The New York Times, June 5, 2019
Some of the scenes in Mark Honigsbaum’s “The Pandemic Century” were so vivid they had me drafting movie treatments in my head. Midway through the book, I was picturing a doctor climbing the front steps of a rowhouse in Annapolis, Md., in the winter of 1930. His knock on the door goes unanswered, so he makes his way inside. An auto mechanic is sprawled in a living room chair, muttering in a feverish sleep. His wife wanders in from the bedroom, shouting gibberish. From the kitchen, her mother emerges unsteadily, a rattling cough rising up from deep in her lungs.
The camera cuts to a wire bird cage suspended from the ceiling. Lying on the bottom is a dead parrot, claws up.
The great parrot fever outbreak of 1930 has slipped from our collective memory. But at its peak, it was the stuff of panicked headlines — “Parrot Disease Fatal to Seven” in The Los Angeles Times, for example. From coast to coast, parrots were passing pathogens to their owners. Over the course of six months, upward of 800 cases of parrot fever were recorded worldwide, and 33 Americans died. The ranks of the dead included some of the scientists who were struggling to identify the outbreak’s cause.
An old error played a role in their deaths. In 1892, a French microbiologist announced he had found the microbe that caused parrot fever. In fact, he had actually picked out a strain of salmonella that had nothing to do with the disease. Thirty-eight years later, in the midst of the 1930 outbreak, scientists finally discovered the actual culprit: a species of bacteria now known as Chlamydia psittaci.
That knowledge became a powerful weapon. Doctors began to diagnose the disease accurately, and birds began to be screened. The outbreak subsided, and parrot fever has been under control since. Fewer than 10 people a year in the United States still come down with the disease, but they can be cured with antibiotics.
Honigsbaum, a journalist and historian, builds “The Pandemic Century” from nine such tales. Whether familiar or forgotten, parrot fever or Ebola, he finds striking similarities among them. And those similarities ought to make us worried about the next outbreak. If history is any guide, things may not go well.
The confusion over the parrot fever pathogen was not unusual. Time and again, pandemics have gotten a head start because we didn’t realize what we were dealing with. When soldiers began dying off from influenza at the end of World War I, doctors were confident the disease was caused by a species of bacteria called Bacillus influenzae. In fact, the flu is caused by a virus, and B. influenzae is just an opportunist that sometimes infects weakened lungs. The 1918 pandemic would go on to kill 50 million people worldwide.
The 2014-15 West Africa Ebola outbreak came as a shock, because Ebola had never been documented there before. Yet scientists had already found antibodies in West Africans, suggesting the virus had spread to the region years earlier. Their paper was rejected from a journal, with one reviewer flatly declaring, ”I don’t believe there is Ebola virus in West Africa.”
Another common thread to Honigsbaum’s cases is how they arose. We often engineer our own epidemics. In 1976, hundreds of American Legion members attending a convention in Philadelphia got sick, and 34 died. It turned out yet another kind of bacteria was lurking in the hotel’s water tower. The microbe, known now as Legionella, might be new to us but it had lived for millions of years in soil and water, where it attacks amoebae. By building air cooling systems, we created a new environment where it could thrive and wind up in water droplets that could get inhaled.
Our ignorance about pandemics tends to swing to dangerous panic. Once H.I.V. came to light in the early 1980s, infected people were treated as pariahs, blamed for their own illness and shunned as if you could catch H.I.V. from a handshake (you can’t). During the West Africa Ebola outbreak, the sudden arrival of mysterious medical teams sparked rumors that they were actually coming to harvest organs and steal blood. Honigsbaum quotes the Dutch microbiologist Peter Piot in a rueful mood: “There is an epidemic of Ebola in West Africa, then there is a second epidemic, an epidemic of mass hysteria.”
Each chapter in “The Pandemic Century” is deeply researched. To report on the Zika virus, Honigsbaum visited Recife, a Brazilian city hard hit by the outbreak, which left behind children with devastating birth defects. His account of the 1918 influenza pandemic feels fresh, thanks to his deep dive into archives and recent research into its origins. There’s much to learn here. But in order to fit nine pandemics in one book, Honigsbaum chose to leave a lot out. And some omissions are misleading.
His account of H.I.V., for instance, feels like a look in the rearview mirror at a vanishing threat. “Today, in an era of antiretroviral drugs, when a diagnosis of AIDS is no longer an automatic death sentence, it is easy to forget the panic, hysteria and stigma of the early days of the pandemic,” Honigsbaum writes. It’s true that deaths related to H.I.V. have fallen drastically in the United States (there were 15,807 in 2016). But Africa, not the United States, has long been the center of the worldwide H.I.V. epidemic, and far too many people there still can’t get retroviral drugs. Seventy percent of all H.I.V.-related deaths take place in Africa; in 2017 alone, an estimated 670,000 Africans died. It is not yet time to talk about H.I.V. as a pandemic of the past.
To cover all nine stories, Honigsbaum sprints through unfamiliar ground. He refers to an “indirect immunofluorescence assay to demonstrate seroconversion” and leaves readers to guess what that might mean. Sometimes he plunges into dense paragraphs running a page or two long, packed with the tangled details of public health politics.
Despite all those details, I was still left with some misgivings about the central message of the book, embodied in its title. Should we call the past hundred years the Pandemic Century?
The parrot fever outbreak was cinematic, but with 33 deaths in the United States and comparably low numbers in Europe, it hardly ranks as a pandemic. The rise of H.I.V. and the 1918 influenza were unquestionably catastrophic — but other centuries saw pandemics as bad or worse. Columbus and the Europeans who followed him didn’t need jet planes to deliver deadly pathogens to the Americas. In a recent study, University of Oxford researchers estimated these diseases killed off 56 million people — 90 percent of the population of the Americas — by 1600.
What made this past century unusual was not pandemics per se, but our expectations about beating them. The germ theory of disease and other scientific advances in the 19th century fostered a sense of mastery over the microbial world. But pathogens have continued to crash our species barrier despite those advances — H.I.V. from chimpanzees, influenza from birds, Zika from monkeys, to name just three. In fact, the way in which the world has improved its standard of living has sometimes brought us into contact with diseases we might never have faced otherwise.
Honigsbaum’s tour of history leaves him gloomy about the future. “The only thing that is certain is that there will be new pandemics and new plagues,” he promises. But he overlooks efforts that might help fight future pandemics or even stop them before they start — such as projects to keep people at a healthy distance from potentially dangerous wildlife, global viral monitoring networks and programs to deliver information instead of fear to communities. Surely the value of understanding history is that it gives us a chance to stop repeating our mistakes.