Summary of Deadliest Enemies by Michael T. Osterholm and Mark Olshaker

BookSummaryClub Blog Summary of Deadliest Enemies by Michael T. Osterholm and Mark Olshaker

No matter how many breakthroughs we make in modern medicine, infectious diseases remain our deadliest enemies. There have been many outbreaks in the last couple of years which has culminated in the current pandemic of Covid-19 we are facing. It has been well documented by many researchers over the years that an outbreak of infectious disease is not something that can be avoided in modern times. In fact, our current situation demonstrates just how vulnerable we really are. 

But how can we understand and handle future events like this better? It may be worthwhile looking back at the epidemics of the past to get a better idea of what it takes. This is where this book by epidemiologist Dr. Michael Osterholm and writer, Mark Olshaker comes in.

In this book summary readers will discover:

  • An epidemic involves detective work
  • The world may end with a sneeze, not a bang
  • Mosquitoes, the flu and antibiotic-resistant bacteria – the persisting diseases of our time
  • What can be done to prevent pandemics

Key lesson one: An epidemic involves detective work

When many people start experiencing similar symptoms, the experts start paying attention. When the number starts increasing they start digging deeper to find out where it all began. This is the goal of epidemiology, to track and trace the spread of disease in order to control and prevent it. To do this, information is key.

Back in 1981, the Centers for Disease Control and Prevention or CDC were trying to find out why a seemingly large number of healthy people in New York and California were developing Pneumocystis carinii and Kaposi’s sarcoma. Osterholm was part of this team and the first thing they did was case surveillance. This was simply identifying similar cases through doctor surveys. In doing so, they found a commonality. The patients were mostly young, gay men. As they gathered more information, the cause of the illness began to take shape. It was identified as a retrovirus that attacks the immune system and was spread by blood transfusions and sexual activity. This new virus was HIV. Experts continued with their detective work tracing the origins of the virus to sub-Saharan Africa. HIV changed the world as we knew it. From a few hundred cases identified in 1981, the numbers now stand close to 40 million and we have yet to find a cure. It is no longer referred to as a pandemic but a hyperendemic. Even though researchers have developed medication to treat HIV, it still remains a tricky virus to develop a vaccine and cure for.

Epidemiology often leads to complex and sometimes unlikely results. Another example of an outbreak trace in the 80s was when a number of teenage girls were dying from Toxic Shock Syndrome. No one could figure out why this rare disease had suddenly swept the country. The first thing epidemiologists did was to look for any common factors or patterns amongst all the cases. The most obvious pattern was that the majority of patients were teenage girls. Next, they noticed that most of the girls got sick during the first few days of their period. So what was the connection? Researchers decided to use a case-control study to figure it out. They gathered information from TSS victims and control groups using a questionnaire. They then compared the answers to try and identify the root of the problem. Compared to the control group, the girls suffering from TSS used a new super-absorbent tampon from Procter & Gamble. So, this tampon was assumed to be the problem and the company pulled the product from stores. However, girls kept getting sick. This meant that it was back to the drawing board for researchers. It was only then found that it was not the tampon that was causing TSS but a bacterium that loved super-absorbent materials. It was found on all brands of tampons but Procter & Gamble were just the most popular brand. With the source of the problem found, manufacturers could now prevent this from happening again by limiting harmful materials during production. 

These two cases of epidemiology are completely different in scale and outcomes but the way in which the diseases were tracked were the same. In terms of the HIV outbreak, finding the source and transfer of the disease was complex. In contrast, the TSS outbreak demonstrated that sometimes you need to look closer before coming to a conclusion. Things may not always be so clear cut.

Key lesson two: The world may end with a sneeze, not a bang

As of late, they have been four possible ways that life on earth could come to an end. Nuclear war, asteroid strike, climate change and a global pandemic. The first three have gotten most of the attention as they are unique events whereas an outbreak of disease occurs quite often. We have had to deal with the plague, Spanish flu, smallpox, SARS and ebola. But compared to natural disasters, pandemics have a further reach and can last for long periods of time. This is why they should not be overlooked. Also, given the way our global economy works, we are dependent on world trade and connectivity. If a pandemic strikes that stops this from happening, we can only imagine what would happen. 

Two types of pathogens are most likely to cause major pandemics. These are viruses, specifically those that cause respiratory infections and antibiotic-resistant bacteria. The main condition required for infectious diseases to spread is large, interconnected groups of people and animals. This allows the disease to be quickly transmitted between people. In the past, when people live in small villages and population densities were low, the spread of disease was limited. However, in modern times, both human and agricultural animal populations have escalated dramatically. Travel is also much easier now. This means that any infectious disease outbreak would be highly transmissible. 

