Public Health Engagement Aff Notes



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Disease

Disease Turns

Allowing a pandemic to erupt may deteriorate strength of similar disease strains


Canadian Press '09 (Associated Press, "Experts say pandemic could have a silver lining", CTV News, December 22, www.ctvnews.ca/experts-say-pandemic-could-have-a-silver-lining-1.467208, CL)

TORONTO - When you think of a flu pandemic, the images that come to mind are of people sick and people dying. But influenza experts quietly admit there may be a silver lining -- or several -- to the H1N1 pandemic that erupted this year. Not just in the event itself, which was milder than feared, but also in the viral legacy it may leave. In the wake of this pandemic, flu vaccine could be easier to make or could cover more targets. A tricky problem of drug resistance could disappear. And the toll influenza takes on the elderly could conceivably ease, at least for awhile. Before going too far down What-If Road, however, it's important to note that predicting influenza's path is a mug's game. The longer people study it, the less likely they are to try to guess what influenza viruses may do. "I don't know - right now everything's a possibility as far as I'm concerned," Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy, cautions when asked about what the flu landscape might look like in the aftermath of this pandemic. Still, even experts who share that understanding are thinking about some possibilities. Their optimism is in large part fuelled by a phenomenon known as viral replacement which has been seen in previous pandemics, or at least the three that have been studied using modern laboratory techniques. In simple terms, during the pandemics of the 20th century - 1918, 1957 and 1968 - the new virus snuffed out its viral predecessor. If the same thing occurs as a result of the pandemic of 2009, the world might actually one day look back fondly on the swine flu virus that caught us all by surprise last spring, some suggest. "If this pandemic virus were to replace seasonal strains, either H3(N2) or H1(N1), that may be a blessing in disguise," says Dr. Danuta Skowronski, an influenza epidemiologist at the British Columbia Centre for Disease Control. To grasp the significance of what might be afoot, it's helpful to have some flu basics. Influenza viruses are divided into three large families, A, B and C, though C viruses are thought to bit players when it comes to human illness. Pandemics can only be triggered by influenza A viruses. And historically there was only ever one subtype of influenza A around at a time. But that changed in 1977 when H1N1 viruses, which had stopped circulating 11 years earlier, mysteriously re-emerged. (It is widely believed the virus "escaped" from a Russian lab as a result of a research accident.) Since then, there have been two flu A viruses circulating, seasonal H1N1 and H3N2. Annual flu shots target both A viruses plus one of two families of influenza B viruses. Influenza B causes a fair amount of human illness. And earlier this year there was some debate about making a four-component or quadrivalent vaccine to include both B families. But there has been hesitancy because making the trivalent vaccine every year is challenging enough. If the pandemic H1N1 gets rid of both H3N2 and seasonal H1N1, vaccine manufacturers would only need to include one influenza A component - the 2009 H1N1 - in seasonal flu shots. They could make a bivalent - two component - vaccine, which would be easier to produce. Or they could stick with a trivalent shot, but have it cover one A and both Bs, making the shot more protective. Getting rid of both of the previous seasonal A viruses also appeals from another point of view. H3N2 is a nasty virus, one which takes a heavy toll on the elderly. No one in public health would miss H3N2 if it disappeared. "It would be the most amazing thing," says Dr. Allison McGeer, a flu expert at Toronto's Mount Sinai Hospital. "Because a the great majority of nursing home outbreaks are (caused by) H3N2. You get rid of 80 per cent of influenza outbreaks in nursing homes - (it would) be brilliant." Dr. Anthony Mounts, a flu expert with the World Health Organization, says since this pandemic started people have gone back and studied the patterns of H1N1 and H3N2 seasons. When H1N1 viruses predominate, younger people are generally hit harder; during H3N2 seasons, as McGeer observes, the worst of the illness occurs in the elderly. "Why that is, I don't think anybody really understands," he says. But children and adults respond better to flu vaccine than do seniors, whose immune systems are breaking down with age. So if the burden of influenza shifts down the age spectrum, the primary tool available to fight it - vaccine - could be targeted to people who get more benefit from it. And younger people are less likely to die of flu than seniors, in whom a bout of flu can be the proverbial final straw. "That might be actually the silver lining, is that this is something that's less deadly than H3 and maybe something that we can do more about," says Mounts, who, like Osterholm, is quick to warn "it's all conjecture at this point." The WHO's top flu expert injects a note of caution of his own. Dr. Keiji Fukuda points out the pandemic caused by H3N2 was the mildest of the three in the last century. Its behaviour as a pandemic virus did not foreshadow what was to come. "Do we know that this H1N1 virus is going to always be like it is now? The chances are: Probably not," Fukuda says. "I mean, it could stay mild all the time, but I think the lessons from H3N2 is that something which starts out and looks relatively mild in fact can become something which becomes more severe over time." As it is, many flu experts think we may be stuck with H3N2 for awhile yet. They are not convinced the pandemic virus can oust it as well as seasonal H1N1. Dr. Arnold Monto, of the University of Michigan, notes H3N2 viruses are still circulating in pockets of Southeast Asia and in the tropics. He won't venture to guess whether they will die out there too, or if those regions will serve as a reservoir for resurgent H3N2 activity. "Flu is un-pre-dict-able," he says, stringing out the word for emphasis. Dr. Nancy Cox isn't convinced H3N2 is going away. But the head of the influenza division of the U.S. Centers for Disease Control would be happy with a one-for-one exchange, with the pandemic H1N1 replacing the seasonal virus of the same name. That's because seasonal H1N1 viruses are resistant to oseltamivir (Tamiflu), the main drug used to fight flu. The pandemic H1N1 viruses are susceptible to Tamiflu, though they are resistant to two older flu drugs, amantadine and rimantadine. Those two drugs aren't widely used anymore because resistance to them develops easily. Swapping viruses that are immune to Tamiflu for ones the drug works against would be a bargain, Cox suggests. "Getting rid of resistance in circulating H1N1 viruses would be a real silver lining."

