Smithsonian: Globalization Changed How We Fight Disease

Globalization has contributed both to spreading diseases quickly via travel and faster transportation systems and providing early warnings that lead to swift prevention mechanisms and treatments: “the rise of civilization – namely, the development of agriculture, animal husbandry and domesticated life – led to the growth of catastrophic illnesses such as smallpox, tuberculosis and polio,” writes Daniel Fernandez for Smithsonian magazine. A new exhibit “Outbreak: Epidemics in a Connected World” focuses on the globalization of disease and the connections among humans, animals and the environment. Infectious diseases – like Ebola in Sub-Saharan Africa, caused by handling infected animals, or Nipah in Southeast Asia that starts by eating raw date palm sap infected by fruit bats– know no national boundaries. The exhibit demonstrates how cures are developed by a combination of expert efforts combined with grassroots observations, alerts and solutions. Fernandez reports on how the museum’s collections assisted in research on the hantavirus that emerged in the Southwestern United States in 1993 – understanding how weather patterns influenced plant and rodent populations. Multiple health, conservation and wildlife organizations have adopted the theme: “one world, one health.” – YaleGlobal

Smithsonian: Globalization Changed How We Fight Disease

A National Museum of Natural History exhibition explores how the world’s human, animal and plant populations are highly connected for both diseases and cures

Daniel Fernandez

Tuesday, June 5, 2018

Smithsonian: In the Greek poet Hesiod’s Works and Days, the first humans “lived remote and free from ills, hard toil and heavy sickness.” There were neither maladies, nor misery, nor mayhem. But when Prometheus brought fire to man, he angered Zeus, and as punishment, the king of the gods sent Pandora down to Earth. When she opened that fateful jar from Olympus every imaginable woe poured out—and from that moment onward, “Diseases came upon men continually by day and by night, bringing mischief to mortals silently.”

There’s more than a grain of truth in the ancient fable. As modern anthropologists note, the rise of civilization—namely, the development of agriculture, animal husbandry and domesticated life—led to the growth of catastrophic illnesses such as smallpox, tuberculosis and polio. In the last 10,000 years, the human relationship to disease has changed in dramatic ways. Modern technology allows people to move around the globe further and faster than our ancestors could imagine.

More than half the world’s populace now lives in urban areas, which present no shortage of new ills stemming from environmental pollution, squalid housing and inadequate sanitation. Changes in agriculture and new infrastructure projects continue to open new pathways for disease, and global processes such as climate change affect the geography and ecology of our planet in dramatic ways.

These connections among humans, animals and their environment are the focus of a new exhibition at the National Museum of Natural History. “Outbreak: Epidemics in a Connected World,” explores the influence of zoonotic viruses, some 800 diseases that spread from animals to humans and vice versa. These include well-known ailments such as HIV, influenza and Ebola, along with lesser-known contagions such as chikungunya. The show runs through May 2021, and falls during the hundredth anniversary of the Spanish flu pandemic, an influenza outbreak that affected about one-third of the world’s population, killed at least 50 million people, and demonstrated the remarkable threat of disease in a world moving towards globalization.

Curator Sabrina Sholts spent three years developing “Outbreak” along with a team of experts from hospitals, nonprofits, government agencies and pharmaceutical companies. As a physical anthropologist, she says the work was an eye-opening experience, particularly because of the broad range of backgrounds the exhibition needed to capture. “For my work, I have always thought about diseases in terms of humans,” Sholts says. “But, I now realize it’s so contextual… We can’t separate human health from the health of the natural world.”

To better acknowledge these connections, the show embraces the theme of “One World, One Health.” Sholts attributes the phrase to William Karesh, a scientist who worked on campaigns against Ebola for the Wildlife Conservation Society in the early 2000s (it’s also been embraced by organizations such as the World Health Organization, USDA and the International Society for Infectious Diseases). The goal of One Health is to develop policies and interventions that account for social, political and economic realities, not just disease etiology.

