Disease

The debate over the border crisis has descended to a sad—and depressingly familiar—place

Want to know how far we’ve sunk? Here’s how far: There was never any chance at all that we would handle the crisis of thousands of unaccompanied immigrant children running for their lives and arriving at our border with any maturity or grace at all. There was never a chance we’d take them in, get them fed and settled, and then consider sensibly how we can address the immigration-emigration mess on both sides of our border—and on our border—while working to send the kids safely home.

Instead we got the usual circus, the usual call to send in the troops, lock down the border, impeach the president—because, well, why not?—and under no circumstances to consider the comprehensive immigration reform bill languishing in the House. And now, at last, we have arrived at the inevitable sub-basement level of the debate. Now the nativists and xenophobes have played their nastiest—and least surprising—card: the border must be secured and the immigrants sent back because they are, of course, diseased.

That ugly cawing has been growing in the past week—and a lot of it has come from the usual sources. “Our schools cannot handle this influx, we don’t even know what all diseases they have,” said Rep. Louie Gohmert (R-TX). Alan Long, the Mayor of Murrieta, Calif., where sign-waving protesters blocked buses carrying immigrants detained at the Texas border, argued, “[Y]ou don’t ship people that are ill and contagious all over the country.”

In a letter to the Centers for Disease Control, Rep. Phil Gingrey (R-Ga.) added his addled voice: “Many of the children who are coming across the border also lack basic vaccinations such as those to prevent chicken pox or measles. This makes Americans who are not vaccinated—and especially young children and the elderly—particularly susceptible.”

But as numerous sources, most notably The Texas Observer and the New Republic, have reported, the immigrants have more to fear from us than we do from them. The fact is, children from Guatemala, where health care is fully subsidized by the government, have a better chance of being vaccinated than kids in Texas, where one in six people is uninsured. The fact is, in Honduras, El Salvador and Guatemala again, the vaccination rate for measles is 93%, compared to 92% in the U.S.—and it’s much lower in some poorly vaccinated pockets like New York City, where there has been a recent measles outbreak.

The myth of the diseased immigrant is not exclusively an American phenomenon. All cultures exhibit it and none can completely avoid it. The behavior is deeply, deeply rooted in our brains—specifically in our amygdalae, where base feelings like rage and suspicion and impulsiveness lie. As I write in my upcoming book The Narcissist Next Door, this form of tribal narcissism—of elevating your group above others—was essential for our early survival. The clan that knows you best is the one that is likeliest to protect you and feed you and keep you alive. Wander too far from the campfire and you may run into the alien other—unfamiliar people who would just as soon eat you as say hello. So we’re hardwired to see them as strange and menacing and the people we know as familiar and good.

In the modern era, that simplistic truth becomes harder to sustain, so we lard it up with invented justifications: it’s not that people from the other side of the border are innately bad, it’s that they pose a particular menace. Their frail genes will weaken our hardy stock; their dark-skinned men can’t resist our light-skinned women; and, inevitably, they bring diseases that can strike us all dead.

The nativists and their raging amygdalae have always made claims like this and surely always will. The measure of a culture is not in silencing them—they will never go completely quiet—but in marginalizing them. They are free to descend to—and live in—the sub-basement of the debate. Everyone else is welcome to come up and enjoy the daylight.

"Children are especially vulnerable."

Thousands of people in South Sudan are being put at risk by a cholera outbreak, says international aid group Save the Children. Cholera has infected 2,600 people in 9 of the the country’s 10 states, according to the group, leaving 60 dead since cases were first reported in May.

“Save the Children’s feeding clinics are dealing with an influx of severely malnourished children. We urgently need to further funds to provide families with life-saving food supplements,” said Save the Children’s Country Director Pete Walsh in a statement Friday.

The cholera outbreak is tied to an ongoing conflict in the country. South Sudan is home to a long-standing civil war, with the most recent violence escalating in December after President Salva Kiir accused his former deputy of attempting to launch a coup.

Aid agencies are struggling to receive needed funding even as the fighting has pushed the country to famine. Save the Children says the seven major international aid agencies operating in the country face closure, currently short an excess of $92 million.

“We are seeing a lot of cases of malnutrition at our treatment centers,” Save the Children Director Francine Uenuma tells TIME. “Children are especially vulnerable.”

Save the Children is working closely with local treatment centers, hoping to develop assessment plans and prevention education. However, with the rainy season approaching, conditions are only expected to deteriorate further. Walsh says that flooded roads will only slow down the delivery of life-saving drugs.

