Five things you need to know about the flu right now

Today, January 9, 2013, we are the peak of influenza activity in the United States. Places like Boston, Chicago, and North Dakota are seeing a surge in cases of influenza. The Centers for Disease Control and Prevention (CDC) is reporting that flu activity is widespread and intense in most of the nation.

WIDESPREAD!

INTENSE!

So here are five things you need to know about the flu right now:

1. The flu likes unvaccinated people. While there are some people who will get the flu eventhough they’re vaccinated, comparing apples to apples, people who are not vaccinated have a higher risk of getting the flu. There is an injectable vaccine and a nasal spray vaccine. The evidence seems to point to the spray being better for children and the injection being better for adults, while older adults need the high-dose vaccine. So get your flu vaccine, and get it each year. The flu likes to mutate, a lot. And, no, you can’t get the flu from a vaccine. If you do, you would be the first person in the world to do so, and scientists would like to talk to you.

2. The flu likes dirty people. The flu vaccine makes it harder for the virus to make you sick if it infects you. It doesn’t act as a magical barrier that keeps the virus off of you. To do that, you need to wash your hands, and wash them well. A simple rinse and go will not do. By washing your hands often, you minimize the chances of catching the flu from all the surfaces you touch during the day. When you touch a surface with the virus on it and then you touch your nose, mouth, or eyes, you have a good chance of getting infected. If you’re a food handler, you have a good chance of making a lot of other people sick if you don’t wash your hands well. That would be embarrassing.

3. The flu is deadly. Most of us will get through the flu just fine because most of us are otherwise healthy. We’ll feel bad for a few days and then recover with no lingering problems. This is not the case for people who have underlying medical conditions, and there are more of us with those underlying conditions out and about nowadays. What are those conditions? They include diabetes, pregnancy, asthma, cancer, heart conditions, lung conditions, even neurological conditions. This is why it is important for people who can be vaccinated to get vaccinated, and for everyone to wash their hands. Doing this protects people who are too weak or too sick to protect themselves. To date, according to CDC, there have been 18 deaths in children. That’s 18 too many, especially in an era where the flu is completely preventable with vaccination, hand hygiene, and social distancing.

4. The flu likes friendly people. Ever wonder why the flu is so active in the winter? One of the reasons is that people tend to pack into tight spaces in the winter. We do this almost automatically to get away from the cold weather. (The cold, dry air also helps the flu survive longer in the environment, so that’s a double whammy.) We pack ourselves into movie theaters, malls, schools, and at work, and we share the virus with everyone. So, if you are sick, stay away from crowds. If you want to increase your chances of not being sick, vaccinate, wash your hands, and stay away from crowds. (I don’t mean for you not to shop, but do it as off peak hours, online, or in places that are not too crowded.) If you must take the train in a crowded car, stay away from people who look ill and wash your hands as soon as you get to your destination.

5. The flu is inside you long before you know it. It takes between one to two days for you to feel the signs and symptoms of the flu once you’ve been infected. But here’s the kicker: You’re infectious one to two days before symptoms as well. That means that you can be completely healthy and be spreading the flu around. This is why quarantines generally fail when it comes to the flu if you base those quarantines on signs and symptoms. A perfectly healthy-looking person can make it through a checkpoint and be infectious. So, if you know you’ve been exposed, stay away from people who are susceptible to serious complications form the flu, complications like pneumonia and death.

Now that you’re armed with knowledge, you’ll be more likely to make it through the flu season, no colloidal silver or magic required. Good luck. I’ll see you on the other side.

Everything leads to vaccines

People who have come to know me over the last year or so that I’ve been blogging, know that I am all about teaching science and technology to our youngsters so that we don’t go down the path of destruction as a nation and a society. Knowing science and technology will help our kids distinguish between good and evil, between things that are and things that can’t possibly be. When they read the news or hear the soothsayers and politicians, kids who know about science and technology will think critically about what they are reading and not fall for the lies while defending the truth.

Unfortunately, we’re not quite there.

