Apocalypse from now on

When its economy was booming, it used to be said that when the USA gets a cold, Europe gets pneumonia. Now it presides over globalised insecurity. When Hong Kong gets pneumonia, the world goes into a panic.

In the early months of 2003, a few thousand cases of an obscure viral chest infection have spread around South-East Asia. Courtesy of air travel, a few hundred have turned up in Canada, Australia, even in Britain (so far six cases, no deaths). To date, out of some 4500 cases worldwide there have been 260 deaths. A condition for the microbiologists to check out, certainly. But a global public health alert? Surely not.

Because nobody knows much about severe acute respiratory syndrome (SARS), it offers a blank screen on to which the world can project its fears. It seems to be spread directly to close contacts – but who can rule out a more dangerous airborne contagion? The death rate is only four percent – but could it become more virulent? After all, there is currently no treatment and no vaccine. It might turn out to be just another flu-like illness – but what if it turned out to be like the 1918 flu pandemic that killed 40million people? SARS is nothing like AIDS, but just suppose it turned out to be even worse?

Though SARS the disease is unlikely to become a major infectious epidemic, the SARS panic has already blighted the East Asian economies and further damaged the international airline business, still reeling from 9/11. Major cities like Hong Kong and Beijing are in a state of paralysis, and Toronto has been effectively put in quarantine.

Though manufacturers of (useless) paper masks are in clover, everybody else is in a state of fear. In east London we are beginning to see the ‘worried well’ of the SARS scare, and local GPs have been advised how to protect themselves against this potentially lethal contagion (though we have yet to record a single case).

In her commentary on the panic about AIDS in the late 1980s, the American critic Susan Sontag noted the widespread ‘sense of cultural distress or failure’ in Western society that seemed to create a need for an ‘apocalyptic scenario’ and ‘fantasies of doom’. This gloomy mood explained the ‘striking readiness of so many to envisage the most far-reaching of catastrophes’.

Fears about an explosive epidemic of a lethal infectious disease compound existing anxieties about bioterrorism, nuclear war, or some environmental disaster, to create a peculiarly modern kind of apocalypse. The end is believed to be nigh, but this is a protracted condition rather than a terminal event, a state which looms but never happens. It is a case, as Sontag puts it, not of ‘Apocalypse Now’, but of ‘Apocalypse From Now On’.

Terrorism and war have now made a sense of impending doom even more pervasive. The fact that even apocalypse can become an ordinary expectation constitutes, for Sontag, ‘an unparalleled violence that is being done to our sense of reality, to our humanity’.

Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

An earlier version of this article appeared in The Lancet on 12 April 2003.