Pandemic period:
Phase 6: Increased and sustained transmission in general population.
History is filled with accounts of plagues whose destructive force is truly hard to grasp. The Black Death of the fourteenth century killed seventy-five million people worldwide, including two-thirds of Europe’s population! Two hundred years later the disease returned as the Italian Plague of 1629–1631, killing 280,000 people and then spread from country to country, becoming the Great Plague of Seville (1647–1652), killing 60,000 people (25 percent of Sevilla’s population); then the Great Plague of London (1665–1666), which killed nearly 100,000; the Great Plague of Vienna (1679) in which 76,000 died; the Great Plague of Marseille in 1720–1722, which killed another 100,000; before moving onto Moscow in 1771 and slaughtering 200,000 more. And that’s just the bubonic plague.19
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Hard Science—Pathogen
A pathogen (a.k.a infectious agent) is what causes illness in an organism. The name itself is a translation from the Greek meaning “that which produces suffering.” The major classifications of pathogens includes Bacteria (such as anthrax, tuberculosis, pneumonia, etc.), Viruses (AIDS, herpes, influenza), Protozoa (malaria, cryptosporidiosis, giardiasis, etc.), Fungi (ringworm, candidiasis, cryptococcosis, etc.), Parasites (roundworm, tapeworm, etc.), and Prions. The immune system, along with “good” bacteria in the body, fights invasion from pathogens. When the immune system is compromised or weakened, pathogens can create opportunistic infections.
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Aside from Black Plague, there have been a number of major epidemics throughout history that have torn their way through whole cultures. During the Peloponnesian War (430 B.C.E.), typhoid fever killed a quarter of all the Athenian troops, and roughly the same percentage of the overall population of Athens during a four-year period. Typhoid fever is an incredibly virulent disease that often kills its host so quickly that they don’t live long enough to spread the disease, so in a sense the strength of the disease probably kept it from wiping out all of Greece…and maybe all of that part of the world. Talk about cold comfort.
The Plague of Galen (165–180 C.E.20) also known as the Anto-nine Plague, scythed its way through the Roman Empire. There is some doubt as to whether the disease at the heart of the epidemic was measles or smallpox, but what’s not in doubt is that it cut down nearly five million citizens of the Empire, including a couple of emperors, Lucius Verus21 (130–169 C.E.) and Marcus Aurelius Antoninus (121–180 C.E.). At the height of this plague, two thousand people a day were dying in Rome, according to the historian Dio Cassius.
The first recorded outbreak of bubonic plague was the Plague of Justinian, which lasted from 541 to 750. The outbreak began in Egypt and swept into Constantinople like a tsunami, killing ten thousand people a day. The Byzantine historian Procopius wrote that this plague killed close to half of the population of the known world. Sit with that thought for a minute.
Cholera, another killer disease, has racked up seven pandemics so far, with a body count in the tens of millions. The first of these plagues began in Bengal in 1816 and spread outward from there, reaching China and the Caspian Sea before it slackened its lethal pace in 1826. But three years later it was back, striking Europe in 1829 and then leaping across the Atlantic to America in 1834, until it again slowed in 1851. It struck in Russia between 1852 and 1860, killing over a million people; then three years later it hit Africa. North America took another hit in 1866; and a sixth wave hit Germany in 1892. In 1899 it struck Europe again, but now science had begun to catch up to the needs of the suffering population, this time the disease did relatively little damage. However, when you speak of a disease like cholera, “relatively little” still doesn’t equate to a cheery outcome. For decades the disease seemed to be in retreat and then it hit Indonesia in 1961, then shot through Bangladesh, and back to Russia. Every time health experts think the disease is gone, it rears its ugly head again.
The flu, or influenza to give it its proper name, is an infectious disease caused by an RNA virus of the family orthomyxoviridae, and it’s racked up its own disheartening kill rate. And like the other disease, it has attacked in waves over the centuries. There have been documented cases of influenza dating back to the third and fourth centuries B.C.E, but modern tracking of the disease as a pandemic began in Africa in 1510. It blossomed on the Dark Continent and then spread like wildfire through Europe.
Influenza is constantly mutating, and when a new and particularly aggressive strain appears, the dying starts. The worst outbreak was the Spanish Flu of 1918, which killed somewhere between fifty and one hundred million people in just eighteen months. It edges out the Black Plague as the worst pandemic in human history.
By comparison the Asian Flu of 1957–1958, which killed about 70,000 people in the United States, is considered “mild.” That’s another thought to digest for a bit.
And there are so many other diseases that have spread to epidemic proportions: chicken pox, measles, typhus, smallpox, tuberculosis, and others. Many of these are diseases we once believed had been eradicated. It’s beyond disturbing to discover how wrong we were about that. Many of these are commonly referred to as Old World diseases because they came with the settlers when the New World was discovered and conquered. It is a widely held belief among historians and epidemiologists that up to 95% of the Native American peoples were killed by these Old World diseases. Before Columbus landed, the Americas hosted a populace of many millions. Chicken pox and measles did more slaughter than bullets in conquering the West; and before you go off thinking that well, this was an “act of God”—there are plenty of recorded cases of settlers giving blankets to the Indians knowing full well that they carried infectious agents. Biological warfare has been going on for a long, long time.