If you’ve been watching the news lately, you know that there is an outbreak of fungal meningitis going on in the United States right now (October 2012). It is being caused by contaminated batches of a steroid injection that is given into the spinal column of persons with chronic pain. It’s supposed to relieve the inflammation that may be causing the pain. Unfortunately, it seems that a company that compounded — put together —  these steroid injections had a problem with their quality control that allowed for the batches to be contaminated with Aspergillus, a fungus that is found most everywhere in the environment.
Okay, so you have the facts. The outbreak is being caused by a fungus that got into injections given for pain. A fungus is causing this. People are being infected and dying from a fungus.
Fungus.
Now, if you went to school and paid attention in basic biology, you will know that fungi are not bacteria. You will know that bacteria are not fungi. There will be knowledge in your head that tells you that bacteria and fungi are not the same thing.
On the other hand, if you’re the anti-science, anti-vaccine type, then you will think that meningitis caused by a fungal agent (Aspergillus) is surely a plot to get more people to get the vaccine against bacterial meningitis, like this lady does:
anti-vaxer thinks there's a plot
Put me down for a $1,000. This is a sure thing!
Of course, this “knowledgeable” anti-vaxxer also asserts that “vaccination confers no protection against any form of meningitis likely to be deadly or even to cause serious morbidity.” And the additional conspiracy theory delusion that “these vaccination injections won’t be contaminated with fungal meningitis as a ‘little extra something’ to get for the money that you will be forced to cough up for the shot?”
I wish I was making this up. Clearly, Margaret doesn’t know the difference between fungi and bacteria, based on the evidence she has presented. And what is that about vaccinations, meningitis, and morbidity?
If she had been educated in how to conduct proper research on topics before she spewed her anti-vaccine rhetoric, Margaret would have stumbled onto such evidence as this:
or this:
Basically, our current body of knowledge about meningitis (the bacterial, vaccine-preventable kind) tells us that it is a major source of morbidity and mortality. We also know that vaccines against the principal strains of meningitis-causing bacteria have reduced the indices of death and disability from them. This is why we continue to push vaccination on vulnerable populations. You see, people can and do die from bacterial meningitis, and many are debilitated or crippled by it. Just ask Rayna DuBose, who lost her limbs to bacterial meningitis while in college. Or go ask Olivia Giles, who also lost limbs to bacterial meningitis.
Maybe Margaret would like to submit her theory to the parents of Jacob Nunley.
In any case, when an opponent to vaccines delivers such anti-science sentiments, we need to stand against them. If someone was on the fence about the meningococcal, streptococcal, or Hib vaccine for their kid and read Margaret’s statement, and then decided not to vaccinate, then that person may very well be placing themselves and others at risk. Bacterial meningitis is very contagious. Bacterial meningitis is very serious. Bacterial meningitis is very deadly.
Words have consequences, and so does ignorance.

I really don’t have a problem with anti-vaxxers

I really don’t have a problem with anti-vaxxers. We live in a country where you are very much free to make your own stupid decisions. Just this morning, on my way to work, I saw some stupid kid riding a motorcycle in and out of traffic. That was his choice to make. We also live in a society where there is a rule of law, and, if that kid were to hurt anyone due to his incredibly stupid actions, then the law would deal with him and make him pay the consequences.

Likewise, you are free to refuse any and all vaccines for yourself and for those in your legal custody. You can go on assuming that you live in a bubble and that your lifestyle — whatever that may be — will keep you safe from communicable disease and from giving those diseases to really vulnerable people. In fact, I will go to war, if necessary, to protect your right to make stupid decision. No, the government should not be in the business of getting all up in our business.
Unfortunately, left to our own devices, we will make some incredibly stupid choices, like not vaccinating against measles and contributing to the eradication of the measles virus, like we did with smallpox. (If we got better than 95% of the world’s population immunized against measles, in one generation’s time, we’d be done with it. No more measles vaccination would have to be given after that. This is the real anti-vax stance.) So we have to help people along into making the right decision for themselves and their community.
Still, there will be those who will lie and cheat their way out of a societal responsibility, like the draft-dodgers did, like the people who get on the road during a weather emergency, and like those who price-gouge during an emergency. So the government — at all three levels — has no choice but to get all up in people’s business in order to promote the public welfare. If you’re going to make use of those things for which we pay taxes, then you’re going to have to follow the rules about vaccinating and other such things. Period.
Even with that in mind, I really don’t take it personal when a member of my own family decides that their child has autism because of vaccines, that they will no longer vaccinate, that I’m in the pockets of Big Pharma because I point out the bias in their thinking, and that they don’t wish to speak to me about anything ever again. I really don’t.
What I do take personally is the continued effort from anti-vaccine groups and people to misinform the public. They continue to lie and present distorted “evidence” that vaccines are the ultimate evil. They will say almost anything to scare people away from vaccines. To them, vaccines are a method to depopulate the Earth or part of some massive conspiracy to make people ill in order to line the pockets of the pharmaceutical companies.
Then they will take it one step further and prey on the uninformed, forcing them through fear to make the same horrible and dangerous decisions to not only do away with immunization but to consult quacks and frauds for serious healthcare decisions. That’s what I take personal. That’s what makes me incredibly angry.
Why do I take it so personal?
I take it personal because I care too damn much about people on this planet. Even with 7 billion of us milling about, I still care for each and every single life… So much so that I have made it my life’s work to look after people. Public Health fits me like a glove, and I am very much incensed that these bozos are actively trying to bring it all down.
To be honest, the most frustrating thing of it all is that I will not stoop to their level. I will not lie. I will not cheat. I will not twist the data to convince anyone of my point of view. I will not accuse anyone of anything until I have the evidence to back it up. And I will most definitely not raise anyone to a level of a deity, i.e. worship them. It’s frustrating because it would make my work easier. It’s so easy to lie.

