3362. How Climate Change Is Contributing to Skyrocketing Rates of Infectious Disease

By Abraham Lustgarten, ProPublica, May 7, 2020

A catastrophic loss in biodiversity, reckless destruction of wildland and warming temperatures have allowed disease to explode. Ignoring the connection between climate change and pandemics would be “dangerous delusion,” one scientist said.

The scientists who study how diseases emerge in a changing environment knew this moment was coming. Climate change is making outbreaks of disease more common and more dangerous.

Over the past few decades, the number of emerging infectious diseases that spread to people — especially coronaviruses and other respiratory illnesses believed to have come from bats and birds — has skyrocketed. A new emerging disease surfaces five times a year. One study estimates that more than 3,200 strains of coronaviruses already exist among bats, awaiting an opportunity to jump to people.

The diseases may have always been there, buried deep in wild and remote places out of reach of people. But until now, the planet’s natural defense systems were better at fighting them off.

Today, climate warming is demolishing those defense systems, driving a catastrophic loss in biodiversity that, when coupled with reckless deforestation and aggressive conversion of wildland for economic development, pushes farms and people closer to the wild and opens the gates for the spread of disease.

Aaron Bernstein, the interim director for the C-Change Center for Climate, Health and the Global Environment at Harvard University’s T.H. Chan School of Public Health, said that ignoring how climate and rapid land development were putting disease-carrying animals in a squeeze was akin to playing Russian roulette.

“Nature is trying to tell us something,” Bernstein said.

Scientists have not suggested that climate played any direct role in causing the current COVID-19 outbreak. Though the virus is believed to have originated with the horseshoe bat, part of a genus that’s been roaming the forests of the planet for 40 million years and thrives in the remote jungles of south China, even that remains uncertain.

Scientists have, however, been studying the coronaviruses of southern China for years and warning that swift climate and environmental change there — in both loss of biodiversity and encroachment by civilization — was going to help new viruses jump to people.

There are three ways climate influences emerging diseases. Roughly 60% of new pathogens come from animals — including those pressured by diversity loss — and roughly one-third of those can be directly attributed to changes in human land use, meaning deforestation, the introduction of farming, development or resource extraction in otherwise natural settings. Vector-borne diseases — those carried by insects like mosquitoes and ticks and transferred in the blood of infected people — are also on the rise as warming weather and erratic precipitation vastly expand the geographic regions vulnerable to contagion. Climate is even bringing old viruses back from the dead, thawing zombie contagions like the anthrax released from a frozen reindeer in 2016, which can come down from the arctic and haunt us from the past.

Thus the COVID-19 pandemic, even as it unfolds in the form of an urgent crisis, is offering a larger lesson. It is demonstrating in real time the enormous and undeniable power that nature has over civilization and even over its politics. That alone may make the pandemic prologue for more far-reaching and disruptive changes to come. But it also makes clear that climate policy today is indivisible from efforts to prevent new infectious outbreaks, or, as Bernstein put it, the notion that climate and health and environmental policy might not be related is “a ​dangerous delusion.”

The warming of the climate is one of the principal drivers of the greatest — and fastest — loss of species diversity in the history of the planet, as shifting climate patterns force species to change habitats, push them into new regions or threaten their food and water supplies. What’s known as biodiversity is critical because the natural variety of plants and animals lends each species greater resiliency against threat and together offers a delicately balanced safety net for natural systems. As diversity wanes, the balance is upset, and remaining species are both more vulnerable to human influences and, according to a landmark 2010 study in the journal Nature, more likely to pass along powerful pathogens.

The casualties are amplified by civilization’s relentless push into forests and wild areas on the hunt for timber, cropland and other natural resources. Epidemiologists tracking the root of disease in South Asia have learned that even incremental and seemingly manageable injuries to local environments — say, the construction of a livestock farm adjacent to stressed natural forest — can add up to outsized consequences.

