bleach vs mad deer disease

it's deer hunting season, and the bad news is that some deer in the USA are affected with Chronic wasting disease, caused by a prion that is similar to the mad cow disease (vCJD) that was found in the UK several years ago.

the prion family of neurological disease has variations that affect many animals: not all are infectious to humans.

To date, about 260 cases of vCJD, mostly in the United Kingdom, have been reported related to consuming beef but none in which the disease was acquired in the U.S.

Other TSEs are found in specific kinds of animals. These include BSE, mink encephalopathy, feline encephalopathy, and scrapie, which affects sheep and goats. Chronic wasting disease (CWD) affects elk and deer and is increasingly prevalent in certain areas in the United States. To date no transmission of CWD to humans has been reported. top

there are now reports that bleach might stop the spread by deactivating, but not killing, the prion of CWD LINK

Bleach isn’t the cure-all for CWD. It only works on nonporous surfaces, but it’s the first thing scientists have discovered that inactivates the abnormal prion that’s wreaking havoc on cervid herds. What’s more, we know the concentration and exposure time for bleach to be effective. And it works any time, today or in three weeks, because, unfortunately, the prions don’t disappear.

Chronic wasting disease in deer/elk has been spreading in the USA.

CWD is affecting many deer and elk in the USA... and some worry it will cross the species barrier to infect humans similar to how mad cow disease spread to humans (who ate brain/nerve tissue in meat from the infected cows).

so if you are a deer hunter in an area where there is CWD, how do you butcher the meat?

so far there has not been proof it spreads to humans, but macaq monkeys and squirrels might be able to be infected.  link2

and there have been cases from eating squirrels in the USA.

In 1997, a number of people from Kentucky developed vCJD. It was discovered that all had consumed squirrel brains, although a coincidental relationship between the disease and this dietary practice may have been involved.^[39]

LiveScience report on a case in NewYork state also associated with eating squirrel.

So is there a link between CWD in deer and CJD in humans?

Creutzfeldt–Jakob_disease

CJD is caused by a protein known as a prion.^[5] Infectious prions are misfolded proteins that can cause normally folded proteins to become misfolded.^[4] Most cases occur spontaneously, while about 7.5% of cases are inherited from a person's parents in an autosomal dominant manner.^[4] Exposure to brain or spinal tissue from an infected person may also result in spread.^[4] There is no evidence that it can spread between people via normal contact or blood transfusions.^[4] 

translation: You can't get regular CJD easily from contact with a patient with that disease (unless you are incontact with infected tissue/blood), but that might not be true in the variant version (vCJD) aka mad cow disease.

,
,,the mad cow disease that affected humans in the UK was called Varient CJD (wikipedia) from eating beef contaminated with brain/nerve tissue and also from blood transfusions if the donor had the infectious prions in their blood.

the good news: Not everyone who was infected got the disease: there is a genetic link to whether or not you were susceptible.

the bad news: it could take up to 50 years to develop the disease.

In New Guinea, a disease Kuru was known to be caused by cannibalism, where the family ate part of the brain of the dead: forbidding the practice was thought to have eliminated it, but now there have been new cases reported. Were these new cases from a long latent period, with the disease appearing 50 years later from modern mortuary practice, or from secretly continuing the practice?

Measles: outbreaks

they were hoping that Measles would be eliminated world wide.

Latest outbreak: Samoa with 6 dead according to the NYTimes.

more at the UKGuardian which doesn't have a paywall:

Since then, at least six deaths, mostly infants under the age of two, have been linked to the outbreak, the health ministry said in a statement late last week. Of the 716 suspected cases of measles, 40% required hospitalisation....

Measles cases are rising globally, including in wealthy nations such as the US and Germany, where some parents shun immunisation mostly for philosophical or religious reasons, or concerns, debunked by medical science, that such vaccines could cause autism.

this is in Samoa: American Samoa is not involved (yet...) because it's vaccination rate is higher (90 percent).
sigh.

And after the Dengue vaccine scandal, some parents didn't get their kids vaccinated here int the Philippines, so we had an outbreak too

Sudden cardiac death in athletes

a good article at Runner's world LINK lancet article about NDE LINK headsup FR LINK

the history of Insulin

Dying alone in Japan

There is a bestselling manga in Japan called "stargazing dog" about a middle aged man who was fired from his job due to downsizing, had his wife and children leave him, and ended up dead of neglect in the middle of a field.

the author insists it was not a sad book.

A manga titled “Stargazing Dog” starts with the discovery of the skeletal remains of the protagonist who lost his job and family and died in an isolated field with his dog at his feet. However, Takashi Murakami, 54, author of the manga, said this is not a tragic story. “He was not unhappy at all,” Murakami said of the protagonist. Murakami objects to characterizations of people who die alone as sad “losers in life” who have not prepared for death. Of course, the author says, people who do not want to die alone should receive help and support. What he objects to is the classification that all isolated deaths indicate the person has lived an unhappy life.

most of those who die, die alone in their own homes, neglected by their families.

The author feels society has unfairly attached labels to those who die alone and those who die surrounded by loved ones.

WINNERS, LOSERS OF LIFE “The ‘winners’ might be the group of people who can disperse the risks and avoid living in isolation,” said Midori Kotani, 50, president of a research center for senior citizens who specializes in clinical thanatology.

Eight years ago, Kotani, who also teaches at Rikkyo Second Stage College in Tokyo, lost her husband. His death spurred Kotani to form a group to help people maintain their lifestyles after their partners die. “If you want to avoid isolation or a lonely death, it is important to connect to people other than family members who can be relied upon when you are still vigorous,” Kotani said.

Akihisa Kono, 50, who runs a surgical hospital in Sakai, Osaka Prefecture, saw many lonely death cases when he was a medical examiner in the prefecture. Kono said that Japan’s wealthy and convenient society helps to free us from the troubles of meeting people face-to-face.

But, he added, “The communication skills of people are worsening regardless of age, which widens the disconnect within a community and between generations and leads to isolation.” Since the first half of the 1990s, the number of “muen botoke,” people who die alone and go unnoticed, even by their children or relatives, has been rising in Yokosuka, Kanagawa Prefecture.

The number started surging after fiscal 2005. Alarmed by the trend, the city four years ago started supporting “Shukatsu” (preparing for death) for people who live alone and are financially strapped. Kazuyuki Kitami, a social worker at the welfare division of Yokosuka city, said changes in society are fueling the trend in lonely deaths. “It is not about losing bonds but rather the environment has made it easier to sever bonds,” Kitami said.

