Old Germs, New Enemies: Battling the ‘Serial Killers’ : Books: Diphtheria. Cholera. Plague. With so many diseases we thought vanquished making news, we need to rethink our relationship with viruses, says author Laurie Garrett.

Every day the index of misery grows.

In Russia, a diphtheria outbreak has reached epidemic proportions. In Rwanda, the drug-resistant cholera that blazed through refugee camps this summer remains a killer. In the United States, once-vanquished diseases such as tuberculosis and measles have returned like avenging conquerors to ravage poor, urban areas. And the latest entry from the “killer germ” front is a sobering reminder of ancient times: a plague outbreak in Western India that has killed dozens of people and caused hundreds of thousands to flee the area.

“We are in a new historical phase,” says Laurie Garrett, author of the soon-to-be published, “The Coming Plague: Newly Emerging Diseases in a World Out of Balance” (Farrar, Straus & Giroux).

“Our relationship with microbes is different than ever before,” she says. “I don’t think it’s Fantasy X, apocalyptic thinking.”

Garrett’s book is an exhaustively researched, often-gripping tome--covering everything from African viruses to toxic shock syndrome and AIDS.

At 730 pages, the book is a collection of “disease detective” stories as well as an ambitious history of mutant viruses and bacteria over the course of this century.

Newsweek magazine calls it a “brilliant downer (that) is must reading.”

Adding to the book’s impact is its timeliness. Recent cover stories by Newsweek and Time magazines have sounded the alarm on the failure of antibiotics to defeat new generations of bacteria and the overall virulence of killer bugs.

“The Hot Zone”--a book about the 1989 outbreak of Ebola virus in Virginia--is on the bestseller list, and a movie about a deadly virus gone awry--set to star Dustin Hoffman--is also in the works.

Likewise, last June’s appearance of the so-called flesh-eating bacteria--reports of which were endlessly replayed on TV news--remains fresh on many people’s minds.

Garrett’s interest in infection, however, is the product of a much longer gestation. A former science correspondent for National Public Radio and fellow at the Harvard Public School of Health, Garrett wrote “The Coming Plague” in 17 months after several years of observing phenomena in sub-Saharan Africa, Central America and the Middle East, which challenged her assumptions that the defeat of disease by science was at hand.

“As I traveled more and more in developing countries, I found diseases that I had grown up with and thought were quite common were killers, and that diseases I had never heard of were killing tens of thousands of people and taking millions of lives every year,” recalls Garrett, a health and science writer at New York Newsday.

Still, the overall picture didn’t come into focus for her until a 1987 gathering of scientists and researchers in Washington, D.C. There, for the first time, Garrett says, she heard experts voice grave concerns about medicine’s inability to cope with the burgeoning number of virulent contagions that had suddenly manifested--fears that, in essence, validated her anecdotal experiences. That started her hunt, she says, “and by the time I had 12 file boxes (of research), I said, ‘It’s time for a book contract.’ ”

In “The Coming Plague,” the litany of blame for the new onslaught of global infection is a long and complex one. Indeed, Garrett, who has an advanced degree in immunology, points out that few of the often-lethal contagions facing the world--such as hantavirus and Legionnaires’ disease--are new. Many have existed either in less virulent states or in local environments for years, perhaps centuries. But in the past 20 years or so, social and environmental factors have intruded to amplify the quality and quantity of their destructiveness.

Ironically, in the case of bacteria-induced diseases, Garrett says, it has been the very antibiotics that successfully treated scourges such as gonorrhea, tuberculosis and malaria that provided the mechanism for their hardier strains to evolve.

Because modern medicine was unable to completely rid the world of such diseases, the surviving bacteria either mutated or transformed themselves into antibiotic-resistant strains, even as scientists blithely declared the battle over and moved on. “We called the game but the microbes didn’t stop playing,” Garrett says.

Likewise, in the case of viruses, Garrett says, similar amplifications of old contagions, along with man-made factors, created the new and deadly specimens that have seemingly appeared from nowhere.

For example, by testing old blood supplies, scientists have found the presence of the human immunodeficiency virus in samples dating to the 1970s, at which point the virus was spreading very slowly in Central Africa and the United States. Yet it was in 1975, say researchers, that “something happened” and HIV exploded in both areas of the world, an event that would not be detected until years later.

Garrett and other researchers now theorize that factors such as rising intravenous drug use and the increase in gay sex in North America, and war, refugee migration and famine in Africa likely spurred the beginnings of the epidemic.

“You can’t divorce our social problems from diseases of population,” says Dr. Richard Wenzel, an infectious disease specialist and epidemiologist at the University of Iowa. “For an epidemic to get rolling, it has to have susceptible people.”

Given this, the immediate outlook is not a hopeful one, says Garrett, adding that estimates show that by the next century, there will be an increasing number of megacities--those with populations of more than 10 million--in developing, economically disadvantaged countries.

The new megacities, which will likely be filled with former rural dwellers living with below-standard levels of sanitation and nutrition, may become veritable caldrons of new plagues--with the host nations unable to pay for the costs of disease prevention or containment. Even today, faced with epidemics of malaria or AIDS, some impoverished countries can afford to spend only $2 to $3 yearly per person for medical care.

Garrett, who coincidentally was in India during the recent pneumonic plague outbreak, says that despite the deaths and widespread panic, the scenario could have been much worse. “If this had been an airborne virus, it would have spread globally,” she says. “The masses were on the move.”

But residents of most industrialized nations, which provide the most research on disease and the best medical care, have little cause for comfort. Not only is vaccine development “in a state of crisis” and “every aspect of public health . . . in a state of chaos,” Garrett says, but in light of the ever-increasing mobility of the world’s population, new viruses and diseases can travel with unprecedented rapidity and impunity.

One incident recounted in “The Coming Plague” tells of an undetected microbe that, thanks to the convenience of jet travel, spread through four continents and infected hundreds of people within a week’s time in 1989 before officials were even aware of its existence. Fortunately, the virus--known as the Ebola Reston and found in monkeys--didn’t prove harmful to humans, unlike its more destructive African Ebola counterparts.

Still, the message the virus left in its wake is harrowing, and depending upon people’s response--or lack of it--a potentially lethal one. Garrett is mindful that as long as social, economic and environmental conditions deteriorate worldwide, and as populations continue to grow, the microbes will have the upper hand.

“The time it takes for humans to evolve is on the scale of centuries,” she says. “But the time it takes for a bacteria or virus to evolve is on the scale of minutes. That’s their advantage.”