Aug 102014
 
Who knew there were so many potentially significant health events in the US at present.

Who knew there were so many potentially significant health events in the US at present.

As realistic preppers, we know that we don’t always get unfiltered ‘real’ news and sometimes there are ‘policy issues’ that intrude on how news is shaped and reported.

This is particularly true of enormous potentially world-changing events.  While your local newspaper can be relied upon to be first to break the story if a local cat gets stuck up a tree, and also to give prominence to news that furthers their own ideological agenda, other stories can sometimes get delayed, re-written, or totally ignored.

The good news is that these days the major news outlets – the three traditional television networks and our local newspaper and radio stations – have now been eclipsed by all the other news sources out there, and all equally close to us through the internet, no more than a url and a click away.

The problem is that there are so many of these second and third level news outlets, news gatherers, and news finders that they all tend to get lost in the crowd, and it is hard to know where to find reliable and timely news that is important to us.

One vital thing that we as preppers are very focused on is getting early advance warning of trends and changes that may impact on our society and which may herald an oncoming significant event that might see a Level 1/2/3 scenario as a result.

We like the Drudge Report for general news distribution, but his selections of articles tends to be broadly focused at more or less mainstream readers.  We subscribe to a number of prepper type reader forums as well, but these tend to be a mix of rumor and nonsense, with only occasionally useful/important alerts mixed in with the other content.

The current prominence given to Ebola frankly has us unsettled, but perhaps for the opposite reason to what you might think.  We are puzzled why this present outbreak in West Africa is being given so much exposure and importance.  Is there something the authorities know which they’re not yet telling us?  Is there some other hidden agenda item?

Similar issues sometimes surround other important trends and stories and developments in the world.

We came across an interesting and very useful site today that automatically scans much of the internet for health related news.  It is so good at doing this that it found the first stories about the latest Ebola outbreak nine days before the outbreak was labeled as Ebola, and long before the western press started to write about it.  The site is www.healthmap.org.  It was originally intended as a tool for public health agencies, but it is open for anyone to use and for anyone to sign up for email alerts, and most of their content is in ‘plain English’ rather than in obscure obtuse medicalese.

We see on their event map (using the ‘diseases near me’ feature) that at present it is reporting on the spread of West Nile virus further into the American Redoubt (a mosquito borne virus that is taking over the world and not receiving nearly enough attention).

In addition to the general map, they also have specific tracking projects for diseases such as flu, Dengue Fever (another relatively new but significant entrant into the US) and a ‘Predict’ map that apparently anticipates possible future diseases that are spread from animals to humans.  A lot of good stuff.

They offer a newsletter alert service that we recommend you sign up for.

All in all, a great and free service that hopefully helps us to keep better informed and ahead of health/disease type issues.

Aug 082014
 
Pictures like this add to the shock and scare value of the present news about Ebola.

Pictures like this add to the shock and scare value of the present news about Ebola.

The news seems filled with stories about Ebola currently.  On Thursday the CDC issued its highest level alert, something it has only done twice before.  Today, WHO did the same, declaring it an international health emergency.

Newspaper articles tell horrifying stories about Ebola being ‘out of control’ and overwhelming the national health systems of countries like Sierra Leone, and of victims being dragged into the streets and being left there to rot in Liberia.

On the face of it, this is all alarming and concerning.  And, as preppers, we are of course always looking for such signs of pending problems.  But, if we scratch the surface of the Ebola hysteria, a different type of truth appears.

The current Ebola outbreak in West Africa has resulted in less than 1000 deaths over the course of six months (although this number is steadily increasing).  How many other diseases, in Africa and elsewhere in the world, have killed more than 1000 people in the last six months?  What makes Ebola so special as to get the CDC and WHO both giving it highest priority, and why does Ebola fill the pages of newspapers at present?

To put this number in perspective, in a typical flu season in the US alone, somewhere over 200,000 are hospitalized and up to 50,000 people die.  Yes, up to 50,000 people die of flu every year in the US, but the death of 1000 Ebola sufferers in West Africa now has the US CDC giving Ebola a higher priority status than flu (and a higher priority status than cancer, Aids, and everything else).  This really makes no sense.

Ebola surely doesn’t deserve this status because of its ‘rapid’ spread.  1000 people in six months is slow compared to true worst-case scenarios that have occurred in the past.  It also isn’t because of its implacable mortality rate.  Even with the worst of healthcare facilities in West Africa, it seems that somewhere between 25% and 40% of patients are surviving.

It also isn’t because it jumps from person to person like wildfire.  At present it seems that the virus is only spread through contact, not coughing.  The CDC say that an infected person can be treated in a regular private hospital room.

Has political correctness now invaded our healthcare system as well as everything else?  We are forced to conclude that this is indeed the case.

