While Ebola dominates the news cycle, it's not all about new cases, quarantines, patients being cleared, or deliberate fear mongering. The course of medicine and the science supporting it continues to progress. I've collected links to a number of health-related news stories which I'll get to below.
But first, a teaser for what may be one of the more important developments for the long term. What's one of the critical elements in controlling Ebola? Correctly diagnosing infected people as quickly as possible. A new technology under development promises to add a powerful new tool to that task.
More below the Orange Omnilepticon.
I've been accumulating a number of links to health related stories; rather than write each one up in detail, I'm putting a brief description of each with a link to the original. There's plenty of fascinating items to peruse. I'm grouping them as they seem to fit together; look for the graphic page element to fence them off.
If there's anything that's critical in medicine, it's making a proper diagnosis. Lab tests can be critical.
New Scientist reports on a new technology that could make it possible to rapidly identify Ebola or any number of other diseases. Better yet, it's easy to use, doesn't require complicated instruments or even a lab to use once it's been prepped, and it's not all that expensive.
The key to the technology is the ability to print sequences of DNA on paper, then freeze-dry and store the discs at room temperature. The DNA is reactivated by adding water. Once active, it enables the paper to change colour if a chosen target – such as a segment of Ebola viral RNA – is present in the water.
The target fragment binds to a gene switch in the DNA, which triggers the production of a colourful substance such as the protein that gives jellyfish a green glow under ultraviolet light, or proteins from bacteria that produce colour changes visible to the naked eye. The colour the paper changes to indicates which of the target pathogens has been detected.
More at the link. One of the things that is exciting about this is that it can give results within 30 minutes. It's still under development, but the potential is huge for this and other diseases.
Ebola vaccines are on the way, and understandably the pace has been accelerated by the press of events. The
BBC has a report from WHO saying
millions of doses may be available as early as June 2015, assuming they pass testing for effectiveness and safety.
New Scientist looks at modeling of the outbreak in West Africa; how quickly the toll could mount, and how quickly it might be brought under control. The models give both bad news and good news.
...a new model by David Fisman and Ashleigh Tuite of the University of Toronto in Canada – the first to take account of efforts to fight infections – suggests that if things continue as they have been up until now, 700,000 people could have had the virus by the time the epidemic in Liberia, Guinea and Sierra Leone subsides – in early 2016.
Fisman's prediction is based on reported cases of Ebola. (The previous prediction of more than a million cases by this coming January had assumed that the actual number of cases is 2.5 times the reported cases, so the same multiplier could be applied to Fisman's figure.) Importantly, he can track whether efforts to limit contagion grow in proportion with the epidemic. So far, the data from West Africa suggest that this is in fact happening. But if anything happens to slow that fight, his model suggests that total cases could balloon to many millions.
How quickly efforts to control the spread of Ebola ramp up will make a big difference in the outcome; an effective vaccine becoming available could amplify that even more.
A couple of opinion pieces from New Scientist discuss other factors that bear on controlling the outbreak. At present the U.S. is resisting an outright travel ban, but the pressure continues to build. A discussion of why that would be a bad idea is here. The bigger picture view is that the current outbreak is demonstrating the patchwork nature of efforts to address health issues on a global basis - and the connected world means what happens anywhere could have an impact everywhere. The suggested remedy - one which will terrify conservatives everywhere - is a global agency to battle diseases.
Global infectious disease control, as it now stands, is a disjointed effort riddled with gaps and inconsistencies. Crises like the current one in West Africa are handled by the WHO, relief agencies, NGOs and national governments with no central authority. Even Margaret Chan, the director of the WHO, has acknowledged that the epidemic has progressed from a public health crisis to "a crisis for international peace and security".
These gaps and inconsistencies aren't just exposed at times of crisis. The WHO, for example, has been unable to enforce states' international obligations to report disease outbreaks. It has similarly been unable to set up adequate systems for disease surveillance and response. Another glaring weakness is that the system doesn't give the private sector anincentive to develop and distribute affordable drugs, vaccines and diagnostics to the poorest nations.
The inadequacy of the current system is emphasised by some stark facts. While it is true that there has been an overall improvement in infectious disease control over the past 20 years, about a quarter of deaths worldwide are still caused by infectious diseases. In sub-Saharan Africa that number increases to more than half.
And new infectious diseases are emerging all the time – more than 300 in the past 75 years.