Sholts points to Nipah virus, which affects communities across Southeast Asia, as an example. When the disease first emerged some 30 years ago, epidemiologists struggled to determine its source. But during an outbreak in Bangladesh a few years back, researchers discovered that exposure occurred in just two ways: When a host cared for an infected person, or when they consumed raw date palm sap.

Harvesters collected this sap during the winter months by shaving off bark from date trees and allowing the sap to collect into pots overnight. Through investigation, researchers found that these pots were contaminated by fruit bats, who spread the virus through saliva and other bodily fluids. Instead of exterminating the bats, as might have been the case during the early 20th century when yellow fever, hookworm and malaria prompted elaborate eradication campaigns, they proposed a simpler intervention: Encouraging locals to use an inexpensive bamboo cover to reduce the likelihood of bats polluting the sap.

The importance of these grassroots solutions is one of the themes of the exhibition. “We didn’t want to feel like it’s just the United States playing a major role,” says Jonathan Epstein, the vice president for science and outreach at EcoHealth Alliance and a contributing expert to Outbreak.

When it comes to addressing more endemic ailments or developing biomedical solutions, though, experts often turn to other groups for help, including museums like the Natural History Museum. “The collections help us to understand the magnitude and rapidity of change,” Sholts explains back in her office, which is populated with boxes of bones and upright skeletons.

Sholts jokes that her one scientific contribution to the exhibition is a human skull collected from a man diagnosed with influenza and tuberculosis. While he died almost a century ago, Sholts and other scientists can study the plaque on his teeth, which still contain the DNA of pathogens and microbes that were present in his mouth. Using advanced technologies, they can then characterize these viruses and see how they’ve changed over time.

That scholarship not only helps to better prepare for future outbreaks but can explain the cause of present-day epidemics. When hantavirus emerged in the Southwestern United States in 1993, for example, research using the museum’s collections showed that the disease was present in deer mice as far back as 1979.

Through testing, scientists found that the spread of the disease was not a result of recent evolution, but changes in demography. More people were living in the region than before, and with increasing urbanization, it was more likely for people to come into contact with rodents carrying the disease. That year, the rodent population was also larger than average because of an El Niño season: Increasing precipitation had led to increased plant productivity and a larger available food supply. Putting these factors together shed light on why and how the seemingly mysterious virus had emerged.

For Sholts, these stories are examples of how individuals working together can make a difference even in the face of frightening and difficult challenges. She says that amid the despair that diseases so often inflict, it’s important to highlight narratives of hope and examples where individual ingenuity and perseverance made a difference. With more than 10 million people expected to attend the exhibition in the next three years, she hopes these personal narratives will excite visitors and encourage them to consider a path in public health, too.

But if you can’t make it to Washington D.C., don’t despair. A “DIY” version of the show is available online with materials translated into six different languages. It’s a new venture for the museum, born out of the fact that Sholts and fellow curators knew there was no way to capture every potential pandemic–even in the 4,000 square-foot exhibition space. Beyond the show’s materials, the team also included layout examples and created engagement guides to help local communities design exhibits tailored to their unique location and history. Sholts points to a newly-created simulation about Ebola from the Museum of Science in Boston as an example of how people are already getting involved.

“Today, an outbreak anywhere is a threat everywhere,” she says. “The cultural context of the exhibit demands more from us because we’re all connected.”

The exhibit “Outbreak: Epidemics in a Connected World,” runs through May of 2021 and is linked with the 100^th anniversary of the Spanish flu epidemic, which killed more than 50 million people worldwide.

Smithsonian

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Coronaviruses

man wearing masks is screened by gowned health worker for COVID-19

Ominous March of a Virus

The World Health Organization declared COVID-19 a global pandemic on 11 March 2020 with confirmed cases in more than 110 nations. The disease swiftly spread throughout the world.