Around the world, according to the World Resources Institute, only 15% of the planet’s forests remain intact. The rest have been cut down, degraded or fragmented to the point that they disrupt the natural ecosystems that depend on them. As the forests die, and grasslands and wetlands are also destroyed, biodiversity sharply decreases further. The United Nations warns that the number of species on the planet has already dropped by 20% and that more than a million animal and plant species now face extinction.

Losing species has, in certain cases, translated directly to a rise in infectious disease.

Americans have been experiencing this phenomenon directly in recent years as migratory birds have become less diverse and the threat posed by West Nile encephalitis has spread. It turns out that the birds that host the disease happen to also be the tough ones that prevail amid a thinned population. Those survivors have supported higher infection rates in mosquitoes and more spread to people.

Similarly, a study published last month in the journal Proceedings of the Royal Society B found that as larger mammals suffer declines at the hands of hunters or loggers or shifting climate patterns, smaller species, including bats, rats and other rodents, are thriving, either because they are more resilient to the degraded environment or they are able to live better among people.

It is these small animals, the ones that manage to find food in garbage cans or build nests in the eaves of buildings, that are proving most adaptable to human interference and also happen to spread disease. Rodents alone accounted for more than 60% of all the diseases transmitted from animals to people, the researchers found.

Warmer temperatures and higher rainfall associated with climate change — coupled with the loss of predators — are bound to make the rodent problem worse, with calamitous implications. In 1999, for example, parts of Panama saw three times as much rainfall as usual. The rat population exploded, researchers found. And so did the viruses rats carry, along with the chances those viruses would jump to people. That same year, a fatal lung disease transmitted through the saliva, feces and urine of rats and mice called hantavirus pulmonary syndrome emerged in Panama for the first time, according to a report in the journal Emerging Infectious Diseases.

As much as weather changes can drive changes in species, so does altering the landscape for new farms and new cities. In fact, researchers attribute a full 30% of emerging contagion to what they call “land use change.” Nothing drives land use shifts more than conversion for farmland and feedstock — a result of the push to feed the planet’s 7.8 billion people. As the global population surges to 10 billion over the next 35 years, and the capacity to farm food is stressed further again by the warming climate, the demand for land will only get more intense. Already, more than one-third of the planet’s land surface, and three-quarters of all of its fresh water, go toward the cultivation of crops and raising of livestock. These are the places where infectious diseases spread most often.

Take, for example, the 1999 Nipah outbreak in Malaysia — the true-life subject matter adapted for the film “Contagion.” Rapid clearcutting of the forests there to make way for palm plantations drove fruit bats to the edge of the trees. (Separate research also suggests that climate changes are shifting fruit bats’ food supply.) They found places to roost, as it happens, alongside a hog farm. As the bats gorged themselves on fruit, they dropped pieces of food from the branches, along with their urine, into the pigsties, where at least one pig is believed to have eaten some. When the pig was slaughtered and brought to market, an outbreak is believed to have been spread by the man who handled the meat. More than 100 people died.

The U.S. Centers for Disease Control and Prevention says that fully three-quarters of all new viruses have emerged from animals. Even the 2014 Ebola outbreak in West Africa is believed to have begun when a boy dug into a tree stump that happened to be the roost of bats carrying the virus.

As Christine Johnson, the associate director of the One Health Institute, an interdisciplinary epidemiological program at the University of California, Davis, puts it, global health policymakers have a responsibility to understand how climate, habitat and land use changes lead to disease. Almost every major epidemic we know of over the past couple of decades — SARS, COVID-19, Ebola and Nipah virus — jumped to people from wildlife enduring extreme climate and habitat strain, and still, “we’re naive to them,” she said. “That puts us in a dangerous place.”

Once new diseases are let loose in our environment, changing temperatures and precipitation are also changing how those diseases spread — and not for the better. Warming climates increase the range within which a disease can find a home, especially those transmitted by “vectors,” mosquitoes and ticks that carry a pathogen from its primary host to its new victim.

