Global Contagions as seen from 1995: Initiation in The Hot Zone

A recital of an essay by Ronald L. Barrett, Jr. IV°. Originally published in The Scroll Of Set, Issue #139, Volume XXI-3. May 1995

Introduction

This is a recording of an essay I came across when browsing through some back issues of The Scroll of Set online. It mainly centers around the conception of infectious epidemics, forms and functions of known virii, and a "fictional novel" titled The Hot Zone, authored by Richard Preston and published in 1994.

I wanted to share it with you all so you can consider the level of consciousness mass global epidemics were residing in back in 1995.

[1] Initiation in the Hot Zone

by Ronald L. Barrett, Jr. IV°

Life is wyrd. It is a conspiracy of inefficient mechanisms that assemble themselves into the most incongruous of organisms at the margins of order and chaos. Just as chickens might exist so that eggs can reproduce, so living creatures might be considered devices for replicating genetic programs, passing on copies of their blueprints before being consumed by the forces of entropic decay. Between assembly and decay these organisms operate as open systems, defying and delaying entropy through the exchange of matter and energy with their respective environments. Organisms may sometimes employ strategies of mutual cooperation in these endeavors, but more often the game is one of mutual consumption and fierce competition for limited resources.

Initiation is a self-ordering change process at the intersection of life and intelligence. Here the human organism is an open system to the experiences of both matter and spirit. As an evolving organism, the human being eats, shits, reproduces, and interacts with other life forms. As a developing proto-deity, the human becoming ascends to his own tune. It is important to understand that these processes are not exclusive of one another. Instead they form a complimentary dialectic in the initiatory process. Humans are not isolated from the natural order, but rather potentially independent of it. In order to achieve this independence, however, the Initiate must come to understand the material processes of his own life, and of those who would consume it.

Yuri X. was a twenty-something Eastern European immigrant and Haight Street junkie who was admitted last year to the emergency room at the University of California, San Francisco. This was the night that I was working a 12-hour graveyard shift as a clinical nurse on 9- ICU. Ordinarily I worked on the neuro-ICU, specializing in patients who have had neurosurgery for aneurysms, tumors, and head injuries. But it was a quiet night on the neuro unit, and things were getting heavy on “nine”. So up I went, an R.N. with less than two years experience, to a place where anything could happen - even Yuri.

I met Yuri sometime after midnight. He came up from the E.R. on a gurney surrounded by cluster of doctors urgently scurrying about. He was not my patient, but with three nurses working as a team in a “pod” of four ICU beds, we all became pretty intimate with one another by the end of the night. My patients were holding steady, so I offered to help.

In the meantime, Yuri had been semi-situated into the ICU. He was half-dressed in street clothes, with cardiac leads, IV fluids in his arm, and supplementary oxygen in his nose. He sat up in bed, trying to look cool despite his obvious signs of shock. His pants had been cut up to his crotch, displaying a set of large and diffuse bruises on each thigh. I couldn’t figure it out.

While helping out with Yuri, I found out that he was strongly suspected of having necrotizing fasciitis, a fast-spreading and potentially fatal bacterial infection that causes the patient’s skin to rot off. The only known treatment for the disease is to surgically remove an even larger area of tissue down to the muscle, and administer a broad spectrum of IV antibiotics in hopes that they will beat the critter before the patient becomes septic and dies.

Glancing over to Yuri’s glass-walled room, I saw that he had found the controls to the television. With the T.V. facing away from me, I looked beyond Yuri to the scene of a familiar horror film reflected off the windows to the night sky. A young woman was being chased by a floating psychiatrist- turned-Cenobite. The movie was Hellraiser II.

“How come you’re watching a horror film?” I asked.

“It takes my mind off things. It helps to see someone who’s worse off than I am.” He replied.

