A Realistic Assessment of Epidemic Disease After TEOTWAWKI- Part 1, by Dr. DMC


In 1850, malaria occurred throughout the entire region of what is now the lower 48 states, with the exception of some of the higher altitudes of the Rocky and Appalachian mountains. It sickened and killed thousands of the pioneers moving westward, even though the type of malaria most common in the country tended not to be the most fatal form of the disease. Today, malaria is so uncommon that American physicians often fail to recognize the rare cases seen in travelers or immigrants.

Cases are rare, and deaths are even rarer. Perhaps surprisingly, the mosquitoes that can spread the disease are still here in very large numbers. So, why did this disease disappear from the U.S.? The answer to this question is very important to anyone interested in preparing for a time when modern medicine and public health would not be available. It demonstrates that unexpected diseases will provide more danger to survivors than will all the roving gangs and escaped prisoners combined.

Why Malaria Not in U.S. Anymore

One might guess that the reason malaria is not here anymore is because we cured all of the cases with drugs and killed a whole lot of mosquitoes with insecticides, eventually eliminating the parasite that causes the disease. These actions obviously played some role in the elimination of the disease, but they really were relatively minor factors. After WWII, two very powerful tools for fighting malaria became available to fight malaria: DDT and the anti-malaria drug chloroquine. They were both inexpensive and very effective, so health workers throughout the country started using them extensively to fight the disease.

However, in many ways, the health workers were too late. Even before the advent of modern antibiotics and anti-malaria drugs and even before the availability of modern insecticides, malaria occurrence had already started to wane. The disease was gone from major swaths of the country. The disease remained in Florida and around the Gulf of Mexico with smaller pockets elsewhere, but malaria had disappeared from most of the country. The reason for this disappearance, even in the absence of modern drugs and insecticides, was simple: an improved standard of living.

A Disease of Poverty

Malaria, like so many other important illnesses, is a disease of poverty. The poverty we refer to here implies poor housing, poor nutrition, unsanitary and crowded living conditions, and most important, bad water. As the American living conditions improved, people could afford to put screens on windows, to protect drinking water from sewage, to eat enough nutritious food to allow their immune systems to function at a high level, and to wash both their bodies and their clothing.

Later, the houses got air conditioning so that windows could be closed. People starting staying inside more, away from the disease-carrying mosquitoes. Radio, then television, kept people inside. Although these changes led to an ever-increasing American waistline, they also eliminated the malaria parasite from the American population and the disease disappeared from the United States. Drugs and insecticides helped, but the disease was already on its way to elimination well before modern chemistry provided these new tools.

Why Important in TEOTWAWKI

So, why is this story important to anyone contemplating TEOTWAWKI? Remember that the mosquitoes that spread malaria are still around. If America’s high standard of living is destroyed, people will be exposed to the mosquito again, and with time, the parasite will find its way back into the U.S. Air conditioners won’t work anymore. Windows will break. Screens will tear. Our predecessors probably had a small degree of immunity to malaria inherited from their parents and stimulated through constant exposure to infected mosquitoes.

That immunity provided only partial protection, not preventing relatively mild recurrences of illness. But modern Americans have not been exposed to these parasites; we have no immunity, and we have no vaccine for malaria. The result could be a perfect storm of immunologically vulnerable people living in primitive conditions with poor hygiene and several accompanying diseases. Malaria would return with a vengeance. Furthermore, it is only one of several diseases that most Americans thought they would never see again.

Benefit of Modern Public Health and Utilities

Modern public health and public utilities provide a number of services that ensure an environment in which people can lead healthy lives. Those services include water purification, sewage treatment, garbage collection and disposal, disease outbreak investigation and quarantine, mass immunizations, and food safety inspections. Some services that may not be visible to the general population are actions like mosquito control, dog catching, public accommodation (hotel and motel) hygiene, and animal carcass removal.

Public safety issues like proper highway signage, road maintenance, and dam safety inspections receive little attention from the public. These services can sometimes be intrusive, but what happens to a modern society when the services disappear? Like malaria, many other diseases would return in the absence of these services. The rest of this essay will discuss some of diseases that would provide an increased threat to a surviving population.

Upper Respiratory Infections

Many of these threats are kept at bay by immunizations. They include diseases like whooping cough, strep throat, and diphtheria. Probably the biggest threat to a remnant population would be influenza, the flu. This disease has taken on the status of a very uncomfortable inconvenience for many, but it is much more than that. Even in modern America, an average of about 30,000 people die every year from the flu. The virus mutates so fast that several new strains emerge every year.