A 2008 study in the journal Nature found nearly one-third of emerging infectious diseases over the past 10 years were vector-borne, and that the jumps matched unusual changes in the climate. Especially in cases where insects like infection-bearing mosquitoes are chasing warmer temperatures, the study said, “climate change may drive the emergence of diseases.”

Ticks and mosquitoes now thrive in places they’d never ventured before. As tropical species move northward, they are bringing dangerous pathogens with them. The Zika virus or Chikungunya, a mosquito-spread virus that manifests in intense joint pain, were once unseen in the United States, but both were transmitted locally, not brought home by travelers, in southern Texas and Florida in recent years.

Soon, they’ll be spreading further northward. According to a 2019 study in the journal PLOS Neglected Tropical Diseases, by 2050, disease-carrying mosquitoes will ultimately reach 500 million more people than they do today, including some 55 million more Americans. In 2013, dengue fever — an affliction affecting nearly 400 million people a year, but normally associated with the poorest regions of Africa — was transmitted locally in New York for the first time.

“The long-term risk from dengue may be much higher than COVID,” said Scott Weaver, the director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch in Galveston. “It’s a disease of poor countries, so it doesn’t get the attention it deserves.”

The chain of events that ultimately leads to a pandemic can be long and subtle, steered by shifts in the ecosystem. The 1999 West Nile outbreak in the U.S., for example, came after climate-driven droughts dried up streams and rivers, leaving pools of stagnant water where mosquitoes bred unhindered. It turns out the loss of water also killed off their predators — dragonflies and frogs that depend on large watering holes were gone.

Coronaviruses like COVID-19 aren’t likely to be carried by insects — they don’t leave enough infected virus cells in the blood. But one in five other viruses transmitted from animals to people are vector-borne, said U.C. Davis’ Johnson, meaning it’s only a matter of time before other exotic animal-driven pathogens are driven from the forests of the global tropics to the United States or Canada or Europe because of the warming climate. “Climate is going to shift vulnerability to that,” Johnson said, “and I think some of these regions are not prepared.”

The changing climate won’t just affect how the diseases move about the planet, it will also shape how easily we get sick. According to a 2013 study in the journal PLOS Currents Influenza, warm winters were predictors of the most severe flu seasons in the following year. The brief respite in year one, it turns out, relaxed people’s natural defenses and reduced “herd immunity,” setting conditions for the virus to rage back with a vengeance.

Even harsh swings from hot to cold, or sudden storms — exactly the kinds of climate-induced patterns we’re already seeing — make people more likely to get sick. A study in the journal Environmental Research Letters linked the brutal 2017-18 flu season — which killed 79,000 people — to erratic temperature swings and extreme weather that winter, the same period in which a spate of floods and hurricanes devastated much of the country. If the climate crisis continues on its current trajectory, the authors wrote, respiratory infections like the flu will sharply increase. The chance of a flu epidemic in America’s most populated cities will increase by as much as 50% this century, and flu-related deaths in Europe could also jump by 50%.

“We’re on a very dangerous path right now,” said the University of Texas’ Weaver. Slow action on climate has made dramatic warming and large-scale environmental changes inevitable, he said, “and I think that increases in disease are going to come along with it.”

Twelve months before the first COVID-19 case was diagnosed, a group of epidemiologists working with a U.S. Agency for International Development project called PREDICT, or Pandemic Influenza and other Emerging Threats, was deep in the remote leafy jungle of southern China’s Yunnan province hunting for what it believed to be one of the greatest dangers to civilization: a wellspring of emerging viruses.

A decade of study there had identified a pattern of obscure illnesses affecting remote villagers who used bat guano as fertilizer and sometimes for medicine. Scientists traced dozens of unnamed, emerging viruses to caves inhabited by horseshoe bats. Any one of them might have triggered a global pandemic killing a million people. But luck — and mostly luck alone — had so far kept the viruses from leaping out of those remote communities and into the mainstream population.