Now, don’t get us wrong.  Ebola is a spectacularly nasty disease, and having two-thirds of the people who get an Ebola infection die is a terrible outcome.  It is also true that currently there are no preventative vaccines, and no specific treatments for if/when a person does get an Ebola infection, but work is underway on new treatments and even on vaccines too.

It is also true that our society is more at risk of a global pandemic than ever before.  A person can be infected on one side of the world today, and then travel to the other side of the world tomorrow.  You may have heard the comment about how everyone in the world is no more than six people away from knowing anyone else, and indeed more recent studies suggest we are now more like only five people away from anyone else – that degree of contact applies to spreading disease, too.

In particular, it takes somewhere from two days to three weeks for an Ebola infection to become apparent in a person, allowing lots of time for that person to travel from somewhere to somewhere else, and the rudimentary type of health screening of arriving passengers at airports around the world will not detect Ebola during this incubation period.

The good news part of the Ebola incubation period is that a person only starts spreading the Ebola infection when they become symptomatic.  So we only have to be concerned about the few days between when a person starts feeling ill and coughing, etc, and when they are hospitalized and diagnosed with Ebola.

What Should Preppers Do

There’s precious little we can currently do about Ebola.  But you should definitely keep a watching brief on the Ebola news, and understand if the outbreak starts to spread outside of West Africa.  The CDC website is a good source of regularly updated information.

It is also helpful – if you haven’t done this already – to plan and prepare for how you could continue to work, without needing to be physically present at your place of employment.  For some people, this will be impossible, but if you are an office worker, shuffling papers (more likely, electronically moving computer data these days) or a phone representative, maybe you can spend much of each working day doing your tasks remotely from home.

Your employer should be considering this too.  In the event of a pandemic, the business will be at risk as much as you will personally be at risk, and both your survival and the business’ survival might depend on it being able to fragment and ‘virtualize’ with people working other than in one central office.

Beyond that, you should keep your supplies well stocked.  Disruptions to the food chain are almost inevitable if society gets crippled by a broad pandemic.  You should also keep your medical locker and protective gear fully provisioned too, so that if someone in your group gets afflicted, they can be cared for without endangering the rest of your community.

It is almost certain that one of the first failures in a future pandemic will be our hospitals and healthcare system.  Currently there are just over 900,000 hospital beds in the US – one for every 400 or so people.  But many of these beds are in use every day, so the number of available vacant beds is very much less.

Something that only affects as few as 0.25% of the population would overwhelm the healthcare system – and even if there were available beds, would there be available nurses and doctors?  Even if there were both beds and staff available, would there be available healthcare supplies?

Particularly with some type of virus for which there is no cure, there may be no benefit in being hospitalized, even if it is possible, and especially if you can provide competent palliative care at home.

If any sort of pandemic does start attacking our cities, you need to minimize your contact with other people as much as possible.  Try to keep away from all public places, and if you need to go to do shopping, do so in off-hours when the stores are likely to be nearly empty.

One more thing.  Your biggest risk of infection is by touching some other contaminated surface (what is called a ‘fomite’ in medical terminology).  Be sure to regularly wash your hands, and try to develop an awareness of the surfaces you are coming in contact with.  The next time you push open the door in front of you, wonder how many other people have touched the same door handle that you have.  A virus might survive some days on the surface of that handle.  That’s not to say you can’t safely touch the handle (assuming no cuts in your skin) but it is to say that you need to use hand cleanser or something on your hands on a regular basis – not just prior to eating food, but on an ongoing basis.

Think this through.  You touch the infected surface and your hand gets some virus infection on it.  You then touch your car steering wheel five minutes later, and transfer the virus to your steering wheel.  You step out of the car, and several hours later, someone else gets into the car, and also touches the steering wheel.  Your ‘safe’ seeming steering wheel has now infected someone else.

Summary

We do not see any cause for undue alarm about Ebola today.  We don’t know what the future holds, but as of today, and other than the general preparations we mention above, there’s nothing any of us need to do except remain alert.

In broader terms, we rate it unlikely that Ebola will become an actual threat to our society.  But we do consider the wider risk of some type of pandemic to be credible and concerning.  We have written several other articles on this topic, which you can see here.

Aug 012013
 
Chaotic scenes in emergency warehouse hospitals during the 1918-20 Flu Pandemic.

Chaotic scenes in emergency warehouse hospitals during the 1918-20 Flu Pandemic.

One of the problems we wrestle with is when we should bug out to our retreat.  When does a Level 1 situation become a Level 2 situation, and when should our strategy shift from staying where we are, to abandoning city life and bugging out to our retreat?  We’ve written about many aspects to do with bugging out and when we should do so before.

