, it is a given that governments do not learn from past mistakes... So what does anybody think will be the thing that they learned long ago that they will apply to the next crisis? (I'm not holding out much hope, based on their track record in present times as well as past cases in this book.)
3. People are predicting huge population growth in Africa, but I wonder: what will be the next nightmarish disease that stops that from happening?
4. It is known that being too clean can cause autoimmune problems and children; the question is: "Just how dirty do you let the children get?"
5. A lot of these things are beyond anyone's control: movements of refugee populations are great ways to generate/propagate diseases. I just don't think that the world is going to lapse into political stability just because of disease control arguments.
6. If you don't believe in the Curse of Cham, does the position of black people in this book on disease chip away at that belief?
If you are agnostic, does it push you over the edge? (Governments in all of these violent/ low-cognitive-ability-African countries create the instability that facilitates disease spreading, then are unable to mount a public health response, then deny that there are gay people on the continent, then deny that HIV-->AIDS, then when it does cause AIDS it's a biological germ created by white people to shrink the number of black people.)
How can that many people be that stupid by accident? And through that many steps?
7.Just because of the nature of various pathogens, the next epidemic is just around the corner. Do you live your life in fear, or do you just be aware that epidemics spontaneously generate all the time?
Verdict: RECOMMENDED. Worth the time and worth the price.
New vocab:
Doughboy
Sylvatic cycle
Biological hemorrhagic fever.
Marburg virus.
Brazilian meningitis.
Lassa fever
Panzootic
Permissive host (p.165. things like pigs carry huge numbers of diseases of their own and also other animals).
iatrogenic
Yaws
ascariasis
Nosocomial infection
Koch's postulates
Sporulation
Parastatal
Bacteremia
Virulence factor