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Viral Vitriol

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By the time the President of the United States made a public statement about the epidemic, several people had died and an untold number were already infected. But, when he stepped to the podium to address the media, his words weren’t anything some in the audience had hoped he’d say. His brief speech wasn’t about funding or education directed towards stemming the scourge and ultimately finding a cure; it was about policy. A cacophony of jeers slammed into his geriatric face, and he merely lifted an eyebrow, as if saying, ‘Well, that’s all I need to say about it.’ Indeed, that’s all anyone should have expected Ronald Reagan to say about AIDS.

On June 5, 1981, the “Morbidity and Mortality Weekly Report,” a publication from the Centers for Disease Control and Prevention, presented data about the peculiar cases of 5 young men, “all active homosexuals,” who had developed Pneumocystis carinii pneumonia (PCP) at 3 different hospitals in Los Angeles. Two of them were dead by the time the report came out. PCP is a very rare form of pneumonia, occurring only in people with depressed immune systems. That seemingly healthy young men in large urban areas around the country were coming down with it seemed to contradict medical scripture about the ailment. Because the patients were all “active homosexuals,” however, the CDC labeled the new disease “Gay-Related Immune Deficiency” (GRID). Within months, however, the CDC realized that “active homosexuals” weren’t the only victims. Intravenous drug users were also coming down with the mysterious new disease; then prostitutes, but also other people who didn’t fit into any of those groups. They quickly renamed it Acquired Immune Deficiency Syndrome (AIDS). But the damage was already done by those 2 words: “active homosexuals.”

When Reagan addressed the press on September 17, 1985, he mentioned AIDS only to declare a travel ban for all HIV-positive and AIDS-afflicted people. By then, scientists had identified the AIDS virus, and the U.S. Food and Drug Administration (FDA) had approved usage of the first test to detect it, the ELISA test. Scientists had already confirmed one critical fact about the new scourge: it was a blood-borne pathogen; infectious, but not contagious. Still, panic had set into the nation. Gay men were being targeted with more violence than they ever had been in the nation’s history. Even as the gay-rights movement gained momentum in the 1970s, gay men didn’t face the sort of vitriolic backlash as they did with the rise of AIDS.

In 1983, Pat Buchanan, a former speech writer for President Richard Nixon, published a column about the AIDS epidemic, in which he claimed, “The poor homosexuals – they have declared war on nature, and now nature is exacting an awful retribution.”

In 1986, Libertarian Lyndon LaRouche proposed legal discrimination against people with HIV and AIDS as a matter of public interest. He wanted federal and state governments to protect people from AIDS in the same way it protects the citizenry against other diseases by quarantining them in concentration camp-like structures.

Reagan’s lack of concern for the burgeoning epidemic has always been a sore point for human rights activists. The former actor, however, repeatedly extolled the virtues of personal responsibility, even with health matters, and bemoaned government involvement. During his 1966 run for governor of California, Reagan denounced President Lyndon B. Johnson’s Medicare program as “socialized medicine.”

But, previously, the U.S. government did respond quickly to health scares. When several people attending the annual legionnaire’s convention in Philadelphia in September of 1976 came down with a vicious flu-like ailment, health care workers jumped into action and almost immediately identified the source: a water-borne bacteria later called Legionella.

That same year U.S. health officials warned the public about a pending influenza epidemic, swine flu, and urged people to get vaccinated as soon as possible. Panic set into the American psyche and several individuals rushed to their doctors. The resulting hysteria now stands as one of the worst debacles in U.S. healthcare history.

When 7 Chicago-area residents died from ingesting cyanide embedded in Tylenol capsules in the fall of 1982, the federal government jumped into action to help Tylenol maker Johnson & Johnson manage the crisis. The company pulled every single one of its products off store shelves, resulting in a multi-million dollar loss, and then reintroduced them with tamper-resistant packaging. It’s difficult for younger folks to imagine now, but there was a time when you could open a bottle of something and not have to peel away a layer of plastic or foil. The crime spawned only one known copycat incident – in Auburn, Washington in 1986 – but it remains unsolved.

