Pass the Purell

Asks Burt:

What’s the next big public health risk? Not public health scare, since that’s as likely as not to be something like “psoraisis” given the panicked ignorance that characterizes medical “journalism.” And we have to exclude the “unknown unknowns,” of course, since if something completely new mutates that’s an “out of the blue” sort of thing.

But what do we know is lurking out there that has the potential to recall 1918?

I’ve put this one off until the very end because this is my answer — fish if I should know.  I got no clue.

Also, I don’t really have a better answer that this one provided by commenter Ken:

As fas as an acute “kill a lot of people very quickly”, I think zoonotic illness from Africa/Asia will be the leader in the clubhouse. As far as chronic concern, I’d have to say the baby boomers hitting prime Alzheimer’s ages soon is high on this list. You could also say the staggering rises in Type II diabetes in younger people that have been obese since they were about 9.

I wish I had more epidemiological expertise to offer, but I don’t.  My best guess is somewhere in “unknown unknown” territory, which makes for a craptacular answer.

Sorry.  (At least if it’s a horrible virus that transforms the infected into an unholy army of flesh-eating undead, you can rest assured that it’s OK to kill them.)

So with that, why not have an apocalypse-themed open thread?

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. The 1918 flu comes back every year.

    The difference is that these days, supportive care for upper-respiratory viral infections isn’t something you only get if you’re the top ten percent of earners (and the response to complications is better than “hope he doesn’t die”).

    • You mean regular people have access to life saving medicine? SOCIALISM!

  2. I keep wondering why SARS didn’t spread further. It’s probably still out there somewhere.

  3. I suspect–and here I’m just speaking off the cuff–that epidemics have a social or institutional component. The 1918 virus was probably very deadly on its own, but the massive dislocations and food and fuel shortages incidental to by the First World War probably made it even more deadly.

    • I don’t know. Treating the flu hasn’t changed *THAT* much in the last 100 years, has it? (Outside of flu shots, I mean.)

      Stay in bed. Drink plenty of fluids. Get lots of rest. Watch The Price is Right.

      I don’t think that the dislocations and food and fuel shortages from WWI are enough to cover the mortality rate of that particular flu strain. It was, what? 10%? And, from what I understand, it wasn’t limited to killing the elderly or the very, very young.

      We’re in different territory entirely for that bug.

      • You might be right. But I think–or suspect, as I’m certainly not even close to being an expert–that the following coincidental features of the war contributed to the 1918 epidemic and might go some distance to explaining why it wasn’t only the very old or very young who died:

        *** With people moving around more, more people were exposed to the virus.

        *** Soldiers in the trenches, already weakened by the trench conditions, may have been weaker and less able to fight the flu.

        *** Food and fuel shortages may have also made some people weaker than they otherwise might have been.

        Again, I might be talking out of my……desktop. But I really do suspect epidemics often owe their virulency in part to other factors. A similar argument has been made for the Black Death in Europe. the plague would have probably been devastating regardless, the argument goes. But it came at a time when Europeans had less food per capita because it had more people. I’m not sure how valid this argument is, but on the surface, and assuming some of the assumptions are true, it makes sense.

      • “Drink plenty of fluids” I think was still non-trivial for a lot of people in the first 25 years of the 20th century. That is, fluids that didn’t have their own beasties in them.

        • Even so, that doesn’t explain why it killed more 20ish year-olds than 50ish year-olds.

          There was something special about that particular strain of flu.

          One theory I’ve heard is that there was a particularly bad flu that went around in the 1890’s. The folks who had caught that flu did okay when the 1918 flu hit.

          From The Wikipedia:

          The global mortality rate from the 1918/1919 pandemic is not known, but an estimated 10% to 20% of those who were infected died. With about a third of the world population infected, this case-fatality ratio means 3% to 6% of the entire global population died.[29] Influenza may have killed as many as 25 million people in its first 25 weeks. Older estimates say it killed 40–50 million people,[4] while current estimates say 50—100 million people worldwide were killed.[30] This pandemic has been described as “the greatest medical holocaust in history” and may have killed more people than the Black Death.[31] It is said that this flu killed more people in 24 weeks than AIDS has killed in 24 years, more in a year than the Black Death killed in a century.[32]

          That ain’t a fluids problem.

          • It might be partially a fluids problem.

