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Old Apr 29th 2010, 08:13 PM
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Default Eminent Mass Destruction- evolution

Was that dramatic?

I hesitated to put this in the science thread because I think people are afraid of science and also, this involves politics, the environment, the economy, health care, religion and morality.

I'm talking about the evolution of microbial life and our general blissful ignorance.

On the top of my mind today is Mycobacterium tuberculosis. If you couldn't tell by the name, this is the bacteria that causes tuberculosis in humans.
We don't care much about tuberculosis in the US anymore because it's been treatable and as it has been treatable, it has slowly lost it's primary host in the US. Not so in other countries.
Less and less so in the US every day.

Here's my anecdote and I hope it sends shivers down your spine:
In this modern era, going to college means you have to have a computer and you do a lot of school business on it. I get about 6 emails per day from the college notifying me of events on campus, registration information, clubs and what not. You know, the stuff you line up for mass deletion.

I actually pay attention to what office the email is from and about two weeks ago, I noticed that one of my emails was from the Dean of the college. Pretty rare so I opened it.
It said that there had been a confirmed case of active TB reported on our campus. All people who had interaction with this person on campus would be notified in person and be tested. If you didn't get a phone call, you hadn't been in contact with this person.

Well, it isn't a big campus but twice the size of my hometown so I figured I was probably in the clear. Although, I wondered how they would ever know with whom this person had been in contact.

TB is passed through the air. Second to AIDS, it is the leading cause of death by microbes (bacteria and viruses primarily). I bet you didn't know that. The reason that it is so successfully spread is because, unlike most airborne pathogens, the little bastards get coughed up with sputum and then just float in the air or land on surfaces where they last for DAYS.
All you have to do to get TB is breath.

This is not to say that everyone who gets TB becomes immediately contagious. That's actually bad news. The bacteria is completely undetectable for up to two weeks after the host is infected. After that, if the host was pretty healthy to begin with, nothing usually happens except that they carry it around until something else happens and their immune system suffers a set back and then the little bastards come out of their tubercles and head out again.
Imagine how long it takes someone to figure out they have TB when they were actually sick, at first, because they had strep throat or the flu or the common cold. How many people think "gees, I feel like crap but I have finals this week and I really have to go to school"? Or, of course, to work because they are hourly employees or are hanging onto their jobs by a thread and trying to impress the boss.
And maybe one of those folks had latent TB - infected for the past 10 years unknowingly.

But hey, it's okay because, as was done on my campus, you can track down all the likely contacts and test them for TB and then get them on a treatment program. Since they're on campus, they're relatively easy to keep track of.

They found seven more cases on campus as a follow up to this person. Another email came out. This one wasn't from the Dean so it was even less likely to be read. It said that if you were concerned, you could get tested for free at the health department by telling them you were from our campus.

We have some very good medical professionals on the faculty. Lots of Indian immigrants too old to compete with their younger kin in the medical field anymore. They can tell you all about TB because it's still a really big deal in India. In fact, it is such a big deal that they still vaccinate people for TB in India.

Why don't they do that here? Well, because if you've been vaccinated for TB, you will test positive forever and ever. The only way to tell for sure if a person from India has TB is to x-ray their chest. Or ask them and trust them to tell the truth. Who would lie about that?!

This guy: A personal injury lawyer - Mr. Son-in-law of CDC TB specialist who didn't want to interrupt his honeymoon plans.
As you read that you may have noticed that they said "a particularly rare resistant form of TB".

Well, it turns out he had a less severe strain so he sued the CDC for leaking his name. And then, he had a big chunk of his lung removed surgically (not by a pissed off fellow passenger which probably should have happened).

Ironically, in the good old days of smoking on airplanes (blechhhh), the air aboard tended to be circulated with fresh air. Now days not so much. It's less fuel efficient and thus more expensive to operate. So all those folks were trapped on board with this guy who knew he was sick and contagious circulating that bacteria through the airplane all over Europe and the US.

The strain they THOUGHT he had was less severe in that it wasn't the "extremely drug resistant" kind, just the "multi drug resistant" kind. That XTD kind is hard to treat. But, there's always hope. If you get the TB they thought he had, chances of successful treatment are 30%. The other 70% are "consumed" ('cause that's what we used to call it - consumption).