Disease results in a “survival of the fittest” type evolution that strengths our populations


Pappas '14 (Stephanie Pappas, a science writer for LiveScience, where she focuses on psychology and neuroscience, "Black Death Study Shows Europeans Lived Longer After 14th Century Pandemic", The Huffington Post, May 12, www.huffingtonpost.com/2014/05/11/black-death-europeans-pandemic_n_5289650.html, CL)

The Black Death, a plague that first devastated Europe in the 1300s, had a silver lining. After the ravages of the disease, surviving Europeans lived longer, a new study finds. An analysis of bones in London cemeteries from before and after the plague reveals that people had a lower risk of dying at any age after the first plague outbreak compared with before. In the centuries before the Black Death, about 10 percent of people lived past age 70, said study researcher Sharon DeWitte, a biological anthropologist at the University of South Carolina. In the centuries after, more than 20 percent of people lived past that age. “It is definitely a signal of something very important happening with survivorship,” DeWitte told Live Science. [Images: 14th-Century Black Death Graves] The plague years: The Black Death, caused by the Yersinia pestis bacterium, first exploded in Europe between 1347 and 1351. The estimated number of deaths ranges from 75 million to 200 million, or between 30 percent and 50 percent of Europe’s population. Sufferers developed hugely swollen lymph nodes, fevers and rashes, and vomited blood. The symptom that gave the disease its name was black spots on the skin where the flesh had died. Scientists long believed that the Black Death killed indiscriminately. But DeWitte’s previous research found the plague was like many sicknesses: It preferentially killed the very old and those already in poor health. That discovery raised the question of whether the plague acted as a “force of selection, by targeting frail people,” DeWitte said. If people’s susceptibility to the plague was somehow genetic — perhaps they had weaker immune systems, or other health problems with a genetic basis — then those who survived might pass along stronger genes to their children, resulting in a hardier post-plague population. In fact, research published in February in the journal Proceedings of the National Academy of Sciences suggested that the plague did write itself into human genomes: The descendants of plague-affected populations share certain changes in some immune genes. Post-plague comeback: To test the idea, DeWitte analyzed bones from London cemeteries housed at the Museum of London’s Centre for Human Bioarchaeology. She studied 464 skeletons from three burial grounds dating to the 11th and 12th centuries, before the plague. Another 133 skeletons came from a cemetery used after the Black Death, from the 14th into the 16th century. These cemeteries provided a mix of people from different socioeconomic classes and ages. The longevity boost seen after the plague could have come as a result of the plague weeding out the weak and frail, DeWitte said, or it could have been because of another plague side effect. With as much as half of the population dead, survivors in the post-plague era had more resources available to them. Historical documentation records an improvement in diet, especially among the poor, DeWitte said. “They were eating more meat and fish and better-quality bread, and in greater quantities,” she said. Or the effect could be a combination of both natural selection and improved diet, DeWitte said. She’s now starting a project to find out whether Europe’s population was particularly unhealthy prior to the Black Death, and if health trends may have given the pestilence a foothold. The Black Death was an emerging disease in the 14th century, DeWitte said, not unlike HIV or Ebola today. Understanding how human populations responded gives us more knowledge about how disease and humanity interact, she said. Y. pestis strains still cause bubonic plague today, though not at the pandemic levels seen in the Middle Ages.

Won’t Spread

Pandemics won’t spread—Ebola proves


Fox '14 (Maggie Fox, Senior writer for NBC News, "Don't Panic: Why Ebola Won't Become an Epidemic in New York", NBC News, October 23, www.nbcnews.com/storyline/ebola-virus-outbreak/dont-panic-why-ebola-wont-become-epidemic-new-york-n232826, CL)

A New York City doctor just back from volunteering in Africa with Doctors Without Borders has tested positive for Ebola — a high price to pay for trying to help fight an epidemic that’s killed more than 4,500 people and threatens to infect tens of thousands. The doctor, identified as Dr. Craig Spencer of Columbia University, correctly warned other experts before he was taken to Bellevue Hospital, which has been gearing up to tackle Ebola cases. New York Presbyterian Hospital/Columbia Medical Center, where he usually worked, says he stayed away during the virus’ 21-day incubation period. “He is a committed and responsible physician who always puts his patients first. He has not been to work at our hospital and has not seen any patients at our hospital since his return from overseas,” it said in a statement Thursday night. Ebola only spreads via bodily fluids. Think wet and warm. The virus lives in vomit, diarrhea, blood and sweat. Heat kills it, it doesn’t survive being dried out, and it doesn’t travel through the air. It also doesn’t appear to stick to surfaces much, so unless Spencer threw up in a public place, he would not have exposed the public to the virus. Even if he did, someone would have to touch it and then carry wet particles to their eyes, nose or mouth to become infected. Ebola patients cannot infect others before they are sick themselves. No one has been documented to have spread the virus before showing symptoms such as a high fever, vomiting and diarrhea. The virus builds up in the body as patients get sicker. In fact, people in the early stages of Ebola infection often test negative for the virus, because there’s not very much in their blood. While the virus is found in sweat and that might make people wary of public transport, what's meant by that is that it’s found in the profuse sweat of very ill patients and unlikely to be in the normal perspiration of an otherwise asymptomatic person. The people most at risk of Ebola are caregivers and health care workers, who are physically touching Ebola patients at their sickest. In 40 years of studying Ebola outbreaks, no one has seen a mystery case. People are infected by direct contact with others — not casual contact on buses, trains or in the street. Thomas Eric Duncan, the first person to die of Ebola in the United States, didn’t infect his girlfriend or other people who were in an apartment with him after he became ill. Close to 50 people who had some sort of contact with him all have passed the 21-day incubation period without disease. He did infect two nurses who had been intensively caring for him when he was very ill. Ebola has to get inside you to infect you. Unlike measles or tuberculosis, you can’t just breathe in Ebola virus and get infected. For one thing, it doesn't float in the air like those germs do. It must get into the eyes, nose or mouth, or get past the very strong barrier that is human skin, carried by a needle or perhaps through a fresh cut. Soap and water quickly removes Ebola virus and bleach or alcohol kills it quite effectively