He said sharp social changes can be traced back to two time periods: in 1990, when the average family size shrank to three members or fewer, and the 2000s, when the use of cellphones spread. People now have fewer immediate relatives to connect with, and human relationships are maintained chiefly through smartphones.

Those who find themselves with few real-life connections may die alone, and their families or relatives might not care, he said. “What generates such an atmosphere that even relatives don’t receive the remains? I think we need to think about that question,” Kitami said.

and it's not just the eldely who disappear

Ebola, Measles and Diarrhea killing children.

StrategyPage writes about the Ebola epidemic in the DRC/Central Africa.

The good news:

international and Congolese health workers have a new weapon in their arsenal. Two days ago 11,000 doses of the new American Ad26-ZEBOV-GP vaccine arrived in North Kivu province. North Kivu, South Kivu and Ituri are the three provinces in the epidemic’s epicenter. Another 39,000 doses will arrive shortly. As of October 20, there were 3,243 Ebola virus cases and 2,185 deaths in Congo. Uganda has had four confirmed cases and three deaths. 

the bad news:

 Sadly, in 2019 measles has killed more people in Congo than Ebola. So far over 4,100 Congolese have died this year from measles. Estimates are that Congo had over 200,000 total measles cases in 2019. Over 140,000 of those cases were children under the age of five years. (Austin Bay) 

there was a push to eliminate measles from the world (similar to how smallpox was eradicated in the recent past).

This 2014 article discussed some of the problems of getting the vaccine into the chaotic DRC (Democratic Republic of the Congo).

So what are some of these bottlenecks? First, access to routine vaccination services is extremely limited. The population is spread over large geographic areas with very limited road and public transport networks. Second, in several provinces, health clinics perform poorly due to shortages of health staff, ill-equipped health structures, irregular supplies of vaccines and inadequate cold chain equipment for vaccine storage.8,9 Third, the logistics challenge of accessing children in distant areas is overwhelming.

the article goes into details about the logistical problems.
One problem with measles vaccine is that since it is a "live" attenuated virus, it needs refrigeration. So if it gets warm, it deteriorates and doesn't work. That alone is a major problem.

and when I read in the article that there are reports of a alot of measles despite the reports of a high rate of vaccinations.

I not only wonder if the vaccine had been kept cold and had been given properly, but if the health care workers just faked the data to get paid.

and that doesn't even mention little things like roaming gangs who steal medical equipment, rob health care workers, and terrorize locals, or that many people are fleeing the war between insurgencies and government troops.

nor does it mention the propaganda war against vaccinations. This has been notorious with both polio and measles, usually in Muslim countries where the Mullahs take a half baked anti vax conspiracy theory from the web and tell their people not to get their kids vaccinated.

But these rumors are also complicating the ability to control the ebola epidemic. (something mentioned in the SP article)

The government and medical aid organizations are battling rumors that Ebola is a hoax. ... Many locals refuse to believe Ebola is what local and foreign doctors say it is. Traditional healers and the few Islamic terror groups in the area also oppose efforts to use modern medicine to treat Ebola. The traditional healers see it as a threat to their livelihoods while the Islamic terrorists believe Western medicine is really an infidel (non-Moslem) plot to poison Moslems or Africans in general.

Opponents to Ebola treatment encourage violence against those providing this treatment and that has led to some deaths and a considerable amount of violence.

Then we have this complaint: the upsurge in measles cases might have been partly because health resources have switched from vaccinating for Ebola rather than routine childhood vaccinations.

A combination of factors – increased violence, growing mistrust towards medical teams in the wake of the Ebola outbreak as well as the diversion of resources to deal with Ebola – have resulted in reduced vaccination coverage in general.

....Community mistrust towards the outbreak response team has been cited as one of the challenges. Another is the high levels of insecurity due to battles between the army and armed groups. This has affected access to health services by communities.

you don't say.

and from my experience, a lot of the "measles" deaths won't be reported: often the children would die of croup, pneumonia a week or two after the measles rash disappeared.

And then there is the problem of tuberculosis: Measles causes "anergy", meaning your resistance against tuberculosis goes down, and then you can die of TB. TB also is seen when the immune system is weakened by malnutrition, HIV, malaria, or other infectious diseases. 

and yes, malaria remains a major killer of children and adults in the area.

and don't forget that one of the major killers of young children is various forms of gastroenteritis, or diarrhea disease, usually viral, which usually is because of lack of clean water.

Sigh.

There are ways to fight all these diseases (been there, done that: baby clinics, digging wells, village health workers with WHO rehydration fluid, supplying chickens and cheap protein supplements and nutrition villages), but when there is a war and the roads are not safe, when clinics are robbed or medical personnel are killed, then the plan collapses.

been there, done that too. 

Sigh.

cross posted from my main blog

Military suicide

strategyPage has a long essay on PTSS, suicide, and the military, and how the military is trying to control the epidemic.

LINK

Military epidemiologists (experts on medical statistics) have long sought to convince people outside the military that the rise in suicide rates within the military has little to do with the stress of combat and mostly to do with the stresses of military life during wartime or peacetime. In other words, the increased suicides were not concentrated among the combat veterans, who make up less than 15 percent of those in the military but are more evenly distributed among all service personnel.

For example, during the last decade over 75 percent of suicides were among troops who had never gone overseas. The military, especially the army, has long documented all deaths and the Department of Defense in 2013 released a study of all suicides since 2001, when more troops saw combat, to 2008, when the heavy fighting in Iraq ended.

A similar study for 2009-2012 suicides found little change. The researchers also point out that the reasons for suicides in the military are quite similar to those for civilian suicides, especially when victims are of the same age, education, and other factors as their military counterparts. In other words, periods of intense combat for the military have little impact on the overall suicide rate because so few troops are exposed to combat.

These revelations were not well received by the mass media which makes much of the rising suicide rate in the military but pays less attention to rising suicide rates among civilians of the same age and education. That was 9 per 100,000 in 2001 but had risen to 17.5 in 2013 and by 2016 was 26 per 100,000 men aged 25-44, which is the age of most men in the military.

This was declared to be a health emergency, and to a certain degree, it was. What was missed in all the discussion was that the higher suicide rate in the military is usually below the rate for civilians of military age.

Pain pills and trauma care

People rarely die of prescription opioid medications they are prescribed. 
Well, duh. Sounds about right.

even those on high doses for chronic pain don't get "addicted": They might need to be withdrawn slowly from the medicine, but the psychological problems of addiction are not there (i.e. they take it to get rid of the pain not to get high).