What makes it even more problematic is the fact that there is a possibility that the next pandemic is man-made. As much as viruses are known to mutate easily, researchers have also complicated matters by creating viruses in the lab. They do this in order to prevent human infection by diseases in other species. But, if the technology to create these viruses end up in the wrong hands, with the wrong intentions, the repercussions would be horrific. Biological warfare is not just something you see in the movies. The possibilities of this happening are real. Just take a look at anthrax. If a small plane released 200 pounds of anthrax spores, it has the potential to kill three million people. 

And besides man-made pathogens, the fact that a pandemic could start at any place at any time makes it even more deadly. A good example of this was the 2014 Ebola outbreak which came from nesting fruit bats. The quick containment of the disease was only due to the way it is spread. Infection only occurs through direct contact with a person who is infected and already exhibiting symptoms. If the outbreak had not been contained quickly, it could have spread across the world. The scary part is, even though it has been contained, the disease still remains in fruit bats and could reinfect humans at any time.

Key lesson three: Mosquitoes, the flu and antibiotic-resistant bacteria – the persisting diseases of our time

Mosquitoes are vectors for some of the most infectious diseases known. West Nile Virus, yellow fever, malaria and Zika are just some of the diseases which the mosquito can spread. Despite mosquitoes being identified as vectors for disease more than a century ago, they still remain a problem today. The fact that the population in the tropical areas where mosquitoes thrive has exploded, only means that more people are vulnerable to the diseases they carry. Scientists are trying to modify mosquito populations so that they cannot act as vectors, however, they have yet to be successful.

Antibiotic-resistant bacteria are also fast becoming a problem. Microbes, in general, are constantly evolving. Our use of antibiotics to treat illness though has seriously increased the rate at which this happens. As a result, more robust and resistant bacteria develop. The strains of the bacterium which causes pneumonia, for example, already show some resistance. As much as this can’t be stopped, because we need antibiotics to survive, doctors can slow down antibiotic resistance. They need to stop over-prescribing antibiotics for common ailments. Governments can also start regulating the use of antibiotics in livestock more closely. These changes need to be made to protect us in future.

Influenza is another persisting problem in the world. The flu kills approximately 40 000 people a year in the United States. However, in 1918, the flu killed about 100 million people across the globe. The flu remains a deadly problem and is only exacerbated by the rapid mutations which occur in this virus. This causes the development of new strains of the flu and why scientists have to develop a new flu vaccine every year. Furthermore, because animals and humans live together closely all around the world, mutations happen even faster. Therefore the flu presents the most risk of starting a global pandemic.

Key lesson four: What can be done to prevent pandemics

Whether a pandemic comes in the form of the flu virus, antibiotic-resistant bacteria or biological warfare, we have to be prepared for it. Just like how a new flu vaccine is created every year to prevent a global pandemic, scientists have to develop new vaccines that will be effective against multiple strains of diseases. This, however, will take funding and dedication from everyone involved. 

Pathogens can easily cross borders, so international cooperation is also needed. The creation of an international organisation to cover threats of infectious diseases is important for the future. They can be broken down into groups that cover the different types of pathogens and disease vectors.

 Lastly, it is time that everyone realises that life on earth depends not only on humans but also on all other lifeforms. We have to take care of other animal species and ensure their wellbeing as well. Organizations need to research how human and animal populations interact and how the spread of infectious diseases can be curbed.

As much as this will take time and an immense amount of funding, it is necessary. Our lives literally depend on it. 

The key takeaway from Deadliest Enemies is:

There have been many infectious disease outbreak in human history. However, the world is more vulnerable now than it ever was back then. This is due to rising populations of both humans and animals which makes transmission much easier. The implications of a global pandemic could be devastating, resulting in the collapse of economies, famine and violent conflicts. It is therefore imperative that we take heed of the enemy now and prepare ourselves for the future. Funding needs to be allocated towards research into new vaccines and the control of disease vectors. International cooperation is needed as well to ensure that everyone works together to prevent a global pandemic in the future.

How can I implement the lessons learned in Deadliest Enemies:

Infectious diseases can emerge at any time from unlikely sources. It is therefore inevitable that all of us will experience illness at some time or the other. Always ensure that you use antibiotics wisely and complete the course you have been allocated to avoid antibiotic resistance from developing. Also, taking the flu vaccine each year is actually beneficial. Don’t underestimate its importance. 

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