Vaccines solve


NIH '08 (NIH Medline Plus, "Vaccines Stop Illness", National Institute of Health, Spring 2008, https://medlineplus.gov/magazine/issues/spring08/articles/spring08pg6.html, CL)

To prevent the spread of disease, it is more important than ever to vaccinate your child. In the United States, vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not protected by vaccines. Vaccine-preventable diseases have many social and economic costs: sick children miss school and can cause parents to lose time from work. These diseases also result in doctor's visits, hospitalizations, and even premature deaths. Some diseases (like polio and diphtheria) are becoming very rare in the United States. Of course, they are becoming rare largely because we have been vaccinating against them. Unless we can completely eliminate the disease, it is important to keep immunizing. Even if there are only a few cases of disease today, if we take away the protection given by vaccination, more and more people will be infected and will spread disease to others. We don't vaccinate just to protect our children. We also vaccinate to protect our grandchildren and their grandchildren. With one disease, smallpox, we eradicated the disease. Our children don't have to get smallpox shots anymore because the disease no longer exists. If we keep vaccinating now, parents in the future may be able to trust that diseases like polio and meningitis won't infect, cripple, or kill children.

Quarantine Works

Quarantine methods in the SQ are the most effective


Hill-Cawthorne '14 (Grant hill-Cawthorne, lecturer in Communicable Disease Epidemiology at the University of Sydney, "Quarantine works against Ebola but over-use risks disaster", The Conversation, October 1, theconversation.com/quarantine-works-against-ebola-but-over-use-risks-disaster-32112, CL)

A man in the United States has become the first known international traveller to be infected in the West Africa Ebola epidemic and carry the virus abroad. He is thought to have been infected in Liberia and developed symptoms six or seven days after arriving in the United States to visit family. He’s being treated in isolation in Dallas, Texas. Quarantine, in the form of isolation, is an important component of the response to Ebola infection. As people are infectious only once they develop symptoms, isolating them and having health-care workers use personal protective equipment significantly reduces the risk of onward transmission. The director of the US Centers for Disease Control and Prevention (CDC) says the man will continue to be treated in isolation. In a process known as contact tracing, everyone he has come in contact with since he became symptomatic on September 24 will be located and monitored for 21 days (the maximum incubation period of the virus). Anyone who shows symptoms will also be isolated and treated. The Ebola virus is unlikely to spread further in the United States because these measures are known to be effective. Indeed, their absence has contributed significantly to the spread of the virus in resource-poor nations of West Africa.

The benefits of quarantine: Countries have been practising this measure against infectious diseases well before we understood what caused and transmitted infections. The earliest mention of isolating people in this way is in the books of the Old Testament, for leprosy and other skin diseases. The word “quarantine” comes from the Italian “quaranta giorni” which simply means “40 days”. It refers to the 40-day isolation period imposed by the Great Council of the City of Ragusa (modern day Dubrovnik, Croatia) in 1377 on any visitors from areas where the Black Death was endemic. In its most basic form, quarantine is the isolation of people with a disease from unaffected people. The measure has clear benefits; it was effective during the 2003 pandemic of SARS-coronavirus when the isolation of cases and their contacts for ten days was arguably one of the most significant interventions for containing the outbreak in only five months. And it has frequently been used to control Ebola outbreaks. Since the virus' first and most severe outbreak in 2000, Uganda has used quarantine measures to good effect, isolating contacts of cases for up to the 21 days of the viral incubation period. Surveillance, a more Ebola-educated populace and targeted quarantine measures have meant Uganda had only 149 cases with 37 deaths, one case and death, and 31 cases with 21 deaths in subsequent outbreaks in 2007, 2011 and 2012. Nigeria has also demonstrated the efficacy of a contact tracing and isolation approach. Despite being one of the most populous countries in Africa and having cases introduced into Lagos, a city of 21 million people, its last case was seen on September 5. Removing infected and potentially infectious people from the community clearly helps reduce the spread of disease, but it still requires a place for people to be isolated and treated. That’s what’s missing in countries still in the midst of the epidemic, and also what continues to drive it.

Quarantine empirically works at a high level


Nishiura et al. '09 (Hiroshi Nishiura, Nick Wilson, and Michael G Baker, Associate Professor / MD, PhD at the University of Tokyo, "Quarantine for pandemic influenza control at the borders of small island nations", BioMed Central, March 11, bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-9-27, CL)

Background: Although border quarantine is included in many influenza pandemic plans, detailed guidelines have yet to be formulated, including considerations for the optimal quarantine length. Motivated by the situation of small island nations, which will probably experience the introduction of pandemic influenza via just one airport, we examined the potential effectiveness of quarantine as a border control measure. Methods: Analysing the detailed epidemiologic characteristics of influenza, the effectiveness of quarantine at the borders of islands was modelled as the relative reduction of the risk of releasing infectious individuals into the community, explicitly accounting for the presence of asymptomatic infected individuals. The potential benefit of adding the use of rapid diagnostic testing to the quarantine process was also considered. Results: We predict that 95% and 99% effectiveness in preventing the release of infectious individuals into the community could be achieved with quarantine periods of longer than 4.7 and 8.6 days, respectively. If rapid diagnostic testing is combined with quarantine, the lengths of quarantine to achieve 95% and 99% effectiveness could be shortened to 2.6 and 5.7 days, respectively. Sensitivity analysis revealed that quarantine alone for 8.7 days or quarantine for 5.7 days combined with using rapid diagnostic testing could prevent secondary transmissions caused by the released infectious individuals for a plausible range of prevalence at the source country (up to 10%) and for a modest number of incoming travellers (up to 8000 individuals).


