Pandemic—Bigger than We Think: Part One
The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Burden Lundgren
September 9, 2020
When the pandemic arrived last spring, Americans first treated it like any other disease emphasizing testing for diagnostic purposes and medical treatment. They also learned about, “Flattening the curve.” With so little attention paid to public health in this country, it was not surprising they missed the fact that flattening the curve only means achieving a slower—not a lower—rate of infection. It is directly aimed at preserving system integrity, not individual lives.
While the medical response to the pandemic was nothing short of heroic, the public health response was fragmented to the point of chaos. Public health addresses populations, not individuals. It is just bigger than clinical medicine. In the case of a pandemic, bigger is really big! Every corner of the globe is affected. We are looking at millions of cases, hundreds of thousands of deaths (or more), millions of tests (or more) and, if we are lucky, billions of vaccine doses. But we need to think even bigger.
The pandemic is just the latest example of our species’ history of heedlessly crashing into the environment and reaping dire consequences. Nature is complex, and its elements are interdependent to an extraordinary degree. To a considerable extent, humankind has brought about its own plagues by its drive to organize in cities, establish extended trade routes, wage wars in foreign lands and destroy the habitats of both pathogens and prey. Cities are especially problematic. Their development depended on the ability to farm bringing livestock into close proximity to humans at once altering the parasitic landscape and providing near-endless fresh supplies of victims. Indeed, throughout most of our history, massive disease die-offs caused cities to be unable to sustain their populations without in-migration.
Yellow Fever, another epizöotic viral infection, offers a useful model. In certain tropical areas, it exists in arboreal monkeys in the canopy. It is a danger only to humans, often loggers, who invade the forest and are bitten by the mosquito vector. The disease is usually limited to those originally infected. Bigger outbreaks occur in savannah zones of emergence and are typically dead-end interactions. But when infected mosquitoes reach a city, they light an epidemic fire. What brings in those mosquitoes? Trade. In the case of North America, they were brought by slave ships.
We live in increasingly urbanized and globalized environments. That will not change. That means we
need to be increasingly careful of disrupting the pathogen-rich natural systems around us. Instead, we are doing the opposite. Humans are invading natural areas stressing wildlife, crowding animals rendering them more likely to become diseased and intensifying human-animal contact offering ever more abundant opportunities for pathogens to make the leap to humans. It has been theorized that crowding animals into smaller and smaller areas actually increases the virulence of the organisms they carry. Loss of habitat is often cited as a danger to animals. It is an even greater threat to us.
Even what might seem to be relatively minor environmental intrusions can have significant consequences. The Poconos in Pennsylvania are part of the Appalachian chain. It would be hard to find a more scenic area. The last grey wolf in the state died in 1892. Mountain lions are classified as “extirpated.” But hunters kill nearly 400,000 deer there every year, so you might be excused for thinking that deer overpopulation would not be a problem.
In the latter part of the 20th century, developers took over many thousands of acres in the area and built thousands of homes in the deep woods. Hunters had to go elsewhere, but deer did not.
With no predators, deer thrive, and so do the ticks that live on them. The deer’s rampant browsing alters the ecosystem right down to birds and insects. Two animals that thrive in these disturbed environments are rodents and bats—the latter being basically a virus factory (think Ebola). The former are the first incubators of the ticks which acquire the pathogen there and then fasten on the deer. As the large deer populations destroy native plants, invasive species, which are much more tick-friendly, become more abundant. And, as North America warms, we can expect more ticks.
The ticks would be no more than a nuisance were it not for the fact they carry Lyme Disease (and other infections). Lyme Disease is seldom fatal, but its course can be miserable often causing years of suffering. After human infection, the cases become a medical problem. Public health efforts are largely mapping (with the Poconos being the heart of the epidemic) and education. There are 30,000 cases reported yearly in the United States, and this is almost certainly an undercount.
Lyme Disease is not COVID-19, but it is illustrative of the fact that similar problems will keep recurring unless we look at their upstream causes and their intersectionality with disciplines other than our own. The usual bureaucratic smokestack focus has not served us well with COVID-19, and will not serve us well with similar threats. If we want healthy people living on a healthy planet, we need to get out of our lanes.
Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care. After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA. She has served as a consultant to a number of non-profit groups. Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].
