Friday, January 23, 2015

Time offers "The Science of Epidemics" in supermarket counters


Time Magazine offers an illustrated coffee-table booklet “The Science of Epidemics: Inside the Fight Against Deadly Diseases, from Ebola to AIDS”, now often found in supermarkets and pharmacies. The book is edited by Siobhan O’Connor, and comprises 112 pages, large paper, with many photographs and charts.
  
There are 17 chapters, with many of them dedicated specifically to Ebola. Some of the chapters had been published before in individual Time issues, or online.
  
In the early chapters, the facility for treating Ebola at Emory University in Atlanta is seen as an “ark” where everything has been thought of.   It views the difficulty that Texas Presbyterian Hospital in Dallas encountered with its first Ebola patient from Liberia as understandable.
  
The world is simply not prepared for the enormously labor intensive aspect of Ebola patient care.  In Liberia and west Africa, officials had been making arrangements for people to be cared for at home by other family members, rather than brought to hospitals, and this would obviously put others in a household at grave risk.

The book reasonably explains with Ebola is very infectious but not “contagious” in the way that flu is. 

But then the book moves on to other major scourges, with influenza being the biggest.  It explains what the “H” and “N” mean (regarding how viruses enter and then leave cells).  It maintains that the 1918 Spanish flu epidemic was so deadly to young adults precisely because for about twenty years there had been no H1N1 virus around, whereas older people had built up some previous exposure.  The 2009 H1N1 outbreak seems to have been less virulent, however.

The book does explain the way influenza lives in birds and other farm animals.  Most “bird flus” don’t easily become transmissible person-to-person, but if one does there is grave risk of a major epidemic

Although much is made about mutations and the effectiveness of influenza vaccines, in practice it seems as though adults get repeated vaccinations and small exposures to a variety of forms of flu over the years, their immune systems become able to respond to similar but mutated viruses, resulting in shorter illness with less severe symptoms. I always get the flu vaccine.  In 2002, while in California, I got a flu-like illness with two separate spikes of dry cough, chills and fever.  In March 2011, I got a flu-like illness for a couple days and missed the SLDN dinner (I would have made the donation anyway/.  The vaccines are far from perfect, especially this year, but they will usually blunt the symptoms of distantly related strains. 
    
The magazine discusses other epidemics, such as plague, polio and measles.  With polio, it seems that paralytic cases increased once indoor plumbing was introduced in the early 20th Century.  When people used outhouses, they were exposed to very small amounts of virus that tended to immunize most of them. 

The book is critical of people who refuse vaccinations or to let their kids be vaccinated.  Such families are often higher income.  But the result is lower “herd immunity” and a greater risk that an epidemic can tale hold. The recent measles outbreak from visitors to Disney theme parks related to parents not having vaccinations done.  I had measles in age 6 in 1950, and perhaps it did some damage. 
    
The book gives a somewhat detailed account of how China handled SARS, and later Middle Eastern countries dealt with MERS.  These infections can cause severe pneumonias in a substantial fraction of cases, even though similar coronaviruses are usually rather harmless, causing colds and laryngitis. 
The book could give more coverage on the way infection control procedures and quarantines could affect the lives of people inadvertently exposed, with the monitoring and “social distancing” required.  Some bar and restaurant businesses probably could not survive a major pandemic with the related public health closings.

In some pandemics people who “recover” might be expected to “volunteer” to help the sick, since they would be immune. Until there is a vaccine for Ebola, it will be a real challenge for people to go there to volunteer, given in addition the mandatory isolation period upon returning.

The last chapter covers the attempts in San Francisco to wipe out active HIV with the RAPID (Rapid Antiretrovirual Program Initiative for new Diagnoses) program.  There is a chart showing that now 53% if HIV transmission happens with male-male sex, and 27% male-female, but relatively little female-male. It is that observation that the religious right tried to manipulate in the 1980s with attempted anti-gay legislation in Texas, that did not pass.


The book tends to pooh-pooh theories that bloodborne viruses will mutate in a way to become easily contagious.

Wikipedia attribution link for Ebola Virus Disease diagram, HHS (p.d.)   

Another picture:  from the Franklin Institute.  But many viruses have serious central nervous system effects.  Is that "Donovan's Brain"? (a 1950s movie).  

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