No Extinction

Pandemics won’t kill everyone—extinction won’t happen


Adalja '16 (Amesh Adalja, an infectious-disease physician at the University of Pittsburgh, "Why Hasn't Disease Wiped out the Human Race?", The Atlantic, June 17, www.theatlantic.com/health/archive/2016/06/infectious-diseases-extinction/487514/)

“You’ll tell us when you’re worried, right?” That was the question posed to me countless times at the height of the 2014 West African Ebola outbreak. As an infectious disease physician, I was interviewed on outlets such as CNN, NPR, and Fox News about the dangers of the virus, and the answer I gave was always the same: “Ebola is a deadly, scary disease, but it is not that contagious. It will not find the U.S. or other industrialized nations hospitable.” In other words, no, I wasn’t worried—and not because I have a rosy outlook on infectious diseases. I’m well-aware of the damage these diseases are causing around the world: HIV, malaria, tuberculosis; the influenza pandemic that took the world by surprise in 2009; the anti-vaccine movement bumping cases of measles to an all-time post-vaccine-era high; antibiotic-resistant bacteria threatening to collapse the entire structure of modern medicine—all these, like Ebola, are continuously placing an enormous number of lives at risk. But when people ask me if I’m worried about infectious diseases, they’re often not asking about the threat to human lives; they’re asking about the threat to human life. With each outbreak of a headline-grabbing emerging infectious disease comes a fear of extinction itself. The fear envisions a large proportion of humans succumbing to infection, leaving no survivors or so few that the species can’t be sustained. I’m not afraid of this apocalyptic scenario, but I do understand the impulse. Worry about the end is a quintessentially human trait. Thankfully, so is our resilience. For most of mankind’s history, infectious diseases were the existential threat to humanity—and for good reason. They were quite successful at killing people: The 6th century’s Plague of Justinian knocked out an estimated 17 percent of the world’s population; the 14th century Black Death decimated a third of Europe; the 1918 influenza pandemic killed 5 percent of the world; malaria is estimated to have killed half of all humans who have ever lived. Any yet, of course, humanity continued to flourish. Our species’ recent explosion in lifespan is almost exclusively the result of the control of infectious diseases through sanitation, vaccination, and antimicrobial therapies. Only in the modern era, in which many infectious diseases have been tamed in the industrial world, do people have the luxury of death from cancer, heart disease, or stroke in the 8th decade of life. Childhoods are free from watching siblings and friends die from outbreaks of typhoid, scarlet fever, smallpox, measles, and the like. So what would it take for a disease to wipe out humanity now? In Michael Crichton’s The Andromeda Strain, the canonical book in the disease-outbreak genre, an alien microbe threatens the human race with extinction, and humanity’s best minds are marshaled to combat the enemy organism. Fortunately, outside of fiction, there’s no reason to expect alien pathogens to wage war on the human race any time soon, and my analysis suggests that any real-life domestic microbe reaching an extinction level of threat probably is just as unlikely. Any apocalyptic pathogen would need to possess a very special combination of two attributes. First, it would have to be so unfamiliar that no existing therapy or vaccine could be applied to it. Second, it would need to have a high and surreptitious transmissibility before symptoms occur. The first is essential because any microbe from a known class of pathogens would, by definition, have family members that could serve as models for containment and countermeasures. The second would allow the hypothetical disease to spread without being detected by even the most astute clinicians. The three infectious diseases most likely to be considered extinction-level threats in the world today—influenza, HIV, and Ebola—don’t meet these two requirements. Influenza, for instance, despite its well-established ability to kill on a large scale, its contagiousness, and its unrivaled ability to shift and drift away from our vaccines, is still what I would call a “known unknown.” While there are many mysteries about how new flu strains emerge, from at least the time of Hippocrates, humans have been attuned to its risk. And in the modern era, a full-fledged industry of influenza preparedness exists, with effective vaccine strategies and antiviral therapies. HIV, which has killed 39 million people over several decades, is similarly limited due to several factors. Most importantly, HIV’s dependency on blood and body fluid for transmission (similar to Ebola) requires intimate human-to-human contact, which limits contagion. Highly potent antiviral therapy allows most people to live normally with the disease, and a substantial group of the population has genetic mutations that render them impervious to infection in the first place. Lastly, simple prevention strategies such as needle exchange for injection drug users and barrier contraceptives—when available—can curtail transmission risk. Ebola, for many of the same reasons as HIV as well as several others, also falls short of the mark. This is especially due to the fact that it spreads almost exclusively through people with easily recognizable symptoms, plus the taming of its once unfathomable 90 percent mortality rate by simple supportive care. Beyond those three, every other known disease falls short of what seems required to wipe out humans—which is, of course, why we’re still here. And it’s not that diseases are ineffective. On the contrary, diseases’ failure to knock us out is a testament to just how resilient humans are. Part of our evolutionary heritage is our immune system, one of the most complex on the planet, even without the benefit of vaccines or the helping hand of antimicrobial drugs. This system, when viewed at a species level, can adapt to almost any enemy imaginable. Coupled to genetic variations amongst humans—which open up the possibility for a range of advantages, from imperviousness to infection to a tendency for mild symptoms—this adaptability ensures that almost any infectious disease onslaught will leave a large proportion of the population alive to rebuild, in contrast to the fictional Hollywood versions. While the immune system’s role can never be understated, an even more powerful protector is the faculty of consciousness. Humans are not the most prolific, quickly evolving, or strongest organisms on the planet, but as Aristotle identified, humans are the rational animals—and it is this fundamental distinguishing characteristic that allows humans to form abstractions, think in principles, and plan long-range. These capacities, in turn, allow humans to modify, alter, and improve themselves and their environments. Consciousness equips us, at an individual and a species level, to make nature safe for the species through such technological marvels as antibiotics, antivirals, vaccines, and sanitation. When humans began to focus their minds on the problems posed by infectious disease, human life ceased being nasty, brutish, and short. In many ways, human consciousness became infectious diseases’ worthiest adversary. None of this is meant to allay all fears of infectious diseases. To totally adopt a Panglossian viewpoint would be foolish—and dangerous. Humans do face countless threats from infectious diseases: witness Zika. And if not handled appropriately, severe calamity could, and will, ensue. The West African Ebola outbreak, for instance, festered for months before major efforts to bring it under control were initiated. When it comes to infectious diseases, I’m worried about the failure of institutions to understand the full impact of outbreaks. I’m worried about countries that don’t have the infrastructure or resources to combat these outbreaks when they come. But as long as we can keep adapting, I’m not worried about the future of the human race.