A major concern when bugging out is to beat the rush of other people, all seeking to abandon the cities at the same time, such as to make safe efficient travel impossible.  Talking about safe travel, we also wish to bug out before travel becomes actively dangerous, with modern-day highwaymen preying on distressed evacuees.

A not so commonly stated concern, but surely one which must be of equal importance, is beating any travel restrictions that might be imposed on people by county, state and federal authorities.

How likely is it that there would be travel restrictions imposed in an emergency?  Although it would seem that the right to travel is a derivative right from the First Amendment’s right to peaceably assemble (ie anywhere), the reality may be different and there is no end of examples of our rights being trampled on, both in the normal course of day-to-day living, and of course, in special situations which the authorities seem to believe allow them to suspend the Constitution and its protections.

Of course, the reactions by the authorities will vary depending on the emergency, but a new research paper by three researchers at MIT would seem to encourage such travel restrictions, at least in the case of epidemics and other biological type emergencies.

The study shows that even only a moderately contagious disease could see the rate of infection decrease by 50% if the authorities were to restrict where people could travel.  That’s a strong argument in favor of imposing travel restrictions and you can be sure that it has been well received by the people who might wish to act in such a way in the future.

One could even argue that in this particular case, restricting people’s freedom to travel as they wish and choose is a fair and appropriate thing to do for the greater good of everyone, but that’s not going to be very comforting to you, is it, when it prevents you from escaping a disease-ridden city and making it safely to your rural retreat!

Restrictions on travel could be enacted very quickly and with no warning.  A decree, possibly by state governors and almost certainly by the nation’s President, is all that would be required, and of course, the very nature of a travel restriction is that the authorities would not want to give any warning or allow a grace period, because that would encourage and accelerate people’s travel plans.  We saw restrictions on travel and public assembly during the Spanish Flu pandemic of 1918-20, so the precedent is already in place.

It is foreseeable, in any future disruptive emergency, that one of the first things the authorities will attempt to do is ‘freeze in place’ the current situation.  That is understandable, because currently they have a reasonably accurate understanding of population distributions and therefore, the population based issues and needs and potential problems, and if people started moving every which where after an emergency, the authorities would fear they were becoming even less able to adequately and appropriately respond.  It seems only too likely that the authorities will decide that so as to ‘better help us all’, the first thing they should do is limit and restrict our abilities to help ourselves.

The bottom line to those of us with remote retreats?  We need to move there at the first sign of problems.

We talk about this need repeatedly in our series on bugging out, and if you were to read just a single one of our articles, perhaps it should be this one which talks about the difficulties we will have and the delays we will likely create in making the decision to bug out.

Jan 282013
 
A US hospital ward during the Spanish Flu epidemic, 1918-1919.

A US hospital ward during the Spanish Flu epidemic, 1918-1919.

You probably know that these days few retail stores maintain much inventory, and neither also do the wholesalers and distributors or even the original manufacturers (who also don’t keep much inventory of raw materials, either).

This was most recently shown in an unexpected form – the surge in demand for firearms and ammunition subsequent to the Sandy Hook school shooting on 14 December.  As of today, six weeks later, most firearms and ammunition remains either unavailable or only available in very limited quantities, and at prices that have more than doubled compared to what they were on 13 December.

Even though you can surely bet that the manufacturers are scrambling to increase production as much as possible, and even though it is six weeks since the Sandy Hook shooting, and even though surely a lot of the demand for guns and ammo has already been soaked up in the first six weeks, everything remains somewhere between scarce and totally unavailable, and the prices remain ridiculously sky-high.

We also see this on a regional basis, too.  A power outage – or sometimes even simply the threat of a likely one in the future – is enough to cause the disappearance of generators from store shelves, for example.  Or, in another form, currently (at least here in the Pacific Northwest) bad weather in some parts of the country have resulted in vegetable shortages.  Broccoli that used to sell for about $1.40/lb for the heads at our local supermarket is now selling for $3/lb, and there’s a lot more stalk on the ‘heads’ than there used to be, too.  A nicely printed notice explains that cold weather has affected the broccoli crop.

The ‘more efficient’ practices that are being universally adopted in every facet of commerce only work as long as nothing occurs to upset the projected smooth lines for demand and supply, and the very narrow range of values/variables where supply can adjust to reflect chances in demand.  As soon as something happens to upset the demand projections, the supply process struggles to adapt.

This doesn’t matter too much when it simply means that the price of broccoli more than doubles, so as to encourage people to stop eating broccoli and switch to frozen peas instead.  Even the disappearance of most guns and ammo from retailers is hopefully not a life and death matter for most people.  But what about when something truly is a life and death matter – when a medical emergency occurs?

