Pandemic

by Sonia Shah

  * * *

  The most nightmarish flu pandemic in modern times struck in 1918. The pandemic virus—H1N1—had amplified and grown virulent under the unusually crowded conditions of trench warfare during World War I. It caused more than 40 million deaths around the globe, mostly due to bacterial pneumonia, a complication of the viral infection (which would be treatable today, unless caused by a resistant strain).

  H1N1 sank out of sight after that. It seemed as if the virus disappeared. But it hadn’t. It had retreated into some repository somewhere, just as cholera had in New York City in the fall of 1832. And just as cholera had, it remained quiescent until a sufficiently large crowd of susceptible humans formed, allowing it to strike out again. That happened nearly a century later, in 2009, precipitating the less deadly but still potent “swine flu” pandemic of that year.

  The virus’s century-long hideout, the virologist Malik Peiris told me when I met him in Hong Kong, was the bodies of pigs.

  I thought of this as we left the pig shack in Laocun, shuffling single file behind the farmers down the dark path between the pig enclosures toward the door. One pig in the far end of the enclosure had roused and started climbing over the others toward us. Propped up at the pen’s gate, he reared up suddenly at shoulder height, tilting his large head to turn one wide, almond-shaped pale-green eye into mine. It was as if he had something urgent to say, and I held his gaze for a moment. But all he did was emit a terrible sound, like the low roar of a howler monkey. I looked away and shuffled along behind the others, heart pounding. In the subtly shifted air our movements left behind, the pathogens brewed in his crowd mingled with those brewed in mine.

  FIVE

  CORRUPTION

  The pathogen that can spill over, spread, and cause disease is a dangerous creature to be sure, but it’s actually only halfway on the multistage journey toward pandemicity.

  The fate of the second other half of its journey is determined by how societies respond. It’s true that sometimes pathogens crash like a tidal wave, descending too quickly or harshly or cryptically for societies to understand what to do before it’s too late. But in many cases, collective defenses of even the most crude sort—isolating the sick and warning each other of a disease’s spread, say—can act like an underwater barrier, breaking the wave of death and destruction.

  That levels the contest between pathogens and humans. Human cooperation is, biologically speaking, a formidable thing. Most mammals cooperate with each other only when they’re related by blood. Not us. We cooperate more frequently, more intensively, and on a larger scale than any other species on Earth. Our ancestors hunted for big game together and took care of each other’s sick. They passed down their knowledge in books and stories accessible to strangers. Thanks to our superior capacity for social cooperation, our kind came to dominate the planet’s resources and habitats. It wasn’t because we’re more aggressive or clever than other species. Think of the complex technologies that our cooperative behaviors have made possible. The laptop on which I write these words today is the result of countless people, across bloodlines and generations and continents, contributing their expertise to the mass production and distribution of a powerful tool to millions of others around the world. Even the most aggressive, clever individual working in isolation couldn’t have done it.

  Cooperative strategies are especially important to defend ourselves against new pathogens because they don’t necessarily require high-tech interventions or sophisticated understanding of the pathogen itself to be effective. Even societies with the most rudimentary sense of how pathogens spread can implement effective containment strategies by capitalizing on their ability to work cooperatively. The Acholi people of Uganda are one of the few ethnic groups in Africa whose traditional beliefs about infectious diseases have been studied by medical anthropologists. Many believe that diseases spread through sorcery and spirits. Their traditional responses to epidemics nevertheless limit pathogens’ spread: at the first sign of contagion, they work together to isolate the sick, mark their homes with long poles of elephant grass, warn outsiders not to enter affected villages, and refrain from a number of potentially disease-transmitting behaviors, including socializing, sexual intercourse, eating certain foods, and traditional burial practices.1

  Larger, more formally organized societies can implement even more efficient containment strategies based on cooperative behaviors, like quarantines and those made possible by rapid long-distance communications. They’re well poised to do so. Many of the institutions of modern society, after all, are designed to enhance our natural capacities for cooperation, by punishing noncooperators and encouraging the rest of us to pursue even relatively mundane collective actions, like paying taxes and getting flu shots.

  And so, when pandemics unfold, it’s not just because peculiarly aggressive pathogens have exploited passively oblivious victims or because we’ve inadvertently provided them with ample transmission opportunities. It’s also because our deeply rooted, highly nuanced capacity for cooperative action failed.

  In a general sense, this happens when sufficient numbers of individuals choose to pursue their own private interests rather than public ones. For obvious reasons, there are various economic and biological theories that attempt to quantify the conditions under which such choices are made. A simple way of looking at it is by considering the costs and benefits to the individual. The costs of cooperating include the loss of opportunities to pursue private interests (among other things) while the benefits include the increased likelihood of reciprocal behaviors from others and freedom from their opprobrium (among other things). So long as the costs don’t exceed the benefits, people will choose to cooperate. Take paying taxes. The cost to me is that I can’t use my tax money to buy, say, a new couch. But the benefit is that the government will fund my public library and will not send the IRS out to get me. And so I pay my taxes.2

  But if the costs of cooperation outweighed the benefits, perhaps I wouldn’t. This is what happened on a citywide scale in nineteenth-century New York and is happening on a global scale in many countries today. The factors that allowed cholera to take hold of newly industrializing cities—lack of faith in political governance and the rapid growth of the industrial economy—simultaneously conspired to make selfishness pay off. A bounty of new riches and power tempted private interests, but since the regulatory infrastructure required to restrain their excesses had yet to be built, they faced few penalties when their pursuit of that bounty undermined public health. As the power and influence of private interests eclipsed that of public entities, the strategies that could have obstructed cholera crumbled.

