Will We Be Compassionate During the Next Epidemic?

Each generation of physicians is confronted with the specter of unknown diseases. The current, likely waning, epidemic is HIV/AIDS. Yet, this has been a relatively benign disease vis-à-vis risk to physicians, nurses and other health care professionals. For example, shaking hands, physical examinations or hugs are not hazardous.

But, what about the next disease? Recently, the poultry-spread influenza in Hong Kong led to the specter of a global pandemic spread by preclinical 747-laden carriers, save for the low human-human and animal-human contagiousness. Had the disease been spread more efficiently, caregivers would have been at risk worldwide. How would you have behaved towards your patients with URI symptoms?

A prior case of treatment through exemplary leadership can be drawn for Kalaupapa in the 1800’s. When infected with Hansen’s disease, the young, old, strong and infirm Hawaiians were removed from the family, loaded on a barge, shipped to a peninsula on the north side of Molokai and cajoled (or thrown) into the water to swim ashore to live and die in the leper colony. Despite these deplorable conditions, a young Belgian-born, uninfected priest, Father Damien (Joseph de Veuster), agreed to leave Honolulu permanently, as these trips were unidirectional, and minister to the lepers. Over twelve years, he contracted the disease and died of it four years later. Despite the risks, he had agreed to minister to those in need. (Aside: a trip to Molokai is highly recommended as even six years later, I still contemplate it often as perhaps the most profound experience vis-à-vis medicine in my life.)

Yet, the cynical physician may naively believe that these examples, and many others over the past 100 plus years, are unique, or that modern medicine will eliminate future scourges. How often do such diseases occur?

An indirect clue to the frequency of microbial evolution can found in the United States. Historically, it is widely suspected the great cities of Native Americans were exterminated by pestilence. Particularly, they were affected by small pox and measles, as well as perhaps many other maladies. Yet, they had only had contact severed with Asia approximately 10,000 years previously (yielding a minimum incidence rate of one new diseast/5000 years).

Currently, the world’s population, and thus, the sum of the current microbes that affect Homo sapiens are geometrically greater. The logical conclusion is that pandemics of respiratory system-spread microbes will occur with far greater frequency in the future, rather than being a rarity, (that is, without the threat of biological warfare) and likely, even with intensive outbreak surveillance.

Will we be compassionate when confronted with the next outbreak? History and knowledge tell us we will not have to wait long.