“Bleeding Belgium” is an ironic historical allusion for public health

Support among the American public for quarantine appears at this point to be overwhelming. You can know this if you walk down the street and ask people, or if you look at a CBS poll that found 80% of respondents think citizens returning from West Africa should be quarantined until it’s clear they do not have the disease.

But America’s ‘professionals’ in the scientific and medical communities, and certainly those in the White House, seem deeply uninterested in the views of common people. When pressed on the issue they, especially the president, offer only gobbledygook and slogans. We can’t be safe here until they’re safe over there! They sound like propagandists for Bleeding Belgium in World War I.

Peggy Noonan, “From Ellis Island to Ebola,” 10/31/2014

Leave it to right-leaning columnist Peggy Noonan of The Wall Street Journal to write something so transparently xenophobic that it defies all logic.

That “gobbledygook” Noonan is talking about is just the medical science she can’t understand. And she is not alone in her ignorance…which is no wonder why the scientific and medical “professionals” she is referring to “seem deeply uninterested in the views of common people.”

This from the same “common people” who wanted to quarantine AIDS patients in 1985 despite an understanding among public health professionals from years before how AIDS was and was not transmitted.

This propaganda piece appeared on page 14 of the New York Tribune on November 5, 1917. It made the emotional case that the United States needed to go to war to protect Belgium from Germany as a matter of U.S. national security.

This propaganda piece appeared on page 14 of the New York Tribune on November 5, 1917. It made the emotional case that the United States needed to go to war to protect Belgium from Germany as a matter of U.S. national security.

Considering that “common people” like Peggy Noonan describe medical and public health terminology as “gobbledygook,” thank goodness the professionals are disinterested in their views!

The end of the excerpt from Noonan compares the Democrats in the White House and the medical scientists to the U.S. Committee on Public Information propagandists from World War I who made the case that we needed to go to war in Germany to protect “Bleeding Belgium,” specifically making the argument that failing to protect Belgium made the United States less safe.

But Noonan’s failure to understand far more recent history makes her argument more comical ironic than absurd. Consider this November 16, 2002 quote from President George W. Bush as he made the case to go to war in Iraq.

We are committed to defending the nation. Yet wars are not won on the defensive. The best way to keep America safe from terrorism is to go after terrorists where they plan and hide.

In her column, Noonan told the story of Thomas Duncan, the Liberian national who died from Ebola after coming to the United States (and infecting at least two nurses who cared for him). He had originally tested negative before he left Africa but ultimately incubated enough of the virus to kill him.

As you might imagine, Duncan’s family has a few questions about the care he received.

To Noonan, this was a great reason to keep nurse Kaci Hickox — who had tested negative for Ebola and showed no symptoms — under mandatory quarantine after her return from Sierra Leone, where she temporarily worked with Doctors without Borders. (Hickox is also an employee of the U.S. Centers for Disease Control and Prevention, which certainly complicates matters a bit since she knows a thing or two about public health and epidemiology.)

Never mind that the only two people who became infected with Ebola because of Duncan were the nurses who cared for him. (After all, who else was coming into contact with his bodily fluids?)

By the way, Thomas Duncan entered the United States on a flight from — where else? — Belgium.

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?