The Problem :  A Lack of Surge Capacity for Medical Emergencies

When any sort of biological event occurs, the flipside of the problem becomes the lack of ‘surge capacity’ in our hospitals.  These days, even the annual flu seasons can be enough to overwhelm medical resources – for example, this article reports on some hospitals being overwhelmed with flu patients and having to turn people away and (on page two of the article) how Boston declared a health emergency, due to there being 700 confirmed cases of the flu.

Now just think about that.  The article doesn’t indicate over what period of time these 700 cases of flu occurred, but if we consider that the flu usually affects a person for less than a week, and if we say that maybe the flu outbreak started in early December, then the 10 January article might imply perhaps a worst case of 250 flu cases a week, not all of which resulted in the victim being hospitalized.

The population of the greater Boston area is 4.5 million, and of the central Boston city area alone is about 670,000.  To have 250 flu cases – not all requiring hospitalization – is surely a teeny tiny blip in the overall health statistics of either the central city or the larger metroplex, but is apparently enough to trigger a medical emergency.

Now think about what would happen if 5% of the population were simultaneously afflicted by a serious disease that did require hospitalization.  That’s far from impossible.  It might be the result of a bio-weapon attack on the US by a hostile power, or it might be simply the result of a new mutation of the flu or other virus that becomes more virulent and more readily communicated from person to person.  The famous Spanish flu outbreak of 1918-1919 saw, in total, 25% of the US population infected (and a 2.5% death rate).

Let’s continue to use Boston as an example.  It is neither unusually better nor worse than any other city/region in the country, and seeing as how we started with a Boston example above, let’s continue with Boston into this future projection.

In the case of Boston, a 5% infection rate would be 225,000 people, and in the central city, about 33,500 people.  If something as ordinary and predictable as the annual flu season, with 250 people all affected at the same time, is enough to trigger a medical emergency, what would happen when the 250 people increases not by ten-fold, but by 100 fold or even by 1,000 fold?

To view this from another perspective, the ratio of hospital beds to population is currently at a level of about 2.5 beds per 1,000 of population, as a national average, and even though we have an aging population, this ratio is declining significantly (it has dropped 13% in the last decade, as can be seen in this article).

So, continuing the Boston example, and assuming they have close to the national average ratio for hospital beds, the greater Boston region probably has about 11,250 beds in total.  That sounds like a lot, but compare that to 225,000 people all afflicted with a disease at the same time.  That’s one bed per 20 patients.

The Three Limiting Factors

So, the first limiting factor is that these days there are fewer hospital beds as a percentage of the population as a whole.  The US has fewer than half as many beds, as a percentage of the population, as does most western European nations (see, for example, this table).

There’s more.  First, those hospital beds aren’t empty and waiting for sudden unexpected patients.  Most of them are full with ‘normal’ patients that come and go all the time.  The number of empty beds available for unexpected extra medical requirements is massively less.  That’s just guess that, by rescheduling some elective and non-urgent surgeries and other procedures, hospitals could free up half their beds.  So we have half of 11,250 beds for 225,000 people – one bed per 40 patients.

Second, it is a truism that many doctors and nurses are already overworked.  Even if hospitals could surge to beyond 100% capacity for accepting patients, where would the extra staff come from to care for and treat these extra patients?

Don’t forget – the doctors and nurses will be as likely to be victims of the epidemic as any other sector of the population, so there might be fewer of them available due to some percentage being afflicted by the illness too.

Third, what about medicines, equipment, and other related supplies?  The country has been in the grip of a largely under-reported shortage of an increasing number of medicines for several years already – for example, look at this FDA list of medicines currently known to be in short supply.  What happens if suddenly the demand for medicines skyrockets ten or twenty-fold (or, more likely, one hundred fold or more)?  Where will these medicines come from?  The answer – nowhere.  What say the care and recovery process involves blood transfusions?  Blood banks never have an abundance of additional blood – where will that all come from, too?

That is without even thinking about the astonishing fact that at present, medical science is losing the battle against bacteria.  Our compulsive over-use of antibiotics is causing most bacteria to evolve into resistant strains more quickly than we can develop new antibiotic agents.

And what about all the equipment needed to monitor patients?  It is easy enough to quickly add extra beds and to place them anywhere space exists in hospital wards, but what about the patient monitoring equipment?  Drips – and drip holders.  Even such mundane things as needles – how much spare inventory of needles do hospitals keep on hand?

Summary

It is wonderful that for most ailments these days, we can be in and out of hospital in only a few days, whereas just a few decades ago, we’d have been spending a similar number of weeks.  But this has caused a massive reduction in the number of hospital beds as a percentage of the population, and has reduced the ability of hospitals to accept a sudden surge in patients as a result of some type of medical emergency.

