Sunday, February 18, 2018

Flu or bird flu in Yemen?

AlJ has a report about people dying of "birdflu" in Yemen.

Already dealing with severe malnutrition and a cholera epidemic, many people in Yemen are now dying from what is thought to be bird flu.
As the country faces this new health crisis, hospitals remain critically short of resources after years of conflict has caused the country's health system to crumble.
yup things are a mess, but I suspect this is ordinary flu, which has caused quite a few deaths in the USA where people are well nourished.

We had birds infected with bird flu awhile back here in the Philippines, and had to kill a lot of chicken and quail.

People in close contact to dead birds or meat can catch the virus. A couple hundred cases a year.

The real danger is if the virus mutates and causes person to person transmission: That could result in a catastrophe similar to 1918 Spanish flu epidemic.

Since the reports are few, and we don't have lab confirmation or headlines elsewhere, I suspect it is ordinary flu.

LINK

but flutrackers site does have this discussion.

they are blaming stray dogs, and indeed flu can spread via dogs andstray cats, this might either be true or just a rumor because of the Muslim hatred of dogs as disease spreaders.

link

 The Asian H5N1 virus is a specific, very infections influenza strain that is deadly to birds. H5N1 first cropped up in Southeast Asia, causing huge fatalities in poultry. It has been documented in people, pigs, domestic and wild cats and, rarely, dogs. How the virus gets into mammals isn’t clear; they may become infected by eating contaminated birds or coming into contact with their bodily fluids. It also isn’t clear how bird flu affects dogs; reports range from no symptoms to fever to respiratory problems to death

Sunday, February 11, 2018

defunding medical needs, or a way to cut the bloated system?

Instapundit linked to a NYPost article on 7 ways to stop a plague.

don't bother to read it: it is a WAGD (we're all gonna die) post with an agenda:

Sadly, epidemic prevention doesn’t currently seem to be a priority for the US government. In February, the CDC announced they would need to cut their global disease-prevention efforts by 80 percent due to lack of funding.

all over the internet: WAPO here.

one wonders if this is true, or similar to the "Banned words" kerfuffle a couple months ago that turned out to be fake news.

what was cut was an Obamacare part of the funding.

and it seems to be do gooder stuff for bureaucrats to implement programs to investigate stuff that affect people.

as in bloated bureaucracy where most of the funding goes to pencil pushers, and good folks spend a lot of time in meetings and in "documentation" or "writing proposals".

reminds me of the IHS: We had two docs, six nurses, two in lab and one in x ray, eight in medical records, and an office full of a dozen bureaucrats to process paperwork so our people could get care.

and I saw the same number of people a day (about 20) that I saw in private practice, where I had a secretary and a nurse (and later, a part time typist).

to hire someone took months of paperwork, as if people could sit around that long and not get other job offers.

I would apply for Educational grants, and find that they would pay for it two days before the conference was scheduled, and in one conference, sponsored by a government office, I didn't find I had been accepted until the week afterward, because of the delay in processing my paperwork. (I learned quickly to go to regular CME meetings and pay for it myself and hope I would be reimbursed, and then put up with the lecture by the bureaucrat why this was wrong).

The months to find replacements of medical personnel meant msot of these clinics were short on people who actually worked with patients, so we were always overworked.

as for prevention programs: Yup. we had them.

So, for example, to get money to set up a diabetic teaching program, you had to write a complicated proposal and send it upstream and wait...and wait... and finally you got funding, maybe, for a dietician to come and give a couple of talks.

Then you had to do paperwork to get the dietician hired, taking into consideration if they had dibs on the job because they worked for the government or if they had a CDIB card.

Ditto for equipment and repairing stuff...the clinic took 3 years to get a new badly needed extension, and we couldn't use the defribrillator when we got it because it hadn't been okayed by the electrical expert (a good idea, but why so long?).

To Know A Fly is a humorous novel about scientific research, and shows that even 50 years ago, how much time was wasted in getting money:
It is believed in some quarters that to become a successful modern biologist requires a college education and a substantial grant from the Federal Government. The college education not infrequently is as useful for acquiring proficiency in the game of Grantsmanship as it is for understanding biology.
No self-respecting modern biologist can go to work without money for a secretary, a research associate, two laboratory assistants, permanent equipment, consumable supplies, travel, a station wagon for field collecting, photographic supplies, books, animals, animal cages, somebody to care for the animals, postage, telephone calls, reprints, and last, but by no means least, a substantial sum (called overhead) to the university to pay for all the stenographers hired to handle all the papers and money transactions that so big a grant requires.
as to how to handle an epidemic:

Here is an article on SARS, which was stopped by old fashioned ways.

I am not in favor of cutting funding needed to prevent disease, and am worried that the bureaucrats will decide to cut needed personel instead of cutting all those paper pushers and excessive regulations that cost a lot of money and cut productivity.

and don't tell me that good people in the government bureaurocracy wouldn't do that to poor people.

