Deadliest Enemy

The U.S. has spent trillions on its military, but the nation’s biggest threat may come in the form of microscopic organisms. “There has never been a time in history when the challenges to controlling and preventing the global spread of infectious disease has ever been this daunting,” says the Director of the Center for Infectious Disease Research and Policy, Dr. Osterholm.<br /><br />Osterholm and Olshaker review some of the world’s latest infectious disease threats BEFORE COVID-19—diseases that include Zika, Ebola, SARS, and MERS. More importantly, they also lay out a 9-point strategy to address emerging infectious disease threats. The top priority is preventing pandemic flu. [If only the Government had paid attention….]<br /><br />Of note, Osterholm has a great deal of respect for Dr. Fauci and is less enamored with the WHO. He sees the latter as a slow-moving bureaucracy; but does strongly encourage creation of a multinational organization that would be able to do things like develop new methodologies for manufacturing vaccines. For instance, he believes that a multi-year flu vaccine is possible.<br /><br />Highly recommend this highly readable discussion of infectious diseases and their prevention.<br />

<i>"...we don't always make rational distinctions between what is likely to kill us and what is likely to hurt us, scare us, or simply make us uncomfortable."</i><br />- Michael Osterholm, Deadliest Enemy<br /><br />I picked this book up after hearing Dr. Osterholm on The Joe Rogan Experience #1439. I could probably write a whole piece about how Joe Rogan has become mainstream. It is a strange world. Anyway, like most of us, I've been a bit consumed in Feb/Mar/Apr 2020 with reading everything I can on infectious disease.<br /><br />Dr. Osterholm, like Bill Gates, seems almost prophetic in this book. It was published in 2017, but seems prophetic not just in-terms of predicting the crazy aspects of a massive, airborne virus epidemic, but also in recognizing the weaknesses of our global and political preparedness. I guess that is one piece of dealing with epidemiology and public health. You can't just be science-focused, you also have to possess very little naïveté about the way economics and politics impacts public health. Thank God for people like Dr. Osterholm and Dr. Fauci. Their work seems a bit Sisyphean, but still maintain a pretty good perspective as they go on with their research, their realpolitiks, and their gentle persuasion. What a job.