The opioid crisis got bad after I left practicing medicine and moved here, but I know of two deaths in people who stole narcotic medications from cancer patients and died of an overdose. One was a known druggie, but another was a 13 year old girl at a party who was told to "drink this" and did. She was unpopular so obeyed the girl who gave it to her (probably as a joke). The source of the narcotic was the girl's grandmother, who kept liquid morphine for break through pain in her purse. Sigh.

but the dirty little secret is that the little old ladies often sell or borrow pain pills from each other because... arthritis pain.

A lot of older people just use a single mild opioid tablet at bedtime so they can sleep.


Yes, NSAIDs are just as good: indeed, for a lot of pain they are better, because they relieve inflammation: but in the elderly they have the risk of bleeding ulcer and kidney damage, so may kill more people than prescription opioids. So which are safer? It's hard to do a "clean" study, since the abuse cases and suicides confuse the statistics LINK

as for the suggestion to use Paracetamol (Tylenol), sorry: it just doesn't work as well, and it only lasts for 4 hours so you have to take a lot of pills to stay comfortable and again they do not relieve inflammation (which causes pain).

Drug abuse is a societal problem.

But of course, if you acknowledge it is Chinese fake percocet/ oxycontin /Fentanyl being smuggled in via Mexican drug cartels, you might have people actually saying yes build that wall to keep out drugs.

and my question: Where are the churches here? Isn't this a moral weakness to use drugs to get high? And how many take drugs because they were in despair, and no one was there to comfort them?

Ah, but PC churches have different priorities: Too busy worshipping Pachamama and changing Wikipedia pages for their enemies I guess...
--------------------------------------------------------------------------------

The Good news: from StrategyPage: Freeze dried plasma will save lives.

you give it to people suffering from blood loss. Plasma has been used since World War II (one of my professors was in charge of the blood bank using this to treat D Day casualties) but the new version is portable and doesn't require refrigeration.

The bad news: The French have been using it since 1994, and the US military has been using the French version since 2010 but is still trying to get the paperwork done to make it for the USA.

Article on the history of treatment of shock with plasma and blood transfusions and with IV fluid. LINK

A black physician, Dr. Charles Drew, developed the logistics of providing blood to the injured used in World War II.

His pioneering research and systematic developments in the use and preservation of blood plasma during World War II not only saved thousands of lives, but innovated the nation’s blood banking process and standardized procedures for long-term blood preservation and storage techniques adapted by the American Red Cross.

The Strategypage article notes other lifesaving methods devised for the military and now used in civilian life, such as hemecon and woundstat, used to stop bleeding and the abdominal belt to stop internal bleeding from the aorta.

not mentioned: Don't forget the helicopters.

The opening scene of MASH shows the helicopters bringing in the wounded, but in the last 30 years, helicopter transfer for civilians is becoming more common: Indeed, when possible they will land at your car accident site or near by (e.g. in parking lots) to take you to the Emergency room in some isolated rural communities.


the bad news: Consumer reports laments often they are used when alternative transport is available, leaving the person with a huge bill. But the problem is that when you call the ambulance, you don't often know how serious is the injury, or if the patient might die at the less equipped local hospital, or deteriorate during the long ambulance ride (when I worked in Northern Minnesota, it was 6 hours to Minneapolis and three hours to Fargo by ambulance... and in rural Pennsylvania a trip that is ten miles by map might take an hour and 30 miles by the mountain roads).

This article about a central Pennsylvania auto accident discusses how people are rescued and transported by medivac helicopter. 

I know the area.

Boalsburg is 30 minute drive to state StateCollege and another one hour or more drive to Altoona and in this case, the helicopter landed in a nearby parking lot.

the maps insist it is only a 45 minute drive to drive the 49 miles, but that is not true: that assumes the car accident happened near the interstate highway, that there is perfect weather, and that you can break the speed limit... 
And the dirty little secret is that it is hard to care for a critical patient in a noisy moving ambulance or in a fixed wing transport...

(I have no experience in the helicopters but these medevacs are well equipped, with experienced personnel, so things are less primitive than when I used to make ambulance runs in ambulances or in the fixed wing Cessna owned by the local undertaker that we used to borrow in the 1980s to transport people 150 miles to Rapid City from the Reservation).

My son in law is a Medevac pilot, Keep him in your prayers. 

----------------------------------------

In World War I, those suffering mental problem from combat were said to be suffering from "Shell shock".

And the SP article cited above notes that yes, post traumatic stress syndrome is more common in those who had mild brain concussions from IED explosions.

While largely the result of being exposed to a lot of combat, it was, by the late 1990s, realized that head trauma, usually from being too close to a lot of explosions, played a part as well. Work on PTSD continues, especially now that more methods have been developed, including medicines...

more HERE. 

however PTSD also occurs in civilians who had traumatic experiences. WEBMD discusses diagnosis and treatment.

Joe Kenda (of Homicide Hunter) discusses:

Kenda knows he suffers from post-traumatic stress disorder similar to what military veterans experience, and the show is a way for him to release some of the pent-up stress that still eats away at him to this day.

“It doesn’t go away,” says Kenda, who worked his way up to commander of the Major Crimes Unit. “You can’t un-see those things, you can’t not think about them, and you can’t forget them, even though you want to...

There are certain events that will trigger a memory, and it’s startling. Imagine having a nightmare while you’re awake. That’s what it can be sometimes.”

Sigh. Been there, done that. We docs see a lot of horrors too, cases of suffering we couldn't stop, or abuse cases or accidents, or of treatment that didn't work,  and you keep busy so just put the memory in a box and carry on. But after retirement, the memories pop back suddenly, and all I can do it give the problem to the Lord...

sigh.

(cross posted from my regular blog.)

CDC in the news

CDC: most violent deaths are... suicides.

by white males, young or old, or AmerIndian/Innuits.

homicides are more likely among Black non Hispanic teenage males.

Less than 1 percent are death by law enforcement.

----------------------------------

CDC reports one third of those with Lupus (SLE) take opioids for pain, and the experts are not happy about it.

Quick: What's wrong with this statement.

