“Chronic Wasting Disease in North America.” By USGS, National Wildlife Health Center [Public domain], via Wikimedia CommonsIn the mid-1980s a new disease, Bovine Spongiform encephalopathy (BSE) appeared in Britain. Better known as mad-cow disease, this disorder attacked the brain of first cattle, and later a small number of people who had consumed their meat. The most likely manner in which the disease was introduced into the food chain was through processing cattle into feed for other cattle. Only by converting cattle into unwitting cannibals -in order to to take advantage of waste products from abbatoirs- was the prion that caused the disease introduced into humans. In Britain the images of quivering, drooling, staggering cattle on television unleashed a public panic. (1)
BSE was a classic example of an iatrogenic disease, which is an illness created by humanity itself. The disease is caused by a prion, which is not a living thing. Prions are strange. It’s believed that they are malformed proteins, which can trigger other proteins to similarly mis-form. This creates a terrible cascade that impacts the brain, thereby causing neurodegeneration. They are also incredibly resistant to heat, so they do not readily break down during cooking, which would eliminate the risk of most pathogens and helminths. Once a living organism such as a person is infected, there is no known treatment for the disease. …
Harvesting Opium. Public Domain, https://commons.wikimedia.org/w/index.php?curid=2699338
I’ve been teaching a course on the Global Drug Trade this year, and my class recently covered the opioid crisis, including the emerging drugs of fentanyl and carfentanyl. If you haven’t heard of these drugs before, you might want to read German Lopez’s Vox article “How an elephant tranquilizer became the latest deadly drug in the opioid epidemic.” While the epidemic exists in the United States, these drugs are causing havoc in British Columbia, Canada. What is distinct about these drugs is that they are not only dangerous to the user, but also first responders. The crisis has been so serious that it has caused people to rethink how we deal with illegal drugs in a profound manner.
In my class there was a great deal of discussion of whether the broader opioid epidemic is being covered differently in the media because many people using these drugs are middle class, white and older. They are also distinct, my students noted, in that most people who become addicted do so because they received a prescription for the drugs legally. There is no question but that major corporations have pushed these drugs, as this wonderful John Oliver piece describes. The epidemic has deepened, because when people have difficulty accessing legal opioids they have turned to heroin. …
Colorized transmission electron micrograph of Avian influenza A H5N1 viruses. By Photo Credit: Cynthia Goldsmith Content Providers: CDC/ Courtesy of Cynthia Goldsmith; Jacqueline Katz; Sherif R. Zaki [Public domain], via Wikimedia CommonsThere have seldom been as many times over the last 100 years when the world has faced such a diversity of emerging infectious diseases. For this reason, I want to review some of the best websites and blogs for tracking pandemic threats. Michael Coston has a wonderful blog titled Avian Flu Diary, which tracks emerging infectious diseases, particularly avian influenza. I particularly recommend his March 13, 2017 post “Avian Flu’s Global Field Experiment.” In this post, he describes in detail the diversification and geographic expansion of avian influenza threats over the preceding six months. Although the blog post is written for the lay reader, its information is scientifically sound and based upon a deep knowledge of influenza.
If you are interested in tracking news related to influenza, you’ll also want to follow the Virology Down Under blog. Ian Mackay often provides the best numerical analysis available regarding outbreaks. The Bird flu report collects tweets regarding avian influenza by experts in the field. FluTrackers.com is not a visually engaging site, but it collects detailed information on avian influenza, which is organized by world region. Finally, for influenza the H5N1 blog is one of the best sources on the web. The page also has links to almost every other valuable website regarding influenza and global public health. …
There was a brief flurry of media coverage regarding Zika after the discovery that it was spreading within Florida last month. Over the last couple of weeks, however, it seems to have receded from the headlines. Some recent coverage, however, really provide a sense of the human toll of Zika. Reveal is a new podcast from the Center for Investigative Reporting, which provides long-form coverage based on work in the field. Their report, “From A to Zika” documents how people in Puerto Rico are experiencing the virus, and attitudes towards the outbreak in South Florida. It also describes the scale of the challenge that officials face fighting the virus during a deep financial crisis in Puerto Rico. …
Aedes aegypti mosquito in Dar es Salaam, Tanzania, 2009. Photo by Muhammad Mahdi Karim, Wikipedia Commons
In July 2016 the CDC issued an advisory notice that warned pregnant women -or women planning to become pregnant- against traveling to 45 different countries. With the virus’s arrival in Florida, however, the public in that state is now wrestling with what this means for mothers and their partners. The issue is now becoming a topic in the election contest in Florida, as Mark Sumner described in a (not impartial) recent article in Daily Kos. In the piece he quotes Trump’s vice-chairman for Miami-Dade as saying that Zika was an “insignificant issue,” which was less important than building a wall “to keep the illegals out.” Yesterday Donald Trump himself declined to say that Congress should reconvene to vote on funding Zika research and prevention. …
Digital photo taken by Marc Averette. The downtown Miami skyline as seen from I-195 5/16/2008. Wikipedia Commons
Zika has already become a significant health issue in Puerto Rico, where there have been more than 5,500 infections. More than 600 of these infections have been in pregnant women. The outbreak has also set off massive public debates on the island regarding everything from insecticides to the structure of local government. It was inevitable that Zika would eventually appear in the mainland United States. Still, it couldn’t help but be surprising to see a CDC warning about travel by pregnant women to two counties (Miami-Dade and Broward) in Florida. It’s important to keep this news in perspective. So far only 14 people have been reported to have locally acquired Zika, in a very restricted geographic area in Miami. Mosquito control activities have gone into high gear in this area. One can hear an audio copy of the briefing about this news here on the CDC website. The CDC also has a dedicated webpage on Zika, which is a helpful site for information regarding the epidemic. …
Image of Zika virus from the CDC/ Cynthia Goldsmith (http://phil.cdc.gov/phil/details.asp?pid=20541) [Public domain], via Wikimedia CommonsThere is still so much that we don’t know about Zika. I was recently speaking with a medical historian who wondered if people in eastern Africa and Asia might have resistance to the disease, since it originated in those areas, or whether the epidemic will spread as explosively as it did in South America? Will the rate of birth defects be lower in newly affected countries, because mothers have more information to protect themselves? Which species of mosquito will be able to transmit the virus? How rapidly will the epidemic spread? What percentage of babies born to mothers infected with Zika will have neurological issues, even when they do not have microcephaly?