The immunization from one year is probably not effective the following year, because the strain is different. So without a continuous flu vaccine program, many more would become ill and many more would die. The 1918 flu epidemic killed between 20 and 40 million people worldwide, and flu experts believe it is only a matter of time before another strain just as deadly returns. Influenza is not an inconvenience; it is a killer in the absence of modern public health.


Another disease that used to be considered an inconvenient childhood disease in the U.S. is measles. Despite the common perception of this disease as an inconvenience, it actually causes more deaths than any other vaccine-preventable disease in the world. The virus is extremely contagious. About ninety percent of unimmunized people in a room with an infected case will go on to develop the disease. With good supportive care and a high standard of living, the number of people who have serious complications is relatively small.

Where the standard of living is low, however, measles becomes deadly. Measles occurs with other diseases and makes those diseases much worse. An unpleasant case of diarrhea, therefore, becomes a fatality. Health professionals who work with refugee populations have known for years that the most important life-saving measure they can provide to refugee children is a measles vaccination. Measles would bounce back in a post-disaster American faster than any other disease. Any child born after a TEOTWAWKI event and who does not get the measles vaccine would be at very high risk.

Tomorrow, we will continue to look at other threats and how we can best protect ourselves from them.

See Also:

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    1. My thoughts about parents who will not have their children immunized? I’ll just mention that the British doctor who linked autism to childhood immunizations had his license to practice revoked for falsifying data and the journal retracted the article. I don’t think it was retribution from big pharma, though perhaps I should work a little more on my conspiracy radar.

  1. Quinine is effective against malaria and is what gives tonic water its bitter taste.


    So I thought it was all those drunks drinking gin and tonics in the 1950s –er, for medicinal purpose — that got the disease under control.

    Note that quinine can be extracted from the bark of the cinchona tree , found in South America. A course of treatment is about $3 in the Third World but runs over $200 in the advanced medical system here in the USA.

  2. I am not a proponent of indiscriminate vaccination. I would say they have contributed to some decrease in disease. Since vaccination is relatively new on the scene, we can’t absolutely be sure of the unintended consequences. Maybe, just throwing this out there, mankind would develop natural immunity if exposed to diseases now while we have good medical care and clean water and sanitation. If however we aren’t ever exposed to the real, live virus, how can future generations develop natural immunity? Yes measles, mumps, malaria, whooping cough can be deadly but how much more so if we never encounter them or our children. How can we pass on the mother’s immunity if the mom was never exposed?

    It is very interesting to see the progression of the vaccination program in the US. What are we doing? Are we causing more harm or preventing outbreaks. I think it wouldn’t be bad to reel it in a little. Take a look at this website it’s food for thought.

    PS I a mother and a nurse.

    1. CD, if you want to get exposed to some of these diseases, just go on down to South America or many parts of Africa and see what they’re doing to the population that’s built up an “immunity” over the past several hundred years. Then come back and tell me how bad the vaccinations are for your children compared to what the diseases themselves do.

      1. CD:
        I would have to agree with GotUR6 on that note. The child mortality rate due to childhood disease and the fact that a massive amount of the go UN immunized is astronomical and what’s more it could be prevented. What shame.

    2. Vaccines have saved over a billion lives sine the mid 50’s. It is about a 50/50 chance that you are alive today thanks to vaccines. Ditto for your children and grand children if you have them. Do not drink the kool aid that the anti-vaxers serve up. Especially if you are a nurse.

    3. I am also concerned about how our country could be brought to it’s knees by something so simple as measles or mumps epidemics. I would like to see summer camps for kids to volunteer to get natural measles or mumps, so at least a certain percentage of our population has real, lifelong immunity. The medical personnel with real immunity are almost all retired now – what will we do if a measles epidemic is deliberately started here? What will the outcome be when the medical ranks are decimated because the vaccination immunity is not effective or only slightly so?

  3. It would be great if this author can also discuss the best ways to treat patients who contract these diseases post modern medicine. I would like to see what normal people can do, those that have not been able to stock every possible antibiotic and medical kit ahead of time. I prepare within reason with budget constraints. I have read some about this but would like more information. Thank you!

  4. This is a super article because it highlights the challenges we will have AFTER a major event, possibly for the rest of our lives. Malaria had completely dropped off my radar, as did measles. Thank you for posting this extraordinary article!
    It all the more reinforces the criticality of having the ability to process practical amounts of safe water for drinking, hygiene, etc, and that means some level of alternative power at a family level.
    We are SO dependent on our unseen infrastructure.
    Question: Might new flu strains be reduced or slowed in the aftermath of a nuclear/EMP attack as a result of a suspension of trade with China? Don’t most flu strains originate there? This is something I am unclear about. Commerce and air travel is an efficient vector for transmission.
    Just finished a book called, Pox Americana, which documented the smallpox epidemic in North America including Canada from 1775 to 1782. In an era where the canoe was the state-of-the-art conveyance, smallpox exploded across the continent and killed a staggering number.