I was assessing his legs all the while. The “bruises” had spread beyond the rings that had been drawn on his thighs with a ball point pen. They were even larger than when I had seen them a few minutes ago. I nodded and gave Yuri a confident smile that concealed my thoughts. I knew both his prognosis and the ending to Hellraiser II. The woman in the movie was, in fact, much better off than he. A few minutes later Yuri was rushed to the O.R. to have large quantities of skin removed. There he went into cardiac arrest on the operating table. He survived the experience, but only to endure forty more days of steady torture and permanent disfiguration.

Almost a year later I received a newspaper article about necrotizing fasciitis from Magistra Reynolds. The title read something like, “Flesh-Eating Bacteria Consumes Little Girl”. In addition to a sad case story, it described the increased incidence of this horrible disease as part of a more general reemergence of infectious pathogens in the human population. While not inaccurate, the story played upon the fears of the public without adequately addressing the cultural and biological conditions under which this disease was beginning to thrive.

The same can be said for The Hot Zone, a recent book by Richard Preston on the U.S. Army’s response to a potentially deadly disease among a population of imported monkeys just outside Washington D.C. Closely related to Marburg and Ebola Zaire, incurable viral hemorrhagic diseases which cause massive internal and external bleeding among infected humans, Ebola Reston turned out to be a false alarm: a filovirus that kills monkeys in a similar horrific manner, but which turned out to be harmless in humans.

Nevertheless the book touches on a number of interesting topics. Preston gives a thumbnail sketch of the emergence of Ebola along the Kinshasa highway of central and eastern Africa in the 1970s. There it emerged mainly among prostitutes, hospitalized patients, and healthcare workers in Zaire and the Sudan. Although light on history, Preston does not skimp on the gory details of the chief manifestation of this disease: a condition known as disseminated intravascular coagulation (DIC).

By no means restricted to viral hemorrhagic diseases [of which the filoviruses of Ebola and Marburg are but a small subset], DIC is a condition in which tiny little blood clots form all over the body. These clots fill up in capillaries, restricting blood flow to tissues, thereby causing them to die from a lack of food and oxygen. This cell death is rapid and global, affecting vital organs such as the heart, brain, liver, kidneys, and digestive system all at once. Paradoxically, because DIC uses up all the body’s clotting factors, the victim begins to bleed all over - through the eyes, the nipples, the gums, the GI tract, and the lungs. While all this is happening, the virus is busy destroying the endothelial tissues which line the skin and every organ in the body. Not a pretty way to die.

Preston describes Ebola as a “slatewiper” that kills 90% of its human hosts within a week. There is no cure, and it may someday become airborne. Preston also spends a great deal of time describing the Army’s containment facilities at USAMRID, a medical research center that is partly devoted to studying biological threats to the United States. Along with the CDC in Atlanta, USAMRID has some pretty fancy gear for dealing with very “hot” diseases, to include Racal “spacesuits” and Level 4 laboratories reminiscent of The Andromeda Strain.

As the story progresses, Preston reveals to us that, despite the high level of precautions taken to contain the monkey house in Reston, Virginia, the virus would have probably broken free anyway. The lesson was not that we dodged a bullet, but rather that the bullet that hit us was made of rubber and not lead. These filoviruses remain hidden somewhere in the rainforests of sub-Saharan Africa, and it is only a matter of time before they reemerge, spreadable to any city within a 24-hour plane flight.

Preston’s story, however, is a bit sensational. Basing his research on interviews with some of the persons involved, he fills in many gaps with literary license, telling stories about what these people would have thought or done in various situations. He also discusses what could have caused or been the result of event X or Y, based upon a rather cursory understanding of biology.

Preston makes a few mistakes in the book, such as attributing viral replication directly to the supposed “dissolving” of the body’s tissues, and describing the virus “as more ancient than man” when no one has a clue as to its original host. Furthermore Preston’s book is highly biased by Army sources. The CDC researchers, who have had much more experience with these diseases, tell some very different and interesting tales. Preston only alludes to the latter. Additionally, if what he had been writing were true, Preston’s own visit to the Kitum cave, where two people may have contracted the Ebola virus, was highly irresponsible.