For those of us who recall the hysteria over the AIDS epidemic in the 1980s, the current reaction to the Ebola fiasco is painfully similar. Like HIV, Ebola is a blood-borne virus; spread only by close contact with the body fluids of an infected person. They both originated in Africa. HIV has been traced to green monkeys, where it started out as simian immunodeficiency virus, or SIV. How or when it metamorphosed is still being investigated, but researchers believe it made its first appearance in humans in Kinshasa, Democratic Republic of the Congo (then known as Zaire) in the 1920s. Scientists still don’t know the host source of Ebola, but they believe it comes from fruit bats. That’s pretty much where the direct comparisons end. Ebola is far deadlier; it induces a severe hemorrhagic fever, in which the internal organs not only collapse, but literally begin to disintegrate. Once an infected patient reaches the stage where they’re bleeding incessantly, it’s too late to save them. There are now drugs that can slow the advance of HIV and even full-blown AIDS. But, there’s not even a vaccine for Ebola. Agents like ZMapp haven’t gone beyond the experimental stage yet. Now some have the audacity to wonder why there isn’t enough of it.

It’s ironic that the world learned of Ebola before it learned of HIV and AIDS; yet more people have died from the latter. That the developed world never contemplated (outside of scientific circles) that Ebola could spread beyond remote Central African villages signals a certain degree of naiveté, if not stupidity. In this increasingly interconnected global economy, there’s no reason to suspect otherwise.

But, the attitude of ‘them-vs-us’ is what allowed the AIDS epidemic to get so out of hand. The “active homosexuals” comment – something the CDC regrets to this day – burned into the minds of socially conservative activists who saw the scourge merely from the viewpoint of a moral lens. Conservatives warned Reagan not to mention AIDS or HIV during his speech at the 1984 Republican National Convention in Dallas, lest he lose the party faithful. Those in control of the U.S. blood industry, such as the Red Cross, didn’t want to believe their products and patients were at risk from HIV; literally asking some hemophiliacs and organ transplant recipients if they wanted to be placed in the same group as “them” – meaning the gay male / drug user / prostitute gallery.

If the U.S. had taken AIDS seriously from the start, we might have developed protease inhibitors by the end of the 1980s, instead of a decade later. By now, we might even have a vaccine, if not a cure. (If you read my 2012 essay, “I Almost Hope They Don’t Find a Cure for AIDS,” you might understand my sense of trepidation about this particular matter.)

The perception of ‘it’s their problem’ has impacted countless issues of various types: economic, medical, political, religious and social. Some health officials saw the need to work towards a cure, or at least a treatment for Ebola long ago. Dr. Kent Brantly, a U.S. medical missionary, contracted Ebola this past July while working with patients in Liberia. When he was brought to Atlanta’s Emory University, looking like an extreme beekeeper, he became the first person with the disease to step foot on American soil, or anywhere in the Western Hemisphere for that matter. Some people have wondered aloud why he would have spent so much of his time and energy in the first place to work with Ebola patients in Africa, when we have people dying of obesity and drug addiction here in the U.S. Those are fair questions. Yet Brantly sees his purpose in life as more than just a dispenser of medicine and sage advice. His Christian outlook on life (and I don’t want to bring religion into this debate) prompted him to be concerned about everyone around him – not just his immediate circle of family and friends. More than just a few people have used their religious ideology to narrow their view of ‘Others.’ I’ve worked with plenty of them. Just look at the AIDS epidemic. Even now, more than three decades after the epidemic was given a name, several individuals still look at AIDS from a moralistic perspective. They still don’t understand that morality really has no place in health and medicine.

Right-wing extremists have proposed simple solutions to the Ebola epidemic. Sen. Ted Cruz called for a complete ban of people traveling from Ebola-ravaged nations in West Africa. “Common sense dictates that we should impose a travel ban on commercial airline flights from nations afflicted by Ebola,” he said. “There’s no reason to allow ongoing commercial air traffic out of those countries.”

He’s just one of many who have made such idiotic proclamations. But Dr. Anthony Fauci, an early proponent of AIDS research and current head of the National Institute of Allergy and Infectious Diseases (NIAID), literally scoffed at the notion; dubbing it “counterproductive.” “[W]hen people come in from a country, it’s much easier to track them if you know where they’re coming from,” he noted. “But what you do, if you then completely ban travel, there’s the feasibility of going to other countries where we don’t have a travel ban and have people come in.”

There are no direct flights from anywhere in Africa to the U.S. Thomas Eric Duncan, the Liberian man who developed Ebola shortly after arriving in Dallas last month and who died on October 8, had initially flown from Monrovia to Brussels; then from Brussels to New York City.

