The Threat Matrix

I've started reading Michael Osterholm's book, Deadliest Enemy: Our War Against Killer Germs (2017). The idea behind the book is simple:

Unlike natural disasters, whose destruction is concentrated in a limited area over a period of days, and illnesses, which have devastating effects but are limited to individuals and their families, infectious disease has the terrifying power to disrupt everyday life on a global scale, overwhelming public and private resources and bringing trade and transportation to a grinding halt. 

In today's world, it's easier than ever to move people, animals, and materials around the planet, but the same advances that make modern infrastructure so efficient have made epidemics and even pandemics nearly inevitable. And as outbreaks of COVID-19, Ebola, MERS, and Zika have demonstrated, we are woefully underprepared to deal with the fallout. So what can -- and must -- we do in order to protect ourselves from mankind's deadliest enemy?

Last night I read Chapter Four, "The Threat Matrix", and found it quite striking in light of current events. Here are some excerpts that give the general shape of that chapter.

Osterholm begins by noting that our "personal threat matrix" can be highly subjective, not lined up with objective considerations. That's a big part of the challenge for public health officials who try to communicate the realities of disease control as we have come to understand it through epidemiology. The reality is that the threat of pandemics is the greatest threat facing mankind--dwarfing all others--that we can nevertheless prepare for.

... our personal threat matrix is not likely to conform to the qualitatively and quantitatively based ones we mentioned. 

... we all know intellecutally that mile for traveled mile, airplanes are far safer than authomoibles. Yet those of us who are afraid of flying will get in our cars every day without giving a second thought to ththe risks of the road. 

... 

In the 1990s, coauthor Mark Olshaker ... asked [National Hurricane Center] director, Bob Sheets, what the worst nightmare was for a meteorologist in his position. 

"That's easy," Sheets replied. "Category five hurricane--direct hit on New Orleans." 

On August 29, 2005, Hurricane Katrina hit New Orleans. Bu the time it reached land, it had been downgraded to a Category 3 storm. It still managed to kill 1,577 people ... becoming the costliest natural disaster in American history. 

Despite the fact that Sheet's warning was common knowledge in scientific and emergency management communities, no one had sufficiently prepared for such a disaster. 

... 

Infectious diseases in the twenty-first century have the greatest potential ... to give rise to a sudden crisis that would involve the whole world ...

He then presents the scope of the threat that pandemics present:

... a pandemic spreads around the world and lasts for an extended period of time. It does not hit just one locale, leaving all others with the ability to come to its aid. A pandemic hits many locales simultaneously, all of them needing emergency assistance. It has a rolling effect as it hits first individuals, then civil authority, then business, then interstate or international commerce or both. The effects are immediate and devastating, the consequences long-term. 

When everyone is involved in a pandemic, no one has extra help or supplies or food or medicine to send aournd, unless there was sufficient planning. There is a naive belief that the kinds of supplies we need to respond to a pandemic, such as medical products, drugs, vaccines, and N95 respirators--commonly known as face masks--will be a click away on the Internet. Not so. 

Today, we live in a just-in-time-delivery economy where virtually nothing is warehoused for futures sales, let alone stockpiled for a crisis situation. 

... 

Even if an outbreak does not spread beyond a region, it can still be devastating.

Osterholm winds up by proposing four orders of priority. Notably, just as Osterholm feared in 2017, we are witnessing the return of a coronavirus that appears to be a new form of SARS--a form that has taken on some of the "pandemic potential" of influenza. Also notable is his third priority, the threat of intentional or accidental harm caused by the release of a microbe that has been "enhanced" by scientists. That is, at least arguably, what we are facing:

Since we can't actively deal with everything, we propose four orders of priority that, we will argue, should lead to nine distinct but interrelated endeavors we collectively call our.

The first priority is to confront head-on those microbes that cause deadly pandemics, or as we refer to them in our business, pathogens of pandemic potential. These are the deadliest of our deadly enemies. There are only two microbial threats that I believe fit this description. The first is influenza: the one respiratory-transmitted infection that can be spread around the world in short order and strike with lethal force. 

The other pathogen of pandemic potential is actually a growing number of virulent microbes that are more insidious in their transmission but will still greatly impact the health of humans and animals around the world. This is the threat of antimicrobial resistance and the very real possibility of moving ever closer to a "postantibiotic era." Imagine a world more like that of our great-grandparents, where deaths due to infectious diseases we now consider treatable are once again commonplace. 

The second priority is to prevent high-impact regional outbreaks, such as Ebola and coronavirus infections including MERS, and the possible return of SARS and Zika ... 

The third priority is to prevent the use of microbes for intentional harm, to prevent the accidental release of a microbe that has been enhanced by scientists to be more easily transmitted, to be more likely to cause death or serious disease, and to be unpreventable by vaccination or treatment with antimicrobial drugs ... 

... 

The fourth priority is to prevent endemic diseases that continue to have a major impact on the world's health [malaria, TB, AIDS] which ... may be thought of as slow-moving pandemics.

This is the threat matrix for which we have been left unprepared.