The moral of The Hot Zone is highly simplified. Preston talks about the rain forest mounting an immune response to the human race as result of our encroachment. This is more politically than biologically correct. The proximate determinants behind the emergence of these deadly filoviruses among humans lie in our increased contact with other primates possessing similar immune systems. Unfortunately Preston misses the irony of these diseases appearing in the monkey houses of Reston, Virginia, and Marburg, Germany. In both cases it was the demand for primates in the animal research of infectious diseases which brought these new pathogens to the human species.

Preston seems ill-informed about the social, economic, and historical conditions upon which Ebola had spread during the African epidemics. He does not consider how the fall of commodity prices in the mid-seventies, traditional marriage patterns, colonial divorce laws, and civil wars in the Sudan may have effected the practices of medicine and prostitution in these areas.

Preston throws around epidemiological slang such as “amplification” to describe the behavior of the virus, when in fact it has been the behavior of humans which have amplified its effects. Ebola was spread not by airborne transmission but by intimate contact with blood and body fluids through sexual intercourse, needle sharing, and traditional funerary practices.

Yes, only seven percent of those who contracted Ebola from contaminated needles [used by untrained missionaries to give vitamin shots to villagers] survived, but the survival rate was better than 43% among those who were infected through direct contact with people having the active disease. Additionally fifteen percent of the Pygmies in Yambuku presented with antibodies to the virus without ever having symptoms.

Preston’s “slatewiper” was not spreading unhindered across a flat surface, but rather a textured terrain comprised of highly complex bio-cultural interactions. An analogous situation exists for diseases such as AIDS and even necrotizing fasciitis. Yuri’s drug habit and needle-sharing has helped to amplify the probability that others may contract what would otherwise be a rare disease.

That said, The Hot Zone does serve to raise the consciousness of humans as biologically-vulnerable organisms. Here I will introduce some issues for later expansion:

First, over-reliance on antibiotics during the past half-century has selected for highly resistant strains of old diseases. [Here I am referring mainly to bacterial infections. Viruses are treated not by antibiotics, but by “priming” the immune system through vaccinations and a small subset of drugs with limited effectiveness.] It is likely that these pose a greater threat to the human species than any of the supposedly “new” diseases.

The situation is analogous to our use of pesticides. Farmers have used strong chemicals to kill off most of a given generation of insects. But a very small percentage of mutants survive who are resistant to the chemical. A few years later, stronger chemicals are developed, and the cycle of escalation repeats itself.

Even with the recent revolutions in biotechnology, we have been steadily losing the antibiotic arms race. Housing lots of sick people in close quarters for treatment with heavy-duty chemicals, hospitals are the major breeding grounds for “new-old” diseases such as multidrug resistant tuberculosis (MDRTB) and Staph. aureus (M/NRSA). If you have walked into a clinic or hospital recently and wondered what happened to that once-familiar scent of ammonia, it is because there is a common nosocomial pathogen (a bug that grows in hospitals) called Pseudomonas æruginosa, that has adapted to the point that it can actually feed off of disinfectants made of quaternary ammonium compounds.

Laurie Garrett comments on this and other issues in a book entitled, The Coming Plague - a very thorough, well-written, and well-researched history of infectious diseases since the advent of antibiotics linked to a discussion of newly emergent pathogens, to include Ebola and Marburg. Garrett echoes the predictions of many epidemiologists and public health physicians that the days of magic- bullet cures are drawing to a close. Soon we will be returning to a disease ecology not unlike the one that existed before the Second World War. However this alone should not have a drastic effect on human demography. The dramatic declines in human mortality and increases in longevity during this century occurred independently if not before most cures for infectious diseases were discovered. Our gains in somatic fitness over the last four generations have had more to do with improved nutrition and sanitation than all the high-tech interventions combined.

