The Coming Plague: Newly Emerging Diseases in a World Out

  • Paperback
  • 750 pages
  • The Coming Plague: Newly Emerging Diseases in a World Out of Balance
  • Laurie Garrett
  • English
  • 17 June 2018
  • 9780140250916

10 thoughts on “The Coming Plague: Newly Emerging Diseases in a World Out of Balance

  1. Mario the lone bookwolf Mario the lone bookwolf says:

    A 25 year old, unheard, ignored Cassandra call full of detailed descriptions, this book deals with the question of how the evolution of killer viruses, potential pandemics, plagues, sexually transmitted epidemics,... may continue in the future.

    Garrett describes the connection of third world poverty and the spread of diseases, something completely ignored by mainstream media because of the political and economic implications, except an epidemic gets too extreme and gets NIMBY. This, chapter 14, named Thirdworldization is a reason for shame for the rich, industrialized countries, but what is not?

    The general question is, as so often, not if, but more when, how, where and hopefully not me.
    When: There are many ticking time bombs, be it manmade problems with superbugs due to overuse of antibiotics, urbanization with more and more people living close together, the possibility of spillovers in companion with natural destruction, as unexplored areas with new species of primates are exploited, other manmade problems like side effects of genetical engineering, the option for use as biological weapons, climate change and global warming that help germs immigrate to new territories and possibly frozen ones come back to live, terrible public health and prevention politics, no further development of new and preventive vaccines and antibiotics because there is no money to make with this stuff, except if it is the flu,...

    How: As an element of warfare or one lumberjack, being bitten by a monkey or getting in contact with body fluids spreading it in his hometown and from there to a larger city to the capital to….. Or a multiresistant superbug out of a secret biowarfare lab or an industrial farming facility, whatever the difference is, the farming might get much more subsidies. There are so many great film plots around this.

    Where: The only positive thing. If one doesn´t live in a larger city, but a rural area, by simply shooting everyone nearing the village after the breakout, bad things can be prevented and outposts have a long tradition of hating anything foreign, so that should work well. Except when there is a longer state of emergency, break down of infrastructure and food supply, leather rockers cannibalizing around, virus apocalypse, yada yada yada.

    The author is a biologist with specializations in bacteriology and immunology who switched to journalism and the chapters read like great storylines for hard biopunk Sci-Fi stories. The underrepresented biopunk genre deserves more authors who are biologists, geneticists, bioengineers,... So please, take a creative writing course and create the next big thing, because the Sci-Fi hall of fame is filled with just mostly astrophysicists, chemists, physicists and similar, mainly not bio-focused, authors.

    All of the points the author mentioned a long time ago, the suggestions she made on how to be able to deal with the problems have been commendably solved by a wise and united world government and public-private partnerships with international institutions that... Just joking, we are doomed (when living in large cities)! Doooomed. (I love to say that.) Now, it´s really enough. Ok, once again: „Move along people, nothing to see here. The government is competent and capable to deal with the situation.“

    One more: They build bioweapons by combining elements of something extremely deadly like smallpox or ebola with the flu and anything that can spread by air and is extremely contagious. Something like a droplet infection that spread genetically enhanced HIV, multiresistant tuberculosis, hepatitis C,… this way might be no effective immediate use bioweapon, but something for the long-term destruction of a country, especially if the own population is immune and vaccinated against it.

    A wiki walk can be as refreshing to the mind as a walk through nature in this completely overrated real life outside books:

    I read it inspired, or let´s say terrified, yes, that sounds much better, by the current coronavirus outbreak.

    CNN live updates

    John Hopkins CSSE world map

    Youtube statistics

  2. Lori Lori says:

    She nailed it in 1994. Maybe won't be COVID-19 but one of them. Terrific, informative, well-written, I still remember it but not surprised it's a bestseller again.

    I was seeing a guy getting his Ph.D. at Harvard School of Public Health and leaving him even more sleep-deprived than your average Sci.D. getting a Ph.D. in public health by hitting him on the arm to wake him up multiple times a night as questions occurred to me. Maybe if I'd written them down we'd still be together. (Kidding!)

    (Focus, Lori. You don't like reviews or reviewers who make the books about them -- cough cough [not a coronavirus cough...or is it?] -- Lolita.

    Can someone please muzzle the orange lummox and Igor and let Dr. Fauci of our NIH run this? Tough choice: one's daddy paid to get him into school, then paid the school to take his grades and lock them up! -- and the other has been a worldwide leader in efforts to study and contain infectious diseases, especially AIDS and Ebola.

  3. Gregory S. Gregory S. says:

    A couple weeks after I read this wonderful book (years ago) I was walking across the Brooklyn Bridge and saw a woman that looked just like the jacket photo of Laurie Garrett. I stopped and asked Are you Laurie Garrett? And, of course, she was. Then I said something impossibly stupid--like You are to disease what the Beatles are to music. That wasn't what I actually said, but it was something equally idiotic and I'm sure I embarrassed the poor woman.

    I attended a reading she gave a few years later when she was releasing a book on the public health system, and afterwards I wanted to get her to sign my copy--but I was afraid she might remember me. And I was also afraid she wouldn't. So I just left when the lecture was over.