The widespread and long-term use of prescription opioids among this cohort of patients with SLE was striking given lack of evidence regarding safety and efficacy of opioids for treating chronic pain associated with rheumatic disease (1,7).

translation: we don't have scientific studies that opioids work for this type of pain (just ignore the experience of thousands of physicians who find it's the only thing that keeps their patients comfortable enough to function)

Particularly concerning is that some of the less appreciated medical risks associated with long-term opioid use, such as myocardial infarction, immunosuppression, and osteoporosis (8), are potentially compounded in persons with SLE, whose baseline risks for these comorbidities are elevated because of the underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies.

translation: opioid use is associated with these things, but hey, the disease of the patient cause them too.

Further, recent preliminary data suggest that opioids are associated with increased mortality in lupus.¶

so is it from the opioids, or because we give opioids to the patients whose lupus is worse?

The study about increased mortality is, of course, a "metanalysis" meaning it took a bunch of studies and averaged the results.

so what does this mean?

A qualitative review was performed because the number of articles pertaining to specific adverse effects of opioids was typically small, and the diversity of adverse effects across systems precluded a quantitative analysis.

hmm.. in other words, not a lot of data out there so the analysis might not be accurate.

Through a variety of mechanisms, opioids cause adverse events in several organ systems. Evidence shows that chronic opioid therapy is associated with constipation, sleep-disordered breathing, fractures, hypothalamic-pituitary-adrenal dysregulation, and overdose.

True. Constipation in cancer patients on opioids is a big problem no one wants to talk about. You get respiratory depression, and I've seen this in the elderly, who are doing well on their opioid dosage until they pneumonia... a Overdoses might be accidental or deliberate (not just suicide but from taking extra dosese because you hurt and take a second or third dose before the first dose starts to work).

However, significant gaps remain regarding the spectrum of potentially opioid-related adverse effects. Opioid-related adverse effects can cause significant declines in health-related quality of life and increased health care costs.

or maybe they increase the quality of life when taken. That part is not addressed.

------------------------------
remember all the hysteria about the Zika virus causing mental retardation among infants whose moms were exposed to it?

well the dirty little secret is that Rubella does this too:

but thanks to vaccine, (MMR means Measles Mumps Rubella) it has gone down world wide.

CDC report:

Progress toward rubella elimination has resulted in 168 (87%) of 194 countries protecting infants with RCV and 81 (42%) eliminating rubella transmission. Equity between countries using rubella-containing vaccine has increased as lower-income countries have introduced rubella-containing vaccine.

this paper notes the decrease in cases from 2000 to 2016 

In 2016, 22,361 rubella cases were reported to WHO, a 97% decrease from 670,894 cases reported in 2000, and a 76% decrease from 94,277 cases reported in 2012 

there is a big worry that the increase in refusing "measles" shots (actually MMR shots) will increase the rate of fetal rubella syndrome: 

but one might not see this until these unvaccinated kids grow up and get pregnant.

and in some poorer countries, only measles vaccine was given, not the MMR combination which is usually used in the USA.

CDC Measles outbreak

Measles outbreak summary: 

most were isolated cases, some were from immigrants who didn't get shots (or maybe whose shots didn't work: in my experience the vaccine is unstable and doesn't work if not given properly).

herd immunity probably kept the disease from spreading to most unvaccinated kids, but the outbreak among Orthodox Jews in the NYCity area was an exception.

I know why the antivax idiots refuse the shot: Because Hollywood types spread the message that the vaccine causes autism.

And I know why the Muslims in some areas refuse the shots: Because the Imans read the hysterical anti vax stuff in the British papers and told their people it was a plan to destroy Islam.

And I know why the Philippines has an outbreak: The Denguevax scandal, where some kids who got the vaccine (but shouldn't have) got a fatal cases of Dengue, so some parents now refuse all vaccines (we also have polio and at least one case of diphtheria here).

But why Orthodox Jews, who usually are sophisticated? Maybe because an anti vax type group targeted them:

NYTimes article:

“The Vaccine Safety Handbook” appears innocuous, a slick magazine for parents who want to raise healthy children. But tucked inside its 40 pages are false warnings that vaccines cause autism and contain cells from aborted human fetuses.

“It is our belief that there is no greater threat to public health than vaccines,” the publication concludes, contradicting the scientific consensus that vaccines are generally safe and highly effective.

The handbook, created by a group called Parents Educating and Advocating for Children’s Health, or Peach, is targeted at ultra-Orthodox Jews, whose expanding and insular communities are at the epicenter of one of the largest measles outbreaks in the United States in decades.

or maybe because they were told the vaccine contained forbidden substances (similar to the ubercatholic trads who refuse vaccines because they were made from stem cell lines from aborted fetuses, despite the Vatican saying it was okay if the alternative vaccines weren't available).

WaPost notes it's not just NYCity, but Israel who has an epidemic;

The reason, health officials say, has nothing to do with religion and everything to do with the ultra-Orthodox way of life, as well as public health services that don’t meet the needs of large families. “Most rabbis encourage vaccination based on the Torah commandment to protect one’s life,” said Rabbi Yuval Cherlow, founder and head of the ethics department of the Tzohar Rabbinical Organization in Israel. “In Judaism, the majority has the right to dictate what takes place in the public space to ward off danger.” Still, “there is no pope in Judaism, and no one can force you to vaccinate,” Cherlow said. In 2018, Israel’s Health Ministry reported 4,000 cases of measles, compared with 30 the year before. In the United States this year, 387 cases have been reported through March, compared with 372 during all of 2018, according to the Centers for Disease Control and Prevention.

why?

no, it's not religion, but anti vax beliefs about autism.

maybe because they don't trust the government.

and maybe because it is spread from other countries in Europe including the Ukraine, where immigrants come from.

Or maybe, the article says, because they have so many children they don't get around to getting the kids all their shots.

Ironically a lot of the cases are in kids under one year of age: Usually we don't give the vaccine to these kids since it doesn't work well (due to immunity inherited from mom). In Africa, we did give it to kids over 6 months but repeated it at 18 months, because partial immunity was better than none, and most of the kids who had partial immunity who got measles survived.

This is where "herd immunity" is important: If enough people are immune, the disease is less likely to spread to the entire community, and means most infants would never be exposed to it.

the language of pain

Are generics safe? Zantac the latest problem

BBC reports on Zantac/Ranitidine recall.

article is lousy: Gives no reason and points no fingers, nor does it say if it is only generics or the brand name.

Bloomberg says it is made in China and India.

In the meantime, the Italian Drug Agency said last week it was ordering a recall of all versions of Zantac made with active ingredient from Saraca, the Indian manufacturer. Italian regulators also banned the use of some types of Zantac produced by other pharmaceutical companies pending analysis of the drugs.