  The most blatant example of this in nineteenth-century New York concerns the hijacking of the city’s drinking-water supply. It’s true, as mentioned earlier, that the island of Manhattan had scarce freshwater supplies, due to the polluted Collect Pond and the brackish Hudson and East Rivers. But the city had another option besides drinking the contaminated groundwater under its tenements and privies: tapping the Bronx River, a freshwater river that flowed from what is today Westchester County twenty-four miles south to empty into the East River.

  A physician named Dr. Joseph Browne and the engineer William Weston had proposed that the city build a public waterworks to provide clean, uncontaminated Bronx River water to New Yorkers in 1797. Such a system was affordable: Browne and Weston estimated it would cost the city $200,000, which could be paid for with a new tax. It was technically feasible. Several prominent cities in the industrial world were in the process of building elaborate clean-water distribution systems, such as Philadelphia, where steam engines lifted river water high into reservoirs and then piped it to residents. It would have assured that New Yorkers’ drinking water was uncontaminated by fecal bacteria. The Bronx River water flowed upstream of the city and its privies, and Browne and Weston planned to filter its waters through a bed of sand and gravel, in a process now known as “slow-sand filtration.” That would have removed more than 90 perce
nt of the bacteria and protozoans in the water.3

  And it would have substantially improved the quality of life in the city in ways that were obvious to contemporary observers. New Yorkers often complained about the city’s lack of water to clean the streets and fight fires. They worried about the health impact of the filthy streets, which according to conventional wisdom endangered the public’s health by allowing “pestilential diseases” to fester. (“In suggesting the means of removing the causes of pestilential diseases,” a group of leading physicians in New York City reported in 1799, “we consider a plentiful supply of fresh water as one of the most powerful.”) And they lived in fear of fire. Fire alarms sounded in 1830s New York City at least once a day. Single conflagrations could level whole neighborhoods of wooden structures. One fire in December 1835 demolished every building south of Wall Street and east of Broad Street, including more than five hundred stores. The public waterworks proposed by Browne and Weston would solve both of these problems.4

  But private interests in pursuit of ideological power and riches scuttled the plan.

  The charming, urbane lawyer Aaron Burr—or, as The Huffington Post put it in 2011, the “bad boy of America’s founding”—was a New York State senator when Weston and Browne came up with their proposal to tap the Bronx River.5 Burr was no ideologue, but he was politically ambitious, which meant aligning himself in the dominant political battle of the day: between the Federalists, mostly bankers and businessmen who wanted to strengthen federal institutions in the still-young nation, and the Republicans, who represented the small farmers and other skeptics who opposed them. Despite his patrician background, Burr threw his lot in with the Republicans and figured out a way to strengthen their hand: by creating a new bank.6

  The Federalist Alexander Hamilton had won a state charter for the bank he’d started, the Bank of New York, in 1791. According to the Republicans, Hamilton’s bank discriminated against them. (That may have been true. “Purely political discrimination against applicants for bank services,” writes the Hamilton biographer Ron Chernow, “was entirely in keeping with the spirit of the times and the vagueness of the line demarcating business from politics.”) A new bank that catered to Republicans could serve as a political counterweight to Hamilton’s bank. The trouble was that creating such a bank required obtaining a charter from the state, and chartered companies had to prove that they provided benefits to the public. That would be easier to prove if the new charter was for a private water company–cum–bank rather than just a bank.

  But before Burr could obtain a charter for a private water company–bank, he’d have to derail Weston and Browne’s proposal for a public waterworks. He tied up the state funds the plan might have tapped. And he told his fellow state legislators that the public waterworks would cost $1 million to build, not the $200,000 that Browne and Weston proposed.7

  Thus hobbled, Browne and Weston’s feasible and lifesaving plan to tap the Bronx River failed to get a charter from the state. As soon as their proposal died, Burr and his allies in the New York City Council applied for and won a charter to launch a private water company and bank: the Manhattan Company.8 The charter allowed the company to raise $2 million from private investors, ten times more than what Weston and Browne had initially estimated would be required to tap the Bronx and what other cities, such as Baltimore, had raised for their urban waterworks projects. And it allowed the Manhattan Company to use whatever funds it raised that weren’t required for the waterworks on any other company business, such as a bank.9

  Almost immediately upon being organized, the company started downgrading its plans for the waterworks. It decided against using cutting-edge steam engines. It would use horses to pull the pumps instead.10 It decided against building a one-million-gallon reservoir in the city. It would build a small reservoir that would hold a tiny fraction—just over 0.001 percent—of that volume.11 It decided against using iron pipes. It would use wooden pipes.12