There are a few useful resources that I’ve found for Zika. Vincent Racaniello is a highly respected virologist, who has a popular podcast called “This Week in Virology” or “TWIV,” and a free online virology course. His lab spent decades working on polio, but recently shifted its focus on Zika. His new blog, Zika Diaries, give a sense of what science is like in an emerging field. Nothing is easy for the lab, from obtaining the virus, to acquiring permission to do experiments with mice.
One of the first tools that I try to create when working on an article is a timeline for events. With Zika, Ben Hirschler at Reuters has already done that work, and created a detailed timeline.
For anyone interested in the early history of Zika’s discovery in Uganda, I recommend Thomas K. Grose’s piece on NPR, which discusses a researcher studying Alexander John Haddow’s records in the University of Glasgow archives. Overall, NPR has outstanding coverage of the Zika outbreak.
Recently a Canadian professor, Dr. Amir Attaran, called for the Olympic games in Rio de Janeiro to be delayed or moved because of the risk that the wave of visitors will accelerate the spread of the Zika epidemic. The director of the U.S. Centers for Disease Control, Dr. Tom Frieden, has now weighed in to argue that the risk to the athletes is small, and many people are already traveling to areas affected by Zika. The Games should therefore move forward as scheduled. Still, it is remarkable that this close to the Games, people are suggesting that they moved, not only because of Zika, but also because of other concerns such as contamination of the waters in the bay of Guanabara. One recent study found that virus levels in the bay were 1.7 million times the permissible limit in California. I confess that when I read this figure my first thought was not for the athletes, but rather how many times I had swum in these waters myself. Sailors are also complaining about the sheer quantity of garbage in the bay, and are concerned that impacts with the trash may affect races.
In the end the games will move forward, and likely will be a success. In the future, however, the experience with the Brazilian games will likely change discussions about the venues for other Olympics. Perhaps more importantly, within Brazil, it will emphasize the point that many Brazilian critics of the games have long made: that the interests of Brazilian citizens have to come first in government decisions, and that basic needs -education, health and sanitation- should be prioritized over mega-projects.
Addendum: Immediately after posting this piece, I read that 150 health experts had written an open letter calling for the Games to be postponed because of Zika. You can read more about their arguments at USA today. What is most interesting in the piece is the argument that the World Health Organization (WHO) has a conflict of interest regarding the Games, given its partnership with the International Olympics Committee.
Smallpox has killed countless people over the last 12,000 years. It is difficult now to understand the terror that smallpox evoked in a pre-vaccination era. When smallpox was introduced into new populations the death rates sometimes could even exceed 90%, as was the case with the Mandans in the 1837 Great Plains Epidemic. The virus was finally wiped out in the wild through a massive vaccination program in the 1970s. The last infection took place in 1977. Now what should be done with the remaining stocks of the virus in Russia and the United States? I recommend a video by Errol Morris on the New York Times website “The Demon in the Freezer,” which examines this issue in detail. The interview with the Russian bioweapons scientist is particularly chilling. What I liked about the video was that it showcased voices from both sides of the debate.
In few countries is the current political, economic and social situation worse than in Venezuela. This is especially dispiriting given that the country faces an outbreak of the Zika virus at the same time that medicines and basic supplies are in short supply. The Institute for Tropical Medicine has been broken into 11 times in 2 months. The offices were cleaned out so completely that the institute was left without any microscopes or key equipment. The situation in Venezuela’s hospitals is catastrophic. The situation has grown so bad that international organizations, such as Human Rights Watch, are now trying to draw the world’s attention to the breakdown in the nation’s public health system. Given that the nation is failing to adequately prevent and treat other mosquito-born illnesses -such as dengue- Venezuela may be on the edge of repeating the disaster that has passed over Brazil. What is frustrating is that this disaster would be needless, because basic public health measures -eliminating mosquito breeding grounds, spraying, screens on windows, mosquito nets, and insect repellent- could do much to limit the damage. Venezuela also faces severe shortages in such common items, including those necessary for family planning, such as condoms. Couples will need these to delay pregnancies until after the epidemic has peaked. Health officials know what to do. Given the countless billions that the country has given away over the last decade, or which cannot be accounted for, it would be a tragedy if there was not a massive effort to stop Zika on the grounds that the country lacked funds. Still, there are grave doubts about even the validity of the health data that the Venezuelan government is sharing. One health group is providing information that suggests that 150 times more people have been infected by Zika in Venezuela than the government has stated.
![By CDC/ Cynthia Goldsmith (http://phil.cdc.gov/phil/details.asp?pid=20541) [Public domain], via Wikimedia Commons](http://introglobal.wpengine.com/wp-content/uploads/2016/07/Zika_EM_CDC_20541.png)