How the EPA might save us from Ebola

Now that the Ebola virus has reached the United States, there is understandably a lot of panic about it. The news media certainly isn’t helping to put our minds at ease.

Ebola certainly is a scary disease, but even in Africa, it’s way down the list of causes of death.

ebola

Graphic courtesy of World Health Organization.

That’s not to say that Ebola is not a terrible and deadly disease — it is — but once we are reminded that it only spreads through direct contact with bodily fluids (including human waste), then we may be more able to be more rational about it.

One major advantage that we have in the United States that people in West African nations lack is modern sanitation. In its list of Ten Great Public Health Achievements in the 20th Century, the Centers for Disease Control and Prevention listed infectious disease control as a top achievement and improvements in sanitation and hygiene as crucial strategies.

Disease control resulted from improvements in sanitation and hygiene, the discovery of antibiotics, and the implementation of universal childhood vaccination programs….

The 19th century shift in population from country to city that accompanied industrialization and immigration led to overcrowding in poor housing served by inadequate or nonexistent public water supplies and waste-disposal systems. These conditions resulted in repeated outbreaks of cholera, dysentery, TB, typhoid fever, influenza, yellow fever, and malaria.

By 1900, however, the incidence of many of these diseases had begun to decline because of public health improvements, implementation of which continued into the 20th century. Local, state, and federal efforts to improve sanitation and hygiene reinforced the concept of collective “public health” action (e.g., to prevent infection by providing clean drinking water). By 1900, 40 of the 45 states had established health departments. The first county health departments were established in 1908. From the 1930s through the 1950s, state and local health departments made substantial progress in disease prevention activities, including sewage disposal, water treatment, food safety, organized solid waste disposal, and public education about hygienic practices (e.g., foodhandling and handwashing). Chlorination and other treatments of drinking water began in the early 1900s and became widespread public health practices, further decreasing the incidence of waterborne diseases. The incidence of TB also declined as improvements in housing reduced crowding and TB-control programs were initiated. In 1900, 194 of every 100,000 U.S. residents died from TB; most were residents of urban areas. In 1940 (before the introduction of antibiotic therapy), TB remained a leading cause of death, but the crude death rate had decreased to 46 per 100,000 persons.

U.S. Centers for Disease Control and Prevention

So that’s a reassuring feather in our cap when fighting Ebola here at home. But we can’t afford to get complacent about it.

Here in my home town of Indianapolis, we have a dirty little problem that nobody wanted to talk about for years. Storm drains that collect rainwater and dump it into waterways are commingled with sewer drains (this is known as a combined sewer system). So, whenever there’s a good rain, well you can probably guess the results.

Each year, the city of Indianapolis dumps between six and seven billion — that’s billion with a B! — gallons of raw, untreated waste into Eagle Creek, Fall Creek, Pleasant Run, Pogues Run and the White River.

Bob Segall, WTHR-TV Indianapolis

That’s a lot of raw sewage overflowing into our waterways where people boat, fish and occasionally swim. Indianapolis’s sewer system is more than 100 years old and simply doesn’t have enough capacity. Scary stuff, especially in light of the Ebola outbreak.

The good news is that help for my hometown is on the way. Because these conditions were a violation of the Clean Water Act, the U.S. Environmental Protection Agency sued the city, which led to a settlement and a Consent Decree for the city to fix the sewage system. Essentially, the city is only doing it because the feds are making them do it. Politicians don’t want to be responsible for massive increases in utility rates.

The city, along with Citizens Energy Group, the public utility that operates the water, sewer and natural gas systems in Indianapolis, is currently building a massive tunnel system to add capacity and minimize (notice I didn’t say eliminate) the overflows. The bad news is that it won’t be done until May 2016.

Indianapolis is far from alone in its challenges with an antiquated sewer system. According to the EPA, there are 213 large systems (each serving 50,000 or more people) nationwide with combined sewer overflows and 1,103 additional large systems with sanitary sewer overflows. The goal is to address all of them by the end of FY2016 — but it will take years beyond that for all of the necessary projects to be completed.

fy 2013 cumulative progress on addressing combined sewer systems

Graphic courtesy of the U.S. Environmental Protection Agency.