You can’t go wrong with the evidence

As I think of moving on to the next thing in my career as an epidemiologist and into public health policy, I have been thinking of what kinds of challenges I’ll face when I make the leap. If you know me, you know that I absolutely cannot stand politics and politicians. I hate that they are willing to say — or do — anything and everything so long as they stay in power. They’ll lie, cheat, and steal, and then deny that they did even in the face of convincing evidence against them.

See, in their silly little minds, they think that they are being “Mavericks” or “Win-at-all-costs Winner” by systematically doing things that are very “questionable” in order to retain their elected position. And it’s not just the elected politicians, either. I’ve met plenty of non-elected people in power who will also go to great lengths to stay in power. They will go along with a horrible plan, even one that they know is horrible, and then not criticize that plan once it is agreed that it was horrible.

So one of my weaknesses in going into public health policy will be my willingness to admit when I’ve made a mistake and the sense of urgency I feel in correcting it. Now, some of you may think that I’m just blowing my own horn by saying that I am self-aware enough to admit my own mistakes — the kind of attribute reserved for historical figures. But I really am not. If anything, admitting my own mistakes has gotten me in trouble when I’ve uncovered mistakes made by me when others would have never found them.

The one big thing I hate to carry around is guilt. I really don’t like it. Ask Pedro. She can detect the slightest hint of guilt on me and make me confess to anything that I’ve done. So it’s going to be hard to be in politics when I am prone to admitting my own mistake. Although, to be honest, I have no interest in being a politician. I’ll just be working with them. But some of them are going to be my bosses, and anything I say or do will be interpreted in light of the day’s politics. This is going to lead to conflict and frustration.

Then again, you can’t go wrong if you have all the science and all the evidence on your side. Even if you make a huge mistake, as long as you did what you did with all the available information and evidence on your side, you really should be in the clear. I’m no mind reader, no fortuneteller. So, if I base the things I will do in public health policy on stuff that has been proven to work, then I should be okay.

Still, I’m sure I’ll find a way to get in trouble.

Everything But The Cursed Vaccine

One of the big arguments that many anti-vaccine people will give you to downplay the importance of immunization is that “vaccines didn’t save us”. They will present as evidence the fact that deaths from vaccine-preventable diseases have been on the decline in the United States in modern times, particularly since potable water and sewer systems were installed in major population centers. They ask, then, that we do away with the US vaccine program and instead encourage good hygienic practices… LIKE WE DON’T DO THAT ALREADY.

If you were to read a public health message from any public health agency in October and November, that message would probably be about influenza, which peaks in the winter here in North America. In those messages, you will never read that the flu vaccine is the only way to prevent influenza. Better yet, you will even read from many public health professionals that frequent hand washing is the best way to prevent influenza, even better than the vaccine.

That’s right, anti-vaxers, the “Pharma Shills” are placing the interests of soap companies above those of Big Pharma. Shocking!

This is because public health professionals, for the most part, see public health problems as multi-faceted, multi-dimensional problems. No one problem is unique. Public health is not monolithic. Every single issue of public health concern has many sides to it, many causes, so it has many ways to approach it. When it comes to respiratory infections – like the flu – that are transmitted from person to person via respiratory droplets, we recommend to the public that they wash their hands, keep their distance if they’re sick and from sick people, and, if one is available, get vaccinated.