<blockquote> <i>This is a critical point in history. Time is running out to prepare for the next pandemic. We must act now with decisiveness and purpose. Someday, after the next pandemic has come and gone, a commission much like the 9/11 Commission will be charged with determining how well government, business, and public health leaders prepared the world for the catastrophe when they had clear warning. What will be the verdict?</i> </blockquote><br />If I had read this book in more normal circumstances, I do not know how I would have responded. Perhaps I would have been slightly unnerved, but I think I would have been able to sleep soundly by dismissing most of it as alarmist. In fact, I did just this a few months ago, when I read Bill Bryson’s book on the body, and scoffed at his claim that another 1918-style pandemic was easily possible. Nowadays, however, reading this book is more depressing than anything. Those in the field saw this crisis coming from miles away, but few of us listened. The epidemiological community must feel rather like Cassandras right about now: uttering prophecies that nobody pays any attention to.<br /><br />(As Osterholm was responsible for most of the ideas in this book, and as it is written from his perspective, I will refer to him as the author in this review.)<br /><br />This book attempted to be the <i>Silent Spring</i> for infectious diseases. That it did not succeed in doing so is attributable just as much to human nature as to the book itself. Limiting the use of pesticides is fairly easy and relatively painless for most of us. But mobilizing the political will necessary to prepare for health crises in the hypothetical future—preparations that would involve a great deal of money and many institutional changes—is not such an easy sell, especially since we had been lulled into a false sense of security. As is the case with climate change, the dangers seemed so remote and theoretical that for most of us it was difficult to even imagine them.<br /><br />After witnessing what this new coronavirus has done to our entire way of life in a few short weeks, I was quite disposed to take Osterholm seriously. And I think the entire content of the book—not just the warnings about a potential pandemic—are valuable. Osterholm turns his attention to a wide array of threats: Zika, AIDS, Yellow Fever, Typhoid, Malaria, Ebola, MERS. We are vulnerable on many fronts, and we are generally not doing much to prepare. <br /><br />One example are the many diseases that are transmitted by mosquito bites. As modern transportation has introduced disease-carrying mosquitos into ever-more parts of the world, and global warming expands the geographic range of mosquitos, this will be an increasing concern. (<i>Silent Spring</i> may, ironically, have contributed to this problem.) Another worry is bio-terrorism. Now that we can see how paralyzing even a moderately lethal virus can be, imagine the damage could be inflicted by a genetically-modified virus. And the technology to edit genes is becoming cheaper by the year. We have already experienced bio-terrorism in the US on a relatively small scale with the 2001 anthrax attacks. This is just a taste of what is possible. According to Osterholm, a mere kilogram of the anthrax bacteria could potentially kill more than an atomic bomb. And it would be far cheaper to acquire.<br /><br />But these are not even the biggest threats. According to Osterholm, we face two virtual certainties: another flu pandemic, and the imminent ineffectiveness of antibiotics.<br /><br />The latter is quite terrifying to consider. Antibiotics are not easy to discover, and our arsenal is limited. Meanwhile, bacteria constantly evolve in response to environmental pressures, including to the use of antibiotics. It is inevitable that resistance to available antibiotics will increase; and this could have a profound effect on modern medicine. Even routine operations like knee-replacements would be unsafe if we did not have effective antibiotics. Slight injures—a scratch in the garden from a rose-bush—could result in amputations or even deaths. And yet, antibiotics continue to be widely prescribed for ailments they cannot treat, and given indiscriminately to livestock, which only accelerates the impending bacterial resistance.<br /><br />The other major threat (as we are learning) is a pandemic. Now, Osterholm was not precisely correct in predicting the cause of the next pandemic, since he thought it would be a flu virus (though he does have a good chapter on coronaviruses, and in any case a flu pandemic is still just as possible). But he is certainly correct in identifying our many structural weaknesses. He notes our lack of stockpiles and correctly predicts a shortage in protective gear, face masks, and ventilators in the event of a pandemic. And though medical science has advanced a lot since 1918, in many ways we are even more vulnerable than we were back then, most notably because of our supply chains. Since so many of our medicines and medical equipment—among other things—are produced overseas, shortages are inevitable if trade is disrupted.<br /><br />Osterholm is quite illuminating in his discussion of pharmaceutical companies and their incentives. As private businesses, they have little to gain by investing in preventative vaccines or in new antibiotics. In the former case, this is because vaccines have to undergo thorough testing and pass FDA approval, requiring millions in investment, only to face the prospect of uncertain demand once the vaccine hits the market. The case of SARS is instructive. After the disease was identified in 2002, companies rushed to make a vaccine; but when SARS receded, interest in the vaccine disappeared and pharmaceutical companies, cutting their losses, stopped work on the vaccine. We still do not have one.<br /><br />The incentive system is just as ineffective when it comes to antibiotics. Finding new antibiotics is costly; and since there are currently many cheap antibiotics on the market, a new patented antibiotic probably would not turn a large profit. Besides, effective antibiotic stewardship requires that we use them sparingly, thus further limiting profit potential. Drug companies have much more to gain by creating products that would require continuous use, such as for chronic conditions. Letting the free market decide which drugs get developed, therefore, is not the wisest decision. Osterholm advocates the same approach as taken by government in weapons contracts, wherein the government essentially guarantees payment for any product that meets specifications.<br /><br />Osterholm’s most ambitious idea for government funding is for a new universal flu vaccine. The flu vaccine we are all familiar with is based on old technology, and can only provide protection from a few strains of flu. Scientists essentially must guess what sort of flu will be circulating in a year; and they must do so every year. But Osterholm thinks that there is good reason to believe that a universal flu vaccine is possible, and recommends we devote at least as much money to such a vaccine as we devote to AIDS research. This seems very sensible to me, since the next pandemic will likely enough come from a flu virus.<br /><br />I am summarizing Osterholm’s book, but I do not think I am doing justice to its emotional power. Now that I am living through the events that Osterholm predicts (in surprising detail), I feel a strange mixture of outrage and fear: outrage that governments did not listen when they had time, and fear that we will repeat the same mistakes when this current crisis is over. I cannot help but be reminded of another situation in which we comfortably ignore the dire warning of scientists: climate change. My biggest hope for the current crisis, then, is that afterwards we will be more willing to heed the warnings of these nerds in lab coats.

HOLY S***. There is a chapter on Corona Virus in this book written several years ago that made me so angry--like we knew this thing was coming--we knew what the likely source was (the ferret meat markets) and we knew it was ugly. We could have stopped this. The other haunting part of this book is at the end where he goes through a bad pandemic scenario and it is literally word for word what we are going through right now (except for he assumes a bare minimum level of Presidential competence, which happens to currently not be the case). <br /><br />Everyone--especially policymakers--should go back in time immediately and read this book like a few years ago.