2013 nei cumulative progress on addressing sanitary sewer systems

Graphic courtesy of the U.S. Environmental Protection Agency.

That’s why I find it totally incredulous that many voices within the GOP have proposed that we abolish the EPA altogether while simultaneously accusing the Obama administration of not being serious about protecting Americans from Ebola. Indeed, budget cuts have also hamstrung the CDC and the National Institutes of Health in their efforts to contain the disease and even develop a vaccine.

“NIH has been working on Ebola vaccines since 2001. It’s not like we suddenly woke up and thought, ‘Oh my gosh, we should have something ready here.’ Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.”

Dr. Francis Collins, Director, National Institutes of Health

NIH funding

Graphic courtesy of National Institutes of Health.

Protect yourself from an epidemic far deadlier than Ebola

Americans are very concerned about the Ebola outbreak in Africa that has now made its way across our borders, and rightly so. Ebola is often deadly, and there is no known vaccine or cure (even though some people do survive it).

But there’s a far deadlier foe out there, and we can protect ourselves against it: Influenza.

Ebola has claimed fewer than 4,000 lives globally to date, none in the United States. Flu claims between 250,000 and 500,000 lives every year, including over 20,000 in the United States—far more American lives than Ebola will ever claim.

Ebola is no joke: The Centers for Disease Control project 1.4 million cases of the disease worldwide by January in a worst-case scenario. But by comparison, the 1918 pandemic killed an estimated 50 to 100 million worldwide. The United States simply cannot afford to be complacent about flu preparedness.

Kendall Hoyt, Politico.com

Ebola and influenza may both be devils, but influenza is the devil we know. Of course, most people who get the flu recover from it quickly — it’s unpleasant, but most people don’t think of it as a life-or-death issue. But, all too often, it is.

So, even though the Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of six months get vaccinated, 55 percent of Americans did not get vaccinated during last year’s flu season…and last year was an improvement over previous years.

Skepticism of the flu vaccine still runs high, so it’s important that people understand the facts.

  • The flu vaccine cannot and will not cause you to get the flu. Period. Because of the way that the vaccine is made, it is impossible for the vaccine to give you the flu.
  • Just because you got the flu that one time after getting vaccinated does not mean the vaccine caused you to get the flu. Now, does that mean that you are guaranteed not to get the flu after you get vaccinated? No. According to the CDC, the efficacy is about 60% (whereas not getting vaccinated has an efficacy rate of 0%), and even when it does work, it usually takes about two weeks for your body
  • You are a good candidate for it. Yes, you. Although pregnant women, the elderly and immunocompromised people are at the highest risk of serious complications from influenza, you can do your part to help them even if you are healthy. It’s quite common to be contagious even while you are not experiencing flu-like symptoms. So getting vaccinated is not only for your health, it’s for everyone’s health.
  • It’s safe. Like any drug, there can be side effects from the flu vaccine…so there are a few instances when the flu vaccine is not a good idea. But, for the vast majority of people ages six months and up, the flu vaccine has been proven safe and effective (albeit not 100% effective) for many decades.

The bottom line is if you’re worried about Ebola, but you haven’t gotten a flu shot, your health priorities are severely out of whack.

I already got my flu shot this season. How about you?

The collision of medical privacy laws and celebrity

As a 2002 graduate of Butler University, I still follow Butler’s men’s basketball team closely just like many Butler alumni. I usually catch a game or two every season at Hinkle Fieldhouse. Of course, this sequence from the 2010 NCAA National Championship Game will be etched painfully into our memories forever.

In 2013 after Coach Brad Stevens left Butler to coach the Boston Celtics, one of my contemporaries on campus, Brandon Miller (who also played basketball for Butler from 1999 until 2003 when he graduated) was named head coach.

The 2013-14 season was a rough one for my Bulldogs for a number of reasons, but the 2014-15 season brought new hope to the team. With one season under Miller and one season in the Big East under the team’s belt as well as the return of Roosevelt Jones from injury…things were looking up. That is, until the university announced last week that Coach Miller was taking a medical leave of absence.