Let me explain it this way. What [expletive] general would ever send their troops to war without telling them all the ways they can defeat the enemy and equipping them with the best tools for the job? (Answer: One that doesn’t want to win.) So we tell the public all the evidence-based ways that they can prevent or control disease. It really isn’t all about vaccines.

But that is not what people in the anti-vaccine camp think. In their minds, we’re out there vaccinating at gunpoint. In their version of reality, we want everyone to develop autism from an imaginary conspiracy in their heads where vaccines cause autism while giving those of us who promote them some major profits. It’s almost like we’re not even on the same planet some times.

So you hear all of these talking heads – so-called experts – claiming that there are other ways, better ways to combat disease, so much so that vaccines are unnecessary and – in the minds of some of them – a dangerous proposition. There’s a pediatrician whose answer to childhood diseases is breastfeeding. There is a whacky lady down under whose answer to horrible things like whooping cough is everything BUT vaccines. (She has even denied that such a thing as whooping cough exists.) There are celebrities who trust homeopathy. And there are the poor parents who’ve believed these things and then lost – truly lost, as in dead – a child to a vaccine-preventable disease.

I’m not going to deny that potable water and sanitation have prevented a lot of death and disease in developed countries, nor am I going to deny that those systems are needed in developing countries to improve their standards of living. I’d be out of a job if I did. (Talk about conflicts of interest.) Potable water eliminates cholera. Draining swamps and installing nets eliminates malaria. Sewer systems take care of other waterborne infections.

But what about things like measles? It’s not waterborne. It’s not in the food. It’s in the air around an infected person, and it’s very infectious. What’s worse, the person is infectious to others before they have any symptoms. At least with diarrheal diseases – with the exception of asymptomatic carriers like Typhoid Mary – you have to get the diarrhea before you give it to others. That’s one good control measure we could instal: Diarrhea? Stay away! Yet that is not the case with measles or chickenpox. Even people with influenza are infectious about 24 hours before they are symptomatic.

The other thing about infectious like measles is that humans are the only reservoirs of the contagion. If we all got vaccinated, or at least the overwhelming majority (about 95%), we could eradicated – as was the case with smallpox. Then there wouldn’t be a need for any more vaccination. But no! Anti-vaccine advocates have done enough damage to the point that measles is making a comeback. I mean, those [expletive] will even go as far as to mail the [expletive] virus to other people!

So, yes, let’s have potable water. Let’s have sewer systems. Let’s give antibiotics/antivirals and continue research into their development and improvement. Let’s wash our hands, cook our food, and refrigerate the leftovers. AND let’s vaccinate, a safe and effective way to give these diseases the stab in the heart they deserve.

Big Dairy

Recently, a raw milk producer in Pennsylvania stopped selling raw milk after several people were infected with Campylobacter bacteria, a nasty gastrointestinal pathogen. Epidemiological investigations revealed that these people had nothing in common except having consumed that raw milk. Of course, people who tout the “benefits” of raw milk over pasteurized milk saw this public health intervention as nothing more than a ploy from the government to shut down the farm. They complained to newspaper editorial pages, blogs, and anyone else who would listen that it was all a plow from the dairy industry to put the farm out of business.