I asked my classmates this morning if any of them had been tested for TB. 1/30 knew what I was talking about. She hadn't read either email. Her boyfriend had been tested because he was in the same class with the girl that, it turns out, dropped out in the first semester because she was so sick she couldn't get out of bed anymore. She didn't know she had TB but why did it take all these months to get around to notifying and testing her classmates?
She is still too sick to get out of bed. Treatment takes months or up to a year.

In countries where AIDS is rampant, so is TB. Remember what I said about a weakened immune system? Guess who gets TB more than anyone else. And guess where most of these folks live? In hovels in Africa where they don't get treatment and the disease spreads like wildfire. There is talk of starting up sanatoriums again. There is no other way to confine a disease that kills up to 70% of it's hosts. They're talking about doing it in the states too. Arizona. You know, in case of emergency.

That's just ONE species of ONE bacteria.

Theirs MRSA and the counterpart from S. pyogenes. There's the viruses: H1N1, E.coli O157 H7 and dozens...hundreds of others.

Every year, we have more and more people coming up with diseases like mine (Crohn's), that are diseases of the immune system. Why?
Every two years, an influenza virus strain mutates enough to make it resistant to last years antiviral drugs. Every ten years, an influenza virus makes a giant leap and we run the risk of pandemic. The latest H1N1 was one of those and we got lucky.

Too many people, not enough antibiotics, poor living conditions, extreme poverty, ignorance, and an attitude that says health care is a luxury for the rich and as long as I can't see it, it won't hurt ME. We're really going to get it.
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Old Apr 29th 2010, 09:55 PM
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Default Re: Eminent Mass Destruction- evolution

I find it amazing how we always feel like we're so prepared, but we never know what the shit is going on. SARS, H1N1, H5N1, it's all the same story over, and over, and over. We pat our backs and talk about what we'd do in the zombie apocalypse and pretend like we've got the gonads to back up the chutzpah. We diagnose our colds on WebMD and think we've got it covered. We go to school when we're beginning to feel a little down because we really shouldn't be missing it in the first place and then all of the sudden we come home with TB and conjunctivitis (ok, the pink eye hasn't happened in a while, but you know what I mean), and how many others did we just pass that along to?

We have the technology, we have the basic science and the basic understanding, but we don't do anything proactive about it. We are still a fantastically reactive culture. I mean, I know I'm speaking very broadly, but on the whole, how many people here would willingly raise his or her hand and attest that "if shit hits the fan, I'm ready, vaccinated, and raring to go!" Yeah. Didn't think so.

I have friends who go to your school, and who only heard about the TB from me. The way those boys get around I'd be surprised if they hadn't been in contact with it. Matt is about to move to California, if he has it, who will he be giving it to when those little glory-nuggets get active in his lungs?

In the Early Modern era (a time of such classics as "she's a witch!" and "burn some incense, I'm sure that'll cut the bad air right out!") people believed that the human body was porous, like a sponge, and that one could absorb bad things through his or her skin (tangentially, they would put chicken anuses on their buboes and pump the chicken's beak until the thing died, believing that the chicken's body was like a reverse bellows, BUT I DIGRESS). Sure, they had no real science, but they were pretty fucking astute, if you ask me.

And they reacted. Your Arizona sanatoriums are the Lazarettos of old. Sure, we can quarantine people, or wear blue masks, or start up just-in-case places to deal with something.

But it's all still just a reaction.

It isn't a cure for, as you so astutely point to as the problem "Too many people, not enough antibiotics, poor living conditions, extreme poverty, ignorance, and an attitude that says health care is a luxury for the rich and as long as I can't see it, it won't hurt ME. We're really going to get it."
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Old Apr 30th 2010, 07:35 AM
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Default Re: Eminent Mass Destruction- evolution

We see about three or four suspected cases of TB in our ER per year. I say "suspected" because until cultures are grown or an assay done, we can't be sure. By that time, the patient has usually been discharged. Of course, these patients are immediately put into negative pressure rooms and all the appropriate Airborne Precautions are taken.