We’re not only lacking in spare ‘surge’ capacity for hospital beds.  Adding new beds into existing hospital rooms and even into corridors is simple.  But we lack the related medical equipment to support each of those new patients, we lack the trained staff to care for them, and we either already have shortages or will quickly run out of medications and even such trivial things as bandages and other assorted hospital supplies.

A prepper community is less at risk and can better respond to epidemics due to the reduced population density in the community to start with and the ability to cut down or even eliminate social contact within the community for a period of time.  But a prepper community should also ensure it has sufficient basic healthcare/nursing facilities and equipment to handle a demand surge in the event of unexpected medical emergencies.

Sep 012012
 

We’re overdue for a flu epidemic. Whether it will be bird flu or swine flu or some as yet unmutated variant, each winter season sees us rolling the dice.

The Spanish Flu Epidemic of 1918-1919 is something that could re-occur at any time, and if (when!) the next flu or other epidemic sweeps over the US, its effects will be much more severe than was the case 94 years ago.

Sure, we have better health care now, but we also have less health care resource and less ‘surge’ capacity for sudden peaks of demand, and less inventories of medications.  We have fewer hospital beds per 1,000 population, fewer doctors, fewer nurses.

We have written before about other elements of bio-risk and epidemics.

We now wish to add two new points to that earlier article.

The first is that back in 1918, the spread of that flu epidemic was gradual rather than overwhelming.  The country had some time to adapt to the threat and prepare for the problems associated with it.  But today, with air travel as the dominant form of travel, and with a much more mobile population, and also with a much more concentrated population (more of the country lives in a handful of big cities, much less of the country lives in rural areas), it seems likely that a new epidemic will spread like wildfire through the country.

This rapid spread will be even more stressful on our limited healthcare facilities – whereas back in 1918-1919 the epidemic was spread over two seasons, a new epidemic can be expected to rush across the entire country in only a few weeks.

The second point is to direct you to a mildly interesting study from MIT that shows the top ten airports through which diseases are likely to arrive and spread.  New York’s JFK comes top of the list, followed by LAX, Honolulu, San Francisco, Newark, Chicago, Washington/Dulles, Atlanta, Miami and Dallas/Fort Worth.

The study looked not just at the number of passengers passing through the airport (if that was the sole criteria, Atlanta would come top of the list) but also at where people were traveling to and from, and their location in terms of impacts on the area and country as a whole.

It is relevant to note that the study does not simply say that if you live close to JFK or LAX you’ll be among the first to be infected, whereas if you live in Bozeman or Boise, you’ll be among the last.  It merely points to these airports as the major distribution points.  For sure, with the possible exception of Honolulu (its inclusion is probably due to the large number of flights from around the Pacific rim that come into HNL) most airports provide both a mix of connecting flights and terminating flights – it is common to see half the people flying into a gateway airport simply changing planes and flying on somewhere else.

Nonetheless, that still means that around about half the people get off their planes and live somewhere in the general area of these airports, which (again with the notable exception of Honolulu) are also the nation’s largest cities.

So it is fair to say that probably the major cities such as New York, Los Angeles, Chicago, DC, and so on will be the first to be impacted by any new epidemics.  Which provides another reason to keep well clear of such cities, but you almost surely already accept that the bigger the city, the less appropriate it is as a place for a prudent prepper to live.

But lesser cities, even in the American Redoubt, will quickly be affected too.  However, most preppers don’t plan to live in the central downtown of any city, but rather some distance out, and if you need to, you should be able to instantly stop any daily interaction with other folks and hunker down until an epidemic has passed by, with no way for the infection to reach you.

May 282012
 

One of a series of maps from the CDC showing the incidence of various types of ticks.

In a Level 2/3 situation, the omnipresence of modern medical care that we have come to rely upon will be much less available.  We will be well advised to plan our lives so there will be less need to seek medical help.

One issue to consider when choosing the location for our retreat is the presence of any insect-borne diseases, any particularly dangerous animals, and other such issues.  This involves not just looking at challenges that presently exist, but also extrapolating further to new challenges that might appear.

For example, the Africanized or ‘killer’ bees that are spreading northwards up from Mexico.  It is far from clear at what point these bees will stop their advance.

Or the spread of ticks carrying various diseases, Lyme disease being the best known but far from the only such disease, some of which can be fatal.  Here’s a recent article about the increasing amount of the country being affected by such things, and here’s a useful map.

At the risk of inviting despair, here’s a series of maps showing the spread of various types of ticks and information on the diseases they can carry.  It would seem that nowhere is safe from some type of tick and disease.

As for other types of animal threats, it is hard to know if they will become more prevalent and severe, or less so, in a Level 2/3 situation.  On the one hand, there may be a reduction in human type impacts on such creatures, allowing them to thrive and increase in numbers.  On the other hand, there could be an increase in human impacts if they are the type of creature that people would choose to hunt for food – we’re just guessing that not everyone will strictly observe the current seasonal restrictions on when, where, and how game can be killed!