Because, you know, raw milk is such a huge threat to the dairy industry.Actually, it kind of is. If all the milk in the United States was not pasteurized, the number of diseases attributable to milk would be through the roof. Everything from E. coli to Listeria to Campylobacter to Brucella (a particularly nasty bug) would be infecting people all over. People would lose confidence in drinking milk, especially if it traveled long distances over several days like so much of our food does today. Raw milk just doesn’t last that long before it goes bad.
Does it have its benefits over pasteurized milk? It’s debatable.
Supporters of raw milk consumption will tell you that it’s chock-full of “probiotics”, bacteria that are good for you because they replace other normal flora and help in digestion better. They’ll also tell you that raw milk contains lactase, the enzyme that helps break down lactose. People who are intolerant of dairy lack that enzyme, so it is believed that they react better with raw milk.
Again, it’s all debatable.
It’s debatable because so much of these good things attributed to plausibility and some sketchy evidence. The whole lactose intolerance thing? Well, they attributed to bacteria in raw milk being able to produce lactase that aids in the digestion of dairy products. But they never explain that the amount of lactase produced by these bacteria would have to be a lot to overcome the lack of lactase production in those who are intolerant of dairy. They also never explain that some of those bacteria may be pathogenic in the end.
To believe that the dairy industry is out to kill the small dairy farmers, you’d have to believe that the dairy industry is spending a heck of a lot of money on something considered useless by those who believe the conspiracy. That something is pasteurization. It’s not a cheap thing to do on a mass scale. So why do it if you’re out to make money? And why demonize those who don’t? If I were Big Dairy, I’d say, “You know what? You’re right! Raw milk is the best milk!” I’d then save money by not pasteurizing AND put all the little farmers out of business by beating them at their own game.
But that’s not what is happening, is it?
It’s not happening because the threat of infections from dairy would skyrocket. Thousands of people would be injured or killed, and the lawsuits would take out the dairy industry altogether… And, well, we’d go back to pasteurizing. It’s not a gimmick. It’s a matter of public health.

Our Darkest Hour

There’s always that point in every story where the hero seems to be all out of options, out of energy, out of the will to go on. The adversaries are too many, and they are at your doorstep. They have threatened to take away everything you hold dear and then some. Kind of like this…


However, as you can see, the hero rises up to the challenge and encourages others to fight alongside him (or her), to fight like they have never fought before.

We have reached that moment, again, in the fight against infectious disease. A measles epidemic spreads throughout Europe and into the Horn of Africa. The same epidemic is now rampant in Australia and New Zealand. Mexico, which had not seen a case of measles in almost twelve years, has seen it come via airplane by way of Paris. The same is true in Ecuador, Venezuela, and Colombia. And here, in the United States of America, the most powerful nation the world has ever seen, measles is on the warpath, marching right on in from Canada and other nations and staying for the duration. It’s not just measles, either. Whooping cough has also returned to places in this country where it had been all but eradicated through proper immunization.

It’s not that we have let the guard down, really. The walls have always been there. Epidemiologists have always been guarding the gates, surveying the horizon for threats unknown. The problem is that we have been outsmarted by an internal, insidious enemy. People who profess to bring you freedom and choice are bringing you measles and chickenpox by mail. They’re brining you whooping cough at your school. Meningitis is not far behind. And neither is the flu this winter.

What I can best describe as SOBs who call themselves “health advocates”, “health rangers”, “health choice promoters” are nothing about health. It’s all about some misconstrued version of reality whereby getting a deadly disease is way better than that goddamn vaccine the motherfucking government is trying to force up your arm, or nose, or whatever. Their own universe lauds them with all sorts of praise for doing their work, for letting children get infected and pass those infections along to those who are weak and unknowing.

I would like to think that we are not at our darkest hour in public health. I really would. But the news are coming in from all over the world… All over the social networks and the internet. I mean, just look at this:

Most people haven’t thought about it because most people are sane, I hope.
And not just online (click to enlarge)

The ignorance these people have and are passing on to others is what we have to fight… Fight like we’ve never fought before.

Mental Health and Hygiene

This whole thing with the child abuse allegations at Penn State reminded me of the biggest – or one of the biggest – problems in public health in the United States and elsewhere in the world. What could be just as bad as malnutrition and outbreaks of infectious disease? What can tear individuals and their families apart like very few other things can and still be largely ignored as a problem?

Mental health.


I remember the look on the face of one of my ex-girlfriends when I told her that I had gone to talk to a counselor. She was shocked. Instead of asking me if there was something she could do, she asked me what was “wrong” with me and if she should be worried about me, not for me. I explained to her that the workload of school and my two jobs at the time were getting to be too much, and that I needed to talk to someone who would hold my thoughts in confidence and see problems from outside and without much bias.

That wasn’t enough for her. She retreated from our relationship to the point that we broke it off after a few weeks. Later, I would find out that she started spreading the rumor that I was “crazy”, so much so that I got pulled into the boss’ office to talk about my “problem”. Can you imagine if I really did have some sort of a paranoid disorder?

I also remember a time when an uncle of mine tried to commit suicide and how the family reacted. Many of them branded him a “sinner” because, through some twisting of their logic and their religion, suicide attempts are sinful, something that God hates.