Our hospital quit yearly PPD testing a couple of years ago. I don't know why, money? I recently got tested on my own (negative, thank you), and most of the nurses do the same. Many other workers don't get tested. We're just asking for it.

I'm exposed to all kinds of nasty pathogens every day. I am, at the same time, very conscious of that fact and take precautions, and don't dwell on it. If I thought about it, I'd never go near a patient. MRSA, C-diff, klebseilla, H1N1... all kinds of bacteria, viruses, fungi and parasites. C-diff spores, for example, can't be killed with the alcohol hand sanitizers and they live on hard surfaces for days, maybe weeks.

MRSA is a fairly common infection seen in the general population. In the past three years, I've watched this bacteria develop resistance to our frontline antibiotic, Bactrim. More and more patients are coming back with unresolved wounds, or multiple wounds, and some are coming back with the infection having spread systemically. Not good. I would guess a large percentage of hospital workers are colonized with MRSA.

Yes, we have emergency plans for mass outbreaks, but the truth is, every hospital would be overwhelmed if a true deadly epidemic were to occur in the U.S. We would not have the staff, the beds or the meds.
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Old Apr 30th 2010, 09:57 AM
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Default Re: Eminent Mass Destruction- evolution

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Originally Posted by Lily View Post
We see about three or four suspected cases of TB in our ER per year. I say "suspected" because until cultures are grown or an assay done, we can't be sure. By that time, the patient has usually been discharged. Of course, these patients are immediately put into negative pressure rooms and all the appropriate Airborne Precautions are taken.

Our hospital quit yearly PPD testing a couple of years ago. I don't know why, money? I recently got tested on my own (negative, thank you), and most of the nurses do the same. Many other workers don't get tested. We're just asking for it.

I'm exposed to all kinds of nasty pathogens every day. I am, at the same time, very conscious of that fact and take precautions, and don't dwell on it. If I thought about it, I'd never go near a patient. MRSA, C-diff, klebseilla, H1N1... all kinds of bacteria, viruses, fungi and parasites. C-diff spores, for example, can't be killed with the alcohol hand sanitizers and they live on hard surfaces for days, maybe weeks.

MRSA is a fairly common infection seen in the general population. In the past three years, I've watched this bacteria develop resistance to our frontline antibiotic, Bactrim. More and more patients are coming back with unresolved wounds, or multiple wounds, and some are coming back with the infection having spread systemically. Not good. I would guess a large percentage of hospital workers are colonized with MRSA.

Yes, we have emergency plans for mass outbreaks, but the truth is, every hospital would be overwhelmed if a true deadly epidemic were to occur in the U.S. We would not have the staff, the beds or the meds.
Having a PPD has always been mandatory for any job I have had or applied for in the medical field. The last job I had we might have had to pay for it but it wasn't that much and they also paid for the Hep-B. Last year, I opted to get the flu vaccination and didn't jump on getting the H1N1...I ended up with the swine flu.

Viruses like the common cold and the flu are what I was taught to compare to garbage/junk viruses. They're constantly evolving and picking up and dumping pieces here and there making it hard to have vaccines against them. That always made me scared for some reason.

Every human body is crawling with these microorganisms as part of our normal flora, and if you really think about it we're lucky not to end up with something like necrotizing fascitis
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Old Apr 30th 2010, 10:56 AM
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Default Re: Eminent Mass Destruction- evolution

Thanks for your expert additions Lily and Drunk Girl. Sometimes I feel paranoid.

Look what I found today: Non-Drug Approach Can Slow Spread of Pandemic Flu

Really? Washing your hands and sneezing into your elbow helps keep you healthy? He knew?! Crimey.
The real relevance of the article is this:

Quote:
he researchers, writing in the May issue of the American Journal of Infection Control, called for large intervention studies, conducted over multiple flu seasons, to assess the impacts of such things as handwashing, cough etiquette, and mask wearing.

Research is also needed into the psychosocial and cultural barriers that make some groups reluctant to accept such measures, Aiello and colleagues said, as well as lab studies to pin down how the flu is transmitted.