We’re also going to guess that not everyone will be wearing bright orange safety jackets in the woods and we’d suggest that the woods could become relatively dangerous places to be in, due to over-eager hunters shooting at anything that moves.

May 142012
 

The H1N1 flu virus as seen through an electron microscope.

Two things make our society massively more vulnerable to what we term bio-risks – anything from deliberately introduced lethal diseases to the results of random mutation of regular viruses and bacteria already in our environments.

But to start with, here’s an interesting fact.  Most diseases don’t like to kill too many people too fast, because they rely on living people for their own survival – as a host to live in, and as a means of passing on their offspring.  If a disease kills too many people, too quickly, they end up harming themselves as well.  So evolution tends to moderate the lethality of most diseases.

Furthermore, in places where there are common diseases, the people develop some resistance to those diseases, meaning the people and the diseases can co-exist in a balanced situation.  That is why we Americans have to take anti-malarial precautions when traveling somewhere rife with malaria for example, even though the local people are living quite comfortably alongside the malaria.

But – and here’s the catch.  Changes in our lifestyles have occurred faster than diseases can evolve to keep up with us.  The two key changes, below, in particular mean that diseases that once posed moderate risks now can pose massively greater risks.

Population is More Densely Crowded

In our modern world, if someone coughs onto a door handle, 100 people might touch that same door handle in less than an hour.  If someone sneezes on a bus or train or plane, the germs carry instantly to 20 or 30 people within a dozen feet of them.

When people lived in rural areas, what happened in one homestead or one small town rarely impacted much beyond that, because people weren’t crowded together for much of every day.  A person would get sick, and stay at home, and their family would largely stay close around them, with only limited interactions with other households.  And if they did travel somewhere, they’d probably be traveling by horse or open carriage, not infecting hundreds of fellow travelers as they did so.

Non-farm employment was typically in small businesses rather than huge office complexes.  There were no such things as shopping malls with thousands of people going in and out of them every day.

The ability of a disease to pass from person to person, within a local area, was much more restricted than now.

People – and Things – Travel Further, Faster, and More Often

The ability of a disease to travel long-distance was even more constrained, 100 and 200 years ago.  100 years ago the fastest method of transportation was the train (at about 40 mph) or boat (less than 20 mph); and 200 years ago, it was the horse at perhaps 10 mph or a boat at 5 mph or less.  In other words, infected people would simply die before they got too far out of their home area (or, perhaps, recover – either outcome meaning the disease was no longer being passed on).

Today we have planes that can fly nonstop, halfway around the world, in less than a day.

The person next to you on the bus might have just flown in from a far away country yesterday, bringing who knows what foreign disease with him.

Or, in the airport, on your way from San Francisco to Chicago, you pass a person who has just landed from London, and who was seated next to someone from Ghana.  He caught an infection from the Ghanaian (who continues to infect more people on his travels), and the man you met is now about to infect people in San Francisco, including you at the airport, and you’re about to now go to Chicago and continue the spread of the disease, infecting someone on your flight to Chicago who travels on to New York, and so on and so on.  Give it a day or two, and the disease is everywhere that has an airport.

It isn’t just people who travel.  So too do things.  Much of the food you eat has come from hundreds or thousands of miles away.  As we sometimes find out to our cost, contaminated meat from one packing plant can impact on people all across the country.  Unwashed lettuce containing a dangerous hazard might start its journey in another country, and fan out all across the country, infecting people semi-randomly across the US.

A crate packed full of clothing made in South East Asian and airfreighted here might also have one or two dangerous disease bearing insects that escape into the greater Los Angeles area upon arrival at LAX.

In the past, people obviously didn’t travel as much, and they also traveled more slowly, meaning that by the time they came down with a disease, they had not had a chance to get far from home, limiting the disease’s spread accordingly.

To return to our earlier malaria example, 100 and 200 years ago, malaria was not a problem outside its prime areas of existence, because people and mosquitos with the disease didn’t travel far away from the prime malarial regions.  But today, a mosquito or a person can be in one part of the world in the morning, and many thousands of miles away by the evening.

Diseases which are not crippling risks to the local acclimated population can become lethal when suddenly introduced to a different population with no built-in resistance.

We Are Less Disease Resistant To Start With

Some credible studies have suggested that our clean healthy lives are actually weakening our immune systems.

When children used to literally eat worms and dirt at the bottom of their garden, when food wasn’t always thoroughly cooked or safely stored, when children would regularly fall over and get cuts and scrapes, people exercised their immune systems and built up a more resilient and healthy system in general.  Exercise, healthy living and healthy food with fewer chemicals and additives all helped too.