    None of this speaks to this book at all, but there it is.

  4. Forrest Forrest says:

    Ebola's back. Want to know how it all started? Read this book. If you're not terrified by the time you're done, you're not paying attention or you have far too much faith in the strength of man versus microbes. I read this for a graduate-level history class on Ecology, Disease, and Population. Needless to say, we spent quite a bit of time studying how disease has shaped human history.

  5. Woman Reading Woman Reading says:

    4 ☆ Science advances quickly, but so do the microbes

    Nature isn't benign... we're not alone at the top of the food chain... The survival of human species is not a preordained evolutionary program.

    So proclaimed Joshua Lederburg, a molecular biologist and Nobel laureate. Despite the speaker's prestige, human nature would want to dismiss his statements. But as nearly the entire world is struggling, at great human cost, against viral Covid19 infection in 2020, his declarations' veracity are self evident while his warning carries ominous heft.
    Humanity's ancient enemies are, after all, microbes. They didn't go away just because science invented drugs, antibiotics, and vaccines... And they certainly won't become extinct simply because human beings choose to ignore their existence... lulled into a complacency born of proud discoveries and medical triumphs, [leaving humanity] unprepared for the coming plague.

    More than 25 years have elapsed since the publication of The Coming Plague, and Laurie Garrett's thesis remains relevant today. Because as quickly as scientists have advanced in knowledge, the microbes (microorganisms such as bacteria, parasites, and viruses) are evolving just as doggedly. What's worse, however, is that she asserted that people are actually aiding and abetting microbes through a variety of actions ranging from ill planned development schemes, misguided medicine, errant public health to short-sighted political action or inaction.

    Garrett illustrated her theme via historical accounts of disease outbreaks since the 1950s, when the health field was confident that humans had vanquished acute diseases. Hubris comes before the fall. Sometimes the records were of the unglamorous, globe-trotting sort with biologists trapping bats, mice, snakes, etc. to identify the disease-carrying vector. Other times, the scientists operated in imperiled circumstances due to military activity or they themselves became infected by the lethal pathogen that they were investigating.

    As this book numbered 750 pages, Garrett included a long litany of horrors caused by microbes. The following were described at some length, and I've sorted them by their preferred modes of transmission:
    Mosquitoes - malaria, yellow fever, dengue
    Mice- Machupo (Bolivian hemorrhagic fever), Lassa fever, hanta-ARDS (acute respiratory distress syndrome)
    Bats (best suspect) - Ebola
    Monkeys - Marburg hemorrhagic fever
    Humans - smallpox, meningitis, STDs (sexually transmitted diseases), AIDS (acquired immunodeficiency syndrome), tuberculosis
    Water - Legionnaire's disease, cholera

    Although the reading experience of this pathogen parade did not feel short, Garrett had only pointed to the tip of the iceberg. For in just 20 years when the US had established biological research stations throughout the Southern hemisphere, more than 60 viruses with terrifying impacts had been identified. The hemorrhagic fevers were quite horrific as they created holes in blood vessels, so patients bled from everywhere within and without the body. As many as half of the patients with the Machupo virus died from a seizure or cardiac arrest after their bodies went into shock.

    Through Garrett's accounts, I learned new concepts that I really would have wished out of reality except that I'm not a 3 year-old. Starting with iatrogenic - which describes disease created as a result of medical treatment (ex. pediatric AIDS infection in hospital nurseries). This differs from nosocomial transmission, which is the two-way spread of disease between patients and medical staff. In the 1990s, virologists believed that the worst scales of disease and death occurred with epizootic events, which happen when a virus is benign with host animal species #1 but becomes lethal when the virus finds animal species #2. Underlying this, of course, was the fear of zoonosis (infectious disease caused by a pathogen that has jumped from an animal and into humans), which is what the world is dealing with now.
    Microbes are masters of genetic engineering.

    Lederburg won his Nobel prize in 1958 because he discovered that bacteria can mate and exchange genes. As the new field of molecular biology has grown, they've since learned of the many genetic strategies microbes have to mutate and develop resistance to antibiotics and other pharmaceutical treatments. For the most part, Garrett wrote about the underlying science in an accessible way for the layperson. There were only about 20 pages on transposons, plasmids, and other microbial tactics of jumping genes which led to glazed vision from detail overload. Because of the improper use of antibiotics, many diseases are now more difficult and costly to treat. And becoming infected with something like MRSA just for being hospitalized is now not a minor concern.

    Garrett's most extensive disease coverage was on AIDS, because that was the most recent and globally significant pandemic prior to her book's publication. She wanted to highlight the failings in response to that crisis in order for us to learn and thus prepare for the inevitable next pandemic. As I've followed the news, we apparently learned nothing. In the US, we were caught with our pants down, not only for the embarrassing handling of the Covid19 pandemic (WH leadership denial and agitation and faulty / inadequate testing) but for the massive, and still tabulating, cost in deaths (with disproportionate racial mortalities) and human suffering economically, socially, and psychologically.