The luck is likely to run out, as Yunnan is undergoing enormous change. Quaint subsistence farm plots were overtaken by hastily erected apartment towers and high-speed rail lines, as the province endured dizzying development fueled by decades of Chinese economic expansion. Cities’ footprints swelled, pushing back the forests. More people moved into rural places and the wildlife trade, common to such frontier regions, thrived. With every new person and every felled tree, the bats’ habitat shrank, putting the viruses they carried on a collision course with humanity. By late 2018, epidemiologists there were bracing for what they call “spillover,” or the failure to keep a virus locally contained as it jumped from the bats and villages of Yunnan into the wider world.

In late 2018, the Trump administration, as part of a sweeping effort to bring U.S. programs in China to a halt, abruptly shut down the research — and its efforts to intercept the spread of a new novel coronavirus along with it. “We got a cease and desist,” said Dennis Carroll, who founded the PREDICT program and has been instrumental in global work to address the risks from emerging viruses. By late 2019, USAID had cut the program’s global funding.

USAID did not respond to a detailed list of questions from ProPublica.

The loss is immense. The researchers believed they were on the cusp of a breakthrough, racing to sequence the genes of the coronaviruses they’d extracted from the horseshoe bat and to begin work on vaccines. They’d campaigned for years for policymakers to fully consider what they’d learned about how land development and climate changes were driving the spread of disease, and they thought their research could literally provide governments a map to the hot spots most likely to spawn the next pandemic. They also hoped the genetic material they’d collected could lead to a vaccine not just for one lethal variation of COVID, but perhaps — like a missile defense shield for the biosphere — to address a whole family of viruses at once. (In fact, the gene work they were able to complete was used to test the efficacy of remdesivir, an experimental drug that early clinical trial data shows can help COVID-19 patients.)

Carroll said knowledge of the virus genomes had the potential “to totally transform how we think about future biomedical interventions before there’s an emergence.” His goal was to not just react to a pandemic, but to change the very definition of preparedness.

If PREDICT’s efforts in China had the remote potential to fend off the current COVID pandemic, though, it also offered an opportunity to study how climate and land development were driving disease.

But there has been little appetite for that inquiry among policymakers. PREDICT’s staff and advisers have pushed the U.S. government to consider how welding public health policy with environmental and climate science could help stem the spread of contagions. Climate change was featured in presentations that PREDICT staff made to Congress, according to U.C. Davis’ Johnson, who is now also the director of PREDICT, which received a temporary funding extension this spring. And until 2016, leadership of New York-based EcoHealth Alliance, the research group working under PREDICT funding in Yunnan, was invited several times to the White House to advise on global health policy.

Since Donald Trump was elected, the group hasn’t been invited back.

“It’s falling on deaf ears,” said Peter Daszak, EcoHealth Alliance’s president.

A White House spokesperson did not respond to an emailed request for comment.

What Daszak really wants — in addition to restored funding to continue his work — is the public and leaders to understand that it’s human behavior driving the rise in disease, just as it drives the climate crisis. In China’s forests, he looks past the destruction of trees and asks why they are being cut in the first place, and who is paying the cost. Metals for iPhones and palm oil for processed foods are among the products that come straight out of South Asian and African emerging disease hot spots.

“We turn a blind eye to the fact that our behavior is driving this,” he said. “We get cheap goods through Walmart, and then we pay for it forever through the rise in pandemics. It’s upside down.”

3335. Getting Viral: Why COVID-19 Is Such a Threat to the 60+ Population and Why the Response May Make It Worse

By Stewart A. Newman, Counterpunch, March 15, 2020

Photograph Source: NIAID – CC BY 2.0

The demographics, virology, and public health dimensions of, and earlier parallels to, the COVID-19 coronavirus pandemic suggest that the current approach to the outbreak in the U.S. and Europe (other than the U.K.) might be on a wrong and dangerous track. In the U.S., this is partly due to Donald Trump’s self-serving blunders, but not entirely. While there are no perfect responses in the current environment (the availability of a vaccine would change everything), the following facts need to be considered.