Reductions in the CDC’s budget also may have played a part in the Ebola mess. As usual, conservative Republicans were quick to demand cuts in health care; rampaging through the CDC’s financial allotments like a drunk rabbi in a Catholic boys’ school. Even President Obama bought into the philosophy that this was a wise move, slashing $72 million from the CDC’s public health emergency preparedness program for fiscal year 2012. I’ve noticed social conservatives are never so eager to cut military spending or funding for more prisons.

I don’t know what’s next in the Ebola scourge. It shows no signs of abating in West Africa, and there’s a good chance more people are going to contract the virus outside of that region. I shudder at the thought of it reaching India or China. Politics and religion don’t have places in health and medical care. Whenever they’re factored into the mix, people get hurt and die. In this modern world, we can no longer afford it.

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Update: Ebola Hits Dallas

On October 5, a hazardous-materials crew cleaned outside the Dallas apartment building of a nurse who was infected with Ebola.

On October 5, a hazardous-materials crew cleaned outside the Dallas apartment building of a nurse who was infected with Ebola.

As some have feared and others predicted, the Ebola situation in Dallas has worsened. The man who became the first person diagnosed with Ebola in the United States was identified a couple of weeks ago as Thomas Eric Duncan, a 42-year-old Liberian native who arrived here on September 20. He died of the disease early on October 8. The facts surrounding Duncan’s case have changed almost as quickly as promises from the mouths of Texas politicians. But, then again, when the media hurries to publish a story, the truth almost always gets lost in the chaos.

Duncan had been accused of lying on a questionnaire he was given upon boarding a flight from Monrovia to Brussels on September 19; one that asks travelers if they’ve had recent contact with an Ebola patient or have recovered from the ailment. We learned almost as soon as news of Duncan’s dilemma became known that he had carried a pregnant 19-year-old woman to and from a taxi cab shortly before he departed Liberia. The woman died of Ebola not long after she’d been turned away from a local hospital because they were filled to capacity. Then, some of her other relatives got sick and died. By the time she passed away, Duncan was already in Dallas.

Now, news reports claim that neither Duncan nor any of the pregnant woman’s relatives were aware she had Ebola. Apparently, the latter didn’t realize it until after she died. Such is the case in Liberia and other developing nations of West Africa. The health care infrastructure is as pathetic as the road infrastructure. That’s why it doesn’t surprise me that the pregnant woman was turned away from a hospital.

“If he had known he had Ebola … he would not have put the love of his life in a situation like this,” family friend Saymendy Lloyd said of Duncan after he died.

But, officials at Texas Health Presbyterian Hospital of Dallas should have known better than anyone in a ramshackle hospital in Liberia. It’s bad enough that – when Duncan first arrived on September 25, complaining of fever and nausea – the hospital merely sent him home with a prescription for antibiotics. Now, we’ve learned he had a 103° temperature that night. I’m not a healthcare professional, but even I know someone with a 103° temperature needs to be hospitalized. Then, there’s the breakdown in information. The nurse who saw Duncan initially recorded his temperature in the hospital system. But somehow, that crucial bit of data got lost in the electronic shuffle. Hospital officials were quick to blame the software, which was designed and distributed by Epic, a Wisconsin-based firm that controls about 20% of the U.S. market in electronic hospital records. Another piece of lost information – Duncan revealed he’d recently traveled from Liberia.

Someone once told me that computers are only as smart as the people who operate them. No, I responded, they’re only as smart as the people who design them. Actually, it’s both. Presbyterian Dallas’ story keeps shifting, so hopefully they’ll settle on a final version before the book and TV-movie come out. Regardless, none of it leaves me with any sense of confidence in the U.S. health care system. The U.S. has spent more time and money building prisons and sports arenas than health care facilities. Our backward-thinking politicians have made sure oil companies got large tax breaks, while funding for education is always put up for a vote – and fails.

Yet, it’s gotten worse. A nurse who tended to Duncan while he was in isolation at Presbyterian has now tested positive for Ebola. The news just broke, so there aren’t too many details, except that she’s a 20-something native of Fort Worth. Supposedly, her apartment has already been cleaned out, although reports state her dog is still inside. Hopefully, the animal doesn’t suffer the same fate as the pet of a Spanish nurse last week. I mean, I’d rather sacrifice the entire Texas State Legislature instead.

And, the drama continues.

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Ebola Hits Dallas

The Ebola virus.

The Ebola virus.

