Books You Should Read: "When Germs Travel" by Howard Markel

Anyone who knows me knows that one of the big things I detest about Public Health as it is set up today is the interference of people who don’t know better into the things that we – the peons working the daily outbreaks and looking for cases of stuff – need to do without restrictions. Of course, I’m talking about politicians. The one issue that has painfully brought this to the forefront in my professional life is immigration. Time after time, I’ve seen politicians at all three levels of government call for the denial of basic health services to immigrants and their children. They reason that it is a waste of resources that could go to Americans.

It’s as if they think that viruses and bacteria know the difference between Pablo, the young apple picker from Oaxaca, and Paul, the corporate up-and-comer from Omaha with the dashing good looks. Pathogens don’t give a crap about who they’re infecting. To them, we’re all just sacs of growth media. The sooner we come to understand this, the sooner we can let go of the stigma that we cause to people based on their ethnicity and/or nationality and move on with what needs to be done.
The book “When Germs Travel” does a great job at telling us all about what happens when germs cross international boundaries and come to a new population – or society – and the kind of craziness that they cause. It covers six epidemics that were triggered by immigrants (or returning travelers) and the stupidity that ensued. For example, an outbreak of bubonic plague in Chinatown causes the authorities to cordon-off the area and not permit people who look Asian from interacting with the other ethnicities. Any epidemiologists worth his weight in salt will tell you that such an intervention by itself is useless.
You can’t quarantine or impose social distancing on just one group of people. You need to do it with all who are susceptible, regardless of race, ethnicity, gender, sexual orientation, disability, etc.
The book also covers the mistreatment of Jewish immigrants as they arrived in New York Harbor from Eastern Europe. They were screened for Chlamydia trachomatis, the causative agent of trachoma, which is an infection of the eyes. In that time, the infection was not treatable with antibiotics, for there were none. People were screened and told to go back to their country if they were found to be infected. On the other hand, if they had the right amount of money or the right connections in New York City, they were allowed to go on through.
A lot of help that screening did.
Not only that, but the screeners – medical doctors –  did not practice good hygiene. A high-ranking government official inspecting the intake points noticed this. That official? The President of the United States. Bo-yah!
I won’t spoil the rest of the book for you, but you know where this is going. You know of the treatment of Hatian immigrants because of HIV/AIDS. You know of the treatment of other immigrants because of Tuberculosis. Oh, you don’t know?
Everyone should.
One thing that resonates throughout the book is the hypocrisy of the decisions taken by politicians and the public health officials influenced by them. That’s right, not all public health workers are infallible and incorruptible. Many of them can be bought or intimidated into taking the wrong course of action when they need to protect the public’s health. And that’s one main reason why I will never, ever become a politician or play the politicians’ games.
I never want someone to write a book about how wrong I was in letting the next big epidemic or a small outbreak of diarrhea associated with a diner get out of control. That’s just plain embarrassing.

How Old Is Epidemiology?

When you think of the earliest epidemiologists – as I’m sure you do on a daily basis since I can’t be the only one with that obsession – you probably think of John Snow. Doctor Snow is credited with stopping a severe outbreak of cholera in London by figuring out the who, when, and where of the outbreak. He also used the earliest for of GIS (geographic information system) to figure out that one water pump was causing most of the cases of cholera. He is the hero of many an Epi.

But he wasn’t the first Epi, was he?

Early humans were not much for encountering other humans and sharing germs because, well, there weren’t that many of us. We didn’t get to meet each other, shake each other’s hands, maybe have some sex, and exchange anything from viruses and bacteria to fungi and other parasites. But then we started to grow in numbers and migrate. Little by little, we decided that it was a good idea to get together in a family unit, then get families together in villages. Those villages grew and became towns. Trade and other forms of business lured people from one village to the other, creating cities.

With all those advances came the rape and pillage sharing of bugs. Those bugs would bring on diseases. In some cases, entire cities were laid to waste by epidemics. In other cases, the entire nation state (a collection of like-minded cities) was conquered. Just ask the Native Americans how smallpox worked out for them. However, not all of us humans are insensitive asses out to make a buck. Some of us care about our fellow man. We longed to heal those who were sick, understand the disease, and then keep it from ever happening again.

Let’s focus on those who wanted to understand and stop disease. (The physicians can have the healing.) Who was the first person to notice that keeping a ship docked for 40 days decreased the chances of the sailors to be infected and bring the disease into the port? Who was the first one to take scabs from people with smallpox, grind them up, and have non-immune people snort them as a form of vaccination? And who ordered villages to be closed from the rest of the world for a determined amount of time as a form of isolation?

Well, there really wasn’t one person.

See, humans are set up to look for and understand patterns. That’s why we love puzzles. Some of us love them more than others, of course. And – much to our detriment – others look at patterns and find the wrong associations. Well, it took those pattern-readers who were right and a lot of luck to be able to stop one epidemic after another. I mean, think about it. We didn’t have the wonderful toys great technology we have now. Even now, we get our collective butts handed to us by bugs. Can you imagine a thousand or three thousand years ago?

We’ve been around for probably as long as humans have been around. We’re the ones that have seen the patterns of disease and done our best to understand diseases and keep them at bay, sometimes to our own detriment. Sure, we’ve not always used science, and we’ve been often wrong. But we’ve been around… We’re always around.