"Certainly, this is a disappointing turn of events"

A 4-year-old girl believed to have been cured of HIV showed detectable levels of the virus, federal officials said Thursday in a blow to anti-HIV efforts.

The Mississippi girl had been off of antiretroviral therapy for more than two years, and doctors believed that she could serve as a model for eradicating HIV in babies born with the virus.

But on Thursday, the National Institute of Allergy and Infectious Diseases said that researchers had found detectable HIV levels in the girl this month.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care and the HIV/AIDS research community,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a statement.

The girl was born with HIV, and doctors administered anti-AIDS therapy nearly immediately after her birth and continued with the treatment for months. After the girl and her mother missed several treatment appointments, doctors found that the girl was still HIV-free — leading them to believe that the early treatment may have successfully eliminated the virus. Still, experts say they knew a relapse was a possibility.

Since HIV was detected in the girl this month, doctors have resumed treatment. But despite her relapse, researchers say her case still provides a valuable understanding of early HIV treatment.

“The case of the Mississippi child indicates that early antiretroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period,” Fauci said in a statement. “Now we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged even further.”

U.S. Embassy is working to confirm case of deadly virus

A U.S. citizen who traveled in regions of West Africa in the grip of an ebola virus outbreak is being tested for the disease in Ghana.

“He is an American and records showed that he had been to Guinea and Sierra Leone in the past few weeks,” a senior health ministry official told Reuters in an interview. The patient is reportedly quarantined in a clinic in the capital Accra and test results, which should be available later on Monday, are being examined at the Noguchi Memorial Institute of Medical Research.

According to Reuters, the U.S. embassy in Ghana has been informed of the case and is working to confirm it.

The ebola outbreak, which started in Guinea, has been declared “out of control” by the health group Doctors Without Borders, which is treating patients in Western Africa. Ebola causes fevers, vomiting, diarrhea and death, and has spread from Guinea to Sierra Leone and Liberia.

[Reuters]

The deadly Ebola virus continues to devastate West Africa

The Ebola outbreak sweeping across West Africa is “totally out of control,” a health official said Friday.

“The reality is clear that the epidemic is now in a second wave,” Bart Janssens, a Doctors Without Borders official, told the Associated Press. “And, for me, it is totally out of control.

“It’s the first time in an Ebola epidemic where [Doctors Without Borders] teams cannot cover all the needs, at least for treatment centers,” Janssens added.

Ebola causes high fevers, vomiting, diarrhea and often death. The latest epidemic that has left more than 330 dead in Guinea, Sierra Leone and Liberia. The outbreak started in heavily populated areas of Guinea and Liberia.

“I’m absolutely convinced that this epidemic is far from over and will continue to kill a considerable amount of people,” Janssens told AP,
“so this will definitely end up the biggest ever.”

[AP]

On Feb. 21, 2003, a 64-year-old Chinese physician named Dr. Liu Jianlun traveled to Hong Kong to attend a wedding. He stayed in room 911 on the ninth floor of the Metropole Hotel. Liu, who had been treating cases of a mysterious respiratory disease in the neighboring Chinese province of Guangdong, was already sick when he arrived in Hong Kong, and the next day he checked into the city’s Kwong Wah hospital. Liu died on Mar. 4 of the disease doctors soon named Severe Acute Respiratory Syndrome, or SARS. But before he died, he inadvertently infected at least 16 people who spent time on the ninth floor of that Hotel.

Some of those people boarded international flights before they knew they were sick, seeding new outbreaks in places like Vietnam, Taiwan and Singapore. SARS had been confined to southern China for months, but once Liu checked into the Metropole Hotel, it was only a matter of time before the first new infectious disease of the 21st century went global. Before it was stamped out months later, SARS had infected 8,273 people, killing 775 people in 37 countries.

It’s that chain of events that must have been on American officials’ minds last week when news broke that the U.S. had its first case of Middle East Respiratory Syndrome (MERS). A male health care provider had been in Saudi Arabia, the epicenter for the ongoing MERS outbreaks, before flying to Chicago via London on Apr. 24. After arriving in Chicago, he took a bus to the Indiana town of Munster, where on Apr. 28 he was admitted to the hospital and was eventually diagnosed with MERS. A deadly respiratory disease that has already infected hundreds, almost all in Saudi Arabia, and killed over 100 people had come to the U.S.

