The threat of a serious disease outbreak is one we humans live with daily, whether it’s a measles outbreak in areas of low vaccination or an outbreak of food-borne illness. And if our films, books and other pop culture influences are to be believed, a virus spreading zombification may be among those threats. Most people write off the threat of zombies as fantasy, but even the Centers for Disease Control and Prevention has published guidelines on preparedness for a zombie outbreak or, worst-case scenario, a zombie apocalypse.
As epidemiologist and antibiotic resistance researcher Tara C. Smith explores in a recent paper in BMJ’s Christmas issue, it is absolutely essential that we understand the threat of zombies and how zombie infections can spread, and then invest funding and research in prevention of a zombie apocalypse. Smith, an associate professor at Kent State University’s College of Public Health, notes that zombies—“also known as walkers, Zed, Zs, biters, geeks, stiffs, roamers, Zeke, ghouls, rotters, Zoms and runners—have become a dominant part of the medical landscape.” We ignore them at our peril.
Of course, to be fair, the CDC has published its zombie preparedness guidelines not because we have any actual evidence of the existence of zombies, but because the steps we would need to take to address a true zombie outbreak so closely resemble the steps we would need to take to prepare for many public health emergencies, including a rapidly moving infectious disease.
In that same spirit, Smith’s article, likewise tongue-in-cheek, explores issues associated with zombies and the viruses that cause zombification that parallel issues related to managing existing and to-be-discovered human diseases. And Smith is not the first in the medical field to consider the ramifications of a zombie outbreak; a previous paper looked at the role of nurses in managing an epidemic of Solanum infection, for example. But Smith has thoroughly researched and presented zombification history, epidemiology, symptoms, cause, transmission, treatment and prevention, and the parallels to the real world may startle you. I therefore asked Smith some questions about what she discovered in her zombie research and then, more seriously, how humans can apply the lessons of zombie fantasy to real-life management of serious diseases.
Which of the zombie infections do you believe poses the most danger to humans? How can we guard against it?
The ones which have longer incubation periods, such as the Solanum virus (World War Z), are the most dangerous. A pathogen that causes rapid zombification should be more difficult to spread worldwide than one which takes days or a week to result in clinical symptoms. For the latter, one could be bitten, hop on a plane or in a car, and be hundreds or thousands of miles away by the time he’s zombified. Stopping someone in that incubation period would be more difficult unless you’re doing an entire-body search for bites, as they will appear healthy for several days. For those that rapidly cause a victim to “turn,” they would be less likely to slip through any kind of quarantines or screenings that may be set up to stem infections. The best way to guard against it would be to have a specific plan in place for potential quarantine or isolation scenarios, designated treatment/isolation centers, and trained healthcare workers (and, possibly, military personnel) who could be called on to assist in an outbreak situation.
You noted in your article that most countries would unfortunately “remain grossly unprepared for a potential disaster of this nature.” If an actual zombie outbreak occurred and began rapidly spreading across the world, do you think our current national and worldwide infrastructure is set up effectively enough to handle it?
Not even close. Even a bad outbreak of influenza stretches our capabilities, and that’s in a wealthy, developed country. A recent report showed how far we still have to go when it comes to a potential outbreak of infectious disease. That report focused on a bioterrorism attack, but the same principles apply whether it’s a purposeful attack scenario, or something straight from Mother Nature. We’re simply not prepared. In developing countries, where infrastructure is poor to nonexistent, they’re in even worse shape, as the ongoing Ebola outbreak acutely demonstrated.
You wrote that “vaccine hesitancy may make it difficult to achieve society-wide uptake of a zombie vaccine.” If we ever developed a safe, effective vaccine against zombification, how should we address those who would invariably resist the vaccine for their children?
I suppose it would depend on whether we were in the midst of an outbreak or not. If we were, there would be a better case for mandatory vaccination to protect those who were still uninfected; refusal could mean that the unvaccinated would be confined to their homes. Seeing such an outbreak in progress may sway the opinions of some vaccine-hesitant parents, as experiencing measles or whooping cough have done in the past. If an outbreak was not ongoing or imminent, likely the same strategies that are used today could be enforced, such as preventing children from attending school if parents refuse to vaccinate. With a disease spread human-to-human by bite, unfortunately young children would be some of the most vulnerable and most in need of protection.
You note, “Some experts have argued that the rise in zombie infections is due to increased surveillance.” What other human diseases is this already true for?
Probably most of them. Many of the diseases which we think of as “emerging” aren’t really new—we just didn’t know about them previously. Lyme disease, hantavirus, Nipah, Hendra—these have almost certainly been circulating longer than we realize; we just didn’t know about them as distinct organisms to search for. Even HIV was circulating in the human population for decades before it was first identified in the 1980s. When you start to actively look for something, you often find more of it.
Are there any other human diseases besides zombification that could result in rotting flesh?
Sure. Gangrene can be caused by a variety of bacterial species, but most commonly by Clostridium perfringens. It causes destruction of the skin or underlying muscle. Necrotizing fasciitis is the scientific name for the “flesh eating disease,” which can be caused by a number of bacterial species. Toxins that they produce causes the skin and soft tissue to become destroyed—and the rotted flesh typically has to be removed to stem the spread of infection. Some tropical diseases, such as leshmaniasis, can cause open sores that take a year to heal. Buruli ulcer is caused by a species of mycobacteria that can cause extended open wounds, resulting in tissue death all the way to the bone. Leprosy is caused by another species of mycobacteria and has a reputation for causing rotting skin (and limbs or noses to fall off) but in reality that doesn’t actually happen that way—instead, ulcers slowly grow and destroy the skin, bone, and muscle of extremities.
What are some real human diseases that can be spread by bite, particularly among children, and can any be prevented by vaccines?
A review of bacterial infections found in human bites showed a wide diversity of bacterial species, including many with Streptococcus or Staphylococcus infections. Virally, both hepatitis B and C can be spread by human bites. Rabies may seem like an obvious one, but almost all human rabies cases come from dog bites, and transmission via a human bite has never been confirmed. Of the common bite-associated pathogens, hepatitis B can be prevented by vaccination.
Can humans learn anything about these zombie outbreaks that can be applied to other infectious diseases or outbreaks?
I think one of the biggest take-homes is the response to an outbreak. We saw last year with Ebola that even for a disease that poses little to no threat to the United States, people went crazy. From the beginning, representatives from the CDC and NIH said that an outbreak was extremely unlikely here, yet pundits clamored for bans on travel, and states instituted quarantines of their workers (which were ill-advised and possibly even illegal). Much of the media, and the citizens it serves, simply ignored the science and bought into the hype, quite possibly putting those in West Africa at a greater risk as it limited the ability of our healthcare workers to assist in the affected countries. In serious outbreak situations, we need the public to cooperate with public health officials to identify those who are infected, and we need those who are healthy to avoid the propensity to panic or let fear drive their actions. And that’s one of the most difficult things to do, as zombie outbreaks show.
This article was written by Tara Haelle from Forbes and was legally licensed through the NewsCred publisher network.