All that, and we're not done with the old diseases either. The
BBC has picked up on a WHO revised estimate of the number of cases of tuberculosis world wide:
nine million.
This New York Times article highlights how disease can make for strange bedfellows; Cuba's efforts to stem the outbreak are highly appreciated because of the country's track record.
The Times also profiles a leader in the world wide fight against a long time scourge: Malaria.
Since he [retired Rear Adm. R. Timothy Ziemer] took the job in 2006, worldwide malaria deaths have dropped 40 percent, to about 600,000 a year from one million.
“He never seeks the limelight, but he deserves a lot of credit for that,” said Mikkel Vestergaard Frandsen, owner of Vestergaard, the world’s biggest mosquito net maker.
Many countries now use the tactics Admiral Ziemer adopted after demanding proof that they worked. For prevention, they include free distribution of nets impregnated with insecticide, indoor pesticide spraying and routine doses of malaria medicine for pregnant women. For diagnosis and treatment, they include rapid blood tests and pills that combine a new fast-acting Chinese drug, artemisinin, with one of several longer-lasting drugs.
The article is a fascinating profile of someone who has been very effective in his job - and has quite the background for it.
One of the big problems in the Ebola fight is the infrastructure; lack of facilities is one thing of course - but an even bigger problem is that local authorities often have no idea at all of what is actually on the ground. The migration of people to cities has resulted in sprawling, haphazard growth which is on no maps. Maintaining public health without that information makes the job incredibly difficult. But,
the Missing Maps Initiative has found a way to fill in the blanks. Here's a plan for an area in Bangladesh, via
New Scientist:
"Dhaka is pretty well mapped," says project leader Ivan Gayton. "But Kamrangirchar, which is one of the most polluted places on the planet, is a black hole."
To make the maps, MSF will give volunteers smartphones they can use to note the location of the features in their neighbourhood, down to each house and water pump. The detail will be added to a digital map called OpenStreetMap that's free to use. Volunteers will be allowed to keep the phones after the project is over, and MSF hopes this will seed the creation of a local chapter of mappers who will keep Kamrangirchar's digital representation up to date.
Those who do not get phones will still be able to contribute. Printed sections of Kamrangirchar's OpenStreetMap will be available for volunteers to annotate with the locations of mosques, hospitals, schools and water sources. Each sheet of paper carries a barcode that will allow MSF workers to simply snap a photo of the finished paper map and have it automatically upload to the proper location on OpenStreetMap.
This idea has potential that goes way beyond public health; it's exactly the kind of information governments need to develop sound development policies, discover problems, and improve services. The public health aspect is justification enough all by itself though.
Scientific American looked at how Nigeria addressed its outbreak so effectively.
The government's first priority was to locate all potential contacts. A team of more than 150 designated "contact tracers" tracked down each of the individuals. Such tracing is the most challenging part of this sort of work, Fasina says, especially in Nigeria, where "houses cannot always be traced by street numbers." With all of those potentially exposed to the virus pinpointed, workers conducted an astounding 18,500 face-to-face visits to check for fever and other Ebola-related symptoms in each of these contacts, according to data in the MMWR paper. The check-ups took a little cajoling, Fasina notes. To get folks to meet with tracers also requires a good deal of effort to remove social stigma around the disease.
emphasis added - It shows how important good maps are.
Consider this:
...After the virus began spreading earlier this year, an organisation called the Humanitarian OpenStreetMap Team recruited hundreds of online volunteers and mapped three cities in West Africa in just 20 hours. This helped medical workers find, isolate and treat people who may have come into contact with the virus. Having such maps at the outset wouldn't have stopped the outbreak, but it might have prevented it from escalating.
In the U.S. the Ebola hysteria being
hyped by the Right Wing Echo Machine for political purposes (Just
look at this!!!) combined with regular media's appetite for sensationalism is ramping up fears. The
BBC came out with this evaluation of how likely catching Ebola on a plane would be.
The Ebola virus does not transmit very effectively until its symptoms become apparent. "People with Ebola do not become infectious to others until they become ill," says Schaffner. Although Ms Vinson reported a temperature of 37.5C (99.5F) before flying, it appears that she was still in the early stages.
By the time a patient is likely to pass it on, they will be feeling very sick and potentially running a very high temperature - and as a result will probably not have boarded a flight in the first place. US Department of Transportation rules allow airlines to deny boarding to air travellers with serious contagious diseases.
But it's unlikely that someone who just happened to be sitting on the same flight would have cause to worry - unless, say, they sat next to a patient in the advanced stages of the illness who vomited or bled on them.