COVID-19 is essentially innocuous in anyone under 50, but is frequently extremely damaging or fatal for those over 60, and particularly over 70. But although it is often claimed (by NIH Infectious Diseases director Anthony Fauci at Trump’s Friday the 13^th national emergency announcement, for instance) that this is due to their immune systems’ being “weak,” or because they are more likely to have underlying conditions, the extreme differential between the impact on this age group and others is reminiscent of an earlier outbreak where those factors did not apply. The 1918 “Spanish” flu pandemic killed upwards of 50 million people worldwide. Of the half-million estimated deaths in the U.S., 92% were under 65, and a full half were between 20 and 40 years old.

The best theory for this selective impact comes from a research group at the University of Arizona, who note that this cohort was exposed to a virus with related properties that circulated around 1900, when they were children that (instead of protecting them) primed their immune systems to respond to the later virus in an inappropriate and damaging fashion. Older people severely affected by COVID-19 also exhibit such immune hyper-reactivity, suggesting that they may have been primed by a pathogen exposure in the 1950s, before the less vulnerable population was born.

So, while old people must strenuously avoid being infected regardless of their current health status, for everyone else, particularly young adults and children, a different policy should be in effect. Vaccination is the safest way to establish “herd immunity,” the condition in which the general population is largely resistant to an infection, and its members, even if they become infected, are therefore incapable of spreading it. Until there is a vaccine for COVID-19, however, the only route to herd immunity is for those who can be infected without getting sick, become so.

That’s why closing schools, colleges, theaters, museums, etc. is a bad idea. Of course, older people (including faculty over 60, who could teach by videolink) should stay away from all of these, but young people could attend and participate with little effect. Shutting down these facilities is less a benefit to public health than to the legal exposure of their owners and administrators. Certainly, attendees would become COVID-19-positive, but they mainly would be oblivious to it. They would need to be warned to keep their distance from their elderly relatives, and vice-versa, but this applies to the prevailing shut-down regime as well, where students and thwarted theatergoers are not prohibited from socializing or being at large. However, just as a tiny percentage of people die from the flu, meningitis, and food poisoning in any public and institutional setting, there would inevitably be a few adverse COVID-19-associated events at schools and colleges. This would lead to huge lawsuits, particularly in the U.S., making an open policy, however desirable, difficult to achieve.

Nonetheless, large sectors of the economy, here and abroad, are nearly collapsing because of fears that are not entirely justified. Apart from impeding and prolonging the establishment of herd immunity, misery is being sown in terms of lost education and arts events, scarcity, and loss of employment. “Disaster capitalism” (in Naomi Klein’s coinage) will ensure that the streamlining will be permanent and many of the jobs will not return. Of course, there will be some benefits, like the curtailment of the environmentally devastating behemoth-cruise industry, but many restaurants and cultural institutions will disappear forever.

It’s a scandal of major proportions that the Trump administration suppressed evidence of the epidemic at its early stages and abolished, well before that, the Center for Disease Control Pandemic Task Force, making sure that the U.S. was ill-equipped to test people. Clearly, it’s important to know who has the virus, even if most people won’t be affected by it. But Trump was interested in keeping the numbers of confirmed cases down. So now we are saddled with bad policy based on misconceptions, and a venal and incompetent administration poised to make it worse.

The U.K. has implemented a COVID-19 management policy at odds with that in Europe and the U.S., which is designed to accelerate herd immunity, as proposed here. The government has received pushback for its non-consultative, top-down approach. It would be a mistake to petition for anything of this sort from a government with authoritarian and racist proclivities. The institutional shutdowns in the U.S. have been voluntary, and when they are reversed, as they must eventually be, that will be voluntary as well. The faster that carefully managed social mixing in the low-vulnerability groups occurs, the sooner herd immunity will be achieved. The institutions and their members who are at the vanguard in coming out of the cold, making it easier for others, will earn the gratitude of society as a whole.