Viruses can easily leapfrog to around the globe with globalization of travel and trade. YaleGlobal began reporting on the new coronavirus on January 10, and with this special report, explores the impact of such diseases.

Read Selected Articles on COVID-19

COVID-19 Updates 110,000+ confirmed cases 3,800 deaths 110/195 countries infected Key is slowing the spread and keeping hospital beds open for the most vulnerable ● Wash hands frequently ● Keep a distance of at least 1 meter or 3 feet from others ● Avoid touching face ● Clean surfaces in frequent use ● Avoid unnecessary travel and crowds. ● Stay home if ill

The outbreak of COVID-19 in China prompted global caution. As a coronavirus, the disease shares symptoms with the common cold and SARS.

The new coronavirus, highly infectious, became especially challenging after emerging in China just before two busy travel periods: the winter break for international college students and the Chinese Lunar New Year.

COVID-19 Symptoms

Symptoms include fever, difficulty breathing and a dry cough, reports the World Health Organization. People may be sick for 1 to 14 days before displaying symptoms. Chest radiographs showing bilateral lung infiltrates. Some patients do not display severe symptoms, and 80 percent recover without special treatment. People over age 65 and people of any age with compromised immune systems are especially vulnerable.

The elderly are especially vulnerable to COVID-19. Early research suggests the fatality rate from COVID-19 for those over age 60 is about 4% and over 15% for people over 80

The World Health Organization offers advice:
● Clean hands often, using soap and water, or an alcohol-based hand sanitizer.
● When coughing and sneezing, cover mouth and nose with flexed elbow or tissue – throw tissue away immediately and wash hands.
● Avoid close contact with anyone with symptoms including a fever and dry cough, but understand that infected people who do not display symptoms can still spread the virus.
●Those with a fever, cough and difficulty breathing should seek medical care early and share travel histories with health providers.
● In areas experiencing cases, avoid direct unprotected contact with live animals and surfaces in contact with animals, and clean hands frequently.
● Avoid consumption of undercooked cooked animal products, and handle raw meat, milk or animal organs with care to avoid cross-contamination.

Social Distancing

Individuals have tremendous control over the impact of COVID-19.

Communities can protect themselves and prevent the spread of COVID-19 by practicing social distancing: staying home, avoiding travel and crowded places, maintaining a distance of six feet, and practicing self-quarantine if exposed to anyone who tests positive, shows symptoms or reports a travel history to hot zones. People can wear masks, especially to protect others, while still practicing social-distancing.

Coronaviruses are transmitted between animals and people. Investigations suggested that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. The source of COVID-19 had not been determined as of March 2020.

“Several known coronaviruses are circulating in animals that have not yet infected humans,” reports WHO. “A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.” By mid-February, the World Health Organization named the disease COVID-19. Researchers later linked the disease to bats.

Online Resources:

World Health Organization

US Centers for Disease Control

European Centre for Disease Prevention and Control

Yale University Research, Clinical and Data-Driven Response to Covid-19

UK National Health Services

5 Points on the Coronavirus: Yale Medicine

What Everyone Can Do To Stop Covid-19: US CDC

Johns Hopkins Center for Systems Science and Engineering

COVID-19 Tracking

Nations vary on level of preparation, as well as staff and hospital beds.

Testing is key to tracking COVID-19 and data-sharing by public health agencies, preventing the disease’s spread and allowing early treatment. Countries that practice transparency, offering more testing and contact tracing, tend to report more confirmed cases. Communities that test, trace contacts and isolate cases can also expect to reopen economies more rapildy.

The Johns Hopkins Center for Systems Science and Engineering site is the leading source for Covid-19 global reports. Early in the crisis, a young student quickly created a website tracking global cases. Major social media firms took steps to limit misinformation, prohibiting apps not linked with official health agencies. The reports are only as good as the data that governments release.

