»  National Review Online

August 12th, 2002

  Rolling the Biological Dice

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I am, I have noted before, not much of a regretter or a worrier. I am like the mouse to whom Robert Burns addressed himself:

Still thou art blest, compared wi' me!
The present only toucheth thee:
But och! I backward cast my e'e,
On prospects drear!
An' forward, tho' I canna see,
I guess an' fear!

Sometimes, though, scanning my morning news web-sites, I find myself guessing and fearing about the future like poor Robbie (who, let it be noted in the context of what follows, died of rheumatic fever at age 37).

The only thing we can actually know about the future, of course, is that it will not be much like the present. Now, a feature of the present that would be very striking to a time-traveller from any past age is the extraordinarily low level of infectious disease. Of the two and a half million Americans who will die this year, less than 200,000 — eight percent — will die from infectious diseases. Within living memory, the rate has been far higher. The graph of infectious-disease deaths in the U.S.A. through the 20th century starts off around 500 per 100,000 population in 1900 and drops steadily and evenly down to 50 in mid-century (except for a huge, narrow spike in 1918 — see below). It then bumps along the bottom for a decade or two before beginning a slow rise through the 1980s and 1990s.

Taking the long view of human history, the past fifty years have been an astonishing disease-free oasis, at least in the Western world. The last really serious general epidemic was the polio outbreak of 1942-53, when some of the most dreaded phrases in the language were "leg braces"  and "iron lung."  The results are still with us: five years ago I broke my leg in an auto accident and had to get around New York City on crutches. Coming out of Penn Station one day, I found myself hobbling alongside a man of sixty or so, also on crutches. Making small talk as we negotiated the escalator, I asked about his accident. "Not an accident,"  he said. "It was polio. Been like this since I was a kid."

Yet polio, as awful as it was, crippled more than killed. The last big lethal epidemic to hit the population at large was the so-called "Spanish influenza" of 1918, which in a few months killed more Americans than all the 20th century's wars. That, though, is almost beyond living memory now; and even its 675,000 deaths are a bagatelle by comparison with the terrible plagues of earlier times. Three thousand New Yorkers died in the great cholera epidemic of 1832, from a city population of 200,000 (a proportional equivalent today would be 120,000 deaths in the city). Further back still, of course, lie the terrible plagues of the Middle Ages, which, in the worst-affected areas, saw off a third of the population. In the countryside of the English Midlands, where I grew up, there are places known to have been the sites of "plague villages,"  from which any surviving inhabitants had fled in the 14th-century Black Death. In a dry summer when the grass is thin, you can still trace the outlines of the houses.

Could there be some similar horror in our future? I confess to having nursed a morbid interest in this question ever since, at about the age of ten, I read George R. Stewart's novel Earth Abides. A 1940s sci-fi classic, this book tells the story of Isherwood Williams, one of the few scattered survivors of a sudden plague that wipes out most of the human race. In the book's vivid last scene, the aged Isherwood dies on the Golden Gate Bridge, across whose rusting girders he is being carried by his great-grandsons, the tribe having decided to move to new hunting grounds. They are, of course, armed with bows, arrows, and spears.

I am going to look on the bright side here and hope that nothing so drastic will happen. It is of the order of things that could happen, though. One certainly gets the impression from reading the newspapers that the endless war between man and microbe (and virus) is gradually warming up. In a column a few days ago I mentioned the Four Horsemen of the Apocalypse, one of whom is Pestilence. I got three e-mails from three separate readers, all claiming to be — and sounding like — medical experts, telling me that TB is now a serious threat once again, with ever more resistant strains showing up all the time. Other kinds of infection are showing new vitality, too: WestNile Virus seems to have definitely made the hop to the human population, with five confirmed deaths in the U.S. this year. There has been an outbreak of legionnaire's disease inBritain; and mad cow disease has shown up in Canada recently. The number of fatalities is negligible, but these outbreaks serve to remind us of the ingenuity and unpredictability of our most ancient and determined enemies.