            I suspect that an epidemic is more than just the potency of the virus or bacterium, although it’s obviously that as well.

          • The prevailing theory is that the actual mechanism of death in that strain of flu is something called a “cytotoxic storm”. Long story short, the inflammatory response of the victim’s immune system kills them. Since younger people tend to have a stronger immune system, they would be more susceptible.

            This is from memory, I’m sure I could find a reference to back that up.

      • It was, what? 10%? And, from what I understand, it wasn’t limited to killing the elderly or the very, very young.

        In fact, it hit young adults the hardest. As I understand it, it provoked a sort of autoimmune reaction called a cytokine storm, and those with the strongest immune systems got the worst of it.

  4. Antibiotic resistant bacteria. The U.S. is currently on track to have the worst whopping cough outbreak since the 1950s. I expect this will become more common, with a variety of diseases.

    • Whooping cough is vaccine preventable, so I wonder to what extent the most recent outbreak is linked to the anti-vax crowd, rather than antibiotic resistence (which is not a problem I’ve heard of in pertussis). On the other hand, I’ve heard lots of concern about antibiotic resistance in tuberculosis and staph aureus.

      TB, of course, is already a serious health issue in the developing world, and MRSA, while not on anything like the scale of 1918 flu, is certainly something doctors and hospitals worry about controlling.

      • My most recent Tetanus shot came with a Whooping Cough booster.

        For what that is worth.

        • If you’d ever seen anyone experiencing whooping cough, you’d be particularly thankful for it.

          *shudder* .It is not a pleasant illness.

          • Ack, hit reply too soon. My point being: I’m glad they’re offering boosters (the vaccine isn’t a lifetime one) because whooping cough sucks, and most people don’t even remember it exists.

        • Yep, I just had to get one of those too (stabbed myself deeply in the thigh with a scrap metal alligator – yes, I know that sounds ridiculous). The doc asked if I was around any kids, and when I said yes they had me get the one with pertussis too.

          • Just got mine a few weeks ago, took off a bit of the pinky whilst slicing cabbage on the mandolin. When I founf out they were giving me the pertussis with the tetanus shot, I thought, “wait, that thing wears off??”

            I kinda recall Louis Black’s rant about the smallpox vaccine, maybe, wearing off.

          • Hardly anyone gets the smallpox vaccine anymore. I only got it as part of pre-deployment stuff to Afghanistan.

      • I don’t think resistance is a big issue with pertussis. I think it is much more likely to be a combination of waning immunity in adults and the anti-vaccine crowd than a problem of antibiotic resistance, though the latter is most certainly an issue of legitimate, significant concern in its own right.

    • I’m with Hanley on this. Interestingly enough antibiotics may turn out to be a strange sort of commons that we’re depleting in a terribly reckless manner. I hope I’m wrong and lots more chemical compounds appear in the pipes but oh.. I sometimes wonder.

      • But we need all those regulations for safety. And we need to make sure those greedy pharma companies don’t make too much money.

        Lest that seem too oblique, we are running out of antibiotics. The next generation of drugs isn’t looking too promising, from what I’ve read. Really big breakthroughs like genetic engineering are right on the horizon, but there is also the very unfavorable regulatory environment holding them back.

        • The antibiotics wouldn’t be running out so fast if they weren’t being overused so badly by the meat industry. Of course, we wouldn’t want to do anything socialist like regulate that.

  5. In the back of my mind, I wonder about a) measles, mumps, and rubella; these are not taken seriously by people and not just the anti-vaxxers; and b) tuberculosis, which seems to persist at an alarmingly high level in inner cities. Although most Americans are too far north to have it be a worry, malaria also kills a phenomenal number of people every year. These are things we know about, and can control and if we catch them early enough we can cure.

  6. Any chance of AIDS making a comeback? Many folks seem to think we’ve beaten it and aren’t as mindful as they should be about protection and safe sex.

    • If they’re able to get out the small relatively cheap private and personal testing kits I’ve been reading about it’ll be a terrible blow to the plague. Ignorance of carrier status has been a major contributor to its transmission (in the developed world) and this would be a body blow to that factor.

      • I could be wrong, but it seems to me that the kind of people who contract HIV and spread it around aren’t really the kind of people who would bother with home testing.