Bloomberg has an article on the problem of generics.

this photo pretty well says it all:

the article discusses the contamination of Valsartan and other ACE2 inhibitor type BP meds.

Companies conduct clinical trials in humans over several years to prove a drug is safe and effective. But 90% of all medications prescribed to Americans are generics. They’re cheaper, they’re supposed to work the same way, and they receive less scrutiny right from the start. Companies manufacturing generic drugs have to show only that patients will absorb them at the same rate as the name-brand medications they mimic.At least 80% of the active pharmaceutical ingredients, or APIs, for all drugs are made in Chinese and Indian factories that U.S. pharmaceutical companies never have to identify to patients, using raw materials whose sources the pharmaceutical companies don’t know much about.The FDA checks less than 1% of drugs for impurities or potency before letting them into the country. Surveillance inspections of overseas factories have declined since 2016, even as the agency is under pressure to get more generics to market more quickly.

the article goes into a lot more detail about the Valsartan contamination and about China's growing pharmacy manufacturing business, but the clue is that the company switched to a different solvent, which was cheaper. Then other companies read the patent application and figured they too could make the drug cheaper and voila, many sources of the BP medicine also produced contaminated medicine.

Can Polio be eradicated?

A long article on the CDC website discusses.

Since the Global Polio Eradication Initiative began, the number of reported WPV cases has declined from an estimated 350,000 WPV cases in 125 countries during 1988 to 66 cases in two countries with ongoing endemic transmission during 2019 (as of August 20, 2019); an estimated 18 million paralytic poliomyelitis cases have been prevented during the past 30 years.

summary:

Top Discussion The new Global Polio Eradication Initiative Polio Endgame Strategy 2019–2023 (1) contains three important pillars: eradication, integration, and containment/certification.

 ...After global eradication of all WPVs and eventual bOPV cessation, fully certified containment of all polioviruses in research and quality control laboratories, vaccine manufacturing facilities, biomedical facilities, and biological repositories is crucial.

Containment efforts include minimizing the number of facilities retaining poliovirus materials and ensuring that all poliovirus research facilities comply with containment guidelines.

Ongoing poliovirus research facilitates the development and deployment of alternative, genetically stable polioviruses that are safe to use in vaccination and that can be produced and used outside containment.

Researchers have made important progress in replacing Sabin strains for diagnostic and serologic assays (e.g., with genetically stable novel OPVs) (4) and in developing IPVs made from Sabin and safer poliovirus strains to reduce risks from the use of live WPV in IPV production. These advances will result in a requirement for fewer poliovirus containment facilities and a corresponding reduction in overall risk for poliovirus release.

lt is ironic that few western "Anti vaxers" get hysterical about polio vaccine, but the dirty little secret is that the easily given oral version would mutate into the real thing in one out of a million cases, causing half a dozen cases a year in the USA before they went back to the (killed vaccine) shot, and even starting epidemics when given in populations that lacked immunity (usually because the Muslim crazies stopped the teams giving out vaccines and you lost "herd immunity").

I am old enough to remember the epidemics of the late 1950s, and had two friends with partial leg paralysis from polio, and one patient years later with "post polio" syndrome.

Ebola update

the Ebola epidemic in Central Africa is still going on and StrategyPage puts the fight against the virus into the perspective of the local wars and the heroism of locals to stop it (with the help of international agencies).

During the week that ended on September 22, Congo’s health teams conducted 2,546,148 Ebola virus screenings. Since August 2018 Congolese teams have conducted over 98 million screenings. That impressive number indicates Congolese health teams have done a lot of potentially dangerous work. Still, experience has shown the risk of Ebola transmission as very high at national (in Congo) and regional levels (central Africa) but low at the global level.

the lack of facilities, the corruption of officials, and the threats against those trying to stop the epidemic are all discussed.

Read the whole thing.

the X rated epstein article

LINK

China and Ebola

Instapundit links to a Canadian site about how a Canadian lab sent Ebola virus to China (on a commercial flight). And something about the Chinese scientists working in the Canadian labs who were fired.

"I think there will need to be an inquiry into the scientists to potentially see whether or not they were compromised or any elements of their work were compromised and that China gained illegal or improper access to Canadian intellectual property ... to see what China may have gained access to without knowledge, prior to this incident," West says.

Hmm... China stealing "intellectual property". Who wudda thot?

Place conspiracy theory here. Is China trying to weaponize Ebola as a bioweapon? Or just trying to make money off of their vaccine?

SciAmerican notes that China has a new Ebola vaccine, and is trying to test it in the present day epidemic in the Congo (Where the one dose Ebola vaccine by Merck is the only one certified, although there is a two dose version by another company that is being tested now).

The head of the Chinese Center for Disease Control and Prevention (CDC), Gao Fu, is reported to have said that a team of experts will travel to the DRC on Friday, bringing with them an unspecified number of doses of vaccine. “We will seek to use the Chinese developed vaccine there to help with control and prevention of the disease, but for the present the vaccines will likely only cover Chinese living in Congo,” Gao is reported as saying in China Daily.

Chinese living in the Congo? Why, yes. They not only have interest in oil, but are there trying to get a monopoly on rare earth metals.

CGTN website notes:

Fearing a major Ebola epidemic, the U.S. European Union, Russia, and China are developing Ebola vaccines. At present more than 15 vaccines are at various stages of testing. Pharmaceutical companies have committed to ramping up the production capacity once the vaccine passes crucial tests, the WHO statement last year said. “This could be the fastest vaccine roll-out in history.”

StrategyPage has been following the wars, chaos, and Ebola in the DRC. LINK

July 25, 2019: A Chinese oil company has halted work in western Uganda due to the Ebola virus threat. Uganda’s major oil fields are near Lake Albert, which borders Congo. The Chinese operate Ugandan fields along with two European partners, Total and Tullow Oil.

China has invested a lot in Africa, and unlike the west, tends to send their own people to run these "development" programs.


A couple years ago, Angola had a major Yellow Fever outbreak, and a couple of Chinese who went back to China were infected.

Yellow fever spreads via mosquitoes, and I guess hospitalizing the cases stopped the spread, or it could have killed thousands.

Just as an aside: on their article about the Central African wars, StrategyPage notes this:

 July 24, 2019: Due to the Ebola virus threat, Saudi Arabia has banned the entry of any tourists or Hajj pilgrims from Congo. The Kingdom said that it reached this decision in order to protect the lives of other Hajj pilgrims.

