Crisis Averted

August 1, 2024
Epidemiology has delivered critical advances in public health, according to an expert in the field. The Covid-19 pandemic was a global tragedy, says Rivers, an epidemiologist who specializes in outbreak science, but it was also a crucial learning experience. As the first event of its size since the 1918 influenza pandemic, it provided tools, experience, and a heightened level of awareness about public health issues. It demonstrated, as well, that global coordination could take place despite political and cultural divisions. Rivers believes that accomplishments of public health are one of the great human success stories, boasting such remarkable achievements as the eradication of smallpox and the near-defeat of polio and several other plagues. The irony, however, is that some of the most important events in the field, when epidemics have been identified, contained, and defeated at an early stage, have gone largely unnoticed. There is, apparently, little media interest in people remaining healthy. Rivers tracks through the history of epidemiology, explaining how the pieces were gradually put together and the progress of epidemics was mapped. An effective response requires many players: doctors who first encounter the signs, a system for reporting, diagnosticians to define the pathogen, laboratory scientists to develop treatment methods and vaccines, and a reliable mechanism for delivery. New threats are appearing at an accelerating rate, with outbreaks that demand a large--scale mobilization of resources occurring about every two years, notes Rivers. She is optimistic about the capacity of the system to respond, with national and international agencies providing important avenues for cooperation. The author clearly knows everything there is to know about her subject, and she writes with clarity, insight, and authority. An informative, accessible package, useful as an examination of the road behind and the path ahead.

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August 5, 2024
Johns Hopkins University epidemiologist Rivers debuts with a penetrating exploration of strategies public health experts have used, or failed to use, to prevent catastrophe. Chronicling how the World Health Organization eliminated smallpox in the 1960s and ’70s, Rivers describes how, after mass vaccination campaigns in the countries where the disease still circulated proved insufficient, health workers paid people to report cases so the workers could vaccinate and quarantine anyone exposed. The combination of strategies was successful, and the last natural smallpox case occurred in 1977. Other success stories include how good “old-fashioned... contact tracing, isolation, quarantine, and instructions to the well for how to prevent infection” stymied the spread of SARS in the mid-2000s. Rivers also features a few cautionary tales, as when she discusses how inadequate infrastructure for waste water contributed to Haiti’s devastating cholera outbreak in the 2010s. A chapter describing the origins of tornado warnings in the late 1940s to demonstrate the wisdom of honest communication with the public about potential threats feels tangential given the overall focus on disease, but the case studies offer helpful insights into what it takes to extinguish outbreaks. It’s a rousing testament to health workers’ grit and competence. Agent: Beth Fleming, Brockman.