Okay, I’m being a bit dramatic. But, officials with the Centers for Disease Control and Prevention have confirmed, along with Texas Health Presbyterian Hospital of Dallas, that an unidentified man has tested positive for the Ebola virus. This is the first time that someone in the United States has been diagnosed with the deadly hemorrhagic fever. Since March of this year, Ebola has wreaked havoc across Western Africa; killing nearly 3,100 people and sickening thousands more. Before now, outbreaks had been limited to rural areas in Central Africa. This epidemic has been the deadliest and most widespread since medical aid workers accidentally discovered and identified it in September of 1976. With roughly a 90% fatality rate, Ebola quickly supplanted smallpox as the most lethal pathogen known to humanity. The current epidemic, however, has had a fatality rate of about 60%.

And, I just knew it would be a matter of time before it would reach a major metropolitan area outside of Africa’s largest cities. I’m actually surprised it hasn’t occurred sooner. I recently told a friend it was never if, but when it would hit. I even added that, with our luck, it would pop up right here in my home city of Dallas, Texas. Sometimes, I just think too damn much.

Confidentiality laws in the U.S. prevent the man’s identity from being released, but officials at first said he traveled directly from Liberia – the hardest hit of the countries in the Ebola outbreak – to Dallas on September 19 to visit relatives who live here. Now, we know that he traveled from Liberia to Brussels on the 19th, and, the next day, from Brussels to Washington, D.C., and then on to Dallas. He began getting sick with fever a few days later and sought medical treatment at Dallas Presbyterian on the 24th. Doctors there just thought he had a bad fever and sent him away with some antibiotics. The biggest health threats, as far as local officials are concerned, have been West Nile virus, HIV and bad driving. The man’s condition worsened, and he returned to the same hospital via ambulance on September 28 where he was immediately placed into isolation. But, here’s an interesting fact: a nurse who tended to him the first time asked the man if he’d been to West Africa, and he purportedly said yes. The nurse is believed to have recorded that information, but the doctors either didn’t catch that (no pun intended) or ignored it.

Now, the CDCP is trying to backtrack and find everyone who’s been in contact with the patient. Earlier today Texas Governor Rick Perry and Dallas Mayor Mike Rawlings took part in a press conference at the hospital where they and the facility’s officials emphasized that they have the matter under control; adding that everyone must remain calm. It’s important to note that Ebola is a blood-born pathogen and – while highly infectious – isn’t contagious. You have to come in contact with an infected individual’s bodily fluids to risk exposure.

I understand that. But, who’s to say hospital workers who first treated the man weren’t lax in cleaning up after him? Among the people he came in contact with are 5 children who attend four different schools in Dallas. Knowing the poor sanitary habits of children (and plenty of adults), it’s possible they could bleed, vomit and / or be careless about cuts and scrapes without realizing the severity of their actions. Anything is possible when dealing with people.

I’m not one to panic, but I am somewhat of a health freak. I’m always washing my hands. I take showers more than once a day. Even my dog is cleaner than most people. Technically, the U.S. has far more resources to combat any deadly epidemic, including media and community outreach avenues. But, I don’t have much confidence in the CDC’s ability to handle this Ebola situation. I certainly don’t have any confidence in the city of Dallas’s ability to do the same. Another troubling fact – a friend of the man contacted the CDCP to inform them about him. In other words, the CDCP didn’t learn of the individual’s possible Ebola infection from Dallas Presbyterian.

I only have to look back at the U.S. government’s response to AIDS, when it was identified in 1981. Because the first victims were gay men, drug users and prostitutes, the government didn’t take it seriously. They reacted with moral condemnations. And, any time people make medical decisions based on religious ideology, people die. If the government had taken AIDS seriously from the start, there might at least be a vaccine by now. Conversely, the U.S. government did respond quickly to swine flu and Legionnaires’ disease; both of which came to prominence in the fall of 1976. They even jumped into action during the 1982 Tylenol poisoning cases, despite that being an isolated incident.

In August, health officials in Liberia and Guinea quarantined entire neighborhoods in a futile effort to stem the Ebola outbreak. If other people in Dallas start getting sick with Ebola, I’d like to see authorities institute a lockdown in a city of roughly 4 million people, which is dissected by major highways and where most everyone has a vehicle. We’ll just have to wait and see what happens.

In the meantime, I’ll try to predict something more positive happening – like a mass die-off of politicians and rap singers.

Top 10 Deadliest Known Viruses.

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