The Spread of a Coronavirus

Investigations showed that coronaviruses like the common cold and COVID-19 are spread mainly through droplet transmission. For example, if an infected person coughs or sneezes , the expelled droplets, if inhaled, can infect another person. Another possible mode of transmission is simple contact with contaminated objects.

COVID-19 is especially treacherous because people with few or no symptoms can still shed the virus, spreading the disease to those who are more vulnerable.

Governments in East Asia encouraged citizens to wear masks, including some public distribution, to keep infection and death rates low. The World Health Organization and the US Centers for Disease Control and Prevention intially discouraged healthy citizens from wearing masks, due to legitimate concerns about short supplies for health providers. The CDC reversed that decision on April 3 and encouraged people to wear homemade cloth masks. Some European nations require masks and others do not. US communities are likewise polarized on the practice.

China took the unprecedented step of shutting down public transportation and cancelling activities in multiple cities. Italy soon followed with national measures including closed schools and bans on public gatherings through the start of April. By April, more than half the world’s people were under various lockdown orders.

WHO Program Budget (US$ millions) 2014-2015 $3,977 2016-17 $4,340 2018-19 $4,422 2020-21 $4,840

Funding: Ounce of Prevention Worth a Pound of Cure

“Ongoing preparedness and investment can go a long way in preventing global public health crises,” argues Sten Vermund, dean of the Yale School of Public Health.

Public health experts strive to delay the spread of COVID-19 to protect the most vulnerable people, prevent hospitals and care facilities from becoming overwhelmed, and buy time for development of vaccines and other treatments. The goal is called “flatten the curve.”

Economic Impact

Pandemics have historically altered societies, and governments strive to address both the health and economic impacts of COVID-19. When the new disease emerged in late 2019, the pace of growth for large economies around the world had already slowed. “This is a supply shock – not a demand shock that can be rectified with monetary stimulus,” explains Stephen Roach, economist and senior fellow with the Jackson Institute of Global Affairs at Yale. Governments have little choice but to take drastic steps that stop economies – travel restrictions, store closures, bans on public gatherings and more. Many approve massive rescue packages to assist citizens and businesses struggling due to the abrupt halt of most economic activities.

Roach urges governments to avoid premature focus on restarting economic engines that could trigger a relapse. The COVID-19 shock has exposed the quest by government and corporate leaders for quantity in economic growth with too many compromises made on quality long-term investment in infrastructure, public health, education and other systems that contribute to resilient societies.

Economist David Dapice urges governments to prepare carefully in reopening economies. Governments and companies must examine balance sheets and debt levels, conducting swift cost-benefit analysis to determine which programs and jobs might survive. The medical and economic crisis will influence new behaviors and patterns around the world. Companies and individuals would be wise to build emergency stockpiles and savings to prepare for other inevitable crises of all types.

PastPandemics: 1918 H1N1, 1957 H2N2, 1968 H3N2, 1981 HIV/AIDS, 2009 H1N1, 2020 COVID-19

Recalling SARS and the 1918 Flu

Global public health officials strive to monitor the spread of any disease. The influenza of 1918-1919, which killed more than 20 million people, is never far from mind.

The speedy spread of a coronavirus from Wuhan, China, recalls the alarm associated with SARS. After the first reported death from SARS in Hong Kong, on March 4, 2003, the disease spread across the globe, affecting citizens in 18 countries. That epidemic lasted for about four months. Seventeen years later, there is better reporting. On December 31, 2019, the World Health Organization raised alarm about pneumonia-like cases in Wuhan. Less than a month later, cases were confirmed in 12 nations, with most in China. By April, more than 200 countries reported confirmed cases.

New diseases spread rapidly due to the speed and intensification of globalization. In the early 20th century, people and troops traveling on trains and ships spread the flu. A century later, affordable air travel and increased numbers of international passengers facilitated the movement of the coronaviruses across continents in a matter of days.

10,000 Animals to Be Culled as SARS Returns to China

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Smithsonian: Globalization Changed How We Fight Disease