Today we have so cocooned ourselves in cleanliness that trivial infections can become more serious.  But – not to worry, because we nowadays have sophisticated antibiotics to protect us from most bacterial infections, right?

We Are Destroying Our AntiBiotic Effectiveness

Alas, no.  Doctors are colossally over-prescribing antibiotics, partially due to pressure from anxious patients (and their anxious parents) and are sometimes now prescribing them even for non-bacterial infections, even though they are useless for such things.

Why do doctors do this?  Two reasons.  First, liability.  They reason ‘Well, the illness is probably not bacterial, but maybe it could be, or maybe there will be a secondary infection that might arise, and if I don’t prescribe the antibiotic, I might subsequently be sued; it costs me nothing to write the prescription, so why not’.

Second, in response to pressure from their patients.  Few doctors develop the close relationship that family doctors formerly had with their patients.  They have become the slaves of their productivity studies; they don’t even have their own friendly warm consulting room.

Instead, they flit from room to room, where their patient is waiting for them, already having been prepared, vital signs checked, history recorded, by nurses and nurse-assistants.  Rather than asking the patient what the problem is, and chatting with them to elicit more information and to relax and build a rapport and trust while doing things such as taking temperature and blood pressure, they read the notes in the computer, then start diagnosing and prescribing almost without interacting with the patient at all.

The former 20+ minute patient visit is now more like 5 minutes.

So in their rush to complete their consultation, it is easy to accede to a patient request, and there is always the hope that the placebo effect may assist the patient, even if the antibiotic itself doesn’t.

The next part of this problem is that patients often don’t take the antibiotic as directed.  As soon as they start to feel better, they stop taking the antibiotic, particularly if the antibiotic has or threatens to have any type of side effects.  This is a very dangerous thing to do, because at this point there are still some bacteria in the patient – hardy bacteria who are slower to die from the antibiotic.  If the poisonous antibiotic stops attacking them, these resistant bacteria recover, and become more resistant for next time and next time.

Furthermore, there are so many antibiotics being prescribed – and for animals as well as people (not because the animals are sick, but to make them grow faster) – that much of the water and ground is now contaminated with low levels of antibiotics, which allow for bacteria to become acclimated to the antibiotics and develop resistance to them.

The result is the appearance of increasingly resistant bacteria.  Here is a terrifying article about the latest developments in antibiotic resistant bacteria.  Read it and be definitely afraid.

How Many Times Can We Win at Russian Roulette?

Remember SARS?  Swine Flu?  Bird Flu?  These – and many other viruses that don’t get such prominent news billing – all credibly threatened to become global pandemics.  In each case, the threat did not become a reality, but it was not due to any particular clever/appropriate response by society.  It was due to good luck and the viruses being not quite as lethal/infectious as initially thought.

But the viruses continue to mutate.  The good thing about mutations is that 98% or more of all mutations create weaker rather than stronger viruses.  But some small percentage of mutations create more lethal and/or more infectious viruses.

With our society the way it is now, the conditions are ideal for a lethal infectious virus to spread like wildfire, across the entire world.  It doesn’t only have to be an influenza type virus.  It could as likely be an antibiotic resistant bacteria.

Good luck has meant this has not happened to date, but as soon as our lucky streak ends, we will be in for a life-changing event.

The Effects of a Pandemic Today Would be Greater than Ever Before

Our vulnerability today in the event of a pandemic is much greater than ever before.

The last major pandemic was the Spanish Flu of 1918-1919.  Back then, continents were linked by slow ship rather than fast plane, and only about one person in five lived in a city.  Most of the population were in low density rural areas, and each city dweller (who did not make his own food) had as many as five rural residents who could make food for him.

Life, back then, was ‘low intensity’.  Electricity was a convenience, but not integrated into every part of our lives.  Wireless radios were just starting to come out.  Television didn’t exist (and at the risk of amazing our younger readers, neither did the internet, either).

In this low intensity world, it is estimated that 25% of the US population came down with the Spanish flu, and 10% of those who caught the flu died from it.  What would the numbers be like today, in our much higher intensity world?

Initially, governments were slow to acknowledge the Spanish flu and the danger it posed, and preferred to refer to the pandemic as ‘only the flu’ so as to prevent panic.  But, whether ‘only the flu’, or not, social disruptions became increasingly extreme.  Restrictions were placed on public gatherings (including funerals and even store sales) and on travel.  In San Francisco and San Diego it became compulsory to wear gauze masks in public, and one town made shaking hands illegal.

Desperate shortages of health care professionals existed, and similar shortages affected other service industries – in some cities, there were not enough phone operators to allow for normal phone service.  There were also shortages of coffins, morticians and grave-diggers, such that mass graves were dug by steam shovel and dead bodies buried en masse.

