Land Of The Free And Home Of The Germs
If you’ve read the paper or watched the nightly news sometime in the past couple of weeks, you’ve probably noted what appears to be a disturbing trend. Specifically, there has been a rash (pun intended) of infectious disease outbreaks locally, nationally, and internationally.
Just a couple of months ago, for example, a Saratoga county resident became infected with Powassan virus after being bitten by a tick. This year alone, fifteen other cases of Powassan virus have been reported in New York State. Up to 5% of deer ticks in the state now appear to carry the virus, which kills up to a third of people who contract it.
More recently, the parasite Cyclospora has sickened more than 500 people in 16 different states, including New York. In two of those states, Iowa and Nebraska, the source of the outbreak has been traced to a pre-washed salad mix packaged in Mexico and sold to two large restaurant chains. It is still unknown, however, how this parasite was spread to the residents of the other 14 states affected.
Finally, and most disturbing, is the discovery of a new strain of avian (or bird) flu in China. Unlike other strains of avian flu that have prompted panic in the past couple of years, this strain -- known as H7N9 -- may have the potential to be transmitted from person to person. In a case published in the August 6 issue of the medical journal BMJ, doctors report that a 60-year-old farmer transmitted the virus to his 32-year-old daughter as she took care of him. If true, this could have deadly consequences. Of the nearly 200 cases reported to date, over 50 people have died (including the farmer and his daughter).
Previous outbreaks of bird flu have largely been contained because the virus couldn’t be passed from one infected individual to another. Those who contracted bird flu were usually those who were exposed to live poultry, such as farmers or butchers. By shutting down poultry markets and slaughtering infected flocks, public health officials were largely able to prevent the spread of the virus. If it turns out that H7N9 can be passed from person to person, it will be that much harder to stop its spread.
Given this, is it any wonder that America has become a land of germaphobes (or rather a land mysophobes, as that is the actual term for someone who is afraid of germs)? While most of us haven’t become Howard Hughes-like recluses who shuffle around the house with Kleenex boxes on our feet, we have gone a little overboard with our approach to personal hygiene. Many of us carry around small bottles of antibacterial gel or disinfecting wipes, we avoid shaking hands, and we quickly back away anytime someone near us sneezes. Some of us will also stop buying pre-packaged salads, at least for a while.
Truth be told, however, we are probably wasting our time and our money. Use of an antibacterial gel like Purell is no more effective in preventing the spread of germs than washing our hands with soap and hot water. At this point, avoiding pre-packaged salads is akin to closing the barn door once the horse has gotten out, as the next outbreak of food-borne illness will likely be traced to some other source. In fact, most cases of food-borne illness are due to our own sloppy habits in the kitchen – not washing fresh produce or fruits before we eat them, or letting raw meat or chicken cross-contaminate food that is ready-to-eat.
We are also rather short sighted and reactionary. We demand that public health officials do something to protect us when an outbreak of Powassan, Cyclospora or influenza occurs, but fail to adequately fund the programs necessary to prevent these epidemics from occurring in the first place. It’s been nearly fifteen years since Laurie Garrett first published her book Betrayal of Trust, which described the systematic dismantling of our country’s public health infrastructure, and the dire consequences should that continue. And yet public health programs are still the first to be cut whenever our local, state and federal government faces a budgetary crisis.
I think it's great that Senator Schumer is calling for increased funding to study Powassan and other tick-borne diseases. I think it is wonderful that food safety advocates are calling for increased FDA and USDA inspections of meat and produce, both domestically produced and imported from overseas. But it’s a case of too little too late.
We can’t continue the cycle of funding such programs every time there is an outbreak, then slashing support when they are successful in preventing new epidemics. If anything, we should devote more and more resources to public health as the frequency of illnesses and outbreaks declines – that means that those programs are working. We need to start rewarding those public health victories rather than responding to public health failures.
A public health researcher and ethicist by training, Dr. Sean Philpott is Director of Research Ethics for the Bioethics program at Union Graduate College-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of Union Graduate College's Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.
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