    1. I agree; Pox Americana is a really interesting book. One of the issues with a post-nuke world would be the impaired immune systems of the survivors. In fact, some observers state that the USSR bioweapons program was never intended as a first use weapon, but rather as a means of cleaning out a surviving remnant population after a nuclear exchange. Nukes followed by radiation sickness followed by biowarfare. The bioweapon efficacy would be improved by the damage to immune systems caused by radiation. Sounds pretty brutal to me.

  5. The opiate problem has been around for a long time. Doesn’t seem related to this but…. While I was stationed in Ft. Bragg in the early 70s we were getting soldiers into the hospital with malaria. They had never been overseas. It turned out they were sharing needles with idiots who had contracted it in Vietnam. Thought it was worth mentioning.

  6. I can assure you that the plagues are arriving. 60 million dead babies and counting. Either the Holy Bible is a lie or we will be held to account.

    Look at the cancer rates, the plagues are already here. War, famine, pestilence, and plagues. These are tools that God, the same God, has used throughout time. He hides these things in plain sight.

    Preaching to the choir here but it bears saying again; Read the Old Testament! It plainly states what is coming our way. We were given everything over the past 500 years coming out of the reformation but now we have forsaken the LORD, the blood of the innocent babies and unjust wars is on our hands. Repent, (by repent I mean a holy man would burn DC to the ground and hang them all from the neck until dead in righteous self defense of our people) and be saved. But the sissified government run American church is horrified by such a thought. Why? The end will be, well, ugly. Oh LORD, raise us up a David!

    1. Cancer “rates” have pretty much remained the same. Most likely you are confused by the simple fact that the odds of getting cancer increase dramatically as we age. Luckily in the past 50-60 years life expectencies have increased dramatically and more people do indeed get cancers but the rates based on age and other factors have not changed (perhaps minimally for some cancers).

        1. The answer is complicated. Some cancers are caused by exposure to certain viruses and these exposures increase with exposure to other people. What that means is that 50 years ago your child might stay close to home their entire life and there weren’t a lot of visitors, tourists and foreigners who came to your town. Today that is the exact opposite.

          Another factor is over the last 50 years we have had massive immigration and many of these immigrants are themselves ill. When they get cancer the statistics don’t differentiate between a 12 year old from Ghana or from Georgia it is just and “American”. So while the rates for American children or American parents may stay the same the rates for all American children have changed slightly.

          Having said this the rates have not changed dramatically and some childhood rates of cancer have in fact decreased. More importantly childhood cancers are statistically rare. Cancer is mostly a disease of older age.

        2. The other commenter is right. Although rough cancer rates may go up, it is because we are living long enough to get cancer rather than dying of things like typhoid at a younger age. There has been a very slight increase in childhood cancers recently. The CDC does not know why this has occurred, but thinks it may be linked to childhood obesity rates. Some people attribute it to increased use of herbicides and there are several online advocacy websites that state this, but there is little support for this in the peer-reviewed literature. There is some evidence of testicular cancer in the sons of women who have had a high level of exposure to certain pesticides.

    2. Fred, “coming out of the reformation but now we have forsaken the LORD, the blood of innocent babies is on our hands”?…Not my hands Fred, I’ve never in my life voted for a politician who advocated for a woman’s “right to choose”. I’ve never in my life voted for a pro choice Democrat. I’ve never in my life voted for any evil that proposes that abortion is OK.
      I remain proud, Fred, that as a Catholic my hands are not drenched with the blood of innocent babies, my Church remains steadfast against this evil, and has always from the foundations of the earth. Judgement will surely come, but I am not afraid.

  7. Good article Hugh.

    While the proVaccination crowd likes to take all thr credit, disease has been reduced because living conditions are so much better, as you note.

    From a prepping perspective, learning about nutrition and which plants and animals have it is invaluable for a good immune system.

  8. Influenza is bird flu from wild birds which travel extensively and can infect wild and domestic fowl (chickens and turkeys) and pigs (bad because they have a respiratory system like humans and receptors for the virus) like humans and birds of all kinds.

    There are several forms of bird flu (influenza). One is seasonal which can really set us on our backs. The government looks to Australia to see what strain they have in order to make up our vaccine. It’s H3N2 this year. And in passing to others it mutates so todays vaccine is only 10-30% effective. I personally will take what I can get. I suspect this year, where the seasonal flu is running way above average, there will be more deaths than the usual 3-49,000.

    Then there is the epidemic which is generally defined as a regional concern but not worldwide.