The university did not and legally could not disclose the reason for his absence, and Coach Miller isn’t talking either.

“Brandon Miller has requested a leave of absence for medical reasons, which the University has granted. We are not in a position to further elaborate and we ask that everyone respect Brandon’s privacy.”

Barry Collier, Athletic Director, Butler University

It’s natural to be curious about things like this, and when the person is a public figure like Coach Miller, the level of curiosity is ramped up a notch. But just because the public is curious doesn’t mean we have a right to know. So it really surprised me when I read this in The Indianapolis Star:

I want to emphasize this is just my opinion: Unless there is a legal reason not to do so, I think Brandon should be upfront about what he is dealing with, especially if he wants to return as coach.

Michael Pointer, reporter

Well, Michael, there are absolutely legal reasons not to do so. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects Coach Miller’s privacy, and the Family and Medical Leave Act of 1993 (FMLA) protects his job. Just because we have different laws for public figures about defamation, libel and slander doesn’t mean that our laws related to health care are different for them as well.

I would think Michael Pointer would know this better than most people. A few months ago, I was attending an open mic night at a local comedy club. Poynter took the stage and explained to the audience that he was in the midst of a medical leave from the Star — and that doing stand-up comedy was part of his (mental health) therapy. As a member of the audience, I certainly have no obligation to protect his privacy…if he really cared, he wouldn’t have gotten behind a microphone and told a room full of people. Still, since he was on medical leave, he would have had to go through a lot of paperwork about HIPAA and FMLA himself.

The other thing for Pointer to remember is that just because Coach Miller didn’t explain his situation to the general public doesn’t mean that he didn’t explain it privately to the university. Maybe he did, maybe he didn’t.

The clinical importance of privacy

I’m not saying that this is what is happening with Coach Miller, because I honestly don’t know what his health status is. But I do think mental health is the best example of why it’s important that we keep health information private for everyone, including public figures.

According to a 2001 report by the World Health Organization, one in four people worldwide has a mental or neurological disorder. And one of the biggest obstacles to treatment is the social stigma associated with these disorders. So, in order to encourage people to get treatment, guaranteeing confidentiality is paramount.

Mental health policies and programmes should promote the following rights: equality and non-discrimination; the right to privacy; individual autonomy; physical integrity; the right to information and participation; and freedom of religion, assembly and movement.

World Health Organization. Mental Health: New Understanding, New Hope, 2001 [emphasis added].

I have also worked as a journalist who always wanted to know the scoop, but I hope Pointer and the public will show Coach Miller the same respect that we showed to him during his very public medical leave of absence.

Link

It’s still not a pretty picture in my home state of Indiana when it comes to preventable medical errors…like severe bed sores, wrong-site surgeries, foreign objects left inside of patients and falls. From The Indianapolis Star:

For the past eight years in an effort to curb the number of preventable mistakes that happen in Indiana, hospitals, ambulatory surgery centers, abortion clinics and birthing centers have been required to report 28 serious adverse events to the Indiana State Department of Health.

In 2013, 111 medical errors occurred at 293 facilities, according to a report recently released by state health officials. That’s more medical errors than have occurred in any year since the state started requiring facilities to report these events.

Indeed, preventable medical errors are the #3 cause of death in America, responsible for 1 out of 6 deaths. So this problem is literally killing us in very large numbers, and we don’t seem to be making much progress.

It doesn’t have to be this way. In a six-country survey, U.S. patients reported the highest rate of medical errors…a dubious honor indeed. (In case you’re wondering, the other five countries in the survey were the United Kingdom, Australia, Germany, New Zealand and Canada.)

I know that physicians and hospitals recognize this problem and are making good-faith efforts to improve this and trying all kinds of strategies to improve it. But why aren’t we making any real headway? Why is the care in the United States so uniquely inconsistent despite costing so much more?

If you’ve read enough of this blog, you probably know the reasons already.

What do you think? I’m interested to read your comments.