SARS is just over 6 months old and already it is difficult to say anything new about the disease. Medical researchers lunged into action in record time, and the media has been by their side all the way, marveling at the coordinated work around the globe and relaying all the frightening details.
It has been two months since the first appearance of SARS in the Western world. In that time the coronavirus has been identified and genetically sequenced, cell receptors for the virus have been found, antibodies to the virus have been discovered, immune cell responses have been analyzed and companies are already locked in legal battles for patents on the virus and tests to identify it. Canadian researchers have found this virus in only 40% of their SARS patients and they find it in 14% of the healthy individuals they've tested. A skeptical medical community and public would want an explanation for this finding, and would want some compelling reasons why the coronavirus should still, in spite of its absence in over half of SARS cases, be considered the cause of the disease. Nevertheless, the media now unanimously refer to the coronavirus as â€œthe SARS virus.â€
There is no longer much time for skepticism in medical research, especially research driven ahead at breakneck speed by a pending epidemic and a potential goldmine of patents.
The mortality rate of SARS is climbing, leveling off, or falling, depending on the population and city being studied. On May 8 the World Health Organization announced that SARS is fatal more than 50% of the time to people aged 65 and older. By contrast, the fatality rate is less than 1% in people aged 24 and younger. Those with pre-existing diabetes are over 6 times more likely to die of the disease, and other serious health conditions make the disease at least twice as lethal.
Geographically, SARS fatality is equally variable, with cases in the Hong Kong, Singapore and Beijing being dramatically more lethal than in the West. No one yet has died of SARS in the United States. In contrast, about 20,000 people in the US die annually from influenza, which has a mortality rate of about 13%.
The FDA has placed any drugs or vaccines being developed against SARS on the "fast track" approval schedule created for AIDS drugs. This means much shorter time to evaluate potential dangers, and it means tens or even hundreds of millions of dollars will be saved by the drug companies that can shorten their trials and expedite their research. There is very little new to be said about SARS, except how tragic it is that our response to infectious disease has come to this. When a new disease appears, the absence of an effective drug or vaccine engenders panic. We have come to believe that drugs and vaccines aren't just our last hope, but our only hope. The greatest triumph of modern medicine is the public acceptance of one simple idea: that we are helpless against disease without the protection of medical professionals and their tools.
The process of doing medicine has become so thoroughly technical that it has very little to do with people anymore, other than as the battleground for vaccines or drugs to fight their battles. Fluids from the sick get studied in laboratories, far removed from the bodies that are struggling to rid themselves of disease, far removed from the environments in which the healthy became infected and sick, and far removed from the mountain of variables that influence the competence of each individual's immune response to an infection.
Medical science focuses entirely on finding drugs, vaccines and even genetic tricks that might tame the new viral villain, rather than on understanding why some die and others don't. These latter variables, coincidentally or not, are the only ones within our personal sphere of influence.
The elderly are typically the most vulnerable to infectious disease, and SARS is no exception. The rest of us, we are led to believe, are mostly at the whim of chance. If we breathe in an infected cough or sneeze, we just hope we aren't in the small percent that die from it. There is another way to view the situation. We can acknowledge what has been known for over a century: susceptibility to infectious disease is related to the health of the person at the time of exposure. Immune status is profoundly affected by everything from nutrient intake and stress level, to environmental exposures, genetics, and exercise habits. It is even affected by the number of social ties an individual has to family, friends, and coworkers, and extroverts appear to be less susceptible to infections than introverts.
All these and many more factors come together in complex ways to determine susceptibility at any given moment. Not every exposure results in infection, and not every infection results in disease. This is true for everything from the common cold to HIV/AIDS. And, of course, SARS. We all fall somewhere on a continuum between highly resistant to infections and highly susceptible to them. We don't have total control over our place in that continuum, but our place is also not entirely random.
Our collective attention too often focuses on the headlines that might tell of a new drug or a vaccine on the way. Perhaps activists will lobby for more money put toward SARS research. We trust the scientists who tell us that this latest virus is new, that it is different, that SARS has made "mother nature ... the ultimate terrorist," as an editorial in the journal Nature put it.