    By the end of The Coming Plague, one would have to engage in willful denial to ignore Garrett's warning. Humankind needs to change our mindset. We are vulnerable and microbes do not respect any physical walls; in fact, they'll live on them in hopes of finding their next host. There will be no success solely with a strategy of national isolation because as economies reopen, the resultant flows in trade and people expose everybody to danger (at least until the majority receive effective vaccination). And as we continue to change our planet in the extreme pursuit of development and wealth, we will continue to aid and abet microbes in their fight for survival to our detriment.

    This is probably the longest nonfiction I've read outside of an academic setting, if not ever. The writing quality became less even as the book progressed. My reader fatigue was matched by editorial weariness, as I encountered more typos. Garrett had quit her doctoral program in immunology to become a science journalist. So she definitely has the necessary scientific background, but the writing could have been improved to strengthen her thesis. I would thus rate the message and content 4.5 stars but the reading experience between 3-3.5 stars at times for a final 4 stars.

  6. Chrissie Chrissie says:

    3 stars
    This book is in-depth. The focus is on history, detailed facts and what we can do to prevent and cope with new maladies. Even if the book is no longer new, it still teaches a lot. We can learn from past mistakes. For me, parts read as a horror story. Then I calmed down. It first came out in 1994, and hey, we are still here! Did I become immune to the horror?! Or did it finally put me to sleep? In places, it sort of felt like a text book. My education was not adequate for a complete understanding of some of the medical discussions. It is heavily footnoted and has an index too. It is no sensational, quick read. It is both scary and deadening. Yes, the pun was intended. The book is directed toward serious readers who want the complete history of the new plagues that have confronted us in the last century, think the Bolivian hemorrhagic fever, the Marbug virus, Yellow fever, the Brazilian meningitis epidemic, Lassa fever, Ebola, swine flu, Legionnaires’ disease, sexually transmitted diseases and injecting drug users, AIDS, toxic shock syndrome and what can be done to stop this trend. Elimination of a disease threat is inextricably bound to economics, development and politics. The fight against disease is inextricably a fight against world poverty.

    Here is the truth: to complete this book I forced myself to read one chapter a day.


    After Chapter 5: Definitely interesting but hard to read. I am no hypochondriac; I tend to treat pains with nonchalance in fact, but when you read this book you start worrying. You certainly get scared of traveling to Africa, and you wash your hands a lot.

    Have decided to read a chapter a day, which is about all I can handle, due only to my own fears. So far I have learned about Yellow fever, Ebola, Lassa fever, Marburg virus.....

  7. Stefanie Stefanie says:

    although it's now somewhat out of date, this remains far and away the most comprehensive and interesting book about diseases i've read. what sets this apart from the rest of the disease books on my shelf is the sheer amount of ground covered and how well it's presented. it doesn't particularly seem like it would be a fast read, yet it is.

  8. Riku Sayuj Riku Sayuj says:

    Covers a lot of ground. We make the same mistakes in every pandemic. This was like reading a history of warfare. What is it with human institutions that we end up reacting the same way again and again?

  9. Lobstergirl Lobstergirl says:

    We're screwed. The microbes are going to win. And make no mistake, climate change is going to accelerate our death spiral. (Though writing in the early 1990s, Garrett discusses the effects of global warming on pathogen populations and spread.)

    One of the most fascinating things about this story is that we are drastically underestimating the number of deaths from microbes and pathogens. If we actually had public health departments that were funded and functioned properly, if we funded public health and epidemiological studies and prevention efforts at the national level to match the need, if we did proper autopsies on everyone and performed the requisite tests, we would find the mortality rates from these infectious diseases jumping enormously. The truth is that many deaths from pathogens go unnoticed and unreported because they are not tested for; they are attributed to causes like pneumonia. (An example is Legionnaires' disease, which we associate with an isolated event in Philadelphia in 1976. But the bacteria that causes Legionnaires' disease probably killed thousands more people in the years after air conditioning systems were invented, and these deaths were attributed to other causes.)

    Garrett's book is a masterpiece of reporting and synthesis that, with the exception of chunks here and there, reads like a novel. Just one tiny example of her thoroughness is a footnote in which she lists every major influenza pandemic since the year 1173, along with the probable origin, geographical scope, and estimated mortality of each. This footnote has its own footnotes (four different sources). And the book has more than 100 pages of footnotes. Some of them have more depth of reporting than a news article in a major newspaper.

    The book is all the more astonishing in that due to an occupational injury, Garrett was unable to use a keyboard and wrote the whole thing in longhand.

  10. Lisa Vegan Lisa Vegan says:

    This is my kind of horror book. I think it scared me more than just about any other book I’ve ever read, but I loved it. I appreciated the author’s skillful and entertaining story telling and admired her scientific accuracy.

    I can’t vouch that the information is current; I read this when it was first published. At the time it was pertinent and I can’t imagine that the basic theory (regarding epidemics) isn’t still valid. I’d continue to recommend this to anyone who’s interested in medicine, disease, and human health.

    I enjoyed this book so much that when Laurie Garrett was speaking in my city, I went to hear her; she’s very personable and knowledgeable.

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About the Author: Laurie Garrett

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