Uh, no.

And these same stories repeat themselves over and over again each and every day all over the world. People who seek mental health care are branded as being crazy or inherently broken. People with addictions are thrown in jail and forgotten. People with trauma of some kind are branded as being “weak” or just not able to deal with life. And don’t get me started on the stigmas of people with depression.

Yeah, like you can be cheery all the time in this economy.

Listen, when you get hepatitis, your liver is infected and doesn’t act normal. It makes you sick on the outside, making you look yellow from all the bilirubin. If you get pneumonia, you’ll be coughing and very miserable. So why is it any surprise that an illness of he brain manifests itself in our mood and in the way we interact with the world. How we see the world is processed by the brain, so it stands to reason that anything wrong with the brain will change our view of the world.

It’s the cultural and social stigma that is associated with mental health problems that really gets to me. I hate it when people say that someone who is addicted to a drug – or food, or anything – is broken or has some sort of control over their addiction. It’s called an addiction for a reason, and it needs to be addressed because addictions don’t just affect the addict. The addict’s entire world is somehow affected, and that effect is most often not a constructive one. But there are so many people, many in power, who ignore their own addictions and treat addicts worse than lepers.

Mental health is a matter of public health that we need to address just like we would any other disease and any other outbreak thereof. We need to come together and work with experts in the field of mental health to look at what is going and attack it head-on. None of this, “it’s a private/family/personal matter” crap because it’s not. Sure, the underlying details of what has lead to the mental disease is private, as are the individual details, like those of any other medical patient, but the overall problem is all of ours.

I mean, I’m sitting here listening to an interview of Darrell Hammond on NPR and feeling very bad about all he’s gone through, how his mother’s mental disease infected him as well. I’m also very proud of him for coming out so sincerely about his condition and how it has affected his life, and I’m happy that a big outfit like NPR is publishing the interview. His book is definitely something I need to read… We all need to read.

Too many things need to be our “Manhattan Projects”, but this is one of those that we can’t allow to go uncontrolled any more.

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.

A (Not So) Quick Word About Recall Bias

I was reading through some of the reviews of a restaurant the other day when I read some comments by several people who swore that they had been made sick by food from that restaurant. One commenter stated that they had become “gravely ill” soon after leaving the restaurant. Another commenter agreed, saying that they had become ill “about a half hour” after eating at the same establishment. Soon after that, others piled on. As I watched the ratings site, I was very upset to see what became a comedy of stupidity hours later.

Judging by the comments, the incubation time for their disease was between 30 minutes and TWO WEEKS. Not only that, but their onsets were days and weeks apart from each other. This leads me to one of two possible conclusions: 1) The restaurant has an enormous problem with regards to hygiene to the point that they are making people sick on a prolonged scale spanning weeks. Or 2) the commenters were exhibiting – at the very least – recall bias and/or – at the very worst –  a mob mentality.

Then again, they could all have been the same person with some sort of vendetta. (I’m not linking or publishing the exact quotes because the restaurant already has enough issues.)

It is very natural for us to associate our illness to the very last thing we ate before we got sick, especially if we are not familiar with things like “incubation times” or the modes by which viruses and bacteria that we eat can make us sick. For example, Norovirus takes just a few viral particles to make a person sick. The incubation time – the time from infection to symptoms – ranges from 24 to 48 hours with Norovirus, certainly not 30 minutes. That is, you’re completely symptom free for about a day before you get really sick form Norovirus.

Salmonella and E. coli make you sick through the cunning use of toxins. Alright, alright… They don’t do it on purpose. It’s just that some of their metabolic byproducts of their own cell membrane may act as a toxin once in our gut. Their incubation times? 12 to 72 hours for Salmonella and 3 to 4 days for E. coli. Again, no where near the 30 minute mark. And certainly not two weeks later.

What could cause disease in 30 minutes or less or your money back?

Staphylococcus aureus or Bacillus cereus can make you sick in 30 minutes after ingesting their toxins… But it’s a stretch in this case, especially in light of others reporting such disparate incubation times.

This is why it is necessary for health departments and health care providers to educate the public on the nature and behavior of gastrointestinal disease – and other diseases as well. Because that lack of understanding can not only lead to a restaurant or other food businesses to be wrongly accused of making people sick – which can have them go under financially – it can also muddy up investigations of serious food borne outbreaks.