The Saudis are aware of the  possibility of various epidemic diseases among the pilgrims, many of whom are from poor third world countries.

And the last European Smallpox outbreak (1972) was brought there by a Yugoslavian pilgrim.

Luckily, most Europeans had received Smallpox vaccination in the past, and by revaccinating 18 million people the epidemic was stopped.

However, if you really want to worry, read this 2001 (pre 911) war game scenerio which proposed a release of smallpox by terrorists at an Oklahoma truck stop.

After 9-11, and especially after the Anthrax letters, our Public health clinic received instructions on how to organize the response: From using schools as hospitals, to vaccinating first responders, to how to do"ring vaccinations" to contacts.

Since I had worked in Africa, I was the one who had to read and organize the possible response. Luckily, only Anthrax (which does not spread person to person) was used to terrorize the population (by whom is another controversy which I won't get into here).

But actually superflus might be the real danger, as the SARS epidemic showed. Then there is MERS (coming to a hajj pilgrim near you), bird flu, and yellow fever (via Brazil), not to mention Dengue, which is now affecting the Philippines.

How bad is our Dengue epidemic? So bad that they are considering restarting the Denguevax program...
the vaccine was blamed for causing a few deaths, but in a severe outbreak would probably save a lot more lives than those with side effects (the deaths were due to improper screening of candidates).

No, no racism here

Damien Thompson quit his post as editor of the UKCatholic Herald because "the new owners” and he “do not agree on the future direction of the company.”

Satireblog EcclesIsSaved writes about it here.

Following a take-over of the Sovereign Order of the Catholic Herald, its Grandmaster-in-chief, Fra' Damian Thompson, has quit his position because of "a difference of opinion".

Commentators have been asking whether the "blood-crazed ferret" has been biting the bishops of England and Wales too hard, in view of his criticism of their lordships' response to the decision of hanging judge Mrs Justice "Blood! Cut! Sever! Aagh!" Lieven to force a woman to abort her baby (a decision now overturned).

Fra' Thompson's "In some ways, possibly, well, one might argue, without making too much of this, that the bishops' response to the court decision was less than it might have been had it been more than it was" was itself a watered-down version of what he originally wrote, namely, "Ye brood of vipers, who hath shewed you to flee from the wrath to come?"

Now that he is a free man and doesn't have to kiss the tushes of the powerful be subtle, he gives his opinions to Raymon Arroyo in an interview.

======

hmmm... I didn't realize that the moderately mentally disabled woman in a court case where a pro abortion judge agreed with a social worker she should be forcibly aborted was a Nigerian... makes you wonder if racism or eugenic thinking was influencing the decision. Note that her mother, a midwife, was willing to adopt/care for the child...

but the best part of the interview starts at 10 minutes, discussing the Amazon synod. Put down coffee and read it (Brits can be sooo wonderfully snotty). and calls it a "PC Disney production... Avatar written by octagenarian European socialists..."
and goes on to mention their wishywashy condemnation of the traditional infanticide by some tribes because they don't want to change their culture.

This is, by the way, nonsense:

among the Shona tribe in southern Africa, traditionally twins were killed, usually by the grandmother, because due to lack of milk, tribal knowledge knew that these twins would lose weight and die slowly (and losing weight and dying this way was a sign they were bewitched, so better to kill the bewitched children before the spell affected others, was the belief).

But you know what? As soon as the missionaries set up schools and clinics, and there were ways to supply formula to the moms, such killing stopped. I met only one lady who said this had happened to her children (probably in the late 1940s), and it made her so upset that she left her husband and went back to her family.

GetReligion blog has a similar story, this one from the Amazon, where tribal elders ordered a child killed, but it was saved by some Protestant missionaries.

but there is more to the story, from the UKTelegraph: The ironic part of this story? when the tribal elders ordered the murder, the parents killed themselves rather than kill their child.

Attempts to change tribal attitudes and counter official indifference are being led by a Brazilian couple, Marcia and Edson Suzuki. They have worked with one tribe, the Suruwaha, for 20 years. Mr Suzuki, the founder of a campaign group called Atini - Voice for Life - said: "We are fighting against doctors and anthropologists who say we must not interfere with the culture of the people."

Such attitudes are exemplified by Dr Erwin Frank, an anthropology professor at the Federal University of Roraima State in the Amazon. Speaking of the tribes, he said: "This is their way of life and we should not judge them on the basis of our values. The difference between the cultures should be respected."

Like other tribes, the Suruwahá considers that if a child has any deformity or disability, it does not have a soul and so - as an animal - should be killed. ...

The Suzukis recounted the harrowing story of one girl, Hakani, who they saved from death and adopted. Born in 1995, Hakani - which means Smile - was still unable to walk or talk by the age of two, prompting tribal leaders to conclude she had no soul and to order her parents to kill her. They committed suicide - eating a poison root - rather than obey the order.

Why do anthropologists assume that these "tribal customs" are holy and not to be interfered with? Remember, the tribes of the Amazon once had sophisticated farming and fishing culture, but died from European diseases a couple years ago.

When there was dire poverty, maybe such children should have been killed since food was very short and they could not support themselves, but now there is an alternative for such children, so there is no excuse: Especially when (like my patient, or like Hakani's parents) they wanted their children to live.

I suspect because the anthropologists and other experts don't see these Indians as human beings, but only as specimens to be kept untouched in a cage

I was aware of the measles vaccine to help them push an agenda to confirm their private vices/, not to mention using them for experimental subjects for a new measles vaccine (reminds me of the Denguvex scandal here: the anti vaxxers are nuts, but there is a reason behind their madness).

Wikipedia page on the book Darkness in ElDorado has details on the sexual exploitation of the tribe: HERE. and HERE.
or you can read the rant by that modern Jeramiah, Ann Barnhardt, about why the pedophiles in the Vatican love them.

or you can just watch the film:






And they are allowing self selected tyrants to terrorize those who have no power to say no, and pretending that the powerless agree with these self proclaimed tyrants.

One does not need to be a Marxist SJW to see the power differential makes the entire argument that the "tribal custom" means the decision of a tyrant to boss people around, especially when there are alternatives for such children and parents.

beware your heart

there are urban legends in the US about patients waking up on the operating table as doctors prepare to take out their organs, or that doctors will "hurry you along" to die to take them out, and a recent story in USA today says that killing people (by euthanasia) to take out their organs is becoming more popular: and is increasingly discussed at medical conferences as a possibility:

At international medical conferences in 2018 and 2019, I listened as hundreds of transplant and critical care physicians discussed “donation after death.” This refers to the rapidly expanding scenario in Canada and some Western European countries whereby a person dies by euthanasia, with a legalized lethal injection that she or he requested, and the body is then operated on to retrieve organs for donation.