H1N1 proves the threat of pandemics are overestimated


Gross '06 (Terry Gross, bachelor's degree in English and M.Ed. in communications from the State University of New York at Buffalo & recognized with the Columbia Journalism Award and an Honorary Doctor of Humanities degree from Princeton University in 2002, "The Next Pandemic: Bird Flu, or Fear?", NPR, Feb 2, www.npr.org/templates/story/story.php?storyId=5183999, CL)

Fear and paranoia often take hold when a disease threatens to become an epidemic. Dr. Marc K. Siegel is the author of the new book Bird Flu: Everything You Need to Know About the Next Pandemic. Bird Flu takes on the issues that are injected with a sense of panic and dread, as many parts of the world have grown to fear the spread of a deadly influenza outbreak in recent years. That outbreak, says Siegel, is a distinct possibility. But he urges those who may be at risk to trust in reason — and ignore the hype — in judging the risks. In making his case for an honest appraisal of the dangers, Siegel cites progress in vaccine work and improved living conditions world-wide as two improvements that should make an epidemic far less deadly than that of 1918. Siegel's previous books include False Alarm: The Truth About the Epidemic of Fear, in which he argues against paranoia and reactionary strategies in health care and public safety. Siegel, who teaches at the New York University School of Medicine, is also a weekly columnist for The New York Daily News. He is a frequent contributor to The Los Angeles Times and The Washington Post. All bird flus are influenza A. Influenza A is primarily a respiratory virus, causing coughing, congestion, sore throat, muscle aches, fatigue, and fever in most species it infects. This strain (also called the H5N1 virus) surfaced in Hong Kong eight years ago, although it may have been around for four decades previous to this. It has mostly been affecting Asian poultry. When tested in the laboratory, it has been found to be quite deadly, killing ten out of ten chick embryos against which it was tested. It is difficult to tell how many birds it has killed in Asia, though, because millions of birds have been killed by humans to prevent its spread. As soon as one chicken develops symptoms, it is killed along with all the chickens that may have come in contact with it. BIRD FLU BASICS It appears to be quite deadly to humans as well, although in Hong Kong in 1997 many humans reportedly developed antibodies to the virus and did not get sick. There is concern that if the virus mutated, it could cause a pandemic because we do not have built-up immunity to it. This mutation could occur either at random or if the virus mixes its DNA with a human flu virus inside a pig or a human. But it's also quite possible (in fact it's even more likely) that it may never mutate at all or that if it does mutate, the mutated virus would result in a much less severe illness in humans. What is influenza? Influenza is a virus. Unlike bacteria, which are single cells, a virus is not a full cell and cannot reproduce on its own. To reproduce, a virus infects a cell and uses the resources of that cell. Essentially, a virus is just a sack of genetic material enclosed by a protein envelope. Viruses don't even fit the definition of "alive," though most scientists agree that they are. There are two types of viruses: DNA (deoxyribonucleic acid) and RNA (ribonucleic acid). Influenza is an RNA virus. Influenza comes in two main varieties: A and B. (It also comes in a C, which rarely causes illness.) Influenza A viruses are found in many different animals, including ducks, chickens, pigs, whales, horses, and seals. Influenza B viruses circulate widely only among humans and generally do not make us as sick as influenza A does. Influenza A viruses are divided into subtypes based on two bumpy proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). These two identifying proteins are why the current bird flu is referred to as H5N1. There are 16 different hemagglutinin subtypes and 9 different neuraminidase subtypes, all of which have been found among influenza A viruses in wild birds. H5 and H7 subtypes include all the current pathogenic strains. How does influenza spread and what complications does it cause? Influenza is spread by airborne droplets and is inhaled into the respiratory tract. It incubates in the body from one to four days before a person feels ill. Complications tend to occur in the very young, in the elderly, and in patients with chronic cardiopulmonary diseases. The major complication of flu is pneumonia from influenza itself, or bacterial pneumonia from pneumococcus or haemophilus. How is influenza diagnosed? Influenza is most commonly diagnosed by recognizing symptoms or by direct examination of respiratory secretions. Blood examination (serology) can determine exposure. What is a pandemic? A pandemic occurs when many people in several different regions of the world are suffering from a specific illness at the same time. Human pandemics may occur when we are exposed to a virus strain for the first time and we lack immunity to it. Is there a bird flu test? The current bird flu is diagnosed by testing the blood for antibodies to the H5N1 strain. The test is 100 percent accurate, though it doesn't tell how sick a bird (or a person) is. Transmission from bird to human is possible but rare, and almost exclusively from close or frequent contact. How does a bird get it? It's endemic in birds, especially waterfowl like geese and ducks. It's usually a benign infection of the gastrointestinal or respiratory tracts of waterfowl, and it has existed in birds for many thousands of years. It can pass from wild birds to the poultry on farms when they come into contact, and certain strains, known as pathogenic avian influenza, make these domestic birds very sick. The flu virus mutates frequently, changing its genetics, but it rarely goes through the changes that allow it to routinely infect mammals. How do birds transmit it to each other? Birds transmit viruses the same way we do: by sneezing, coughing, and touching other birds. Is there a cure once you have it? There is no cure for any influenza for either birds or people. The body's own immune system fights it, and antiviral drugs such as amantadine, ramitidine, Relenza, and Tamiflu are probably all effective against H5N1 bird flu, though the degree of effectiveness hasn't been shown. Although there have been over a hundred reported human cases in Asia, it's not clear if more people have it, but it just didn't make them sick. With most cases of the annual flu virus, the vast majority of people get better without serious treatment as their immune system fights off the virus. It's the cases where prolonged recuperation or hospitalization becomes necessary that worry doctors. How fast would a human pandemic spread? There is concern that air travel would accelerate transmission around the world, although scientific recognition of the mutation early on and the worldwide communication network could help to slow its spread by warning people. What should I be doing to protect myself? People are concerned about the possibility of a coming pandemic. The way this information has been communicated in the media and via several of our public health officials carries the message that something major is in the offing. This makes a worst case seem like the only case. In fact, the government has a reason to consider worst-case scenarios as it attempts to protect us, but we need to consider that a massive pandemic may well not be in the offing. As I suggest here specific measures of personal preparation, I, too, must be careful about hidden messages. When I advise a certain kind of preparation, I must consider if I am inadvertently suggesting that something must be about to happen. I do not think a massive bird flu pandemic that kills many millions of people worldwide is about to happen, for reasons that I will go into throughout this book. The major reason is that, as with mad cow disease, which has killed hundreds of thousands of cows but only a little over a hundred people, we are currently protected by a species barrier. For bird flu to pass human to human, further changes in its structure have to occur. Influenza viruses change frequently, but this form of H5N1 appears to have been around since the 1950s, and in the eight years that it has infected millions of birds (1997–2005), documented human cases have been rare (less than 150 clinical infections with 70 deaths at the time of this writing). We don't know how many thousands have developed antibodies to this virus and not gotten sick from it, so it may not be as deadly as it seems to be to humans. If it mutates sufficiently to infect us routinely, it may do so in a way that causes it to be far less lethal. Should I prepare emergency supplies of food and water just in case? Absolutely not. We've been asking one another this question ever since experts told us that the year 2000 bug in our computers would shut down communications and banking nationwide. Sinister things scare us out of proportion to their actual risk of affecting us, and we respond, quite naturally, by wanting to be afraid. But bird flu can be seen as one in a long line of things we've been warned about, and for which we supposedly need some kind of "safe room" with an ample supply of food and water just in case. In one sense, there is little difference between a grizzled terrorist and a mysterious bird flu. Both scare us beyond their reach, beyond the likelihood that they will hurt us. In the wake of 9/11, our leaders have been playing Chicken Little. First it was anthrax, then West Nile virus, then smallpox, then SARS. In each case we were warned that we had no immunity and could be at great risk. In each case there was no accountability going forward, no "We're sorry, we got this one wrong, but we just wanted to prepare you just in case." It is difficult to trust an official who scared us unnecessarily about smallpox to inform us contextually about bird flu, even if that person is a devoted scientist. The national psyche has been damaged by all these false alarms. We each make risk assessments, scanning our environment for potential threats, worrying more and more of the time. The emotional center of the brain, the amygdala, cannot process fear and courage at the exact same moment. If we could train ourselves to filter out dangers that don't threaten us by setting our default drives to courage or caring or laughter, we'd be a lot better off. We don't need emergency supplies of food — we need leaders and information sources we can trust. In a true emergency, our satellite-driven communication system will be our ally, as long as the warnings we receive are accurate and not overblown. Fear is our ultimate warning system, designed to protect us against imminent danger. Our fear responses should not be overdetermined. By jumping from one fear to the next, we create a climate of distrust. One of my patients told me that he is readying for the coming flu pandemic not only by stockpiling food but by keeping two rifles, ammunition, and a trained German Shepherd at the ready. He envisions a scenario where he may have to barricade himself into his house in order to protect his wife and his two young children. He expects people to be dropping dead in the streets of flu, and he anticipates strangers trying to get into his house to hide from the virus. This Hitchcockian image is not only extremely unlikely, it contributes to a pattern of thinking that pits us against one another. It is only a half stop from this kind of irrational fright to deep-rooted prejudices where everyone is "the other" and the only way to maintain safety is to cordon off your house.

