In 2003, a woman checked into a hotel in Hong Kong. By the time she checked out, she had unknowingly picked up SARS from another guest. She flew home to Toronto, Canada where she became the first person outside Asia to die of a disease no one had ever heard of.
Our family was living four hours away in Ottawa. We had moved there from Australia the year before. Over the next few months, we watched the disease progress. Everything about it had to be learnt from scratch, including how it spread.
And because of that, it was easy to assume that any day it would be in Ottawa. Every death in a nursing home or unusual sick person was a harbinger. Sadly, an estimated 916 died worldwide, forty-four in Canada, before it was contained. It could have been much worse.
It never came to Ottawa, but I started thinking about how a family might fare during an outbreak that wasn’t so well contained. Eventually those thoughts became a novel — Before This Is Over.
I recently read Deadliest Enemy, co-written by Michael T. Osterholm, a doctor who has been on the frontline of many of the headline-making infectious diseases of the last few decades. I particularly took to heart this line: “We could try to scare you out of your wits with bleeding eye-balls and inner organs turned to mush as some books and films have attempted to do, [t]he truth and the reality should prove sufficiently concerning to scare us all into our wits.”
I apologise to the good doctor for fictionalising something that is a serious and very real problem but I hope I might be excused a little. There are no bleeding eyeballs in Before This Is Over. Instead, I wanted to explore some of the ethical and practical issues that ordinary people might face. In my further defence it is not all fiction. Some of the incidents in the book — hospital precautions, quarantined apartment blocks among others — happened or are reworkings of those in Ottawa and Toronto and all the other crises of disease, weather or technological failure that regularly make the headlines.
Epidemics have been fodder for authors for centuries. The book that kicked me into writing my own was Daniel Defoe’s Journal of the Plague Year, published in 1722, set in the plague of 1665. It is as far from a Hollywood blockbuster as you can get. Interspersed between descriptions of daily life — quarantined families dodging their guards, mass night burials, traders selling food from boats in the river to avoid contact — are statistics that map the creep of the disease through London. It was mundane and riveting. This is what I had been imagining back in Ottawa.
At every point in the process of my book — during writing, preparing for publication in Australia, preparations in the US — someone would say something along the lines of “it would have been topical now given the Ebola/Zika/MERS outbreak.” I began to realise that whenever it was released, there would be another disease before too long. That’s not a comforting thought.
And it’s not as if this is a secret. There are people and organisations trying to do something and to make the rest of us care. Recently Bill Gates warned that “a fast-moving airborne pathogen could kill more than 30 million people in less than a year.” The Bill and Melinda Gates recent Annual Letter was mostly devoted to the struggle with known diseases and the huge good that can be done in that area. And it is about preparation and unglamorous work.
Which brings me to vaccinations. For the purposes of telling a story in a reasonable time frame, I cheated on the odd detail. To take a vaccine from identification of microbe to ready for mass usage requires years, not weeks or months. SARS was contained not by a medical miracle pulled out of the hat but by eliminating animal hosts, isolating infected patients and waiting.
Even, as I learned in The Deadliest Enemy, when we are aware of the potential threat of a disease, such as Ebola, there is little incentive for companies to spend many millions to bring a vaccine to market and stockpile it against an outbreak that might not happen, or may happen in a part of the world that cannot be expected to repay the bill for development. And so there were potential Ebola vaccines unfinished at the time of the 2014 outbreak. The lack of them cost thousands of lives and billions of dollars.
I began to realise that whenever it was released, there would be another disease before too long. That’s not a comforting thought.
In Before This Is Over, I didn’t want to explore a post-apocalyptic wasteland of small bands of people scrounging for the last few tins of beans — that ground has been covered, and it didn’t mean much to me. I for one wouldn’t last that long. I live in the middle of a city and with dedicated effort managed to grow one fig and a couple of bowls of cherry tomatoes this year. And I’m guessing I would have stiff competition for the tins in scrounging distance. I thought there were less extreme, more nuanced and probable crises to write about.
The society we live in is a well-oiled machine in which no single person is responsible for, well, pretty much anything. Famously, no one person understands how to build an iPod from scratch. Let alone fix a sewerage system, the electricity grid and the dozens of other pieces of infrastructure that life in our cities depends on. Think back to the last time you were in a blackout, couldn’t leave your house because of an ice storm or a hurricane, or… How long did it last? A few hours? A few days? And after it was over (and maybe even during) there was a kind of thrill of having been dropped out of ordinary life for a brief period. How many days had you planned for? How many could you last without water, electricity, sewerage, food?
It might not be bleeding eyeballs and melting organs, but I find that thought scary enough.