Desolating Scourge

                For most of my life I have known of prophecies of a “desolating scourge” coming to our land and wondered what it would be.  Each time I hear of a terrible disease I wonder “is this it?”  Enterovirus and Ebola are now causing deaths in our nation.  Can they be the desolating scourge?

                Throughout recorded history there have been numerous contagious disease outbreaks, epidemics, and pandemics.  According to webmd.com  “a disease outbreak happens when a disease occurs in greater numbers than expected in a community or region or during a season.  An outbreak may occur in one community or even extend to several countries.  It can last from days to years.”

                According to the same site, an outbreak becomes an epidemic “when an infectious disease spreads rapidly to many people.  In 2003, the severe acute respiratory syndrome (SARS) epidemic took the lives of nearly 800 people worldwide.”

                Again according to the same site, a “pandemic is a global disease outbreak.  HIV/AIDS is an example of one of the most destructive global pandemics in history.”  There have been numerous pandemics caused by influenza:  (1) In 1918 Spanish influenza killed 40-50 million people.  (2) In 1957 Asian influenza killed 2 million people.  (3) In 1968 Hong Kong influenza killed 1 million people.

                Influenza pandemics happen when a “new subtype of virus arises” and few people have immunity to it.  This new virus spreads from one person to another through sneezing or coughing and soon spreads the virus worldwide.  “With past flu pandemics, the virus reached all parts of the glove within six to nine months.  With the speed of air travel today, public health experts believe an influenza pandemic could spread much more quickly.  A pandemic can occur in waves.  And all parts of the world may not be affected at the same time.”

                We have all heard of the Black Plague, which was “one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people and peaking in Europe in the years 1346-53.  Although there were several competing theories as to the etiology of the Black Death, analysis of DNA from victims in northern and southern Europe published in 2010 and 2011 indicates that the pathogen responsible was the Yersinia pestis bacterium, probably causing several forms of plague.

                “The Black Death is thought to have originated in the arid plains of central Asia, where it then travelled along the Silk Road, reaching the Crimea by 1343.  From there, it was most likely carried by Oriental rat fleas living on the black rats that were regular passengers on merchant ships.  Spreading throughout the Mediterranean and Europe, the Black Death is estimated to have killed 30-60% of Europe’s total population.  All in all, the plague reduced the world population from an estimated 450 million down to 350-375 million in the 14^th century.

                “The aftermath of the plague created a series of religious, social, and economic upheavals, which had profound effects on the course of European history.  It took 150 years for Europe’s population to recover.  The plague recurred occasionally in Europe until the 19^th century.”

                Thomas Eric Duncan traveled from Liberia to visit family in the United States and arrived in Dallas, Texas, on September 20.  He developed a fever and abdominal pain and sought medical care on September 25.  He told a nurse that he had traveled from Africa but was sent home with antibiotics.  He returned to the hospital seriously ill on September 28 and was placed in isolation because doctors suspected he had Ebola.  He died on October 8.

                Texas health officials announced on October 12 that a health care worker had tested positive for Ebola.  Even though she wore full protective gear while caring for Duncan, Ebola was transmitted to her.  This is the first known case of the disease being contracted or transmitted in the United States.  The health officials in Texas are monitoring approximately 50 people who could have been infected by Duncan after he began to show symptoms.

                “Ebola spreads through close contact with a symptomatic person’s bodily fluids, such as blood, sweat, vomit, feces, urine, saliva or semen.  Those fluids must have an entry point, like a cut or scrape or someone touching the nose, mouth or eyes with contaminated hands, or being splashed.  The World Health Organization says blood, feces, and vomit are the most infectious fluids, while the virus is found in saliva mostly once patients are severely ill.  The whole live virus has never been culled from sweat.”

                It appears that most of us do not have to worry about catching Ebola – as long as we stay away from people who have been in Africa.  The people who are in the most danger are the health care workers – our doctors, nurses, etc.  We all could therefore be affected by it if we have family members or friends who work in the health care industry.  I am particularly concerned about my son because he is an emergency room doctor.  I hope he is taking appropriate precautions!