Empirics indicate that we always focus on the threat to humans when it won’t spread—combatting the root cause solves better


Gross '06 (Terry Gross, bachelor's degree in English and M.Ed. in communications from the State University of New York at Buffalo & recognized with the Columbia Journalism Award and an Honorary Doctor of Humanities degree from Princeton University in 2002, "The Next Pandemic: Bird Flu, or Fear?", NPR, Feb 2, www.npr.org/templates/story/story.php?storyId=5183999, CL)

How should the government prepare to protect us against the worst case as well as against more likely scenarios The first thrust should be made toward trying to control bird flu in the bird population. Most people who hear about bird flu vastly overestimate how bad this is likely to be for humans, while underestimating how terrible it already is for birds. This particular pathogenic, H5N1, has been spreading and reappearing in birds in Southeast Asia since 1997, and it is quite deadly in birds. Recently it has spread to Turkey and China, and all attempts to stamp it out completely have failed. No one knows what the risk is of it mutating to a form that can routinely be transmitted among humans, but Dr. De Haven, the USDA's chief administrator of the Animal and Plant Health Inspection Service, and many other animal and public health experts believe that the best strategy is to decrease the worldwide viral load by vaccinating large populations of birds in countries where the disease has appeared and culling birds in affected populations.

Alt Causes

Alt causes—lack of government transparency and public trust


Buckley '16 (Chris Buckley, reporter based in China for over a decade whose coverage has included politics, foreign policy, rural issues, human rights, the environment, and climate change for The New York Times, "China’s Vaccine Scandal Threatens Public Faith in Immunizations", The New York Times, April 18, www.nytimes.com/2016/04/19/world/asia/china-vaccine-scandal.html?_r=0)

