More and more of us are being affected by imposed quarantine measures (sometimes at very short notice!). Holiday plans are all over the place (we are not going to the Drakensberg’s, our flight is cancelled, UK residents are banned and there is 14 days of quarantine even if we could get in! Boom, our holiday’s gone BUST!). There is mass quarantining on a global scale. But added to this is the fact that in the UK you must also quarantine yourself if you are exposed to a person with Covid-19. No ifs, no buts, do not pass “Go”, do not “collect £200”. But where does the term quarantine come from, what does it mean and are we “actually” using it correctly?
Okay, you don’t really need me to tell you that the Covid-19 pandemic has been a bit of a nightmare; medically, socially and psychologically. As of the 12th August there have been 20.4 million cases reported worldwide with 744,000 deaths. These are pretty scary numbers but large scale death and destruction from infectious diseases is nothing new.
Infectious diseases have been the leading cause of death for the human species, and over recent centuries there have been some horrendous pandemics that make Covid-19 so far look pretty small. In this blog I’m going to look at just 3 infectious diseases whose pandemics give Covid-19 some perspective…
Cue wavy lines and wobbly music as we go back in time to the 6th Century…
The first of our “recent” plague pandemics is known as the Plague of Justinian (541-542), which affected the Eastern Roman Empire, especially Constantinople and the Mediterranean region. It is estimated to have killed 50 million people during the initial pandemic and in the 200 years after when it continued to circulate. This was up to a quarter of the World’s population at this time! Justinian I was Emperor of Rome when the pandemic started; apparently he caught the plague but survived.
The next plague pandemic was the Black Death (1347-1353) which killed an estimated 30-60% of the population of Europe, about 100-125 million people! There are thousands of ossuaries (bone collections) in Churches around Europe full of the remains of those killed by the Black Death. The Black Death resulted in a number of social, religious and political upheavals that shaped the future of Europe including movement of people in to cities, decline of the power of the Church and increased power of governments.
Editor Chief in Charge and I have spent the weekend trying to work out what we’re going to do if/when we can’t go on holiday later this year because of a certain unmentionable pesky virus. The basic answer is that we might not be going somewhere exotic! But why might not being able to go on holiday somewhere exotic be a good idea?!?
I know… pufferfish!
Pufferfish are tropical fish found especially in Asia. They are called pufferfish because they have a rather unusual defence strategy; they can fill their stomachs with water so that they balloon up into a ball shooting numerous spiky spines outwards. Any predator stupid enough to try and eat a pufferfish gets a mouth or stomach full of spines and probably chokes… nasty. Bloat, from the Disney film “Finding Nemo” was a pufferfish; he blows up like a beach ball every time something startles him… he’s my favourite character and he’s hilarious!
One of the most striking features of the Covid-19 pandemic from my perspective has been the massive volume of scientific papers released on the internet. There have been 10’s of thousands of papers which is both amazing and worrying. But why is it worrying, surely the faster we have more information the better? Well maybe not…
According to recent studies 2% of researchers admit that they have committed fraud in their work, but they thought that 14% of their colleagues had also committed fraud… fraud is basically lying…. Also in a study of 20,000 biomedical research papers 2% contained deliberately falsified images… this was reported on BBC Inside Science - Science Fraud & Bias, Immunity to COVID-19. [My wife told me about this radio broadcast she heard whilst cuddling our two new Cats Protection foster kittens (Toes and Splodge)!]
“I have a patient with a bright red nose” said the junior Doctor.
The Microbiologist double-checked his calendar to make sure it wasn’t March 15th and the junior performing a joke for Comic Relief’s “Red Nose Day”, a charity day here in the UK!
“What do you mean a bright red nose” the Microbiologist asked, adding “it’s not Comic Relief Day, you know?” heading off the “fooled you” prank.
“What!?”... The junior inhaled deeply, ignored the Microbiologist, and continued “It’s a kind of reddish purple and very painful. It looks a bit like cellulitis but it is in a very odd place, and the patient doesn’t have a fever. What antibiotics do you think we should give?”