In the meantime, a simple truth is lost: the progressive decline of immune competence around the globe is precisely because of the products of capitalist production that have invaded our bodies and their living spaces. We now consume vast quantities of chemicals - several pounds annually - that were never put into bodies even a few decades ago. We smear even more of these chemicals onto our skin, a very efficient way to get them into our bodies. We breathe them with every breath and drink them in most of our water. Our lives are filled with stress: work, financial, body image, relationship, terrorism and security and code yellow, etc.
In short, we are creating a world in which simply living is immunosuppressive. As a society we are more susceptible to many things. Bugs are more dangerous to bodies less able to resist them or to control their replication. It is no surprise that medical science gives us many other reasons that we should fear the new germs: they are mutated, or they are resistant to drugs, or our antibodies don't work against them.
Industrial medicine has morphed into a system of finding profitable cures for microscopic causes. Being "treated" means patching up our wounds so we can maintain a minimally functional level while continuing our consumption binge.
Of course this medical system is going to say that the bugs are more dangerous, rather than saying we are all simply more susceptible. Our medical system and the entire system of therapies it dispenses are in service to the demands of capitalism. There is no conspiracy behind this, nor any need for one. A look at institutional constraints and interests make it hard to ignore, though acknowledging it as such doesn't make us feel very comfortable. An important question follows: how might we think about responses to infectious disease epidemics within sustainable and participatory communities? First, within truly participatory communities, the health of everyone benefits by the very nature of the social arrangement. Food, for example, would be predominantly grown and consumed locally.
This one single change would enormously benefit the health of all individuals. Local food means unprocessed food for the most part. Eating a diet of whole foods would go a very long way toward reducing disease and bringing the community up to nutritional competence. This is especially true in a society where currently 20-66% of all patients entering a hospital have evidence of malnutrition, the percentage varying with age.
Work conditions would also be very, very different in such a community, and that would have an enormous beneficial impact on health in the community. Both new and old research shows the profound immune suppression that results from stress, especially chronic stress. In the capitalist work world, such stress is ever-present.
In a sustainable and participatory society, there are no longer factories belching their poisons in neighborhoods, no industries dumping into community wells. The benefit to the health of every individual would be significant.
What does all this mean for infectious disease epidemics? First, reduced overall susceptibility means such diseases are less frequent because they have a harder time moving through the population. Each body a virus encounters offers more resistance to the infection than it does now. Hospitals would no longer be the buildings where the technologies of medicine are delivered to passive recipients. Instead, all those variables already known to benefit immunity and recovery from disease are embraced.
Individuals in such a society suffering serious infectious diseases (SARS or others) must limit their contact with at-risk populations, while increasing their contact with caretakers, with health care professionals who not only deliver supportive care, but also provide human contact, a relationship that is itself healing, supportive, and crucial to raising the vitality of an infirm individual. Micronutrients are just as likely to be dripping from IV bags as are pharmaceuticals, because we already know that many nutrients are anti-viral, anti-bacterial and they significantly reduce recovery time. Hospital meals would not be industrial productions, but prepared consciously to deliver the whole nutrients, the essential oils and the quality calories that we know benefit both short- and long-term recovery.
The tools of conventional medicine would still have their place: CT scans, MRIs, X-rays, and many other technologies make conventional emergency room medicine state-of-the-art. But emergency room medicine accounts for only about 4% of the total US medical expenditure.
Modern industrial medicine is not the last best hope for human health. Resistance to disease is a social endeavor as much as an individual one, and the resources needed can be public and empowering, not private, technical and subjectifying. We each benefit by enhancing the overall health of the community, rather than medicating bodies after they've been infected.
It is a lesson that doesn't lend itself well to bestsellers or Hollywood hits about the next viral threat, but it does remind us that our diseases are a reflection of the world we create for ourselves.
Greg Nigh is a naturopathic physician and licensed acupuncturist practicing in Portland, Oregon. He writes and speaks frequently on topics related to politics, alternative medicine and health care. He can be reached at firstname.lastname@example.org.