The data so far, they concluded, "provide some evidence that face masks, hand hygiene, cough etiquette, reduced crowding, and school closures are effective in reducing the spread of influenza."
Well no shit Kemosabe.
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Old Apr 30th 2010, 12:00 PM
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Default Re: Eminent Mass Destruction- evolution

Quote:
Top Physician-Scientists Voice Grave Concern about Stagnant U.S. Global AIDS and TB Funding

Nearly 300 leading U.S. disease experts expressed serious concern about the White Houseís inadequate budget request for global AIDS and TB programs, saying the proposed funding levels signal a retreat in the U.S. response to the twin epidemics of HIV and TB.

In a strongly-worded letter sent to members of Congress today, the physician-scientists said the consequences of a pullback in combating HIV and TB in the developing world would be devastating. HIV/AIDS experts, in particular, are concerned that insufficient funding requested by the White House could jeopardize the hard-won gains made in reducing HIV-related mortality, preventing new infections, and providing life-saving treatment and care to millions of HIV-positive patients through the Presidentís Emergency Plan for AIDS Relief (PEPFAR).
Source

I figured I'd post this since it seems rather relevant to the thread topic. You are all talking about how this problem is rising, yet the US government is cutting back on funding for exactly this kind of stuff.
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Old Apr 30th 2010, 12:56 PM
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Default Re: Eminent Mass Destruction- evolution

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Sometimes I feel paranoid.
Microbiology has a tendency to make one paranoid. You can't help not to become that after you start learning about all the diseases and infections people can get. Not to mention when you start dealing with these microorganisms 2-3 times a week in lab!

Our first day in lab, we took TSA plates and placed them anywhere we wanted in the building. I placed mine on a bookshelf out in the hall. 10-15 minutes passed and all the students retrieved their plates, gave them to the TA, and the plates were incubated. When we returned to class two days later, my plate had some mold growing on it. The next week...four different types of mold were present! I just couldn't believe that all that mold was floating around in the air and everyone was breathing it in. Shew!
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Old Apr 30th 2010, 01:13 PM
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Default Re: Eminent Mass Destruction- evolution

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Look what I found today: Non-Drug Approach Can Slow Spread of Pandemic Flu

Really? Washing your hands and sneezing into your elbow helps keep you healthy? He knew?! Crimey.
Yes, this seems to be a popular form of propaganda. I was annoyed when I saw this being tossed around in the [overblown] run up to the Swine Flu.

Fact is, washing your hands and sneezing into your elbow helps prevent spreading the disease, it doesn't keep you healthy. But our goverments seem to believe if they don't package the idea as "ALL ABOUT YOU" no one will do it.

Sad commentary on the human race - or our governments. I'm not sure which.
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Old May 1st 2010, 07:08 PM
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Default Re: Eminent Mass Destruction- evolution

I don't think the run up to H1N1 was overblown at all. We were lucky.
We all sat around and laughed about countries that were quarantining but they were the only people that were reacting responsibly.
Here in my neck of the woods, before we knew whether or not this thing was going to be something we could handle, we had many cases in grades schools. The first case caused a closure of the school and a super cleaning. Multiple schools followed shortly after and no schools were closed. In fact, since only a few people died, the schools were sending out notices that your kids better show up or their absences would be unexcused.

Also, although sneezing into your elbow doesn't help you personally when you do it, the culturalization of these habits does a lot of good. Washing your hands isn't nearly as beneficial as not breathing in someone else's germs but it certainly helps and goes a long way toward preventing all kinds of other nasty illnesses.
I used to quietly judge people that didn't wash after using the toilet. Now I quietly judge people that don't wash long enough.

I'll tell you something else that creeps me the hell out is my daughter's high school. They are so preoccupied with behavior problems that they don't let the students use the bathroom. When they do get to use the bathroom, there is never any soap. Then they don't let the students go outside to eat lunch so they're all crammed in the cafeteria with filthy hands, sharing food.

They don't sincerely care about anything except being in control.
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Old May 2nd 2010, 08:40 AM
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Default Re: Eminent Mass Destruction- evolution

This thread is really, really depressing to read.
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