I was told that one reason we were so understaffed and underequipped on one New Mexico reservation was because the government decided it was only 30 miles to a civilian hospital, so there was no reason we needed a hospital instead of a clinic (the fact that the civilian hospital was over a 7000 foot mountain pass didn't matter, nor that often our patients had to drive 30 miles to get to us because they weren't allowed to go there by themselves for care, without our okay.)

So for three months, we had to send every x ray over that mountain pass because our x ray tech quit (you couldn't put out an ad for a new tech before the final day of work, you know: then it took a lot of paperwork to find someone... yes, they could have hired a temporary replacement but no money).

oh yes: And we had to close the place for two weeks after our boiler exploded, which meant no heat. In the wintertime.

Casinos and tribal take over have helped all of this a bit, but anyone who is in love with single payment medicine should just ask their local Native American about it.

so ignore the kerfuffle and wait and see what happens.

But I worry, not that there will not be funding, but that the entrenched bureaucrats will deliberately do something to make a disaster.

But the, after working for the government, I am cynical in this.

Saturday, February 3, 2018

Rabies

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Friday, January 19, 2018

women and legal meth

CDC report tracking the use of stimulents for ADD in women with private health insurance.

Use has surged in recent years.

their main concern is pregnancy related problems:

 The substantial increase in the percentage of reproductive-aged women filling ADHD medication prescriptions from 2003 to 2015, across age groups and U.S. geographic regions, is of public health concern given the high percentage of unintended pregnancies (2) and uncertainty concerning the safety of ADHD medication exposure before and during pregnancy (3). In studies with samples of U.S. pregnant women, ADHD medication use estimates have ranged from 0.4% (2000–2013 data) (4) to 1.3% (2013 data) (1). Although evidence is limited and findings are mixed (3), ADHD medication use during pregnancy might be linked to increased risk for poor pregnancy outcomes, including spontaneous abortion (5,6). The safety of ADHD medications with regard to risk for birth defects is largely unknown, with only one sufficiently powered published study (4).

the reason behind the increase in uncertain: to increase one's ability to work?

Of course, the dirty little secret is that you also lose weight when on these things.

Tuesday, January 16, 2018

Not all the epidemics came from Europe

While checking out the history of diseases that cut the population of the Americas after the Europeans arrived, I ran into the story of an epidemic that was not known to the Spaniards but was known to the Indian curers, and that killed in a different pattern than the European introduced smallpox/influenza/measles epidemics.

HERE is the CDC article discussing the disease.

Recent epidemiologic research suggests that the events in 1545 and 1576, associated with a high death rate and referred to as cocoliztli (Nahuatl for "pest"), may have been due to indigenous hemorrhagic fevers (4,5)... 
Many of the symptoms described by Dr. Hernandez occur to a degree in infections by rodent-borne South American arenaviruses, but no arenavirus has been positively identified in Mexico. Hantavirus is a less likely candidate for cocoliztli because epidemics of severe hantavirus hemorrhagic fevers with high death rates are unknown in the New World. The hypothesized viral agent responsible for cocoloztli remains to be identified, but several new arenaviruses and hantaviruses have recently been isolated from the Americas and perhaps more remain to be discovered (11)
they suspected it was spread by a rodent, similar to hanta virus or the plague.

as for the remarks that maybe the Indians knew about small pox before the Europeans arrived, one wonders if they were describing chicken pox (or even secondary syphilis aka the great pox) which has a similar rash.



Discovery magazine has a less technical article.


Then, four centuries later, Acuña-Soto improbably decided to reopen the investigation. Some key pieces of information—details that had been sitting, ignored, in the archives—just didn't add up. His studies of ancient documents revealed that the Aztecs were familiar with smallpox, perhaps even before Cortés arrived. They called it zahuatl.
Spanish colonists wrote at the time that outbreaks of zahuatl occurred in 1520 and 1531 and, typical of smallpox, lasted about a year. As many as 8 million people died from those outbreaks.
But the epidemic that appeared in 1545, followed by another in 1576, seemed to be another disease altogether. The Aztecs called those outbreaks by a separate name, cocolitzli.
For them, cocolitzli was something completely different and far more virulent," Acuña-Soto says. "Cocolitzli brought incomparable devastation that passed readily from one region to the next and killed quickly." 
After 12 years of research, Acuña-Soto has come to agree with the Aztecs: The cocolitzli plagues of the mid-16th century probably had nothing to do with smallpox. In fact, they probably had little to do with the Spanish invasion.
so today the Atlantic magazine has an article discussing this dreaded disease. DNA studies on teeth show evidence of paratyphoid.


