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Posts Tagged ‘epidemic

“Not with a bang, but with a whimper”*…

 

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Death Table from Tuberculosis in the United States, prepared for the International Congress on Tuberculosis, September 21 to October 12, 1908. Image: U.S. National Library of Medicine

 

Recent history tells us a lot about how epidemics unfold, how outbreaks spread, and how they are controlled. We also know a good deal about beginnings—those first cases of pneumonia in Guangdong marking the SARS outbreak of 2002–3, the earliest instances of influenza in Veracruz leading to the H1N1 influenza pandemic of 2009–10, the outbreak of hemorrhagic fever in Guinea sparking the Ebola pandemic of 2014–16. But these stories of rising action and a dramatic denouement only get us so far in coming to terms with the global crisis of COVID-19. The coronavirus pandemic has blown past many efforts at containment, snapped the reins of case detection and surveillance across the world, and saturated all inhabited continents. To understand possible endings for this epidemic, we must look elsewhere than the neat pattern of beginning and end—and reconsider what we mean by the talk of “ending” epidemics to begin with…

Contrary to hopes for a tidy conclusion to the COVID-19 pandemic, history shows that outbreaks of infectious disease often have much murkier outcomes—including simply being forgotten about, or dismissed as someone else’s problem: “How Epidemics End.”

* T. S. Eliot, “The Hollow Men”

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As we contemplate the end, we might send insightful birthday greetings to Nettie Maria Stevens; she was born on this date in 1861.  A geneticist– and one of the first American women to achieve recognition for her contributions to scientific research– she built on the rediscovery of Mendel‘s paper on genetics (in 1900) with work that identified the mechanism of sexual selection: its determination by the single difference between two classes of sperm—the presence or absence of (what we now call) an X chromosome.

220px-Nettie_Stevens source

 

“When it was in the extremity there was no such thing as communication with one another, as before”*…

 

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The island of Lazzaretto Nuovo, shown here, was one of the isles where the city of Venice quarantined plague-stricken individuals in the 15th century

 

Just beyond the shores of Venice proper—a city comprised of dozens of islands—lie two uninhabited isles with a rich history. Today these landmasses are landscapes of grasses, trees, and worn stone buildings. But once they were among the most important gateways to this storied trading city.

The islands, known as Lazzaretto Vecchio and Lazzaretto Nuovo, are now yielding fascinating insights into Venice’s response to one of the most famous pandemics in history. In the mid-14th century, Venice was struck by the bubonic plague, part of an outbreak, known as the Black Death, that may have killed up to 25 million people, or one-third of the population, in Europe. This spread was just one of several waves of the plague to strike Northern Italy in the centuries that followed.

Venice, as a trading center, was especially vulnerable. “They saw that the only solution was to separate people, to take away the sick people, or suspected sick people,” says Francesca Malagnini, of the University for Foreigners, Perugia, who is herself a Venetian, linguist, and member of an interdisciplinary team researching Lazzaretto Nuovo. “This was the only way to protect everyone’s health and allow the economy to continue.”

Beginning in the early 15th century, the island of Lazzaretto Vecchio was designated for isolating and treating plague-stricken Venetians. Later, Lazzaretto Nuovo became a spot where ships coming from places experiencing the plague, or those with suspected sick passengers or crew, anchored. There, people and goods spent a period of quarantine before being allowed into the heart of the city. (We owe the English word “quarantine” to the Italian term for 40 days, quaranta giorni.)…

Archaeological research is unearthing Venice’s quarantine history to illuminate how the Italian city created a vast public health response 700 years ago and helped lay the modern foundation for coping with pandemics: “Venice’s Black Death and the Dawn of Quarantine.”

See also: “How the Black Death Radically Changed the Course of History (and what that can teach us about the coronavirus’ potential to do the same).”

* Daniel Defoe, A Journal of the Plague Year

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As we stay safe, we might spare a thought for Charles Louis Alphonse Laveran; he died on this date in 1922.  A physician and public health and infectious disease researcher, he served as Chair of Military Diseases and Epidemics at the École de Val-de-Grâce, then joined the Pasteur Institute, then founded the Société de Pathologie Exotique; through his career, he published over 600 papers, journal articles, and books on infectious diseases and their agents.  In 1907 he won the Nobel Prize in Physiology or Medicine for his discoveries of parasitic protozoans as causative agents of diseases like malaria and trypanosomiasis.

