The Next Pandemic Could Be Worse. Much Worse.

By Alec Pruchnicki, M.D.

The Covid-19 pandemic had a traumatic medical, political, and economic effect on the world with a 1-2% mortality rate. But there are diseases around the world right now, and potential diseases in the future, which could be much more deadly. Here are just a few.

The bubonic plague had a mortality rate of 25-50% and the pneumonic plague a mortality rate of almost 100%. In combination they produced the Black Death of the Middle Ages which killed 25-35% of the population of Western Europe. The Plague of Justinian in ancient times sealed the destruction of the Roman Empire and was probably caused by the same organism, yersinia pestis. This is a bacterial organism and responds to antibiotics, but there is always a possibility that a mutation or anti-biotic resistant strain might occur.

Seasonal influenza, a viral infection, causes about 50,000 deaths in the U.S. annually. In 1918 a new variant of influenza was detected at a U.S. Army base in the Midwest. It spread globally and was eventually mislabeled as the Spanish Flu. It had a mortality rate possibly as high as 10-20% and killed anywhere from 20 to 100 million, with the vagueness of the numbers being a result of poor international health statistics. It also had the unusual property of killing young healthy males at a high rate, possibly because their immune reaction was so strong that the resulting inflammation became deadly. There is no reason why another mutation could not produce a similar variant now. As a viral disease, antibiotic treatments are useless and antiviral medications are not equally effective.

Bird flu in the U.S. has devastated the poultry industry but some of its viral mutations have infected mammals and a few farm workers who had prolonged direct physical contact with infected animals. There is no reason that a new mutation couldn’t make it transmissible by air in which case it could become as easy to catch as the common cold. A recent report in the NY Times described an outbreak of, presumably, such a variant in a colony of seals in the Antarctic. The mortality rate there was calculated to be 75%. Seals are mammals, as are humans, and if one mutation occurred there, there is no reason a similar mutation can’t occur anywhere else, including here.

Ebola virus is a hemorrhagic fever spreading in Africa right now. It is spread by direct contact with infected people or their corpses and has a mortality rate of 25-50 %. Although it has the elevated temperature and muscle aches of any virus, it also can cause excessive bleeding as the virus destroys the body’s ability to form blood clots. Bleeding is a common cause of death and the blood is infectious to others. Other equally deadly hemorrhagic fevers like Marburg virus, Lassa fever, Dengue fever, and many others are usually transmitted by direct contact between people, contact with human and animal waste products, and insect bites. There is usually no airborne spread, so far.

Fortunately, there are ways to combat these diseases. The World Health Organization (WHO) has a tracking system that surveys the world, watching for outbreaks of these and other infective agents. The U.S. has funded medical clinics all over the world and they serve as early warning systems to catch new outbreaks quickly. New influenza strains often start in Asia and migrate to the U.S. so medical systems there monitor new strains of the flu, transmit this information to the U.S. and allow for the annual flu vaccine to be adjusted to the appropriate new flu strains. In the U.S., the Centers for Disease Control in Atlanta has a system of communicating with state public health systems and announcing new findings in the Morbidity and Mortality Weekly Report on the internet. The states themselves have public health systems of various types.

Limiting outbreaks of infectious disease is not the best form of medicine. The absence of disease is the best form and so prevention of outbreaks has a high priority. Annual flu vaccinations, adjusted for year-to-year variations, are distributed widely starting each fall. The National Institute of Health (NIH) does extensive research on infectious diseases to look for new organisms or variant strains. New vaccines can now be developed using mRNA technology in weeks, as opposed to many months by older methods, and mass production of the actual vaccines is much faster. Until new vaccines become available, Non-Pharmacologic Interventions (NPIs) such as isolation, masks, shutdowns of workplaces and schools, extensive hand washing and others buy time.

Unfortunately, every one of these methods has been undermined by the Trump administration. The U.S. has withdrawn from WHO and public health workers in the U.S. have been told not to communicate with it without special permission. The U.S. has decreased funding of the NSAID which funded medical clinics around the world and so possibly over a thousand of these early warning stations have been closed. The entire advisory council that planned for the annual flu vaccination program was fired by RFK Jr. and mostly replaced by people with no infectious disease expertise or outright anti-vaxxers. The CDC and NIH budgets and personnel have been drastically cut, although Congress managed to restore a few of the decreases in order to avoid complete breakdown of these agencies. Routine and necessary government funding for mRNA research has been stopped. When vaccines for Covid became available, distribution and mandatory enforcement was limited by the administration and conservatives on the Supreme Court. During Covid, NPIs were frequently unenforced, made voluntary, and the result was unnecessary spreading of the disease.

In the military, annual flu vaccines have been made voluntary, probably leading to the present flu outbreak in Texas. Measles cases have exploded nationally, almost always linked to reduced vaccination rates. Part of the delay in detecting the recent Ebola outbreak has been attributed to the breakdown of communication with WHO.

There is no way to predict what the next national or worldwide epidemic will be. Will it be a bad, but not catastrophic, flu season, an exponential increase in measles cases, a Spanish flu-sized pandemic, an antibiotic resistant yersinia pestis mutant, or a new viral organism triggering a Black Death type disaster? Infectious diseases have not vanished from the Earth. This partial list I have given you is only a small sample of recent new disease outbreaks. Whatever hits us next, one thing is certain. We are now much more limited in how to combat new disease outbreaks, and might be until a new administration, Congress, or Supreme Court, allows us to fight back appropriately. Let’s hope this restoration of our health system comes in time. Our lives depend on it.