CDC officials played down the larger threat of the first U.S. MERS case. “In this interconnected world we live in, we expected MERS to make its way to the U.S.,” Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters on May 2. “We have been preparing for this.” CDC officials will contact and track individuals who might have been close to the patient — including health workers who treated him and fellow travelers on his international flights and his bus ride to Munster — just in case any developed MERS symptoms. That’s not likely. So far MERS hasn’t shown much ability to spread easily from person to person, so the threat to the larger U.S. public is probably very small.

But if that Indiana case remains isolated — and MERS itself never becomes the global health threat that SARS was — it only means we were lucky.

As Schuchat put it, exotic, emerging diseases are now “just a plane’s ride away.” In the past, before international air travel became common, emerging pathogens could begin infecting people but remain geographically isolated for decades. Scientists now think that HIV was active among people in Central Africa for decades before it really began spreading globally in the 1970s, again thanks largely to international air travel. Today there’s almost no spot on the planet — from the rainforests of Cameroon to the hinterland of China — so remote that someone couldn’t make it to a heavily populated city like New York or Hong Kong in less than 24 hours, potentially carrying a new infectious disease with them.

The surest way to prevent the spread of new infectious disease would be to shut down international travel and trade, which is obviously not going to happen. The occasional pandemic might simply be one of the prices we pay for a globalized world. But we can do much more to try to detect and snuff out new pathogens before they endanger the health of the planet.

Because most new diseases emerge in animals before jumping to human beings (the virus that causes MERS seems to infect humans mostly via camel, though bats may be the original source), we need to police the porous boundary between animal health and human health. That work is being done by groups like Global Viral (whose founder I profiled in November 2011) is creating an early warning system capable of forecasting and containing new pathogens before they fuel pandemics. But as the stubborn spread of MERS shows, that’s easier said than done — especially if diseases emerge in countries that have less than open political systems.

Because as it turns out, the driving factor behind the spread of new diseases isn’t just globalization. It’s also political denial. SARS was able to spread beyond China’s borders in part because the Chinese government initially covered up the outbreaks — at one point even driving SARS patients around Beijing in ambulances to hide them from an international health team. Meanwhile, the autocratic Saudi government has made life difficult for researchers studying MERS. Much the same thing happened when the avian flu virus H5N1 began spreading in Southeast Asia in 2004. In every case, a rapid and public response might have contained those viruses before they threatened the rest of the world.

Eleven years later Hong Kong’s Metropole Hotel is now called the Metropark, and Liu Jianlun’s infamous room 911 doesn’t exist any more. After SARS, hotel management changed the number to 913 in an attempt to scrub out the past. Denial is always so tempting. But in an interconnected world, where the travel plans of a single person can seed deadly outbreaks a continent away, it’s no longer an option.

A new study of 2,717 couples by researchers at the University of Michigan finds that not only did 31 percent of marriages involving at least one sick partner end in divorce, but the risk of separation for older couples was higher when the wife, not her husband, was ill

It turns out the newlywed’s vow to stay together in sickness and in health doesn’t always bear out.

Researchers from the University of Michigan found that the risk for divorce is higher for older couples when the wife, not the husband, gets sick.

Some numbers show the that 75% of couples dealing with chronic disease end in divorce. In the Michigan researchers’ study, which is being presented at the Population Association of America’s annual meeting, the researchers looked through 20 years of data on 2,717 married couples. At least one of the partners was over 50 at the start of the study. The researchers also looked for diseases like cancer, heart disease, lung disease and stroke, and how they impacted the marriages.

In all, 31% of the marriages ended in divorce. Men were more likely than women to get sick. Divorce was also more common when the wife got sick, and not the husband. And the study is not the first to find that divorce is more likely when the wife gets a serious illness. Talk about a double whammy of bad luck for women: first you’re diagnosed with a chronic disease, and then you get divorced.

The reasons why are unclear, but the researchers have a couple theories. For one, it’s possible that social expectations for caretaking make men feel less qualified for the job. Although the researchers did not track who asked for the divorce, they note that it’s typically women who initiate, meaning that it’s also possible that women don’t feel like their husbands are giving them adequate support, and they decide they would prefer to rely on friends and family. “It’s…important to recognize that the impetus for divorce may be health-related and that sick ex-wives may need additional care and services to prevent worsening health and increased health expenditures,” said study author Amelia Karraker in a statement.

Having couples’ therapy as part of hospitals’ oncology programs wouldn’t be such a bad idea.