The greater danger may be more insidious. The erosion of public trust could damage China’s immunization program, which has been credited with significant declines in measles and other communicable diseases.“Confidence is easy to shake, and that’s happened across the world and has happened here,” said Lance Rodewald, a doctor with the World Health Organization’s immunization program in Beijing. “We hear through social media that parents are worried, and we know that when they’re worried, there’s a very good chance that they may think it’s safer not to vaccinate than to vaccinate. That’s when trouble can start.” After unfounded reports of deaths caused by a hepatitis B vaccine in 2013, such vaccinations across 10 provinces fell by 30 percent in the days afterward, and the administration of other mandatory vaccines fell by 15 percent, according to Chinese health officials. The illicit vaccines in the current case were not part of China’s compulsory, state-financed vaccination program, which inoculates children against illnesses such as polio and measles at no charge. The illegal trade dealt in so-called second-tier vaccines — including those for rabies, influenza and hepatitis B — which patients pay for from their own pockets. The pharmacist named in the investigation, Pang Hongwei, bought cheap vaccines from drug companies and traders — apparently batches close to their expiration dates — and sold them in 23 provinces and cities, according to drug safety investigators. She began the business in 2011, just two years after she had been convicted on charges of illegally trading in vaccines and sentenced to three years in prison, which was reduced to five years’ probation. Officials have not explained how she was able to avoid prison and resume her business. Ms. Pang, in her late 40s, and her daughter, who has been identified only by her surname, Sun, kept the vaccines in a rented storeroom of a disused factory in Jinan. The storeroom lacked refrigeration, which may have damaged the vaccines’ potency. The police have detained them but not announced specific charges, and neither suspect has had a chance to respond publicly to the accusations. Lax regulation in the second-tier commercial system allowed Ms. Pang’s business to grow, several medical experts said. Local government medical agencies and clinics were able to increase their profits by turning to cheap, illegal suppliers, People’s Daily, the official party paper, reported on Tuesday. Police investigators discovered Ms. Pang’s storehouse last April, but word did not get out to the public until a Shandong news website reported on the case in February of this year. Most Chinese had still heard nothing about it until another website, The Paper, published a report that drew national attention a month later. It was the government’s intolerance of public criticism, critics said, that kept the scandal under wraps, a delay that now makes it harder to track those who received the suspect injections. “We’ve seen with these problem vaccines that without the right to know, without press freedom, the public’s right to health can’t be assured,” said Wang Shengsheng, one of the lawyers pressing the government for more answers and redress over the case. In the last few weeks, official reticence has been supplanted by daily announcements of arrests, checks and assurances as the central government has scrambled to dampen public anger and alarm. Premier Li Keqiang ordered central ministries and agencies in March to investigate what had gone wrong. Last week, the investigators reported that 202 people had been detained over the scandal, and 357 officials dismissed, demoted or otherwise punished. Health and drug officials promised to tighten vaccine purchase rules to stamp out under-the-counter trade. “How could this trafficking in vaccines outside the rules spread to so many places and go on for so long?” Mr. Li said, according to an official account. Without decisive action, he said, “ordinary people will vote with their feet and go and buy the products they trust.” Mr. Xi has so far not publicly commented on the scandal. Dr. Rodewald, the World Health Organization expert, said the proposed changes were promising and would mean clinics would not have to rely on selling patient-paid vaccines for their upkeep. Xu Huijin, a doctor in Heze, said that the concern over the scandal — and unfounded rumors of deaths — had depressed the number of parents bringing children to her clinic for inoculations. “This was badly handled,” she said. “There was a lack of coordination, not enough information. We should have found out about this long ago. Doctors are taught to tell patients the full facts.”

Can’t solve—environmental degradation is strongly linked with disease breakouts


Cook and Ahoobim '16 (Sonila Cook and Oren Ahoobim, partner and associate partner at Dalberg, "The planet's health is essential to prevent infectious disease", The Guardian, May 15, www.theguardian.com/global-development-professionals-network/2016/may/15/the-planets-health-is-essential-to-prevent-infectious-disease, CL)

The Zika virus, now detected in 42 countries, is only the latest in a series of diseases establishing a new normal for pandemics. Sars ravaged South China in 2003, Middle East Respiratory Syndrome (Mers) shocked the Middle East in 2012, and Ebola devastated west Africa in 2014. We have seen avian influenza emerge in new geographies alongside mosquito-borne viruses, such as Chikungunya. Over the past 50 years, more than 300 infectious pathogens have either newly developed or reemerged in places where they had never been seen before. These trends raise questions: Why are infectious diseases occurring with such frequency? Why are pandemics the new normal? The increased rate of outbreak is typically framed as a failure of the health system. Indeed, that is a critical component. But the conditions that allow for outbreak in the first place are rooted in environmental change. The environmental degradation of natural ecosystems has resulted in many negative outcomes, one of which is the outbreak of infectious disease. The vast majority of human infectious diseases, such as malaria, Zika, and HIV/Aids, originate in animals. When we disrupt the natural environment and habitat of animals, we are poking the beast, so to speak. Take deforestation. Destroying the delicate balance of ecological conditions in forests increases contact between humans and potential reservoirs of disease in the animal population. Evidence shows that Ebola may have been spread to humans who came into contact with infected wildlife, enabled by widespread deforestation. The environment plays a critical role in serving as a buffer against infectious disease. A failure to recognise the value of this service that forests provide means that deforestation and infectious disease outbreaks are likely to continue at alarming rates. Infectious disease is a systems problem that requires systems solutions. Treating only one part of the overall problem – whether by vaccination, quarantine or awareness campaigns – merely scratches the surface. Effective solutions must address the system as a whole, including changes to underlying ecosystems. The field of planetary health has emerged to better understand and solve the integrated relationship between human health and the environment. It aims to shed light on health problems induced by large-scale changes to the environment, and to highlight new ways of working to address these often intractable issues. The connection between environmental change and human health is increasingly clear, but this big-picture view is not how we currently orient ourselves. Take existing public health solutions to Ebola, for example, which are to treat the disease, contain its spread, and prevent it by developing a vaccine. These are all necessary, but they miss a large set of tools found further upstream. A way to access these tools might be to ask ourselves: can we prevent transmission of the Ebola virus from animals to humans to begin with? With planetary health, we have an opportunity to redefine prevention to include upstream solutions that safeguard the environment. For Ebola, this would mean that forest protection efforts would be added to the arsenal of tools we use to fight the disease. These solutions can have multiple benefits to the environment and to human health; for example, in addition to preventing pandemics, reducing deforestation can combat climate change, protect biodiversity, and preserve watersheds that provide clean water to nearby communities. “Public health alone can take us only so far in addressing today’s complex health challenges,” said Michael Myers, managing director of the Rockefeller Foundation. “We see the need for a new interdisciplinary field that’s as relevant for this century as public health was for the last – planetary health, or what we consider public health 2.0. By embracing the new reality that our health and the planet’s health are inextricably linked, the field of planetary health will identify more effective approaches to ensuring our own health.” We don’t know what pandemics are coming in the future. What we do know is that with continued environmental degradation, outbreaks will occur with greater frequency, and the toolkit we are using to control them is incomplete. Planetary health can help us expand the toolkit by finding ways to prevent outbreaks occurring in the first place, allowing us to proactively manage the health of the human population, rather than reactively try to control deadly diseases that we don’t fully understand. In recent years we’ve become more sophisticated at understanding and assessing nature’s value to people; from food and fuel production, to water purification and spiritual renewal, natural ecosystems provide countless services that sustain us. Protection against infectious disease is another critical service. It is time to build a field that fully recognises the important role that the environment plays in our collective health. The survival of our planet and our species depends on it.

