The Pandemic-After-Next ™

#180

When thinking about a pandemic, one must contemplate the inevitable (or seemingly so) offshoots of that kind of catastrophe. Those of us who are flu-aware are taking steps to protect ourselves, our families, and even our neighbors against the H5N1 virus. And that is certainly prudent given it’s CFR (Case fatality Ratio). But I would suggest we need to look beyond the avian flu virus, and consider what happens 3 months or 6 months into a pandemic.

Much depends, of course, upon the severity of a pandemic. How badly affected essential services become, the death rate from the virus, and how well we have prepared. But assuming a moderately worst-case scenario, with an attack rate of 40% and a CFR of 25%, we’d be looking at 30 million deaths in the United States from the virus alone. Add to that other deaths caused by collateral damage, and the death toll could exceed 50 million.

Not the worst-case scenario, but even if it’s half this bad, many essential services will fail.

In this sort of scenario, the proper disposal of dead, infected bodies will be a nightmare. And in my view, is unlikely to happen in many areas. Health authorities have already suggested we may be forced to bury our dead in our own back yards. Some bodies may end up stacked up on curbsides, as there will be no other place to put them. Others may be dumped in fields, or perhaps streams or lakes.

If bodies aren’t being picked up, then it is logical to assume that garbage isn’t either. When garbage collectors have gone on strike in places like New York City, it doesn’t take long before the curbs and sidewalks are covered with garbage. Not litter . . . but bags of garbage piled six feet high. I saw a lot of that in New Orleans after Katrina. But at least there, people were actively removing the garbage. During a pandemic, that may not happen.

If the power goes out, then the sewer treatment and delivery systems won’t function. Those on septic tanks will be lucky; all they will need is water to flush their toilets. But for the tens of millions on city sewer, they may quickly find that not only that they can’t flush, but that raw sewage may be backing up into their homes. Many ground floor dwellings may become uninhabitable in short order.

Human waste will have to be disposed of. And few are prepared to do this. Some may figure out a way to dig latrines, or setup outhouses, but many will opt to collect human waste in plastic bags and leave it on the curbside with the trash, in the hopes someone will come around and collect it.

Add to this highly volatile pathogenic soup, the good chance that pet owners, unable to feed their beloved pets, will release them in the hopes that they will be able to fend for themselves. Packs of feral dogs and cats will be combing these biohazardous trash heaps looking for a meal. Flies be fruitful and multiply. And it can also be assumed that routine mosquito control measures will not be underway either.

Already it is not uncommon for coyotes, bears, deer and other wildlife to enter the cities in search of food. They too will descend upon these growing trash heaps, and in doing so, will scatter this garbage as they forage.

What we would have then are all of the ingredients needed to see a major resurgence of diseases not seen in the United States in over a hundred years.

Disease like Cholera, Typhoid, and Dysentery will become common again, just as they are now in the third world where sanitation is marginal at best. Water sources will likely become contaminated.

Mosquito and fly borne illnesses will flare up. Dengue could well appear in places like Texas and Florida, and then move north. Malaria, even Yellow Fever could take off again. H5N1 may even be further spread by flies that feed on, or lay their eggs on, contaminated garbage.

Rats, and other rodents, particularly west of the Mississippi, could bring Y. Pestis (Yersinia aka Bubonic Plague) into the cities. The last major outbreak was in 1924 in Los Angeles, but every year a dozen or so Americans contract the plague. It is endemic in the wildlife in some areas. Leave enough garbage lying around, and it could easily spread.

And the danger presented by packs of wild dogs, or even coyotes, can’t be overlooked. Rabies, a scourge in places like China today, could once again threaten here. Beyond the diseases they might carry, feral animals will pose a significant threat of injury or death from attack.

The list could go on . . . hepatitis, encephalitis, e.coli , meningitis, cryptosporidium, giardia . . .

Diseases that we have held at bay primarily because we dispose of sewage, garbage, and bodies properly, and because we treat our drinking water.

Add in a poor diet and weakened immune systems, and other diseases, like tuberculosis could rear it’s ugly head.

It would seem that, if we truly expect a pandemic will occur, and that many essential services such as garbage collection, water treatment, sewage systems, mosquito control, and body disposal will be compromised, we’d better plan on visitations by these lesser plagues.

Prevention, rather that treatment, should be our first concern.

During a pandemic, many of these diseases could be avoided by simply boiling water before drinking it, using it for cooking, or even bathing in it. Boiling water requires fuel however, and that could be in short supply. Other remedies include bleach, ozone treatment of water, UVC treatment, and some types of filters.

Mosquito and Fly borne illnesses may be reduced by the proper use of screens or nettings to keep these insects at bay. Mosquito repellents may also be used. Having the proper insecticides, and even fly swatters, will help reduce the risk.

Animal control, the elimination of feral animals, must be considered. Not a pleasant thought, but imperative to reduce illness, injury and deaths.

The use of latrines, outhouses, and composting pits for human waste need to be a priority if the sewer systems fail.

Finding some neighborhood solution to the garbage problem, even if your city is no longer hauling it off, will be crucial. Burn barrels, trash pits, something other than setting it out by the curb and hoping for the best.

And simply put, we can’t allow decaying infected bodies to lie about. They will have to be buried; else we will be hip deep in pathogens. If the authorities can’t get this done, then it will be up to those who live in neighborhoods to do it.

The failure to do these things will be an open invitation to a plethora of pathogens. Individually, perhaps none of these would be as horrific as the H5N1 virus, but combined, they could prove to be the deadlier threat.

Additional meds, such as Cipro, Doxycycline, Flagyl, and Quinine Sulfate may be desirable, assuming you can get them, and know when and how to use them.

And having an adequate supply of powdered ORS (oral rehydration solution) on hand would be lifesaving for many of these diseases.

Unlike the flu, many of these diseases will find ways to come into your home. On the wings of mosquitoes and flies. In water from your tap or water collected from a local river or stream. Or delivered courtesy of mice or rats, or even your family pet.

While preparing for pandemic influenza is a great idea, if we don’t prepare for the Pandemic-After-Next ™, we may simply be wasting our time.