                Another disease that seems more worrisome is Enterovirus.  I thought it was one disease but apparently Enteroviruses “are a genus of positive-sense single-stranded RNA viruses associated with several human and mammalian diseases.  Serologic studies have distinguished 71 human entervirus serotypes on the basis of antibody neutralization tests….

                “Enteroviruses affect millions of people worldwide each year, and are often found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool of an infected person.  Historically, poliomyelitis was the most significant disease caused by an enterovirus, poliovirus.  There are 64 non-polio enteroviruses that can cause disease in humans….  Poliovirus, as well as coxsackie and echovirus are spread through the fecal-oral route.  Infection can result in a wide variety of symptoms ranging from mild respiratory illness (common cold), hand, foot and mouth disease, acute hemorrhagic conjunctivitis, aseptic meningitis, myocarditis, severe neonatal sepsis-like disease, and acute flaccid paralysis.”

                I remember the scare caused by polio during my childhood.  My parents insisted that my siblings and I stopped swimming in the ponds full of irrigation water because they thought we would get polio.  We stopped, and none of us got it.  I remember the first polio vaccine I received and the sense of relief at having a possible prevention from the dread disease.  A classmate got polio and wore a brace from his hip down to his foot from elementary school until at least high school.  In my mind I can still see him running across the playground with his stiff leg.  I saw him at a class reunion last year and noticed that he still has a limp.

                Enterovirus D68 (EV-D68) is one of more than 100 non-polio enteroviruses and was first identified in California in 1962.  The symptoms of this disease could include fever, runny nose, sneezing, cough, and aches in body and muscles.  Wheezing and difficulty breathing are considered to be severe symptoms; such patients should receive medical care, especially if the symptoms are getting worse.  “Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum.  EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.”

                Even though Enterovirus is very common with 10-15 million infections per year in the United States, EV-D68 is “particularly pernicious” and has “infected hundreds nationwide in two months.”  “It seems to be most affecting children with a history of asthma or breathing problems.”  Six children have died from this disease in the past two months.  “In the United States, people are more likely to get infected with enteroviruses in the summer and fall.  Cases are likely to decline later in the fall.”

                “Enterovirus may also be linked to a small number of cases of a mysterious neurologic illness in Colorado, Boston, and Michigan.  Doctors in Colorado spotted it first:  a group of 10 children hospitalized with limb weakness, cranial nerve dysfunction and abnormalities in their spinal gray matter.

                “Staff at Boston Children’s Hospital has since identified four patients with the same symptoms.  And a child in Washtenaw County, Michigan, has also developed partial paralysis in the lower limbs after being hospitalized with the virus….

                “As of Friday, the CDC and state public health laboratories had documented 691 cases of enterovirus D68 in 46 states and the District of Columbia.  Five patients who died had the virus strain, even if it’s not certain all of them died because of it.  Madeline’s case is not yet counted in this tally.  There will be more cases, and perhaps more deaths, in the coming weeks, officials said.  Part of this has to do with a backlog on samples, with the CDC explaining `it can take a while … because the testing is complex and slower and can only be done by (the) CDC and a small number of state public health laboratories.’ 

                “The virus also has not yet run its course.  As the CDC pointed out, `Enteroviruses commonly circulate in summer and fall.  We’re currently in the middle of the enterovirus season.’”

                Infants, children, and teenagers are “most likely to get infected and become ill” because they have not previously been exposed to the virus and have not built up any immunity.  “We believe this is also true for EV-D68.  Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.  Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.”

                At this point I do not believe either Enterovirus D68 or Ebola qualify as an epidemic, pandemic, or desolating sickness.  It appears that medical personnel will be able to stop these diseases before they reach that point; however, it is sad to hear of people dying, particularly little children, and fearing for your own children and grandchildren.