NOTE: The number of serious cases under 50 has turned out to be greater in recent days than was evident before. (Those in small children are still vanishingly small). Any restoration of school and campus life needs to take this into account, but the arguments presented continue to be sound.

3325. Merkel Says Two-Thirds of Germans Could Become Infected

By The New York Times, March 11, 2020

Coronavirus outbreaks in Germany

Chancellor Angela Merkel said on Wednesday that the coronavirus was likely to infect about two-thirds of the German population.

“Given a virus for which there is no immunity and no immunization, we have to understand that many people will be infected. The consensus among experts is that 60 to 70 percent of the population will be infected,” she said.

In her first public appearance to address the epidemic, which has already infected more than 1,200 people in Germany, Ms. Merkel said that her government was following the advice of medical experts. She urged citizens to do the same.

“We are at the start of a development that we cannot yet see the end of,” Ms. Merkel told reporters. “But we as a country will do whatever is necessary to do, working within the European bloc.”

That readiness includes flexibility on spending, to help especially the small and midsize enterprises that are losing business, she said.

“This is an exceptional situation, and we will do whatever is needed,” Ms. Merkel said. “We won’t ask every day, ’What does this mean for our deficit?’”

The chancellor urged Germans to accept that it was important to stay home whenever possible and take precautions, to ensure that the health system would be able to withstand the high number of people who could fall seriously ill.  

Major events, including all large cultural performances in Berlin, Munich and elsewhere, such as many soccer games, have either been canceled or will take place without spectators. “How we respond matters,” Ms. Merkel said. “We are playing for time.”

Stocks on Wall Street tumbled on Wednesday, as topsy-turvy trading across global markets signaled continued investor concern about how governments would deal with the coronavirus fallout.

In Europe, major indexes in Frankfurt, London and Paris fell, giving up early gains that had come after the Bank of England said it would cut interest rates to help British businesses. Shares in Asia also fell.

Investors are vacillating between the threat that the coronavirus poses to the global economy and the hopes that governments will unveil a series of measures to help businesses.

President Trump has signaled that he will consider ways to stimulate the economy. Options include cutting payroll taxes and extending the American tax filing deadline past April 15. But so far, the White House has yet to announce any specific measures, and most experts say a payroll tax cut is not an effective way to combat the problems facing the economy.

The S&P 500 fell more than 2 percent in early trading on Wednesday. Stocks tumbled nearly 8 percent on Monday, and rose nearly 5 percent on Tuesday.

Other markets signaled persistent investor jitters. Futures for gold, a traditional haven, edged higher. The yield on the 10-year Treasury bond fell, another indicator of investor nervousness.

Oil prices fell after the Saudi Arabian state oil company said for the second time this week that it would expand production capacity. The announcement signaled no let up in Saudi Arabia’s clash with Russia over supplies, which sent crude prices crashing this week.

The speed of the coronavirus spread across Europe — with Italy accounting for about half of the nearly 20,000 cases on the Continent — has left countries scrambling to come up with a coordinated containment plan.

At the end of February, European nations other than Italy had reported just a few dozen cases. Now, France, Germany and Spain have well over 1,000 cases each.

Britain, the Netherlands, Norway and Switzerland each have at least 400 confirmed infections. Denmark and Belgium have both reported more than 250 cases, and Sweden has more than 350. Belgium reported its first death on Wednesday.

Even the island nation of Iceland has not escaped, with 81 infections in a population of about 364,000, one of the highest number of cases per capita worldwide.

Italy, with more than 10,000 cases and more than 600 deaths, has imposed strict travel limits across the entire country and banned public gatherings.

