Friday, March 13, 2020

Why do so many infectious diseases seem to come from China?

Everyone needs to stop blaming everyone else for this virus.  Let’s talk facts and reason here.

I have argued for the last 25 years that we invest way too much money in studying the trivial effects of genes on chronic diseases, to the detriment of infectious disease research.  Infectious diseases have only been in check for 100 years or so, mostly because of improvement in sanitation in the Western world, and to a lesser extent, antibiotics, vaccines, and antivirals.  But bacteria, viruses and parasites are also subject to natural selection, and are adapting by random mutation to survive despite our interventions.  Evolution is a powerful force, helping all organisms adapt and survive.  

In recent years we have seen many dangerous bugs emerge, disproportionately in China. Why China? Because of population density, substandard sanitation (compared to the West), and economic prosperity.  Yes, economic prosperity...  50 years ago, if a disease emerged in China it would have been largely contained there for a very long time because there weren’t direct flights to everywhere as there are now. 

Viruses mutate all the time, and sometimes these mutations increase either transmissibility or virulence.  But virulence is generally bad for the virus, as if it kills the host, it dies as well, if there aren’t alternative hosts around which can be infected before its current host dies...  When such mutations occur in sparsely populated places, the effects are highly localized and do not spread.  But in densely populated Chinese cities (remember than New York City would be a small to medium sized city in China), there are tons of potential hosts around to infect, such that even highly virulent bugs can take root and become serious problems.  And the connectivity of the world allows them to spread internationally once they reach critical mass in the population.

These sort of events happen all the time in Africa, but because it is still underdeveloped, there is much less connectivity to the world, so they are often localized and can be controlled before they spread.  Climate also plays a role as many tropical diseases spread largely through insect and other such vectors, and don’t therefore do well in more temperate climates...  But as those countries develop and the world becomes more interconnected, these things will inevitably become a bigger and bigger issue over time.  This is simply how evolution works, and just as we develop countermeasures, mutations happen and sometimes will confer advantages to the bugs that allow them to circumvent out countermeasures.  

The current levels of domination humans have over pathogens is not unlikely to be temporary. I have often posited that we may outlive our great grandchildren because we are lucky to be alive in the era when we have suppressed many infectious diseases, before they have had time for adaptations to arise and spread...  But ultimately nature has a balance...   Overpopulation breeds disease, and connectivity helps it spread.  

We shouldn’t blame China for its rapid economic development - but that really is why these problems are starting to emerge as global threats.  And China shouldn’t blame us for germ warfare, as that is as silly as blaming China for our current problems.  These things are inevitable.  And perhaps ending absurdly inefficient big-science genomics research programs like “All of Us” in favor of more research on infectious disease and epidemic preparation measures would be wise (as I have argued consistently for 25 years).

Furthermore, while this virus is pretty mild for most of us, this is an important exercise for the world’s Public Heath system - just as SARS, MERS, and H1N1 were.  By taking this very seriously we can learn a lot about how to better prepare ourselves for truly horrific bugs that will inevitably emerge in densely populated and connected parts of the world.  And if you deal with old folks or sick folks, it’s really important to isolate them and keep them as safe as possible while we wait for countermeasures to keep this infection in check for a while....

But we need to stop blaming China, and China, Russia and Iran need to stop blaming us. We are in this together, and have to accept that in an interconnected world, we have to work together and not worry about casting blame....