Ebola, Rats, Lice, and History, and Hans Zinsser Part 1

With the new CDC prediction on Ebola spread, with a “worst case” of 1.4 million by January, it seems appropriate to revisit the role of disease in shaping history, medical ethics, the limitations of institutional judgment, and the limitations of models in general.

Hans Zinsser’s classic, Rats, Lice, and History was published in 1935. By itself, it is adequate proof of a dimension of history that has never been incorporated into the body of historical theory. Historians seem to keep within the perspectives of personal comfort; no successors have taken Zinsser’s mantle. Disease is merely noted as coincident with events political and economic, when more than occasionally, it has been the prime driver. Disease has driven civilizations into decline, and exterminated primitive populations.

The current Ebola epidemic is of that magnitude. Every model has failed to predict the growth. In a political context, this would result in a “search for the guilty”, as the joke goes. But as politicians feel helpless in the face of disease, it is likely that the failure will not receive the examination it requires. This is a failure, not of individuals, but of systems. ISIS, a disease of the body politic, progressed in the face of an inadequate response. Ebola is a disease of the body corporeal, yet the  response, long on study and consideration, is also inadequate. Historians, studying the decision making processes of our time, may find the superficial analogy supported in depth.

Drawing the analogy might seem as frivolous as a literary trope. But in  both cases, the “process”, carried out by credentialed “experts”, intended to protect us from error, did nothing of the kind. In both cases, singly reached inspired judgments could have saved us from the errors of thousands.

Now the CDC is offering an upper limit, by January, of 1.4 million cases.  As an error bar supplied by a faulty process, the number does not have a lot going for it, but should it come to bite us, the appropriate response is not to juggle appointments and departments at CDC. If, in the future, some medical catastrophe were to befall the U.S., this kind of destructive response could result, and  it would be a supreme sacrifice of talent.

The problem is more fundamental than that. It is the considered process of Western thought that has acquired a mandarin-like character, substituting elaborate procedure for genuine cogitation. The best eye-opener is an arcane novel by the German author Herman Hesse, called The Glass Bead Game.

The growth of these processes seems similar to growth of special interest groups, which begins in any pluralistic system the day after the revolution. But these barnacles of thought grow  outside the realm of politics, so the political reader should avoid the temptation to blame “the other party.” One of the cutest examples I can think of is the admissions process for dental schools. Formerly emphasizing manual dexterity, it now relies on abstract academic achievement. Think about that the next time you have a 360 thousand revs per minute air drill a fraction of a millimeter from the pulp of your tooth.

A conventional historian, searching for deep truths of causation, and  neglecting all the trash of the “process”, would find that the Patient Zero of the Great Africa Depopulation Event died in 1976, in Fort Dix, New Jersey, during the Swine Flu Fiasco. His name was David Lewis, a 19 year old private, and he died in 24 hours, reprising the astonishing speed with which the 1918 epidemic reaped victims. The response of the Gerald R. Ford Administration was a crash program to produce and distribute a vaccine to the entire American public. Many of us remember getting the jab, and thinking nothing of it. But 500 of the inoculated contracted Guillain–Barré syndrome, and 25 died. This might have been tolerable, but the anticipated epidemic did not occur. It never spread beyond Fort Dix.

There followed protracted efforts to analyze why a vaccine for a particular strain of flu should provoke this autoimmune syndrome, while others did not. Since the vaccine was grown in eggs, and egg-based vaccine production is notoriously subject to contamination, theories eventually favored contamination with Campylobacter which:

  • Is known to contaminate eggs
  • Is known to cause immune cross-reactivity with nervous system proteins, causing Guillain–Barré syndrome.

But the original suspicion did not die; it lingers to this day like a bad smell. The reason it lingers is that no vaccine is entirely safe; there is a unique risk/reward profile associated with each one. Average human minds, and many of considerably greater competence, have trouble with this. They don’t like risk/reward. They want to know. Is it completely safe, or isn’t it? In the absence of something like Ebola, this caution, even in the absence of quantitative evidence, cannot be dismissed. One  advanced  flu vaccine, possibly Baxter’s VEPACEL, has EU approval, but the safety profile does not satisfy the FDA.

Now you have the background. Part 2 is already written, but take some time with this, and I’ll post the rest in a little bit.  Over 1000 words in one gulp might be too much for portable devices.