  Worse: even though the bank’s charter granted exclusive rights to the uncontaminated waters of the Bronx River, and it had more than sufficient financing to pipe that water into the city, the company decided to tap a cheaper, easier source: the filthy, excreta-filled Collect Pond. It did this despite acknowledging, privately, that the Collect’s waters were “disgusting” and unfit for human consumption. “The poor Bronx will be neglected perhaps forever,” sniffed a company official in a letter to a relative.13

  The company’s plans outraged New Yorkers. A newspaper correspondent wrote that by distributing the Collect’s “fetid” waters, the Manhattan Company would have the blood of thousands on its hands.14 “It is abominable indeed for the city to be thus trifled with and abused by the company,” another resident wrote to a local newspaper.15 The merchant Nicholas Low called the company “a greater Pestilence than the Yellow fever.”16

  These complaints could have been grounds for revoking the Manhattan Company’s charter. Other states routinely revoked the charters of companies that failed to uphold the public good. Ohio, Pennsylvania, and Mississippi had revoked the charters of banks. New York and Massachusetts had revoked the charters of turnpike corporations for not maintaining the roads. But the Manhattan Company’s expansive charter made it untouchable. It had been granted its rights and auxiliary powers in perpetuity.17

  Over the following years, the Manhattan Company spent a mere $172,261 on waterworks for New York City.18 It devoted the rest of its substantial finances to the bank it opened at 40 Wall Street in 1799. And, indeed, the bank did serve the interests of the Republican elites who’d founded it. DeWitt Clinton, the city’s mayor, who also served as the Manhattan Company’s director, received a loan of nearly $9,000 (over $150,000 in today’s dollars). Burr received $120,000 in loans—nearly as much as the Manhattan Company had spent on its waterworks.19

  Burr profited politically as well. With his anti-Federalist credentials burnished, in 1801 he ascended to the post of vice president to Republican president Thomas Jefferson.20 As even his rival Alexander Hamilton had to admit, the Manhattan Company was “a very convenient instrument of profit and influence,” albeit “a perfect monster in its principles.”21 (Hamilton’s incisive commentary offended Burr, who challenged Hamilton to a duel. On the morning of July 11, 1804, Burr shot and killed Hamilton under the cliffs of the Palisades.)22

  The Manhattan Company distributed contaminated groundwater to New Yorkers for fifty years, through both the 1832 and 1849 cholera epidemics. The company finally ended its charade of calling itself a water company at the end of the nineteenth century, its checkered past as a waterworks hidden save for its corporate emblem of Oceanus, the Greek god of water, which it retained until the 1950s. Today the company that poisoned New York City with cholera is known as JPMorgan Chase, the largest bank in the United States and the second largest in the world.23

  The case of the Manhattan Company might have served as a precautionary tale for the other water-deprived cities that cholera stalked. Yet in fact, it was just the opposite: between 1795 and 1800, eighteen private water companies sprang up in Massachusetts. Between 1799 and 1820, twenty-five private water companies opened for business in New York State.24 In London, five private companies were formed to sell water to urbanites between 1805 and 1811.25 In nearly every case, the investment required to supply clean water to growing towns and cities overwhelmed private companies’ ability to draw profits. Either they ran out of financing or they downsized, readjusting to less ambitious plans that were more profitable—those that distributed easier-to-reach but more likely contaminated waters. Profits were “rarely great enough to induce the directors to build systems adequate to provide all needs,” writes the water historian Nelson Manfred Blake.26 Like the Manhattan Company’s rotten system, rather than prevent the spread of cholera, these badly designed, poorly maintained systems helped to more efficiently distribute it.

  * * *

  Even without the benefit of clean drinking water, collective actions could have averted New York City�
��s cholera epidemics by preventing infected victims from introducing the vibrio into the city in the first place. Political leaders corrupted by ideological and commercial concerns throttled this containment measure, too.

  They could have implemented quarantine. The first one had been enacted by Venice in 1374, when the city’s gates and ports were shut for forty days to keep out bubonic plague (thus deriving the method’s name, from quarante giorni or “forty days” in Italian).27 That was a pretty good containment measure for a pathogen like bubonic plague, which manifests itself in visible pathology in less than forty days. After being held in quarantine for that long, people, ships, and their goods were, as one historian put it, “medically harmless.”28

  By the end of the seventeenth century, all of the major Mediterranean ports in Western Europe had built heavily policed fortresses, called lazarettos, to hold ships, passengers, and goods in quarantine. To implement similar measures on land, lines of soldiers were positioned in what the French called cordons sanitaire, or sanitary lines. One of the largest—an army of soldiers in a twenty-mile-wide formation that stretched for twelve hundred miles across the Balkans, with orders to shoot on sight any passersby who failed to submit to quarantine—held the plague out of Turkey in the eighteenth century.

  Some historians credit the use of quarantines and cordons sanitaire with Europe’s ultimate mastery over the plague, which had disappeared by 1850.29 The historian Pierre Chaunu called it “one of the greatest victories of baroque Europe.”30 The quarantining of ships may have been responsible for the demise of yellow fever epidemics in New York in the first half of the nineteenth century, too, according to the historian John Duffy.31