Friday, October 17, 2014

"The Demon in the Freezer" by Richard Preston

Watching our public health system flail about attempting not just to contain ebola, but to appear convincingly to be acting confidently in a well-coordinated manner, has sadly not been much of a surprise. I've been thinking back again to Laurie Garrett's prophetic, "Betrayal of Trust; the Collapse of Global Public Health," published 14 years ago. I've also been remembering Richard Preston's book, "The Demon in the Freezer," and finding myself grateful that -- horrific and deadly as ebola is -- it isn't smallpox or anything equally deadly and highly contagious as well. Hence, a repost (updated with some pretty and hope-inducing pictures):

Initially, I picked up the audio version of "The Demon in the Freezer," but I wanted to go back and review details (which is easier with a print version) so I checked the dead-tree version out of the library.

I'd known about this book for some time, and thought several times about reading it. But I always decided it would be too scary and depressing, and I needed less stress in my life--not more. I probably should have kept to my resolve. The demon, of course, is smallpox: Variola major. There is also a weaker or "minor" strain of variola: Variola minor.

I always imagined smallpox as a sort of uber-chicken pox: more blisters, worse scarring, significantly more risk of complications and death. But no, smallpox is almost inconceivably worse than that. I never knew there was a hemorrhagic form of the disease--sort of like ebola--where you don't form discrete blisters, but instead bleed out under the skin until your whole skin sloughs off... And the virulence makes SARS look pathetically hard to catch. I also had clung to the foolish hope that having been vaccinated twice as a child, I'd still retain at least some partial immunity. Wrong! The vaccine only lasts about five years.

Current wisdom is that smallpox made the jump from some rodent host to humans back in one of the early agricultural river valleys--along the Nile, perhaps, or the Tigris and Euphrates, or the Indus, or the Yangtze. The mummy of Pharaoh Ramses V (d. 1157 BC) apparently bears blisters that look as if they might be smallpox, but the Cairo museum won't permit invasive procedures that could tell for sure. The Chinese had a goddess of smallpox, T'ou-Shen Niang-Niang, who could cure the disease; they prayed to another goddess, Pan-chen, if a victim's skin began to darken with black pox. The Hindus have a goddess of smallpox named Shitala Ma; not clear if she is good or bad, but one does not want to make her mad. Europeans, Africans, and the Japanese also eventually had personifications of small pox.

The Aztecs, Incas, and North American natives probably never had a chance to personify and attempt to placate the demon goddess; she hit them too hard and too fast. The English first deliberately used smallpox as a weapon in 1763, when blankets from a smallpox hospital were given as "gifts" to natives in an effective attempt to decimate their population.

Having made the jump from animal to human hosts, variola no longer has any natural animal hosts. This meant eradication was possible: limit its spread by vaccinating humans, and soon it would run out of hosts to infect. And this is what the WHO set out to do. By the end of 1977 they had succeeded. Smallpox no longer exists outside of the laboratory. There was even discussion about totally eliminating laboratory stocks of smallpox, including the propriety of deliberately destroying a species--even an arguably "evil" species such as smallpox. Paradoxically, eliminating smallpox as an endemic disease created its potential as a weapon of mass destruction.

Many may know the story of how Dr. Edward Jenner developed the first vaccine against smallpox in 1796, using matter from milkmaids infected with cowpox, a mild relation of the smallpox virus.

Edward Jenner House, Berkeley, Gloucestershire, UK
Edward Jenner's house and laboratory, where he developed the first vaccine against smallpox

Temple of Vaccinia, Edward Jenner House, Gloustershire, UK
This building, in Edward Jenner's garden, is where he would hold free smallpox vaccination clinics

Officially, variola now exists in only two places: the CDC in Atlanta, and an equivalent facility in Russia. In 1989 a Russian scientist defected to Britain, and revealed something of the extent of the Soviet strategic bioweapons program prior to the fall of the Soviet government in 1991. Yet more was revealed (such as the existence of a 20 ton stockpile of weapons-grade smallpox) when Ken Alibek, formerly the first deputy chief of research an production for Biopreparat, defected to the U.S. in 1992.

The plot thickened even more in 2000, when a group of Australian scientists presented a poster on mouse pox at an international meeting. By engineering the mouse IL-4 gene (interleukin-4) into the mouse pox genome, the researchers had created a super-lethal, vaccine-resistant mouse pox virus. Not a big jump from ultra-mouse pox to imagining something similar being done for human smallpox.

Sleep well...

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