Pandemic control depends on vaccination—recent discovery of counterfeit drugs has deeply shaken Chinese trust in the public health system, causing parents to withhold from vaccinating their children


Buckley '16 (Chris Buckley, reporter based in China for over a decade whose coverage has included politics, foreign policy, rural issues, human rights, the environment, and climate change for The New York Times, "China’s Vaccine Scandal Threatens Public Faith in Immunizations", The New York Times, April 18, www.nytimes.com/2016/04/19/world/asia/china-vaccine-scandal.html?_r=0, CL)

HEZE, China — First the news rippled across China that millions of compromised vaccines had been given to children around the country. Then came grim rumors and angry complaints from parents that the government had kept them in the dark about the risks since last year. Now, the country’s immunization program faces a backlash of public distrust that critics say has been magnified by the government’s ingrained secrecy. Song Zhendong, like many parents here, said he was reluctant to risk further vaccinations for his 10-month-old son. “If he can avoid them in the future, we will not get them,” said Mr. Song, a businessman. “Why didn’t we learn about this sooner? If there’s a problem with vaccines for our kids, we should be told as soon as the police knew. Aren’t our children the future of the nation?” The faulty vaccines have become the latest lightning rod for widespread, often visceral distrust of China’s medical system, and a rebuff to what many Chinese critics see as President Xi Jinping’s bulldozing, top-down rule. The scandal is just the latest crisis to shake public faith in China’s food and medicine supplies, but it is the first big scare under Mr. Xi, who had vowed to be different. He came into office promising to “make protecting the people’s right to health a priority.” “If our party can’t even handle food safety properly while governing China, and this keeps up, some will wonder whether we’re up to the job,” Mr. Xi said in 2013, the year he became president. The anger here in Heze, the city in the eastern province of Shandong where the scandal has its roots, is evident. About two million improperly stored vaccines were sold around the country from an overheated, dilapidated storeroom. The main suspect in the case is a hospital pharmacist from Heze who had been convicted of trading in illegal vaccines in 2009 and was doing it again two years later. Many parents said they were especially alarmed that nearly a year had elapsed from the time the police uncovered the illicit trade and the time the public first learned about it in February. “Withholding information doesn’t maintain public credibility,” said Li Shuqing, a lawyer in Jinan, the capital of Shandong Province, who is one of about 90 attorneys who have volunteered to represent possible victims in the case. “In the end, it makes people more distrustful.” To many here, the combination of lax regulation and the secrecy surrounding a potential public health crisis seems like déjà vu. In the SARS crisis of 2003, 349 people died across mainland China and hundreds more died elsewhere after officials hid the extent of its spread. In a scandal that came to light in 2008, at least six children died and 300,000 fell ill with kidney stones and other problems from infant formula adulterated with melamine, an industrial chemical. “The customers worry about fake milk powder, fake medicine, fake vaccines, fake everything,” said Ma Guohui, the owner of a shop on the rural fringe of Heze that sells baby products. “This is certainly going to affect people’s thinking. My boy got all his vaccination shots. If he were born now, I’d worry.”

Nanotech solves better for disease control


Honda '09 (Michael Honda, Opinion Editorial Contributor, "Opinion: Nanotech deserves public and private sector support", The Mercury News, March 4, www.mercurynews.com/ci_11837367, CL)

Nanotechnology's benefits to society may not be obvious. The concept can be convoluted and controversial. Yet it is a powerful, enabling technology, like the Internet, the internal combustion engine and electricity. It fosters new potential in almost every conceivable technological discipline, and its societal impact will be broad and often unanticipated. Like any new invention, the potential for good is as great as the potential for harm. Excitement in the technology industry is matched by a parallel concern regarding nanotech's potentially adverse impacts. This argues for public engagement in private sector nanotech development, which involves the control of matter on a molecular scale. If we shy away from the debate, we lose the ability to shape it. For these reasons, I recently introduced a bill in Congress called the Nanotechnology Advancement and New Opportunities (NANO) Act (HR 820) and supported a nanotech bill (HR 554) by House Science Committee Chairman Bart Gordon, D-Tenn. My bill makes use of California nanotechnology experts' recommendations from my 2005 Blue Ribbon Task Force on Nanotechnology. But before explaining my bill, it's worth mentioning the benefits of nanotechnology and its surprising possibilities. Transportation is one example. Nanotechnology helps automakers build batteries for new zero-emissions electric vehicles that charge in less than 10 minutes and allow travel of 130 miles between charges. Efficiency like this moves us closer to our goal of reduced emissions and a cooler planet. Food safety is another area of potential. Nanotechnology enables health professionals to develop swabs for detecting E. coli and avian influenza. Such early warning systems have enormous implications for the developing world, which continues to struggle with rising disease and pandemics. Nanotech can improve health care. In preventive medicine, contact lenses can be created with color-shifting sensors that check diabetic blood-sugar levels. Similarly, an electrically conductive grid of nanofibers in clothing can monitor the heart and vital signs, detecting problems early for immediate treatment. There is the potential to use nanotechnology for detecting cancer and heart disease, developing cures for cystic fibrosis and designing implants such as artificial hips and kidneys.

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