Influenza has an inordinately high infection rate, somewhere near 50 percent. Imagine if a zombie plague got out there, with its 100 percent infection rate.
There are also some spookier diseases of unknown type or origin, such as the one that hit England in the sixteenth century and killed almost instantly. Known as the English Sweat, this disease seemingly struck without warning and literally dropped its victims in their tracks. The disease has not reappeared and it remains as one of several mysteries in the world of epidemiology…and believe me when I tell you that mystery and epidemic are not words anyone wants to hear in the same sentence.
Nowadays we have a whole slew of slayer diseases:
Avian Flu: Also called bird flu, this is a new bully on the block and has been giving nightmares to infectious diseases experts since 2003. This little monster is carried by various kinds of hosts, including birds, and the carrier is typically asymptomatic, meaning the host does not get sick. This makes it very hard to spot before infection occurs. Heightened awareness of the threat of the disease has been instrumental in preventing its spread.
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Art of the Dead—Graham Pratt
Public Health Hazard
“If there was a zombie uprising I think we would bury our heads in the sand and get bitten in the ass.”
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Zombie Child by Ken Meyer, Jr.
We might have a chance of stopping a zombie plague if it starts in a heavily industrialized country; but if it starts in the Third World it might spread beyond control.
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Yellow Fever: In historical novels you often read of ships flying the Yellow Jack to indicate an onboard infection of this disease, and of whole island populations being wiped out. Many people seem to think that yellow fever, a virus spread by mosquitoes, has been eradicated, and indeed there have been significant advances in prevention and treatment. But not in the Third World. In the absence of regular medical care, adequate hygiene, and other poor conditions, yellow fever continues to claim an estimated thirty thousand lives per year.
HIV/AIDS: Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a global killer that went from b
eing the disease people didn’t talk about to a pandemic that we can no longer ignore. Over 38 million people are infected with HIV worldwide, and to date more than 25 million have died from it. In Africa and other Third World areas, HIV is running rampant and still not enough is being done to combat it, and there is no true cure in sight.
SARS: This is a severe acute respiratory syndrome caused by the SARS coronavirus that apparently began in Guangdong Province, China. Because of the aggressive action of the World Health Organization, the first SARS pandemic claimed only 774 lives between November 2002 and July 2003. In the absence of an organization like that, there would have been hundreds of thousands more SARS-related deaths.
Ebola: Properly known as Ebola hemorrhagic fever, this is a nasty disease that causes organ failure. The virus has a few different known strains. Zaïre Ebolavirus, first discovered in 1976, is the most virulent kind, with a 90 percent infection rate and an 83 percent mortality rate. Sudan Ebolavirus, also first reported in 1976, is somewhat less aggressive. Reston Ebolavirus, discovered in 1989 in Reston, Virginia, was caught before it spread to humans. Ivory Coast Ebolavirus, discovered in 1994, was discovered among chimpanzee populations and resulted in one known human infection (in a doctor treating an infected chimp), but the doctor was treated and survived.
Expert Witness
“A communicable, or contagious, disease refers to any infectious disease that can be transmitted from one species to another or one person to another,” explains infectious disease expert Dr. Robin Dobson. “A disease that carries with it an extraordinarily high degree of communicability—anything above 30%—is a cause for major concern. Something that carries a 100% communicability—which is luckily very unlikely—would be a potential global catastrophe.”
He adds, “The issue here is complex, however, because communicability is only part of the equation. You also have to consider infectivity, which is how the pathogen enters the host, how it survives in that body, and how it spreads throughout the body. Many diseases spread very quickly from the moment of infection, anywhere from a day or two to a few weeks. It’s unlikely we would see anything capable of replicating and spreading throughout an entire host in seconds or even minutes. It would be hours at the very least.”
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Hard Science: Patient Zero
In all plagues there has to be a first case. Whether this is the person who contracted the disease from eating the wrong thing, getting stung by the wrong mosquito, cavorting with the wrong livestock, or being in the wrong place at the wrong time…someone has to be first.
This deeply unlucky individual is called “patient zero” or the “index patient.” The importance of patient zero can hardly be underestimated because how an epidemic begins often provides clues to its origin, which in turn may lead to the best possible chance of either a cure or of some kind of prophylactic measure.
Identifying the patient zero also helps scientists in their attempts to track the spread of the disease.
Why is this person not referred to as patient 1? Well, it’s because someone read it wrong back in the 1980s. When Dr. William Darrow and his colleagues at the Centers for Disease Control were studying the earliest instances of HIV, they believed they had identified the first (or at least first known) infected person. Since this person had come from California his confidential case record was designated as Patient (Out of California), or Patient O for short, O’s and 0’s look pretty close, and someone else read it as the number. And so patient zero came into the worldwide lingo of epidemiology.
