Jeremy Laurance: We should feel lucky to be so well protected from disease

Medical Life

I was walking the Lycian Way on Turkey's Mediterranean coast last week – turquoise sea on one side, towering cliffs on the other and a merciless sun above – as the World Health Organisation declared the first flu pandemic in 40 years. On Thursday when the news came through, we were following the route of the Roman aqueduct at Patara, an engineering marvel that probably saved more lives in the ancient world than all the medical drugs invented since have in the modern one.

But what was the human cost of building the 12m-high structure? Merely walking along it, in the 35-degree heat, was exhausting – for the slaves who constructed it 2000 years ago, it would have been torture.

As privileged travellers in a foreign land, it was a reminder of our good fortune to be living now, in the manner and the place that we do, protected (mostly) from disease and hardship. I was reading Colin Thubron's 'Shadow of the Silk Route', an account of his extraordinary journey from central China to Turkey, in which he observes that the traveller's greatest fear is of dying not of sickness but of heartlessness – ignored, neglected, regarded as disposable.

Returning to the UK, I was struck by the reassuring responses to the pandemic being made by scientists, who only a few weeks ago were warning of the potential threat to global health. "Pandemic" refers only to the capacity of the swine flu virus to spread, not to its severity, they pointed out. The disease caused by it is mild (so far) and there is no cause for alarm, was the prevailing message.

Well, yes and no. Even mild flu kills, as we have now seen in Scotland. If more people are infected then more will die. Government estimates are that 25 to 35 per cent of the population could succumb to the virus, compared with between five and 15 per cent from seasonal flu. That implies anything from twice to seven times as many people infected as in a normal flu year – and a proportionate increase in deaths.

Things could get worse, of course, if the virus mutates to become more severe, as many scientists have warned. But let us stick with the optimistic scenario and suppose it remains mild, at least among the well nourished, well protected populations of the West.

If the virus gets a foothold in the developing world, the scenario could be very different, even without a mutation to make it more dangerous. And that could pose a difficult moral dilemma for western countries, with their vast stores of antiviral drugs and soon-to-be-delivered pandemic vaccines.

If the death toll starts to mount in poorer countries while remaining low in richer ones, will we sacrifice our carefully laid plans for our own protection and begin shipping anti-viral drugs and vaccines to those who need them more? I wonder. Heartlessness could end up killing more than sickness in this pandemic.



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