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Pandemic—Bigger than We Think: Part One
The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Burden Lundgren
September 9, 2020
When the pandemic arrived last spring, Americans first treated it like any other disease emphasizing testing for diagnostic purposes and medical treatment. They also learned about, “Flattening the curve.” With so little attention paid to public health in this country, it was not surprising they missed the fact that flattening the curve only means achieving a slower—not a lower—rate of infection. It is directly aimed at preserving system integrity, not individual lives.
While the medical response to the pandemic was nothing short of heroic, the public health response was fragmented to the point of chaos. Public health addresses populations, not individuals. It is just bigger than clinical medicine. In the case of a pandemic, bigger is really big! Every corner of the globe is affected. We are looking at millions of cases, hundreds of thousands of deaths (or more), millions of tests (or more) and, if we are lucky, billions of vaccine doses. But we need to think even bigger.
The pandemic is just the latest example of our species’ history of heedlessly crashing into the environment and reaping dire consequences. Nature is complex, and its elements are interdependent to an extraordinary degree. To a considerable extent, humankind has brought about its own plagues by its drive to organize in cities, establish extended trade routes, wage wars in foreign lands and destroy the habitats of both pathogens and prey. Cities are especially problematic. Their development depended on the ability to farm bringing livestock into close proximity to humans at once altering the parasitic landscape and providing near-endless fresh supplies of victims. Indeed, throughout most of our history, massive disease die-offs caused cities to be unable to sustain their populations without in-migration.
Yellow Fever, another epizöotic viral infection, offers a useful model. In certain tropical areas, it exists in arboreal monkeys in the canopy. It is a danger only to humans, often loggers, who invade the forest and are bitten by the mosquito vector. The disease is usually limited to those originally infected. Bigger outbreaks occur in savannah zones of emergence and are typically dead-end interactions. But when infected mosquitoes reach a city, they light an epidemic fire. What brings in those mosquitoes? Trade. In the case of North America, they were brought by slave ships.
We live in increasingly urbanized and globalized environments. That will not change. That means we
need to be increasingly careful of disrupting the pathogen-rich natural systems around us. Instead, we are doing the opposite. Humans are invading natural areas stressing wildlife, crowding animals rendering them more likely to become diseased and intensifying human-animal contact offering ever more abundant opportunities for pathogens to make the leap to humans. It has been theorized that crowding animals into smaller and smaller areas actually increases the virulence of the organisms they carry. Loss of habitat is often cited as a danger to animals. It is an even greater threat to us.
Even what might seem to be relatively minor environmental intrusions can have significant consequences. The Poconos in Pennsylvania are part of the Appalachian chain. It would be hard to find a more scenic area. The last grey wolf in the state died in 1892. Mountain lions are classified as “extirpated.” But hunters kill nearly 400,000 deer there every year, so you might be excused for thinking that deer overpopulation would not be a problem.
In the latter part of the 20th century, developers took over many thousands of acres in the area and built thousands of homes in the deep woods. Hunters had to go elsewhere, but deer did not.
With no predators, deer thrive, and so do the ticks that live on them. The deer’s rampant browsing alters the ecosystem right down to birds and insects. Two animals that thrive in these disturbed environments are rodents and bats—the latter being basically a virus factory (think Ebola). The former are the first incubators of the ticks which acquire the pathogen there and then fasten on the deer. As the large deer populations destroy native plants, invasive species, which are much more tick-friendly, become more abundant. And, as North America warms, we can expect more ticks.
The ticks would be no more than a nuisance were it not for the fact they carry Lyme Disease (and other infections). Lyme Disease is seldom fatal, but its course can be miserable often causing years of suffering. After human infection, the cases become a medical problem. Public health efforts are largely mapping (with the Poconos being the heart of the epidemic) and education. There are 30,000 cases reported yearly in the United States, and this is almost certainly an undercount.
Lyme Disease is not COVID-19, but it is illustrative of the fact that similar problems will keep recurring unless we look at their upstream causes and their intersectionality with disciplines other than our own. The usual bureaucratic smokestack focus has not served us well with COVID-19, and will not serve us well with similar threats. If we want healthy people living on a healthy planet, we need to get out of our lanes.
Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care. After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA. She has served as a consultant to a number of non-profit groups. Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].
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