At each meeting, the conversation unexpectedly shifted to an emerging question of “death by donation” — in other words, ending a people’s lives with their informed consent by taking them to the operating room and, under general anesthesia, opening their chest and abdomen surgically while they are still alive to remove vital organs for transplantation into other people...

Recently, the New England Journal of Medicine (NEJM) published an article by two Canadian physicians and an ethicist from Harvard Medical School, who contended it might be ethically preferable to ignore the dead donor rule if patients declare they want to die in order to donate their organs.

ah, the NEJM, who published a dozen pro euthanasia articles in the early 1990's that insisted everything was hunky dorey in the Netherlands so why not copy their practice. The problem? They ignored the many reports in the lay press and in the medical literature that the guidelines were not followed and most cases were not reported, but hey, as the editor assured me, these articles were "opinions" and so didn't have to be factually accurate.

the USA Article continues:

While literally “giving yourself” to others might seem commendable at first glance, let’s discuss three downstream considerations to abandoning the dead donor rule.

►People with physical and mental disabilities have expressed that they feel stigmatized and that society devalues their lives. Would this send them a not-so-subtle message to get out of the way and do something noble with their healthy organs?

►How quickly would we see expansion whereby those who can’t speak for themselves are included as donors?

►What does it mean for all of us when our healers — physicians — are in a position that directly overrides nearly 2,500 year-long prohibitions against taking life?

what happens is that a small minority of physicians quickly decide they will follow the newfangled Oath of Lasagna instead of the Hippocratic oath, a modern oath which insists" If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God."

in other words, they will not "play at god", they will become god, and assume they have the power of life and death over those under their care.

And if you don't think that this is a frightening idea to poor and minority patients you are naive. Tuskegee experiment, anyone? and this is why minorities often refuse living wills or refuse to go along with "end of life" decisions pushed onto them by the establishment physicians (something that is lamented about in many medical journals who can't understand why patients who face prejudice in their daily life, including at many medical establishments, won't just let some strange doctor have the power of life and death over them or their loved ones).

and, as the USAToday article notes: it's not just terminal patients who face this subtle prejudice:

 Consider the case of Ben Mattlin, who suffers from spinal muscular atrophy. In a 2012 column for the New York Times, he wrote of the “thin and porous border between coercion and free choice” for those who feel devalued. On the subtle erosion of his autonomy, he wrote: “You also can’t truly conceive of the many subtle forces (to die) — invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami — that emerge when your physical autonomy is hopelessly compromised.”

what started me on this subject was not the USA today article, but one on StrategyPage, about China. At the end of the discussion of China's economy, China's aggression in the West Philippine sea, and why Hong Kong's population is demonstrating against them, they have this small paragraph:

June 17, 2019: An international tribunal released the results of its investigation into Chinese organ transplant activity. This is not a new problem. At the end of 2014 China announced that it would stop taking transplant quality organs from dead (usually executed) prisoners as of 2015.

Many Chinese and foreigners believed that this profitable organ trade would simply go underground and become another source of corruption. .

Corruption in China? Who wudda thot?

Some of the organs are from executed prisoners, but what about the others? Is there an illegal underground "pay for organ" service, as we see here in the Philippines? or is something more cynical going on?

Since China still executes hundreds of criminals each year, and has thousands of political prisoners, who often go into prison camps and just disappear, there always seems to be available organs for transplant in China.

For years desperate, and well heeled, foreigners come to China, got their life-saving transplant, and noticed that there are a lot of military personnel working in the hospitals. ..

..The Chinese government still insists there is no government involvement in this transplant industry, yet the operations continue and may be closer to 100,000 transplants in some years.

 Sigh.

Wikipedia even has a page on the harvesting of organs from Falun Gong prisoners, whose only crime is to belong to a forbidden Buddhist sect. Dean Koontz wrote a horror novel about this practice, but as a whole, few in the west seem upset at the practice and few even protested when a rich New York writer's book about getting a kidney in China makes light of the question of who died was killed to sell his brother a kidney.

China is a rogue nation in these matters, of course (I mean, they have a million Muslims in re education camps without many in the west protesting about it).

But when Canada starts normalizing the practice of killing people for organs, I think the problem is a a prediction of things to come in the USA.
from https://spectator.org/canada-conjoins-euthanasia-and-organ-harvesting/

ow do you convince society to embrace euthanasia as a means of attaining utilitarian benefit — while also convincing yourselves that your culture remains both moral and compassionate? Once you get past the squeamishness of allowing doctors to kill patients, it isn’t that difficult: First, legalize euthanasia of the seriously ill and disabled. Once the community becomes comfortable with doctors committing homicide as a means of eliminating suffering, you next allow those who want to be killed to donate their organs. After all, they won’t need their livers anymore, so why not let others have them? Next, ensure that the potential of euthanasia to add to the organ supply becomes well known, both to normalize doctor-administered death and to induce people to believe they or a loved one might personally benefit from doctors killing the sick. Finally, over time, you expand euthanasia/organ donation eligibility to patients who are far from death, such as those with neuromuscular disabilities or psychiatric illnesses — better organs, don’t you know — justifying it as you go along with soothing words of respecting autonomy and preventing suffering. Lest any reader believe that I am conjuring a paranoid dystopian fantasy, this very scenario consumed the medical and organ transplant ethics of the Netherlands and Belgium, nations in which patients with mental illnesses and other diseases are admitted to hospitals, killed by lethal injection, and then wheeled immediately into a surgical suite for organ harvesting.

When I bring up these facts in domestic debates about assisted suicide, supporters of doctor-prescribed death sniff that the Netherlands and Belgium are not the United States, and that such crass utilitarian exploitation of the despairing would never happen here. But why? Once we deem certain categories of people to be killable — which is precisely what legalizing assisted suicide and euthanasia does — it becomes all too easy to conclude, as Belgians and Netherlanders have, that since these patients want to die we might as well benefit societally from their deaths.

That is precisely what happened in Canada,

corruption link ignored in contaminaed Valsartan problem

this is cross posted from my main blog.

CNBC notes another batch of Valsartan, a medicine used for high blood pressure and heart failure, has been found to be contaminated with small amounts of a cancer causing chemicals.