Matteo Renzi, a former prime minister, said Italy’s sacrifices would serve the entire continent.

“Today, the red zone is Italy,” he said, but if containment measures fail, “the red zone will be Europe.”

Some of the countries with the fewest cases are taking the most drastic actions.

Greece and Ukraine announced this week the closing of all schools, universities, and kindergartens. In Hungary, Prime Minister Viktor Orban’s government declared a “state of emergency” on Tuesday, granting his administration special powers to address the coronavirus outbreak, including closing universities and theaters.

Poland, which on Wednesday had 25 confirmed cases, will also shut down theaters, museums and art galleries for two weeks starting Friday.

Denmark has suspended naturalization ceremonies because a handshake is officially required for their completion.

In an unusual three-hour teleconference on Tuesday night, the European Council, which comprises the heads of government of the European Union states, decided to set up a $28 billion investment fund and to relax rules governing airlines.

But the leaders failed to overcome disagreements among bloc members about sharing medical equipment like face masks and respirators, given that health issues are the responsibility of national governments.

After the meeting, President Emmanuel Macron of France said: “What we are living is a true world crisis.”

In late January, the first confirmed American case of coronavirus had been reported in the Seattle area. Had the man infected anyone else? Was the virus already spreading?

Dr. Helen Y. Chu, an infectious disease expert in Seattle, had a way to monitor the region. As part of a research project into the flu, she and a team of researchers had been collecting nasal swabs for months from residents experiencing symptoms throughout the Puget Sound region.

To repurpose the tests for the coronavirus, they would need the support of state and federal officials. But officials repeatedly rejected her idea, interviews and emails show,  as weeks crawled by and outbreaks emerged outside of China.

By Feb. 25, Dr. Chu and her colleagues could not wait any longer. They began performing coronavirus tests without government approval. What came back confirmed the worst: a positive test from a local teenager with no recent travel history.

In fact, officials would later discover through testing, the virus had already contributed to the deaths of two people, and it would go on to kill 20 more in the Seattle region over the following days.

Federal and state officials said the flu study could not be repurposed because Dr. Chu’s lab did not have explicit permission from research subjects; the lab was also not certified for clinical work. While acknowledging the ethical questions, Dr. Chu and others argued there should be more flexibility in an emergency.

The failure to tap into the flu study was just one in a series of missed chances by the federal government to ensure more widespread testing during the early days of the outbreak, when greater containment still seemed possible. 

Even now, after weeks of mounting frustration toward federal agencies over flawed test kits and burdensome rules, states such as New York and California are struggling to test widely for the coronavirus. The continued delays have made it impossible for officials to get a true picture of the scale of the growing outbreak, which has  spread to 36 states and Washington D.C.

1597. Paul Farmer on Ebola: “This Isn’t a Natural Disaster, This Is the Terrorism of Poverty”

By Joel Achenbach, The Washington Post, October 6, 2014

Dr. Paul Farmer with a nurse and a patient

Africa’s Ebola problem is now America’s Ebola problem. The best way for the United States to free itself of the terror of this virus is to ensure that it is wiped out at the source, where the epidemic is currently out of control. That will happen only through a coordinated effort to provide the kind of basic, front-line health care that we take for granted in the developed world but which is tragically scarce in impoverished countries.

“This isn’t a natural disaster. This is the terrorism of poverty,” Paul Farmer, the Harvard professor and co-founder of Partners in Health, told The Washington Post after a recent trip to Liberia.

Americans unnerved by Ebola are concerned, naturally, about travelers from West Africa bringing the virus here. But long-term, the only practical (and humane) solution is to stop it there. That’s what Tom Frieden, the director of the CDC, has been saying in recent days as the national news has focused on the Ebola case in Dallas and fears of Ebola breaking out elsewhere in the U.S.

Frieden is one of the major characters in the 6,000-word story we published on Sunday that showed how the world’s health organizations failed to keep pace with the exploding epidemic.