Muttering, “this isn’t just a dial an antibiotic line”, the Microbiologist decided he would like to see this patient’s nose and find out what was going on himself before advising what treatment should be started…
He added “your patient needs a diagnosis before throwing random drugs at them to see if they get better”.
As the Microbiologist walked into the patient’s room to introduce himself he couldn’t help but see that the patient did indeed have a bright red nose. He chuckled to himself; the patient definitely didn’t need one of those plastic red noses.
After a brief embarrassed pause the Microbiologist finally introduced himself. The patient smiled and then unconsciously reached up and stroked his nose with his thumb and forefinger.
With sudden understanding the Microbiologist asked “do you have anything to do with animals, either work or at home?”
“I am a keen keeper of Koi carp and have just finished transferring them to their new pond… I designed it myself” the patient said proudly.
It was the Microbiologists turn to smile. “You have erysipeloid” he told the patient confidently.
“Eh, sip, what? No, I have Koi carp, they’re fish!” said the patient, confused.
I came across a story this week about a patient from Florida, USA, who had been diagnosed with a really unusual infection caused by a microorganism called Naegleria fowleri. It caught my attention because firstly it is very rare and so I was intrigued and secondly because during a lockdown it should be extremely difficult to catch it! So I had to investigate further…
What is Naegleria fowleri?
Naegleria fowleri is a free-living amoeba found in freshwater and soil throughout the World, preferring temperatures between 30-45 oC. It does not survive in seawater. The most common risk factor for acquiring N. fowleri is contact with water through sports such as swimming, water skiing and diving as well as messing around in mud or bathing in contaminated hot springs (it is “free-living” after all!). So this explains my curiosity as to how this patient had acquired their infection as it should be very difficult to “get exposed” to N. fowleri during a lockdown, because there wouldn’t be any water sports or other exposures going on at this time!
Bats are getting a hard time at the moment. They seem to be being blamed for all of the infections threatening our species, from Ebola, Marburg, Rabies, Nipah, Hendra and now SARS Cov2. The name for these animal-related human infections is zoonoses. I can just imagine the bats cringing every time the news comes on wondering what they’re going to be blamed for next.
You have to admit, it’s not great PR to be associated with the scariest viruses known to cause deadly human infections. But is this fair? Are bats really MORE likely to be the source of infections in humans? Do bats harbour more nasty viruses than other animals? Or are they just getting a bad press and we should cut them some slack?
“What antibiotics should we start for Nipah Virus?” asked the newly qualified Doctor.
The Microbiologist nearly fell off his chair.
“What?! Nipah Virus? Who the heck do you think has Nipah Virus?” exclaimed the Microbiologist.
“I have a patient with a headache and confusion and I’ve been reading about the causes of encephalitis and want to treat them in case it is Nipah Virus” the Doctor replied.
The Microbiologist muttered to himself… the only one confused here was surely this Doctor… why did this always happen on a Friday… I’m the only one with a headache…
“Has the patient travelled? Have they had any contact with animals? Have they been in contact with anyone else unwell?” asked the Microbiologist.
“Well no, but Nipah Virus can cause encephalitis so we should rule it out at least” said the Doctor defensively.
The Microbiologist sighed, “let me tell you a bit about Nipah virus….”
The Editor-Chief-in-Charge is a curd nerd… she not only loves to eat cheese BUT she also makes her own cheese. There is nothing quite as tasty as homemade cheese but it’s certainly not fast food. In fact it’s a very, very, very slow food. It takes a day to make, a couple of days to press, and months or years to mature…. But it is great fun and it might surprise you to know that it is also a lesson in microbiology. [I wonder if the ECIC will still be a curd nerd after reading this?!]
So we have been let loose and lockdown is being de-escalated slowly but have we gone too soon? We don’t have a vaccine, treatments give only modest benefits and we’re not so good at social distancing on a beach! “Experts” are a little alarmed at the pace of release and I think we’re going to be stuck with Covid-19 for a while yet, so what shall I blog about this week?
One of the stories that keeps grumbling along in the background of Covid-19 is the potential to use antibodies from patients who have survived the infection to treat patients with active infection. It’s known as plasma therapy and it’s not as crazy it might at first sound.
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