Monday, January 31, 2005

Dangers Old and New;
Pertussis and H5N1

Another Rationale for Universal Health Care

More than just a pesky cough
By Shari Roan
[LA] Times Staff Writer
January 31, 2005

The chronic, spastic cough started with what appeared to be a cold. A few months later, it was ruining Zachary Graham's life. The 16-year-old Sunapee, N.H., resident was often left gasping for air, gagging and unable to sleep. During one particularly ghastly coughing spell, Betty May Graham, Zachary's mom, feared her son was about to stop breathing.

That incident led the family to a lung specialist who delivered a diagnosis that stunned the Grahams: Zachary had pertussis, also known as whooping cough, a disease far better known in the 1930s than today.

"When the doctor said whooping cough, it kind of blew my mind," the teenager says. [...]

A vaccine introduced in the 1940s sent pertussis cases in this country plummeting to a low of 1,010 in 1976. But the disease roared back in the 1990s. According to the national Centers for Disease Control and Prevention, about 10,000 cases were reported in 2003. 
About ten thousand cases of pertussis were diagnosed in the USA in 2003.  That probably is a subset of the true number of cases, since the disease often is mild in adults, and may not be diagnosed.  The disease used to cause almost 10,000 deaths per year in the USA.  We have made a lot of progress since then. 

Of course, we now face new threats.  Bird flu has been reported in 31 areas of Viet Nam, as well as in other Asian countries.  Recently, the first reported cases of human-to-human transmission were reported.  The current strain of bird flu usually passes from animal to human, so it can be contained by killing all suspect animals.  With the emergence of human-to-human transmission, the threat of a pandemic is much greater.  A specialist at the University of Michigan School of Public Health has written an editorial about this in the New England Journal of Medicine.  Dr. Arnold Monto states the threat more directly. 
The report by Ungchusak et al. in this issue of the Journal (pages 333–340), however, clearly suggests the occurrence of person-to-person transmission through close contact with an infected child, leading to both clinical illness and death.
So it is not absolutely certain that human-to-human transmission occurred, but that is by far the most likely explanation.  He goes on to say:
But what if recognized transmission does begin to occur in a limited geographic area? Isolation and quarantine, which have proved effective against the severe acute respiratory syndrome (SARS), will probably not be sufficient to stop the spread of such an infection. Vaccine specific for the new strain will not be available for months after its appearance in humans, although studies of the necessary characteristics of such vaccines are ongoing, mainly under the sponsorship of the National Institutes of Health, and will provide essential information on their use should a pandemic begin. [...]

The logistic hurdles are formidable. A mobile stockpile of the drug would have to exist and be made available in the affected country. Oseltamivir is now being stockpiled by a number of developed countries for use once a pandemic virus becomes established and begins to spread rapidly around the globe. Developing a stockpile in an attempt to restrict the spread of the new virus at its source might mean diverting drugs from other national stockpiles. However, this diversion must happen. [...]

The avian origin of previous pandemic viruses was recognized only after the fact; this time, we have been given a warning. We really are not sure when, or whether, the type A (H5N1) virus will start to spread among humans, but we must be ready to stop it if we can — and, if we cannot, at least to mitigate its effects through the use of stockpiled antiviral drugs and, eventually, strain-specific vaccine.
A faction of neoconservatives argue against universal health care.  They voice various objections, but what it boils down to is this: they don't think they should have to pay for somebody else's health care. 

Guess what?  Health care is everybody's business.  If other people in your community are not vaccinated, it puts you and your family at risk. If other people are not adequately nourished, housed, and otherwise able to attend to their basic health, it puts all of us at risk. 

And if there is a pandemic of bird flu, or if pertussis makes more of a comeback, or if any one of many other illnesses starts to spread, there is not only a risk to your health, there is a risk to your pocketbook.  A pandemic of bird flu would devastate the world economy.  The demand for oil would plummet.  Halliburton may have to lay off some employees.  Dick Cheney might not get his yearly payment from them.  We might not be able to afford to invade Iran.  Boy, wouldn't that be awful?

Seriously, even if one is an unabashed card-carrying capitalist pig who doesn't give a damn about anyone else, and is unashamedly more pro-dollar than pro-life, universal health care -- as distasteful as it may seem -- does more than save lives: it protects the health of our economy. 

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