220px-Charles_Laveran_nobel source

 

Written by LW

May 18, 2020 at 1:01 am

“A map is the greatest of all epic poems”*…

 

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A marmot hiding in plain sight in the Swiss Alps

 

Errors—both accidental and deliberate—are not uncommon in maps (17th-century California as an island, the omission of Seattle in a 1960s AAA map). Military censors have long transformed nuclear bunkers into nondescript warehouses and routinely pixelate satellite images of sensitive sites. Many maps also contain intentional errors to trap would-be copyright violators. The work of recording reality is particularly vulnerable to plagiarism: if a cartographer is suspected of copying another’s work, he can simply claim to be duplicating the real world— ideally, the two should be the same. Mapmakers often rely on fictitious streets, typically no longer than a block, to differentiate their accounts of the truth (Oxygen Street in Edinburgh, for example).

But there is another, less institutional reason to hide something in a map. According to Lorenz Hurni, professor of cartography at ETH Zurich, these illustrations are part inside joke, part coping mechanism. Cartographers are “quite meticulous, really high-precision people,” he says. Their entire professional life is spent at the magnification level of a postage stamp. To sustain this kind of concentration, Hurni suspects that they eventually “look for something to break out of their daily routine.” The satisfaction of these illustrations comes from their transgressive nature— the labor and secrecy required to conceal one of these visual puns…

Slipping one past one of the most rigorous map-making institutions in the world: “For Decades, Cartographers Have Been Hiding Covert Illustrations Inside of Switzerland’s Official Maps.”

* Gilbert H. Grosvenor (President of the National Geographic Society, first editor of the magazine, and champion of cartography [and photojournalism])

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As we hide Easter eggs, we might recall that it was on this date in 1345– according to 14th century scholars at the University of Paris– the Black Death was created… from what they called “a triple conjunction of Saturn, Jupiter and Mars in the 40th degree of Aquarius, occurring on the 20th of March, 1345.”

AKA the Pestilence, the Great Bubonic Plague, the Great Plague, the Plague, or less commonly the Great Mortality or Black Plague, the Black Death was actually transmitted by fleas who had fed on diseased rats.  It killed an estimated 75 to 200 million people in Eurasia, peaking in Europe from 1347 to 1351.

More on “the greatest catastrophe ever.”

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Spread of the Black Death in Europe and the Near East (1346–1353)

source

 

Written by LW

March 20, 2020 at 1:01 am

“There’s one area though where the world isn’t making much progress, and that’s pandemic preparedness”*…

 

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Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston, 1918

 

As we wonder at the ultimate impacts of the novel coronavirus, we might look to history and the lessons of earlier contagions, as University of Michigan law professor Nicholas Bagley did in 2016…

A couple of weeks ago, my wife (also a law professor) and I wrapped up the final session of a seminar that we co-taught called Contagion. We wanted to offer an introduction to the outbreaks of infectious disease that have reshaped American life and law.

The class was one of Michigan Law’s “at home mini-seminars,” which meant we hosted a dozen students at our home over the course of six evening sessions. Really more of a book club than a formal class, we focused on a different disease each time we met: cholera, Spanish flu, polio, AIDS, SARS, and Ebola.

We also drank beer, which makes death and disease more tolerable.

The class was a hoot. And it had a surprising coherence. Every disease provokes its own unique dread and its own complex public reaction, but themes recurred across outbreaks.

  1. Governments are typically unprepared, disorganized, and resistant to taking steps necessary to contain infectious diseases, especially in their early phases.
  2. Local, state, federal, and global governing bodies are apt to point fingers at one another over who’s responsible for taking action. Clear lines of authority are lacking.
  3. Calibrating the right governmental response is devilishly hard. Do too much and you squander public trust (Swine flu), do too little and people die unnecessarily (AIDS).
  4. Public officials are reluctant to publicize infections for fear of devastating the economy.
  5. Doctors rarely have good treatment options. Nursing care is often what’s needed most. Medical professionals of all kinds work themselves to the bone in the face of extraordinary danger.
  6. In the absence of an effective treatment, the public will reach for unscientific remedies.
  7. No matter what the route of transmission or the effectiveness of quarantine, there’s a desire to physically separate infected people.
  8. Victims of the disease are often thought to deserve the affliction, especially when those victims are mainly from marginalized groups.
  9. We plan, to the extent we plan at all, for the last pandemic. We don’t do enough to plan for the next one.
  10. Historical memory is short. When diseases fall from the headlines, the public forgets and preparation falters.

