Monday, October 6, 2014

Obama's Ebola

First off, Stephen W. Brown on Ebola with respect to diseases of the past, from here:

The first ebola cases have been found in the U.S. but the government is assuring us there is no reason to panic, about a disease with a greater than 70 percent mortality rate.
We’d better not panic, this is a time for mature reflection – but we’d better do that mature reflecting in a hurry.
The reason nobody is panicking is there is now almost no one in the Western world who remembers a pandemic disease. I am fortunate enough to have interviewed a man on the occasion of his 105th birthday who told me a bit about the Spanish flu pandemic of 1918 – 1920.
Spanish flu hit towards the end of World War I, and spread to every corner of the world including the arctic and remote Pacific Islands. It infected 500 million people and resulted in an estimated 50 to 100 million deaths. That would be three to five percent of the world’s population at the time.
By the way, the disease’s origin is not known. The connection with Spain is only because Spain as a neutral country did not have wartime censorship. Thus the false impression grew that Spain had been especially hard hit.
Mortality rates for the flu ranged from 23 percent to 71 percent, and oddly the overwhelming majority among young people. Of pregnant women who survived the flu, a quarter miscarried.
When comparing the two diseases, the alarming thing is how much is speculated but how little is known for sure. Where it came from, how it killed, how many deaths were caused by overmedication if any, and why it disappeared as suddenly as it appeared.
Almost a century later with the incredible technology we have available, there is so much we just don’t know about the Ebola/Marburg virus and how it kills.
It does seem to come from the Hot Zone, the tropics of Africa. Versions of the virus are found in monkeys, pigs, and bats. There is a less virulent strain found in monkeys and pigs in the Philippines.
It is spread by contact with body fluids, which leak explosively from the victim in the final stages of the disease.
According to the World Health Organization, “The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools).”
That’s good news about the incubation period, you can’t spread the disease until it’s evident you’ve got it.
The bad news is, it may be very difficult to contain. Some reports have it that surgical gloves and masks may not be enough and recommend full Hazmat suits. One of the highest at-risk groups has been medical personnel.
The worst news is, if an infected person does not show symptoms until up to three weeks after exposure that’s plenty of time to fly somewhere else and spread it. But so far the governments of the U.S. and Europe have ruled out suspending air travel from affected areas.
The administration has however announced plans to send 3,000 soldiers to Africa.
And if any of them become infected…?
In the developed world we’ve pretty much controlled the historically common plague vectors: contaminated water, droplet infection, and insects.
Incurable sexually transmitted disease reemerged with AIDS, but can be prevented by changing behavior. (With difficulty for sure.)
Ebola could be the wild card which potentially overwhelms our public health infrastructure if it ever gets a foothold.
I have no answers, but I’m going to recommend a very good book, “Plagues and Peoples” by William McNeill. And if you get ambitious, Hans Zinsser’s classic, “Rats, Lice and History: A Chronicle of Pestilence and Plagues.”
We can’t all be public health professionals, but we can start educating ourselves to have an intelligent discussion about this before it’s too late.
Now, Greg Cochran on Spanish Flu, from:

Disaster in the South Pacific

The 1918 influenza pandemic hit every country on Earth – well, almost every country. It missed American Samoa entirely, which is interesting.  It’s even more interesting when you notice that it hit the neighboring islands of West Samoa harder than anywhere else.
Worldwide,  the Spanish Flu killed 3-5% of the population – lower in most developed countries, which had better supportive therapy.  Medicos had no useful vaccines or  antiviral agents: in fact they mistakenly thought it was caused by a bacterium. Doctors were useless, but nurses were not.
In the South Pacific, the flu was spread by the SS Talune, which regularly visited Tonga, Fiji, American Samoa, and West Samoa.  Crewmen had picked up the flu in New Zealand and spread it to those ports, excepting American Samoa.
The islands of Western Samoa were administered by New Zealand, which had recently seized them from Germany. The administrator (Colonel Robert Logan) had little administrative experience (former sheep farmer) – he felt that he needed approval from Wellington for any action and he received no instructions.  Medical officers also waited for instructions – none came. In addition, plantation interests were important, and they opposed any quarantine, which was also the case in Fiji. So, no quarantine. Thing went very badly: so many were sick (~90% of the population)  that few were left to care for them. Since food was mostly in gardens, rather in cupboards,  people starved while weak.  Europeans were less vulnerable, and those that could helped, but there were relatively few in Western Samoa.  20-25% of the population died, concentrated among young adults, the highest death rate in the world.
American Samoa was physically quite close to Western Samoa, less than 100km. There were close cultural ties: people intermarried and often sailed back and forth.  But the governmental structure was different.  There were no copra plantations in American Samoa, so you didn’t have any powerful business interests lobbying for suicide.  The US Navy ran the colony.  John Martin Poyer, an officer that had retired from active duty due to illness, was brought back to active duty in 1915 to serve as Governor of American Samoa.
Both American Samoa and West Samoa had advance warning of the flu’s danger: they both had wireless sets and occasional mail.
Washington didn’t micro-manage American Samoa, not being all that interested.  A policy of benign neglect was interpreted by Poyer as an opportunity to act on his best judgment,in the finest traditions of the US Navy.  He imposed quarantine. That was harder that it sounds, because of the frequent family visits between West Samoa and American Samoa – but Poyer also had  the support of the local  chiefs, who understood how serious imported epidemics could be.  The people of American Samoa self-blockaded, on top of official quarantine: they sent out canoes to stop any and all visitors.  They never had a single case.
Of course there was a disaster.  Some people will think that it occurred in West Samoa. Others will think that the real disaster was in American Samoa.

Now put all that together.

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