To put the impact of this flu outbreak in another context, 25 million people have died of AIDS in the first 25 years of this disease.  In comparison, 25 million people died of flu (in a world with a much smaller population) in 25 weeks (many more died in total, over a longer period).

Now think about what would happen today.  And instead of a shortage of phone operators, maybe there’ll be a shortage of public works employees.  We might lose our water or our power or our sewer services.

These days we have many fewer hospital beds than we had then, because people spend much less time in hospitals, and fewer healthcare workers in general.  We have less ‘surge capacity’ to accommodate a massive outbreak of anything – we don’t have the hospital beds, or the hospital space of any type, or the healthcare workers, or the medical supplies needed to manage a sudden outbreak affecting maybe 50 – 100 million Americans.

And those restrictions on public gatherings and store sales?  What happens if you can’t go to buy more food for a week?  For that matter, what happens if 25% of the people who deliver food to the stores are off sick, and 25% of the people who prepare the food are also off sick, and so on?

Does a 25% reduction in manpower mean a 25% reduction in services, or a lesser amount – or, perhaps, a much greater amount?  Does a 25% reduction in police mean a 25% rise in crime, or a doubling in crime?

Talking about the reduction in police, it is probable the police would also need to be retasked to all sorts of additional duties, and just as we’ve seen in past rioting events (eg Los Angeles in 1992)

Here is an excellent three-part article series about our vulnerability to pandemics and what to expect and do.

Terrorist Bio-Attacks

The other new dimension of our ugly world today is the potential for terrorists to release some form of bio-attack into our communities.  Anthrax, botulism, or any of dozens of less well-known but equally deadly evils could be seeded into a small part of our country and then be quickly spread around the country by unknowingly infected individuals.

By the time the authorities worked out what was happening, and decided on what to do about it, much of the country would already be compromised.  There comes a point when the concept of quarantining no longer makes sense, because most of the country would have to be in the quarantine zone!

Unfortunately, all the amazing new tools and knowledge of geneticists and biotechnologists can be used for evil as well as for good.  The totally lax security concerns of researchers who develop dangerous strains of germs and who like to share them with each other, while making good sense in a benevolent world and enhancing the sharing of knowledge and research, are incredibly dangerous and alarming when one of the people receiving the shared knowledge and the lethal research strain of some bug is someone keen to use the knowledge for evil rather than honorable purposes.

Creating and inserting pandemic-causing diseases into our society is dismayingly easy, and does not require nearly the degree of technology and visible infrastructure that is required for developing or delivering nuclear weapons.

Preparing for Bio-Doom

In terms of duration, a pandemic will probably be a Level 2 event.  The Spanish flu attacked the US in three major waves, spanning a good twelve months.  This was in part due to the movement of troops from Europe back to the US at the end of World War 1, and in part just due to natural factors.

New pandemics will spread at a faster rate, for sure, and might therefore last less time in total (but also might extend on at least as long).  The impact on society is unclear, and may be mild or might be severe – in other words, can you survive in place, or do you need to bug out to your retreat?

The end of the epidemic will occur when one of two things occurs.  One possibility is when population densities have reduced to a point where it is no longer being readily transmitted, and where the remaining people will either be survivors who now have immunity after their earlier infection, or naturally resistant people who are not susceptible to the disease to start with.

The other possibility is that our medical scientists will come up with a vaccination or cure for the ailment, enabling people to quickly terminate any infection.  This is the medical equivalent of a ‘Hail Mary’ pass, however.  The lead-times required to first come up with a solution to a new threat, and then to develop enough of the drug that resolves the problem, could be way over a year or more.

Needless to say, it would be very nice to have the option to bug out if possible when confronted by a pandemic.  It is a bit harder to decide when you should do this, though – on the other hand, the good news is that the lack of an obvious defining event means that the entire population of your city region won’t all take to the freeways to evacuate the city simultaneously.

Clearly, you need to keep appraised of the latest bio-risks and the Pandemic ratings given by WHO and CDC to any new threats.  At some point prior to being surrounded by a pandemic and probably infected yourself, you’ll need to shut off contact with the outside world and let the pandemic pass you by.

If there is no threat of social disorder, it probably makes sense to stay where you are.  But if the threat of social disorder starts to increase, and if your normal residence starts to lose essential services such as water and power, then you might want to consider making an orderly departure and moving to your retreat.

During the period of ambiguity as to if an outbreak will become a pandemic or not, you’ll want to become very careful at controlling your exposure to germs.  Washing your hands becomes essential prior to any potential transfer of germs from anything to your hands and then on to anything that could end up in your mouth or nose or eyes.  And gently reducing the time you spend in concentrated crowds of other people is a good thing to do, too.