Not every one of those themes was present for every disease; the doughboys who died of the Spanish flu, for example, were not thought to deserve their fate. But the themes were persistent enough over time to establish a pattern…

For a list of the books that Bagley and the group considered, visit the post quoted above: “Contagion.”

For a measured (but still deeply concerning) assessment of the potential impact of the coronavirus, see The Economist‘s leader.  But lest we leap to the assumption that the stock market is an augur (of either depth or duration of impact) see “How to Think About the Plummeting Stock Market.”  For a much deeper dive into the historical antecedents of our current quandary, see “Pandemics and Markets” at Jamie Catherwood‘s Investor Amnesia (“We’ve been here before”).

Finally, there’s been much written about the ways in which Xi’s handling of the crisis in China might provoke a backlash against him and the Party, both within China and around the world.  But one might also keep an eye on Iran, where the government’s handling of the coronavirus is leading observers to wonder if this (coming as it does in the midst of severe internal tensions, aggravated by the economic pressure of sanctions) could be a “Chernobyl moment” for the regime; see “How Iran Became a New Epicenter in the Coronavirus Outbreak.”  And then, of course, there’s the potential political fallout in the United States.  See also the always-insightful Bruce Mehlman‘s “Washington in the Time of Corona.”

* Bill Gates, at a 2018 conference on epidemics hosted by the Massachusetts Medical Society and the New England Journal of Medicine (Here are Gate’s more current– but consistent– thoughts on “How to respond to COVID-19.”

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As we take precautions, we might spare a thought for Robert Hooke; he died on this date in 1703.  A natural philosopher and polymath, Hooke was a virtuoso scientist whose scope of research ranged widely, including physics, astronomy, chemistry, biology, geology, architecture, and naval technology.  He discovered the law of elasticity, known as Hooke’s law, and invented the balance spring for clocks.  He served as the Curator of Experiments at the Royal Society, London; and after the Great Fire of London (1666), he served as Chief Surveyor and helped rebuild the city.  He also invented or improved meteorological instruments such as the barometer, anemometer, and hygrometer.

But relevantly to the item above, Hooke was a pioneer in microscopy.  His Micrographia, (1665) was a book describing observations made with microscopes (and telescopes), as well as some original work in biology.  Indeed, Hooke coined the term cell for describing biological organisms, a term suggested to him by the resemblance of plant cells to cells of a honeycomb.

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Hooke’s microscope, from an engraving in Micrographia [source]

 

Written by LW

March 3, 2020 at 1:01 am

“Alcohol is the anesthesia by which we endure the operation of life”*…

 

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Alcohol consumption in the U.S has been trending down for several years; in 2018, alcohol consumption in the United States dropped for the third-straight year. Nevertheless…

America is in the middle of an alcohol epidemic.

That’s one takeaway from a new study published this month in Alcoholism, which found the number of alcohol-related deaths more than doubled between 1999 and 2017 from nearly 36,000 to nearly 73,000, and the rate of alcohol-related deaths rose by more than 50 percent from 16.9 per 100,000 people to 25.5.

To put that in perspective, there were roughly 70,000 drug overdose deaths in the US in 2017. Based on the Alcoholism study, alcohol was linked to more deaths than all overdoses — even at the height of America’s opioid epidemic. Alcohol accounted for 2.6 percent of all deaths among people 16 and older in 2017, up from 1.5 percent in 1999…

The study speaks to a problem in American public health and drug policy: While crises like the opioid epidemic (deservedly) get a lot of attention, even deadlier drug crises are often neglected by the public, policymakers, and media…

Alcohol isn’t even the deadliest drug. The Centers for Disease Control and Prevention previously estimated that tobacco smoking is linked to 480,000 deaths each year, or roughly 1 in 5 deaths. In other words, preventing just 30 percent of smoking deaths would prevent more deaths than preventing all drug overdose deaths and alcohol-related deaths combined.

Yet alcohol and tobacco haven’t filled a big part of public discussions about drugs in the past few years, especially compared to the opioid epidemic…

More at “The number of US alcohol deaths per year has doubled since 1999.”

* George Bernard Shaw

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As we contemplate cocktails, we might recall that it was on this date in 1912, during the First International Opium Conference at The Hague, that the first international drug control treaty, the International Opium Convention, was signed.

Raid

Opium article from The Daily Picayune, February 24, 1912, New Orleans

source

 

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