The virus easily outran the plodding response. The WHO, an arm of the United Nations, is responsible for coordinating international action in a crisis like this, but it has suffered budget cuts, has lost many of its brightest minds and was slow to sound a global alarm on Ebola. Not until Aug. 8, 4 1 ⁄ 2 months into the epidemic, did the organization declare a global emergency. Its Africa office, which oversees the region, initially did not welcome a robust role by the CDC in the response to the outbreak.

Previous Ebola outbreaks had been quickly throttled, but that experience proved misleading and officials did not grasp the potential scale of the disaster. Their imaginations were unequal to the virulence of the pathogen.

Now, however, there’s an action plan that has a chance to bring the epidemic under control. Thousands of U.S. military personnel will play a key role. In the coming weeks we’ll see if this more muscular response has come soon enough.

Paul Farmer last month went to Liberia and, with a number of colleagues, flew deep into the bush to visit a provincial hospital. The hospital had only a handful patients. People were afraid of the Ebola virus and had retreated to their homes. Farmer and his colleagues visited a pharmacy where there was virtually nothing on the shelves.

Farmer argues that the only way to solve these epidemics is to focus on the four S’s — stuff, staff, space, and systems.

“All over the world there are warehouses of guidelines and policies and protocols, but you’ve got to have stuff, stuff, space and systems in the places where you need them most. You can’t work magic out of nothing,” Farmer said.

He said if it were a purely “natural” disaster, the case fatality rate would be the same everywhere. But it’s not.

“There’s a reason the case fatality rate is 80 percent in rural Africa and 0 percent in Americans and Europeans who get out in time and get proper medical care,” Farmer said.

He said the world needs to bridge the “know-do gap,” the disconnect between what gets planned in conferences among elite global health leaders and what actually is happening on the front lines of medical care.

In West Africa they need personal protective gear, starting with gloves. They need oral rehydration fluid. They need medicine. Much of Liberia is off the grid, and hospitals need diesel fuel and generators. They need the basics, in other words.

The response to Ebola, Farmer said, “has to be linked to the broader effort to strengthen health systems. We need health workers, clinics and hospitals, too. Re-opening the primary health system in order to take on problems like malaria is part of the Ebola response too.”

In our Sunday story on Ebola we reported a similar observation from a top World Health Organization official, Keiji Fukuda:

…after six trips to Africa during the epidemic, [Fukuda] has seen a more profound truth: Global organizations can provide epidemiologists and laboratory help, but what these resource-poor countries really need are front-line doctors and nurses, and basic resources. In Africa, patients told him, “We don’t have enough food.”

Fighting Ebola isn’t that complicated: The virus isn’t terribly contagious and by isolating patients it is possible to bend the “epi curve” in the right direction. But the basic resources have to be deployed at the front lines. Here’s another key passage from out story:

The epidemic has exposed a disconnect between the aspirations of global health officials and the reality of infectious disease control. Officials hold faraway strategy sessions about fighting emerging diseases and bioterrorism even as front-line doctors and nurses don’t have enough latex gloves, protective gowns, rehydrating fluid or workers to carry bodies to the morgue. “We cannot wait for those high-level meetings to convene and discuss over cocktails and petits fours what they’re going to do,” exclaimed Joanne Liu, international head of Doctors Without Borders, when she heard about another U.N. initiative.

Farmer, for one, is optimistic that the epidemic will be contained with the more muscular response finally being put into action.

“It will work,” he said. “It will be brought under control even as we apply these basic interventions.”

He doesn’t blame any person or organization in particular for the failure to contain the epidemic before it expanded into historic proportions. The failure was collective, Farmer said.

”I wish we’d responded earlier and more publically as a collective. That’s a regret. Between early June until [mid-September], when we left for Liberia, I think a number of us were invaded by a persistent anxiety that we’re not doing enough. Because we’re not doing enough.”