        • BB-

          That was sort of the point of my question. What you said likely WAS true and may still be true today, but people my age (late 20’s) and younger aren’t as terrified of AIDS as earlier generations, so there is the potential for the population of folks who “contract HIV and spread it around” to shift demographics. I’m not saying it has or it will… just wondering if changing attitudes might lead to this.

  7. This article indicates there may be some decrease in the duration of protection when the vaccinations went from DTP to DTaP

    The U.S. groups of 10-, 13- and 14-year-olds who are experiencing a high illness rate had DTaP vaccinations, which were introduced in 1997 at the same time that the prior DTP vaccine was discontinued.

    So, maybe teens need a booster too. That will probably be easy to get, since they’re still in school, with families, seeing pediatricians, etc. Once the kids move out, I think it would be much harder to get boosters done consistently.

    • The booster we give between the ages of 11-12 used to be just Td, but in recent years has been changed to Tdap to keep immunity to pertussis at higher levels.

  8. Aging, the ultimate proof that “natural” isn’t necessarily good. It’s slowly killing every fishing one of us right now.

    • I am always amazed at how many people don’t classify old age as a malady. If someone experienced it at twenty, they would. Why is 70 or so the magic number, and not 700, or 7,000?

      • Dig this: Imagine getting a job in the mailroom of a company where everyone else, without exception, also started in the mailroom. The middle managers, the VPs, the President, the CFO, the COO, and the CEO.

        Whenever one of them died, someone from the mailroom got promoted.

        • It’s not entirely clear to me what this metaphor means.

          • It’ll be explained to you when one of the people who does understand it dies.

          • Now imagine the middle managers, the VPs, the President, the CFO, the COO, and the CEO never dying.

          • I can easily imagine them getting bored and wanting to do something else.

            It seems more humane than insisting that they die.

          • Or, to clarify, I think that folks living until they’re 500 or 1000 would be great. I’d finally be able to catch up on Monk.

            The issue will involve the very first pushes to a healthy 150 or 200 that ask whether we really want Larry Ellison (or someone equally wealthy) to live that long to accumulate even more wealth when, under the old system, it’d be redistributed to his descendants.

            Hell, people would argue that people need to die because our copyright law assumes they do.

            It will all have to do with feelings of entitlement based on their expectations of how things have always worked up until now being thwarted.

            (Note: this is more me predicting arguments than believing them.)

          • Well, there are some people who are actively opposed to anti-aging research, but the vast majority of people are inexplicably apathetic towards the fact that they are, barring yet-to-be-invented medical interventions, destined to sixty years of physical and mental decline culminating in death. At best.

          • Hell, people would argue that people need to die because our copyright law assumes they do.

            This would be a hilarious dark sci fi thriller.

          • Perhaps this would be alleviated by whatever other changes allow us to live to 1000, but our sense of time speeds up as we age. Live long enough, and days would fly by in a matter of moments. Even if you had your health and vitality and loved ones, would you really enjoy life happening so fast you missed most of it?

          • This would be a hilarious dark sci fi thriller.

            Ever read Spider Robinson’s “Melancholy Elephants”?

          • I haven’t. But it looks like he beat me to the idea.

      • Because the magic number used to be 40. 70 is a huge step!

        • Actually it didn’t. The magic number used to be 5 or so, because before modern medicine, roughly half of everyone was dead by that age.

          The other half lived almost as long as we do now. Which put the average lifespan around 30 or 40. Not because that was old age, but only because so many didn’t get past childhood.

          • Learn something new everyday. I didn’t realize average life span was calculated that… crudely. Though, I suppose it is a simple average. Thanks!

          • While it’s true that the decline in infant and child mortality has accounted for the bulk of the increase in life expectancy since ancient times, death rates at all ages have fallen pretty significantly.

            For example, the death rates in 1900 (1998 in parentheses) were (per 100,000):
            35-44: 1020 (200)
            45-54: 1500 (424)
            55-64: 2720 (1030)
            65-74: 5640 (2500)
            75-84: 12,300 (5700)
            85+: 26,100 (15,100)

          • Or, to look at it another way, here’s a historical chart of life expectancy at different ages :

            In 1900, a white male American who’d reached 10 could expect to live to age 60. Today, the number is 76. (For white females, 62 and 81 respectively.) The gain is greater for non-whites, presumably because of better sanitation and access to health care.

Comments are closed.