    The 1918 influenza was not an epidemic as the author stated but rather a pandemic. That is a worldwide phenomena. It is believed to have started in Haskell, Kansas (possibly from swine influenza passed on to them from wild birds). From there it travelled to what is now Ft. Riley and followed the troops to Europe. Short a vaccine you do the best you can. Isolation is the number one preventative. Cleanliness the next. Yes, lots of water. N95-N100 masks and lots of soap and washing. The old estimations of influenza deaths from the 1918 pandemic was 40-50
    million. They now believe it was closer to 100 million.

    Malaria is mostly a human disease which is passed on to a mosquitoe when they bite you and
    then passed on to other humans when they are bitten from that mosquitoe. There are over 3,000 species of mosquitoes but few transmit disease but those that do are “public enemy number one” to the disease epidemiologists. In North America the mosquitoe was under control by using DDT. That was outlawed in the 70’s and we are now seeing a comeback. Some have even become immune to DDT in other parts of the world.

    So, Yellow Fever, Dengue, Chikungurrya and Zika (now showing up on our doorstep) are making a comeback even before TEOTWAWKI has arrived for all the reasons given by the author.

    I can’t imagine us getting a vaccine when our cities lay around us but at least there are things you can do for the pandemic flu now or after a breakdown which are stated above.

    Short of an end of the world scenario the health folks will be working on a vaccine for the flu and other diseases and if we’re really lucky we might be able to get in 9-12 months. And that’s another problem. Several large pharmaceutical companies have dropped out of research on infectious disease drugs because of a lack of a return on investment. Antibiotic resistance is a problem now and will only get bigger as time goes on.

    Even the generic drugs which we use (those that have gone off patent) are made almost entirely in China and India. Let us hope that our JIT delivery system is up and working when we see infectious disease signs appearing around us.

    1. In my small town in Washington state a student went to the local Dr office and tested positive for a strain of H1N1 and the Spanish Flu this week. Haven’t seen the CDC put anything out about the Spanish Flu, I didn’t even know it was still around.

  9. I agree that disease will run rampant and take the life of many after the SHTF but what about the preppers who are holed up in their retreats and don’t have contact with the general population? In my way of thinking, diseases like the measles and mumps and the flu would be non existent in those groups. Mosquito born illnesses would still be a problem for isolated prepper groups but it seems to me that those same people may be healthier then than they are now, at least in regards to communicable sicknesses.

  10. When I was young we were petrified of polio. We walked to school and took the long way around a girls house that had had polio. Polio paralyzed a close family member.

    Then the vaccines came and there was no more polio . It’s almost been wiped off the earth. The only people I know of that think vaccines are bad are the antivax folks and the Taliban.

    Can there ever be a bad result from a vaccine? Yes, just like wearing seat belts can result in a bad outcome , about one in 24,000 times . A wise person gathers facts and makes wise decisions. And one thing they never do is willingly expose their kids to any disease . That’s simply child abuse.

  11. I am not anti all vaccines but I have to question just how effective they are after all these years. A few years back we had a large out brake of whooping cough up here in NW Montana. Over 80% of the children who caught it had been vaccinated. Also about 20 years ago there was a mumps out brake down south and the majority of kids had been vaccinated. Complications from chicken pox are rare and it seems quite unnecessary to vaccinate for that. Also many old timers had measles and mumps and seemed to survive just fine. I personally had the mumps when I was around 13 and besides it being so miserable I had no lasting effects. There has been a ridiculous increase in the vaccines now recommended to young children. I would seriously weigh the pro s and cons before giving many of them to my children.

  12. Thank you for all of the comments on my article. This is a very well-informed crowd! I’ll address a few comments here. One person asked me to address treatment of people with these diseases. Unfortunately, my doctorate is not an MD or DO; I’m one of those academic eggheads with a doctorate in public health, not medicine. My focus is the epidemiology of vector-borne diseases. I would not pretend to tell anyone how to treat these diseases. I do, however, have some background in vaccines. Although there are some bad reactions to vaccines (some fatal) vaccines have been remarkably beneficial for many years. The elimination of smallpox is due exclusively to an effective vaccine (and some very dedicated people). For that disease alone, I am very thankful for vaccines. The worst I ever had was the 7-shot anthrax series. My arm hurt for 3 months (no exaggeration). It is true that vaccines vary in efficacy; some are better than others. They do not, however, have to be 100% effective to work. The smallpox vaccine was not 100% effective but it eliminated the virus from the wild. Finally, the issue of isolation and development of immunity is a interesting question. Some exposures lead to immunity or partial immunity. Total immunological naivite is probably a bad thing unless you live in utter isolation. Read “the White Plague” by Frank Herbert for an interesting take on the subject. Again, thanks for the comments. I may submit another article sometime

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