Second, the above issues do not exclude the possibility that the human species might suffer major losses from the “outbreak” of a new disease pandemic. Ebola and Marburg are somewhat scary in this regard.

Influenza is even scarier. The flu pandemic of 1918 killed 21 million people worldwide in a single season, more than the total number of AIDS cases thus far. In the United States a half million Americans died, and ten percent of the total workforce was bedridden. Influenza has a high mutation rate and a somewhat unique capability of recombining genetic material between different strains, including those that infect other animals such as pigs.

Chiefly an avian virus that lives in the intestinal tracts of water fowl, new strains of influenza emerge each year - spread initially by ærosolized guano. Every February teams of scientists confer to make their best guess at the next year’s strain, from which a new vaccine is produced the following November. Like the San Francisco earthquake of 1906, researchers have been predicting the return of a flu as deadly or deadlier than the H1N1 strain of 1918. But nobody knows for sure. It is strangely humorous to think that civilizations of the 21st Century may suffer some of their greatest disasters not from nuclear missiles but rather flying duck shit.

Third, the influenza example illustrates an important principle of host-parasite coevolution. Flu is well-tolerated by its feathered hosts, producing symptoms only in humans, swine, and a few other mammals. If the flu were to kill ducks like Ebola Reston kills monkeys, it would soon find itself without a home. A more successful strategy of many human diseases is to base themselves out of a species in which they are ever-present and somewhat tolerated (endemic). From this base increased virulence can occur when a population of animals in which a disease is endemic comes into contact with a population in which it is not. There the forces of selection have yet to play themselves out over time, and so most anything is possible for at least the first few generations.

This same principle applies between different populations of humans as well. Humans have undergone at least two major epidemiological transitions over the last ten thousand years. The first occurred during the Neolithic, when increases in population density and the domestication of animals brought about a transition from chronic parasitic ailments to more acute and highly infectious diseases. The latter require high numbers of people to have a constant supply of susceptible hosts, as well as a critical population density in which to jump around. A fast-killing disease just doesn’t spread very far in a band of 20 nomadic hunter-gatherers who are 50 miles from the next water hole. A slow- working parasite can.

The second transition occurred in different patterns and times as a result of urbanization. In the cities of Renaissance Europe, a number of acute diseases were being maintained by a steady flow of susceptible children. The adults who survived were immune to subsequent outbreaks. This was a gradual process that occurred over time. But not so in the New World, where explorers exchanged slavery and smallpox for tobacco and syphilis. The exchange was hardly fair, however, because the contact reunited, so to speak, a population that had undergone the second epidemiological transition with several that had not - at least not in the same manner. The results were devastating for the Native American populations, most of whom were killed by a form of childhood smallpox - endemic to the old world, epidemic to the new.

I would argue that we are currently undergoing a third epidemiological transition in which the entire world is becoming a single urban-like disease pool. The upside of this is that we are not likely to see any repeats of Cortez, because our respective immune systems, whatever their variability may be, are becoming adapted to the same disease ecology. The downside is that most of us will be susceptible should we be infected with diseases endemic to other species such as insects, birds, mammals, and, perhaps most importantly, other primates. We will also be increasingly susceptible to the diseases of our great-grandparents.

Preston’s metaphors of heat and fire are pretty much on target. They just need a bit of expansion. The world population of humans is like a forest with six and a half billion closely-packed trees. It is capable of sustaining both a wildfire and a steady, smoldering burn. The human population is projected to be around 12 billion by the year 2025. This brings us to the larger principle of: “If it ain’t one thing, it’s another.” Population curves of successful predator species show that, rather than maintaining a steady-state within the limits of their resources, they instead exhibit sawtooth patterns of steady increases followed by precipitous declines in numbers. Human animals have exhibited a similar pattern during various periods of prehistory. Our current increase in numbers, unprecedented in any part of our past, is likely to be one giant sawtooth. It’s only a matter of time before we take the plunge. The question is when and how.