But missing from the story: Where was it manufactured?

From Sciencemagazine.

In this case, the valsartan recall was originally traced back to a problem with the material from Zhejiang Huahai Pharmaceuticals. 

Remember that name: ZHP.
That’s the Chinese manufacturer who made the API itself. but some of it was repackaged.
however, it wasn't just ZHP: the newest batch recalled? That was made in India.

the article goes into details about manufacturing, but if you continue reading you find (TADA!) the source of the problem:

But how do you get N-nitroso compounds from the amines, and why was the solvent switched? Well, the classic industrial syntheses of these molecules involved reacting an aryl nitrile with tri-n-butyltin azide (often formed in situ from the trialkyltin chloride).

ZHP themselves appear to have introduced a cheaper, higher-yielding route using just sodium azide and zinc chloride in an aprotic solvent like DMF...

italics mine.

 The excess azide is consumed at the end of the process using sodium nitrite – but nitrite under acidic conditions will give you some nitrous acid, and nitrous acid will react with secondary amines to give you N-nitrosoamines. That would seem to be the root of the problem. Well, one of the roots. The second problem is that no one apparently picked up on the N-nitroso contaminants for years.

so it's also the first world drug companies who are at fault for trusting the manufacturers were being honest and following manufacturing protocol

and after ZHP got away with it, apparently other manufacturers decided they could get away with it too.

why is this little fact important? Because those of us in third world countries know there is a huge problem with contaminated, fake, and substandard medicines mainly from China, and also India and other third world countries.

Yes, much of the medicine is generic but by US/European/Israeli companies, but the dirty little secret is a lot of the world's medicines are outsourced to companies who can manufacture it cheaper.

and the Science magazine article naively wonders what is behind the problem.

 So we’re going to have to think about the way that synthetic routes in the generic API business are monitored, it would seem. People seem to have missed that changing the chemistry for the sartans could lead to this problem, so what else are we missing?

again, italics mine.
Anyone here in Asia could tell you what you are missing:
uh, it's the culture of corruption that is the problem.

World Health Organization article on this problem estimates one out of ten medicines sold in third world countries are fake, counterfeit, substandard or have toxic additives.:

No countries remain untouched by this issue — from North America and Europe through to sub-Saharan Africa, South East Asia, and Latin America. What was once considered a problem limited to developing and low-income countries has now become an issue for all.

With the exponential increase in internet connectivity those engaged in the manufacture, distribution and supply of substandard and falsified medical products have gained access to a global market place. This extends both to consumers and business forums. ...

However, it is in low- and middle-income countries and those in areas of conflict, or civil unrest, where health systems are weak or non-existent that bear the greatest burden of substandard and falsified medical products.

Measles in the DR Congo

AlJ reports:

Nearly 90,000 suspected cases of airborne infection recorded since January, health minister says....
Ilunga added the mortality rate was estimated to be at 1.8 percent, a figure which translates to more than 1,500 deaths.

actually, I suspect the death rate is higher: often the children get better after the rash disappears, then they die one or two weeks later because Measles causes "anergy" or lowered immune system response, and die of pneumonia or tuberculosis.

 "To stop the chain of measles transmission and prevent future epidemics, at least 95 percent of the population have to be vaccinated," he said. More than two million children were vaccinated in April, according to the health ministry, with anothe

r immunisation campaign covering a further 1.4 million others set to be launched "in the coming days".

typhoid in Los Angeles

....

the NewAmerican has an article on the trash problem in Los Angeles.

Typhus is a disease born of filth, most commonly spread by contact with the feces of fleas. It is most often reported in the third world or places such as POW camps where hygiene is of little concern. Last year, Los Angeles County reported a record 124 confirmed cases of the disease, enough to be classified as a full-blown outbreak. So far, in 2019, more than 50 cases have been reported. The reason? Fleas are attracted to rats and rats are attracted to huge piles of food-waste infused garbage, like the ones that currently litter vast portions of downtown Los Angeles. 

he overburdened sanitation department does the best it can, but it simply doesn’t have the manpower necessary to keep up with the gigantic piles of filth that spring up quickly and are left to grow and rot for months at a time. A spokesperson for the city’s Department of Public Works reports that the current backlog for trash pickups around the city’s homeless encampments stands at approximately 8,400, with an average of six calls per site.

the Atlantic article (March) about the problem in Los Angeles among the homeless.

Los Angeles recently experienced an outbreak of typhus—a disease spread by infected fleas on rats and other animals—in downtown streets. Officials briefly closed part of City Hall after reporting that rodents had invaded the building. People in Washington State have been infected with Shigella bacteria, which is spread through feces and causes the diarrheal disease shigellosis, as well as Bartonella quintana, or trench fever, which spreads through body lice.*

Hepatitis A, also spread primarily through feces, infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio, and Kentucky, primarily among people who are homeless or use drugs.

Public-health officials and politicians are using terms like disaster and public-health crisis to describe the outbreaks, and they are warning that these diseases can easily jump beyond the homeless population. “Our homeless crisis is increasingly becoming a public-health crisis,” California Governor Gavin Newsom said in his State of the State speech in February, citing outbreaks of hepatitis A in San Diego County, syphilis in Sonoma County, and typhus in Los Angeles County. “Typhus,” he said. “A medieval disease. In California. In 2019.”.....

. Bubonic plague could be next.

NPR article from August 2018. So it means it's not a new problem.

Medical journal Article about the Hepatitis outbreak in SanDiego that started in 2016.

The hepatitis A outbreak affected 588 individuals. An epidemiologic and morphologic review of the cases with a focus on the UCSD patients was performed. No common sources of food, beverage or drugs have been identified that have contributed to this outbreak. Mode of distribution is likely direct person to person transmission. The health department initiated an extensive public vaccination and education campaign, distributed hygiene kits, deployed portable bathroom and hand washing and declared a local public health emergency. Due to the extensive public health campaign, the outbreak seems to be under control as of January 2018.

the epidemic started in 2016, but the WAPO finally noticed it in 2017, explaining how "power spraying" with bleach and other basic public health hygiene methods were being used to control the disease.

Actually the hepatitis epidemics was the harbinger of these plagues, and it is due to neglect by local governments. And that epidemic was noted as a problem a couple years ago. (2016-2018), meaning it can't be blamed on Trumpie boy, but wait and they will manage to politicize the problem.

Ah, but their priorities are in place: They banned Plastic straws.

cross posted to my regular blog.