So far, the case of the doctor now being treated in New York City seems to show that much was learned from the mistakes in Texas. It should be noted that Texas may have been pre-disposed to such problems, since so much of the medical and political establishment has been focused on denying health care to people, rather than providing it. Opposition to Obamacare, refusing to expand Medicaid, shutting down women's health clinics over abortion, anti-labor sentiments that deprived nurses of a voice in hospital policies... These pre-existing conditions did not bode well for an acceptable outcome.
Charles P. Pierce has a consideration of the New York City response so far. Compare and contrast.
...Bellevue is the oldest public hospital in the country, having been founded in 1736. It housed New York's first morgue. It has been a leader in the study of cardiac disease. It has been a place of innovation throughout its history, being in the vanguard of every medical advance from the dissection of cadavers to the use of the hypodermic syringe. It has dealt with wave after wave of immigration, from all parts of the world, and with the medical complications that came with them. It has served the people of the city through a number of tuberculosis outbreaks, including the most recent ones, and thereby we find our modern parallels.
...I have faith that Frieden knows what he's doing, and that Bellevue can handle this non-epidemic as well as it has handled actual ones, and that New York can take this thing in stride. Have I mentioned, by the way, that Bellevue is now, and always has been, a public hospital, and the hospital in Dallas was not? As the New York Board of Health put it back in 1915:
"The city can have as much reduction of preventable disease as it wishes to pay for. Public health is purchasable; within natural limitations a city can determine its own death rate."
In non-Ebola health news, there are some important developments on the mental health side. New work is elucidating the neurochemistry underlying Seasonal Affective Disorder.
The BBC reports on a small but promising study:
The University of Copenhagen researchers who carried out the trial say their findings confirm what others have suspected - although they only studied 11 people with Sad and 23 healthy volunteers for comparison.
Using positron emission tomography (PET) brain scans, they were able to show significant summer-to-winter differences in the levels of the serotonin transporter (SERT) protein in Sad patients.
The Sad volunteers had higher levels of SERT in the winter months, corresponding to a greater removal of serotonin in winter, while the healthy volunteers did not.
Those looking to improve their exercise experience during high-intensity interval training may find
a study reported in the New York Times of use. Music makes a difference! Again, another small study, but...
The volunteers all reported that the intervals had been hard. In fact, their feelings about the difficulty were almost identical, whether they had been listening to music or not.
What is interesting is that their power output had been substantially greater when they were listening to music. They were pedaling much more ferociously than without music. But they did not find that effort to be more unpleasant. Without music, the workout struck them as about the equivalent of an eight or higher on a zero to 10 scale of disagreeableness (with 10 being unbearable).
With music, each interval still felt like about an eight or higher to the riders, but they were working much harder during each 30-second spurt. The intensity increased but not the discomfort.
In all the hoopla around the latest iPhones from Apple, one woman reflects on how
Siri has made a difference in the life of her autistic son.
For most of us, Siri is merely a momentary diversion. But for some, it’s more. My son’s practice conversation with Siri is translating into more facility with actual humans. Yesterday I had the longest conversation with him that I’ve ever had. Admittedly, it was about different species of turtles and whether I preferred the red-eared slider to the diamond-backed terrapin. This might not have been my choice of topic, but it was back and forth, and it followed a logical trajectory. I can promise you that for most of my beautiful son’s 13 years of existence, that has not been the case.
The science fiction writer John Brunner wrote a story "What Friends Are For" that anticipated this effect. A problem child genetically engineered for strength and intelligence by his parents, proved to be more than their sadly inadequate parenting skills could handle. A court ordered the child be provided with a "friend" - an artificial being programmed by an alien race (among several implied in the story.) The purpose of the Friend was to use its more than human capabilities to meet the child's emotional and intellectual needs while modifying his behavior to acceptable norms. The programming was critical - in effect the aliens who developed it were able to have an outsider's perspective on human nature, and the Friend was able to address those areas that are the greatest problems for humans.
Siri's use in this case may be the first steps towards such a creation. While machines have limitations, so do humans. If the combination can cover those gaps, so much the better.
Meanwhile, organ transplants have advanced with a new development: heart in a box. The BBC takes note of a machine that can take a stopped heart, revive it, and preserve it for transplant. This could greatly increase the number of hearts that could be available for replacement surgery.
And in one final note, researchers have discovered that Bees have healthcare!