"SPILLOVER"

Reading David Quammen’s “Spillover” is both a challenge and a reward, because it is so rich with concepts and vocabulary we need in order to think about the part of culture we call “disease” as in dis-ease, that which makes us miserable.  His vivid but never judgmental writing calls up memories.  Since Quammen lives in Bozeman, he's always been "just over the hill" from me, maybe in a hazmat suit.

When I was an animal control officer in Portland, OR, the second woman hired was a pre-veterinary student waiting for an opportunity to get into vet school.  Her husband became infected by a rickettsia, which is a particular kind of microbe not well understood at the time.  She was extremely wary about some of the places and contacts we made, often unsanitary to say the least.  (Four-inch crusts of animal feces in homes.)  The resident one-celled animals were likely as predatory as some of the belligerent dogs we encountered.  They told us fresh killed animals in the street were more problematic than cold maggoty corpses, because the critters on the newly dead corpses were looking for new hosts.  Also, we became intensely aware of infections in the general animal population, some of which might be zoonoses that could jump to humans.  Portland is a port city, which means ships which means rats.  We were advised not to donate blood because of the bits of beasties we might be carrying.  We were given rabies shots.

In 1981 I was doing my ministerial internship in Hartford, Connecticut, when Lyme disease was first being identified.  One of my parishioners had a knee the size of a cantalope before massive doses of penicillin brought it under control, but it came back later.  Another man in Hartford was my first awareness of PTSD, not because he had just come from a new war but because he had commanded a ship during WWII and sent his soldiers onto a beach into disastrous battle.  Standing on his bridge, he had watched them through binoculars as they died.  That had been decades earlier, but through some trick of aging his memories now came back in the night to torture him with guilt and grief.

When I was circuit-riding in Montana (’82-’85), a nurse told us that now and then mystery diseases would show up that caused the patient to be “wrapped in aluminum foil like a baked potato” and removed to some unknown quarantined place, never to be heard from again.  One of those diseases may have been HIV-AIDS, which was not quite defined yet, but others were probably among the infections Quammen discusses.  Or like them.  One of the strong themes is that infectious disease is a planetary ecology that only includes human beings under conditions of intersection when the vector carriers transport mutated bacteria or viruses to active infection of humans, which is technically called “spillover.”   Then the bugs are zoonoses.  Spillover is not necessarily a continuous stream, but happens when conditions are right, as when a stream spills over its banks due to upstream rain, late melt, erosion from timber cutting or fires, and so on.

When I was a ward clerk just a few years ago in Shelby, a nurse told me about a little circle of sex-sharers and IV needle drug users who had Hep C which somehow mutated into “fulminating hepatitis.”  One after another, they developed bad colds and then died, without passing that mutation to anyone else.  It was a deadend epidemic.

A vector is something that carries the “bug,” a virus or bacillus.  The source accumulation of infectious agents is called the “reservoir.”  The reservoir can be carried by a vector that transmits it to an “amplifier” or a “superspreader.”  This vector can be entirely innocent and not clearly involved in the final transmission of the bug.  As Quammen relates again and again, finding the infectious agent is the first problem and often made possible only by identifying the vector, but backtracking until finding the reservoir has to be the single most effective insight into prevention.

It’s clear that HIV-AIDS originated with African simians and was spread to humans (probably has been doing so for a very long time) through the consumption of bush-meat.   The two most obvious human vectors of HIV-AIDS are IV drug users and sex-workers, because these are two primary ways (outside medical situations) that body fluids are carried across from one person to another.  Other vectors could be birth, nursing, transfusions, organ transplants, and bloody wounds, as from violence.  Almost all HIV-AIDS vectors are humans. Deliberately infected lab animals are caged and destroyed.  

Public health workers know that infected people should be prevented from exchanging body fluids and encourage “barrier prevention,” that is, condoms, clean needles, and so on.  These are often denied to captive HIV carriers, like prison inmates or deportees, on grounds that they are an “extra,” expensive, and make bad behavior safe when it should be punished -- even fatal.  The big hole in this argument is that convicts are released and deportees re-immigrate, still infected, still vectors.

Making barrier prevention work means keeping people alert and consistent, which they won’t be if they are drunk, confused, stressed, or past giving a damn about anything including themselves.  Despair is a superspreader.   Public health workers obsess all the time about how to reach those people.  Because most public health strategies are based on data collection, labeling, stigmatizing, capture, incarceration, forced treatment, deportation, cattle-call clinics -- in short, punishment -- their efforts just don’t work.  Escape IS being a vector.  Secrecy and hiding are amplifiers.

Other parts of our present cultural ecology amplify vectors.  One is our constant obsession with sex and the use of it to promote everything consumable, reducing every good thing to sexual access, even Heaven.  Related is our valuing of the “high,” the extreme/blissful/
orgasmic, often through either transgressive sex or IV drugs.  These are amplifiers but so are stigmatizing, incarcerating, criminalizing -- INCREASING the spread of HIV-AIDS.  What seems blameless and what seems evil are working on each other synergistically to create ecological opportunities for body fluid crossovers.

But what is the real reservoir of HIV-AIDS?  If sexworkers and drug addicts are vectors, what is the cultural reservoir that creates the inevitable re-infection of these carriers?  I do not think it is a virus -- I think it is cultural.  The real reservoir for HIV-AIDS and many other diseases is the unhappy family that produces abused children.

At the heart of the old-fashioned mom-and-dad model of families was a successful dad who provided for and protected his wife and family.  In the past he did this by being reliable, hard-working, successful at competing with other men, skillful, and physically strong.  His reward was that he owned that family.  This was suited for rural agrarian places but has become increasingly impossible since WWII when the industrial revolution finally produced suburbs, automobiles, national highways, and a stoically traumatized former soldier population.  Men were trapped in families they didn’t want without any way to earn enough money for them. Others were emotionally trapped in jobs they hated because it made them able to buy houses, cars, and relief in the form of socially approved alcohol.  Maybe they took off, maybe they resorted to paid sex, maybe they were angry enough to enjoy the forcing of it on whoever was weak and handy, maybe they became abusers of their own children.

Abusive families, male members or not, sexual or not, are the reservoir for pandemic level HIV.  They send out vectors into society (their rejected and damaged children) and they themselves act as vectors buying sex, bringing back the same bugs (now amplified) to their own families -- what’s left of them.  Is this true?  I’m going to work on that question for a while.  At the very least it is a “spillover” of misery into society at all levels.  Misery and despair can be autoimmune diseases that cause people to damage themselves irreparably.