And then, of course, there is AIDS. Like the great majority of Americans, I don't think about AIDS from one year's end to the next. Why should I? It's a behavioral disease, and I don't engage in any of the relevant behaviors. As a monogamous heterosexual who does not mainline heroin or take frequent trips to Rwanda, there is no reason for me to think about AIDS. This is probably foolishness, born of the long complacency we have settled into during this 50-year lull in the war of man versus micro-organism. Having already made the leap from animals to humans, the retroviruses will presumably have no problem making the lesser leap from "high-risk" groups to the general population. The disgraceful and homicidal (and suicidal) antics of promiscuous male homosexuals, recorded by my colleague Rod Dreher in the current print National Review, are ensuring that there is a large breeding pool of humans in which the viruses can quietly mutate; and such mutations are indeed starting to show up. If AIDS does escape into the general population, so that millions of ordinary Americans have to watch their loved ones dying from it, then the fog of silliness, sentimentality and victimology that currently surrounds the disease will clear very fast, and we shall be in a new world of epidemiological realism.

Other signs of our long compacency are not hard to spot; the shambolic response to last year's anthrax scare comes to mind. Politically, public health is a vanity zone, staffed by nonentities, joke figures or race tokens. The office of U.S. Surgeon General is a pure tokenism slot: the current nominee is Hispanic, the current "fill-in"  acting office holder is Japanese-American, and the two previous incumbents were black. I do not wish to disparage the abilities of these persons, about whom I know very little; but anyone with a clue about the nation's political life must surely understand that an unbroken run of "diversity"  appointments like that is a plain sign that the office is not taken seriously.

To see the kind of consequences this might have, just look at the Department of Transportation. Prior to last September 11th, nobody took that seriously, either. In making his cabinet appointments, George W. Bush felt free to assign the Department not merely to a token, but to a twofer token: Norman Mineta — token Asian-American and token Democrat. The results are on display at an airport departure gate near you. Since September 11th, of course, Transportation has become a very serious matter indeed, and Underperformin' Norman should have been fired and replaced with somebody who knows his fingers from his thumbs. Ah, but here you bump up against the other problem with tokens: you can't fire them. That would be "racist."

So we are stuck with some token as Surgeon General. (A token might, of course, be perfectly competent. If so, however, this is sheer good luck. His competence is accidental, because he was not hired for competence.) In the event of a major public-health disaster — an epidemic of serious infectious disease, or a determined bio-terror attack — an incompetent Surgeon General would bring the same lunacy to clinics and hospitals that Mineta has wreaked on airports. Political Correctness may yet be the death of us — not just the odd planeload of us, but tens of millions of us.

It would therefore be nice to think that we can afford to continue our relaxed attitude to public health issues. One's natural tendency to languish in complacency is reinforced by noticing that most* of those sounding the public-health alarm are lefty nuisances — like those tiresome AIDS activists, or author Laurie Garret (The Coming Plague). And indeed, if you think that war offers tremendous opportunities for government to expand its control over our lives and property, imagine how much power people would gladly yield up to the authorities in a plague time. War may be the health of the State, but I suspect a full-blown general epidemic would really put apples in its cheeks. One more reason — as if one more were needed! — to pray that our worst public-health nightmares never come true.

As for man, there is little reason to think that he can in the long run escape the fate of other creatures, and if there is a biological law of flux and reflux, his situation is now a highly perilous one. During ten thousand years his numbers have been on the upgrade in spite of wars, pestilences, and famines. This increase in population has become more and more rapid. Biologically, man has for too long a time been rolling an uninterrupted run of sevens.
              — Earth Abides, by George R. Stewart

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* Not all. Occasional NR contributor "Theodore Dalrymple," who is actually a medical doctor, has spoken out about the public-health threat to his native Britain from diseases brought in by Third-World immigrants. Over here, Sally Satel has taken on related issues in her book PC, M.D.: How Political Correctness is Corrupting Medicine.