It's an ominous read. Truly. <br /><br />This is more a 3.5 star because of the "tone". Smug? He says he is accused of being arrogant. Oh his is not a voice of shy estimation, but of exponential estimations. Truthful and instructive. But truly, also fairly stark rapidly approaching horrific tragedy. The future is a pandemic formation- greatly in the odds. Many people, moving quickly from one continent to another continent guarantee it. <br /><br />If you've read numerous pathogens books, or have thorough knowledge of vectors, bacteria, etc. - then this book will be what you already know. But in a far wider lens of global disease pandemic prevention as it plays out presently.<br /><br />HIV, Ebola, the bacterial diseases returning, virus formed, and others-many categories are covered well. <br /><br />But it is still the fast mutating airborne transferred influenza that is the prime player. Coming faster than climate change or any other war weapon scenario to be "the worst". One similar to the 1918 Spanish Influenza that killed more than WWI. <br /><br />"Humanity has but three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever."

<i>Mother Nature is the greatest bioterrorist of them all, with no financial limitations or ethical compunctions.</i><br /><br />I cannot recommend this book strongly enough.<br /><br />Sure, Osterholm comes across as arrogant and kind of a name dropper (he mentions Tony Fauci A LOT), but we can't let that distract from his message and warnings. This book came out three years ago, and it accurately predicts almost exactly what is happening now. He knew, he warned, and we should have heeded.<br /><br /><i>We cannot overwhelm the pathogens because they so vastly outnumber and outmaneuver us. Our survival depends on outsmarting them.</i> <br /><br />I find the catastrophe he predicts for 6-9 months out after a situation like ours right now to be particularly disturbing.<br /><br />Knowledge is power. Read all you can. Prepare how you must.

Many leaders of governments are now saying "no one could have predicted this would happen". It's clearly untrue. Experts have been warning us about something like COVID-19 and urging world leaders to take action. This book is accessible to an average non-epidemiologist and clearly demonstrates how incompetent most of the governments are in preventing highly predictable events.

I'm really liking this Michael T. Osterholm. Found him through this interview <br /><br />1st Video: <a target="_blank" rel="noopener nofollow" href="https://youtu.be/cZFhjMQrVts">https://youtu.be/cZFhjMQrVts</a><br />Continuation: <a target="_blank" rel="noopener nofollow" href="https://youtu.be/E3URhJx0NSwa">https://youtu.be/E3URhJx0NSwa</a><br /><br /><b>Chapter 13: SARS and MERS: Harbingers of Things to Come</b><br /><i>"An' the dawn comes up like thunder outer China 'crost the Bay!"</i> - Rudyard Kipling

Who should read this book, aside from every politician, public health official and anyone having even a remotest role in the medical field? <img src="https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/hostedimages/1585962399i/29227280.jpg" width="400" height="200" alt="Everyone!" class="gr-hostedUserImg" loading="lazy">

Ситуація з COVID19 перевернула весь світ з ніг на голову. Безліч обмежнь, карантин, дефіцит продуктів та найнеобхідніших "дрібниць" (маски, респіратори, рукавички, захисні костюми) у лікарнях, відсутність вакцини, загальна паніка та відсутність готовності світу до пандемії - це лиш маленька частина речей, з якими стикнувся світ за останні 1,5 року. Хто б міг подумати, що пандемія "зруйнує злагоджене життя" всього світу?<br /><br />А от якщо говорити серйозно, то всесвітня пандемія була лиш питанням часу, хоч і говорили про неї в прив'язці до грипу, а не нового виду коронавірусу. От тільки це питання було не на часі у всіх, бо війна чи зміни клімату набагато яскравіші проблеми. <br /><br />"Смертельний ворог. Людство проти мікробів-убивць" Майкл Остергольм, Марк Олшейкер - це честа і відверта сповідь епідеміолога про ризики та проблеми світу у мікробному плані. Написана дуже просто (ну і звісно переклад не підвів) та доступно, буде чудовим провідником для людей не дотичних до медицини, але які хвилюються про майбутнє та хочуть знати про можливі загрози. <br /><br />Ця книга дійсно якісний медичний нон-фікшик. У мене не було жодного разу відчуття, що автор заграє з читачем, а не говорить правду. Науково доведені факти, історії боротьби зсередини та цинічний і чіткий посил про майбутню епідемію - автори зробили все, щоб попередити читача про загрозу і що з цим робити. <br /><br />Малярія, лихоманка Зіка, жовта лихоманка, ВІЛ/СНІД, пандемічний грип, лихоманки Марбург та Ебола, коронавіруси, які викликають MERS та SARS, проблеми антибіотикорезистентності та вакцинації - і ще трошки деталей про епідеміологічний світ сьогодні. + передмова про панлемію COVID19 та застереження на майбутнє. Реалістично, страшно та відверто, але без нот безвиході та відчаю. Саме такі книги нам і потрібні.<br /><br />Особисто мене найбільше вразив можливий сценарій пандемії, побудований на припущеннях та можливих варіантах подій. І від до жаху схожий з сценарієм подій, які розпочались у 2019 році. <br /><br />Щира рекомендація для всіх, хто цікавиться даною темою, або ж хоче розширити свої знання.