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Dr. Andrea White, a colleague of Dobson’s who worked with him in South America to study smallpox, adds, “Just because an infection exists it does not mean we have an infectious disease. An infection may remain within a host, with or without clinical symptoms or impairment to the host, and it may not spread. Sometimes a disease can be contained within a host so that the infected person does not become an active carrier.”
“There are a number of ways in which the transmission of a disease can occur,” Dobson says. “In general transmission refers to the process by which a disease is passed from an infected host to another person or to a group of people. This can happen through airborne transmission (if the pathogen remains in the air for extended periods of time); through direct contact between infected and uninfected, and this includes everything from kissing to sexual contact to biting; through droplet contact (from coughing, sneezing, etc.); through fecal-oral transmission (which happens often with contaminated water or food sources—you see that a lot in the Third World); through indirect contact, meaning contact with some substance that carries the contaminate; and, of course, through vector borne transmission, which means that it is carried by an animal or insect. Or, in this case, by a zombie.”
“We would have to do studies,” adds Dr. White, “to determine if the contaminate is something that can exist outside of the host. If this plague is strong enough to exist without the support of a living organism, which you see with some kinds of bacteria, parasites and so on, then everything the infected zombie touches is a potential source of infection.”
“And,” Dobson says, “you have to wonder if we have a nidus, or natural reservoir, in play. A nidus is a host who carries the pathogen but does not contract the actual disease. For example shellfish can carry cholera but don’t become infected by it, just as black rats and prairie dogs carry bubonic plague and mosquitoes carry malaria. If that’s the case, then you may have disease vectors other than zombies carrying the zombie infection. That would be very, very bad.”
The Zombie Factor
As with all outbreaks, a zombie plague would need to be placed in its correct historical context, which means that a search would have to be done to see if a similar outbreak has occurred before. If so, the way in which it progressed, the rate at which infection spread, the methods used to identify it and then combat it are all relevant because any steps taken—successes or failures—will refine and inform the steps that doctors take to combat the current outbreak.
It’s equally important to make sure we know exactly what type of outbreak is being faced, especially when faced with something new and potentially radical. Few diseases present with absolutely no historical reference, which is why keeping—and checking—exact medical records is so crucial. If a zombie plague existed, there may be some reference to it, possibly under some other name, in the world’s many shared medical databases. And even if no zombie plague has previously existed, diseases with similar symptomology may serve as guideposts toward treatment, prevention, or even a cure.
Dr. Michael Augenbraun of Brooklyn University Hospital advises us to, “Compare current and historical rates of zombieism to make sure this is real and not someone’s impression. Develop a case control study of cases versus matched controls to determine associations and possible causes. Assuming you have no preconceived notion of how one acquires this illness, this is the only way you can really impose any sort of control program.”
Plagues have been used in a large number of zombie stories, and these are largely responsible for the resurrection of zombie pop culture and which stand as being among the most significant in the recent resurrection of the genre. Certainly Shaun of the Dead, Romero’s Land of the Dead, and the Zack Snyder remake of Dawn of the Dead are all key players in the return of the dead to top pop culture status, but along with Resident Evil one other movie, also released in 2002, stands a little apart as an impetus behind the genre: 28 Days Later.
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Zombie Bugs from Outer Space
At one point during preproduction, the story of Night of the Living Dead dealt with humans infected by an alien pathogen brought to earth in the ill-fated Venus probe, but this was later scrapped. The working title Night of the Flesh Eaters was attached to the film at this point, but Romero and his writing partner, John Russo, decided to take the story in another and far less specific direction.
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This landmark flick, written by nov
elist Alex Garland (author of The Beach) and directed by Danny Boyle (who directed the 1998 film version of The Beach as well as the marvelous comedy Trainspotting), took the supernatural out of the zombie genre and infused it with new “life.” The threat in this film is not a reanimated corpse but rather a human being infected with a virus that hyperactivates the rage impulse in the brain. The virus was being tested on lab monkeys, but a well-intentioned but misguided group of animal rights activists breaks in to a research center and liberates the chimps. It all goes to hell from there as the infection immediately spreads to humans, and once infected a person immediately succumbs to total and uncontrollable murderous rage. The infection spreads so quickly that England is virtually destroyed in four weeks; and there it is suggested that much of the rest of the world may have likewise been affected.
This idea is turned around with the 2007 sequel 28 Weeks Later, in which NATO troops move in to England several months after the plague. All the infected are believed to have died from starvation and exposure, and the world governments (led, apparently by the United States) are attempting to repopulate London. Of course things go to hell and the infection starts again, this time definitely spreading to Europe, where it is presumed there will be no English channel to act as a barrier for a pandemic. At this writing a third film, 28 Months Later is in preproduction.