Now, DNA from 16th-century cocolitzli victims has offered up a somewhat unexpected new candidate: Salmonella enterica, or the bacteria that cause paratyphoid fever. The DNA evidence comes from the teeth of 11 people buried in a large Mixtec cemetery in southern Mexico. Prior archaeological work had linked the burials to the 1545 cocolitzli epidemic, and the city was likely abandoned after the disease killed so many of its inhabitants.,..
Acuña-Soto still favors his viral hemorrhagic-fever hypothesis, and he notes that Salmonella has never caused another epidemic as deadly as cocoliztli in recorded history. The strain most similar to the one found in the 16th-century teeth is rare and not well-studied, but it has a 10 to 15 percent mortality rate today. It is also not entirely known whether Salmonella was present in the Americas before contact with the Spanish or how pervasive it was in Europe..
that was my impression also, that paratyphoid was not that virulent.

But diseases do change with time.

for example the Athenian plague victims  tested positive for regular typhoid, but many dispute that too.

but when you read about how San Diego is being threatened by Hepatitis epidemic because the homeless spread feces on the street, just remember: Typhoid, paratyphoid, cholera and shigellosis, not to mention viral diarrheas, are also spread that way.

update: Long article in Nature discusses the disease but alas is behind a paywall if you want to read the whole thing.

Monday, January 15, 2018

Return of Diphtheria

The BBC reports that there had been an outbreak of diphtheria among the Rohingye refugees in local refugee camps.

Reuters report adds: first there was cholera, now Diphtheria.


Unclean water, crowded shelters and dirty conditions create a perfect environment at the Balukhali refugee camp for spread of preventable diseases. The camp is in Cox’s Bazaar, a town in southeastern Bangladesh. It is home to some of the estimated 650,000 Rohingya Muslims who fled unrest in neighboring Myanmar.
More than 200 mobile vaccination teams have given about 900,000 doses of oral cholera vaccine to the refugees.
However, another contagious bacterial infection, diphtheria, has appeared.


the full report from the UN is here:


UN estimates show that some 655,000 people have fled Myanmar to Bangladesh since August 2017. Diphtheria is an infectious disease caused by a bacterium which primarily infects the throat and upper airways, and produces a toxin affecting other organs. The diphtheria toxin causes a membrane of dead tissue to build up over the throat and tonsils, making breathing and swallowing difficult. The disease is spread through direct physical contact or from breathing in the aerosolized secretions from coughs or sneezes of infected individuals. Between 8 November 2017 and 11 January 2018, as many as 31 deaths and 3,954 suspected cases of diphtheria have been reported from Cox's Bazar. Nearly 10,594 contacts of these suspected cases have been put on diphtheria preventive medication.

they are also giving shots to the kids in the nearby villages.

To limit the spread of diphtheria to communities living near the Rohingya camps and settlements, nearly 160,000 children in 499 schools of Teknaf and Ukhiya sub-districts are also being vaccinated.
National Geographic article here.


this is ethnic cleansing of a group that moved to Burma a hundred years ago but never assimilated and were never considered full citizens. They are Muslim whereas most Burmans are Buddhists.

They have been treated poorly by the locals, to say the least, but this last crisis, which is true ethnic cleansing, was precipitated by some of the earlier refugees becoming terrorists, causing a backlash against the entire population.

Sigh.

Wikipedia article on the Rohingye.

this article suggests the vaccination rate for DPT has actually decreased over the last 7 years from 90 percent to 75 percent coverage.

this article discusses the logistical and social problems of vaccinating the children of Burmese refugees in the Tak area of Thailand, but does not mention the ethnicity of these refugees.

But the Wikipedia article on Tak Province mentions they are Karen refugees.

According to the UNHCR data of 2008, nearly 95,000 of Thailand's 121,000 registered refugees from Burma are housed in several refugee camps in Tak province of which Mae La camp is the largest with around 45,000 Karen refugees.[14]
the Wikipedia article on the Karen people.

 The Karen make up approximately 7 percent of the total Burmese population with approximately 5 million people.[6] A large number of Karen have migrated to Thailand, having settled mostly on the Thailand–Myanmar border....
Around 400,000 Karen people are without housing, and 128,000 are living in camps on the Thailand-Burma border. According to BMC, "79% of refugees living in these camps are Karen ethnicity."[31] Their lives are restricted in the camps because they usually cannot go out, and the Thai police might arrest them if they do
more information on the tribal refugees here.

Fox news article on the resettlement of these refugees in Iowa.

Burma is made up of hundreds of distinct ethnic groups, with one, the primarily Buddhist Bamar, dominating Burmese society and politics. The largest Burmese ethnic groups in the U.S. include the Chin, who live in the west and are persecuted for their Christian beliefs, and the Karen, who are fighting against ethnic cleansing and Burmese military abuses, according to the Ethnic Minorities of Burma Advocacy and Resource Center (EMBARC)  in Des Moines.