Karl Johnson, a legendary virologist with the CDC who headed up the field investigations of Ebola Zaire, once stated that “a virus can be useful to a species by thinning it out”. The problem is, however, that nature is indiscriminate with regard to whom it consumes. One of our best Initiates was killed by a virus that probably emerged from a species of Old World monkeys on the African continent. There is a very real possibility that this virus - HIV - and others like it may thin out our burgeoning population. But while indiscriminate and often incurable, these diseases are not uncontrollable.

Most of these “emergences” are not newly-evolved viruses, but rather old pathogens who have recently learned to exploit human hosts as a result of our cultural practices. Influenza is being maintained primarily through the practice of integrated pig-duck agriculture in China. Dengue Fever [watch this one] is “emerging” from open water storage tanks in urban areas. Rift Valley Fever is closely associated with a certain pattern of dams and irrigation. Legionaire’s disease hangs out in the condensation of air conditioning ducts. Marburg and Ebola are following the trade in laboratory monkeys. AIDS is being spread by shared needles and unprotected sex. All of these are potential wildfires, and all can be contained before they get out of control. The trick is to avoid having to put ona spacesuit and put out a major blaze after it has already been started.

The Gift of Set has afforded us with the opportunity to conquer all predators but ourselves, and to live in any environment save those we create. The challenge is to somehow adapt to our own success. Here the Black Magician can find utility in the alchemical dialectic, where LBM is applied to the substance of external experience in order to create an environment that is optimally conducive to one’s initiation. Likewise, through GBM, the lessons gained from these creative endeavors are applied toward transforming the substance of the self.

Just as human beings in spacesuits have not yet been able to isolate themselves from deadly viruses, so we humans Becoming cannot yet isolated ourselves from the biological conditions of our initiation. Biologically speaking, we are better off strengthening our bodies to defend pathogens through healthy living and exposure to reasonable risks than to seal ourselves off in barriers of false protection.

Magically speaking, we must conduct initiation in the “Hot Zone” through integrated mind-body development, creativity, flexibility, lots of feedforward, and serendipitous decisionmaking. It’s all a game of chance. But as Louis Pasteur once said, “Chance favors the prepared mind.” Reyn til Runa.

Suggested Reading

Garrett, L., The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York: Farrar, Straus and Giroux, 1994. While Preston might have favorable reviews from Stephen King and Robert Redford, Garrett is being hailed by Nobel Laureates. An immunologist-turned- international health writer, Garrett really did the foot work for this book. Written for the educated layperson, The Coming Plague explores the people, events, and larger issues surrounding the emergence of infectious diseases in the latter half of the twentieth century. The book contains chapters on the African Ebola Virus epidemics [from the CDC perspective], Lassa Fever, AIDS, the Swine Flu fiasco, Legionaire’s Disease, and the eradication of smallpox. It is an interesting read, and full of footnotes and references. The Hot Zone pales in comparison.

Ewald, P., Evolution of Infectious Disease. Oxford: Oxford University Press, 1994. Written for those who have an affinity for the natural sciences, Ewald’s book is destined to be a classic of evolutionary biology. For those of you who have heard that host-parasite coevolution leads to attenuation, Ewald will give you good reasons to think again. Virulence is strongly dependent on the mode of transmission, which in turn is strongly dependent on human behaviors. All this is laid out in his Cultural Vector Hypothesis. The book also contains some interesting predictions concerning HIV, and a chapter on biological warfare. A must read for bio-nerds.

Morse, S. (Ed.), Emerging Viruses. Oxford: Oxford University Press, 1993. Contains articles written by leading researchers in all these bugs that we have been hearing about. Morse’s own contribution is excellent. So is a historical piece by William McNeill, author of the classic Plagues and Peoples. The concluding section has articles assessing our preparedness and the politics of inter-governmental cooperation in disease surveillance. Otherwise the book tends toward the biotechnical, to include a review of Ebola by the stars of Preston’s book.