pandemics

medicine

Past pandemics, roots of modern medicine focus of historical novel by Jacobs School professor emeritus – UB Now: News and views for UB faculty and staff

Hard as it may be to believe, there was a time in the not-so-distant past when the idea of living through a global pandemic was inconceivable to most of us.

The COVID-19 crisis changed all that. As medical experts and scientists scramble to find treatments and develop a vaccine, it leads us to wonder: How did doctors deal with a community health crisis in earlier times, without the medical advancements and technologies available to researchers in the 21st century?

A retired professor from the Jacobs School of Medicine and Biomedical Sciences at UB has written a book that addresses many of those questions.

In his history-based novel, “Bloodletting and Germs: A Doctor in Nineteenth Century Rural New York” (BookBaby), Thomas C. Rosenthal tells the story of Jabez Allen, a country doctor who worked in East Aurora during the 1800s.

The book describes the evolution of medical practices in the 19th century through the eyes of Allen, whose life and experiences Rosenthal painstakingly researched and recreated. It explains how Allen’s medical practice developed during a period of enormous social and scientific change that included the Civil War and the cholera epidemic of the mid-1800s.

Rosenthal knows something about the practice of rural medicine. A 1975 graduate of the Jacobs School, he chaired the Department of Family Medicine from 1994 until his retirement in 2013. During his tenure, Rosenthal was instrumental in establishing the Division of Rural Health, the medical school’s rural health campus in Cuba, N.Y., and its groundbreaking residency program in rural health.

Due to his efforts, UB was named a New York Rural Health Research Center in 1992, and in 1993 became one of only five universities in the country designated as a national rural health research center.

Rosenthal’s interest in rural health came from the eight years he worked as a family doctor in the small, Western New York farming community of Perry. He established the practice in 1978 after completing a family medicine residency at the former Deaconess Hospital in Buffalo. In 1986, he became medical director of Buffalo General Medical Center’s Department of Family Medicine. Rosenthal was named director of UB’s family medicine residency in 1987, and executive director of UB’s rural health programs in 1988.

Rosenthal first came across the story of Jabez Allen on a visit to the East Aurora Historical Society, where he discovered an intriguing artifact: a handwritten copy of a medical school diploma belonging to Allen, alongside the official document.

‘Why would a doctor need to make a copy of his diploma?’ he wondered. As it turns out, Allen was reluctant to send out his diploma to the Erie County Medical Board for fear of losing it. Instead, he sent them his copy.

“Allen practiced in East Aurora from 1834 to 1884, making him the perfect protagonist for a book on 19th-century family medicine,” Rosenthal says.

“The century is often referred to as a period of medical enlightenment,” he explains. “In retirement, I indulged myself in the question, ‘Why did it

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health

EU urges quick WHO reform, asks for more transparency in pandemics

By Francesco Guarascio and Caroline Copley

BRUSSELS/BERLIN (Reuters) – The World Health Organization (WHO) should be quickly overhauled, get more powers to handle pandemics and expose its member states’ shortfalls in health emergencies, European Union officials said on Friday.

The comments were made at a video conference of EU health ministers that endorsed an EU document on the reform of the U.N. agency which outlines a series of sweeping changes needed to boost WHO’s powers and resources, as exclusively reported by Reuters in September.

The moves followed criticisms that China and other countries did not share information on the COVID-19 pandemic in a timely fashion at its onset.

“The current pandemic challenges us very acutely (…) but it is very important that the (WHO) reform debate is held in parallel,” Germany’s Health Minister Jens Spahn told a news conference.

He did not say when the reform process should begin, but stressed that as a result of the overhaul the WHO should become faster in its reaction to health crises, while its member states should share more information in emergencies.

WHO officials did not immediately respond to an email request for comment.

“It is extremely important we move ahead with this reform,” EU Health Commissioner Stella Kyriakides told the same news conference.

After months of international pressure, an independent panel was set up in September to review the global handling of the pandemic. The process to reform the WHO would begin after that, officials had said.

The EU draft document, which will represent the EU’s position at a WHO assembly in mid-November, urges the U.N. agency to make public more quickly how and whether its member states respect their obligations on sharing information on health crises.

The United States has accused the WHO of being too close to China in the first phase of the pandemic, when critics say Beijing was slow in sharing crucial information on the new coronavirus which first appeared in the city of Wuhan.

The WHO has repeatedly dismissed these accusations.

“Transparency on who complies with the rules is fundamental,” Kyriakides told ministers at the video conference, according to her speaking notes.

The draft document also says WHO countries should allow independent epidemiological assessments on-site in high risk zones during health crises.

(Reporting by Francesco Guarascio @fraguarascio; Editing by David Holmes and David Evans)

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health

The US just reported its highest number of Covid-19 infections in one day since the pandemic’s start

The US reported more than 80,000 new coronavirus infections Friday — the highest daily case number since the pandemic began.



a person standing in front of a mirror posing for the camera: After changing PPE, an LPN dons her face shield at an Aveanna Healthcare and Fallon Ambulance walk-up COVID-19 testing site during the continuing coronavirus pandemic in Lynn, MA on Oct. 19, 2020. (Photo by Pat Greenhouse/The Boston Globe via Getty Images)


© Pat Greenhouse/The Boston Globe via Getty Images
After changing PPE, an LPN dons her face shield at an Aveanna Healthcare and Fallon Ambulance walk-up COVID-19 testing site during the continuing coronavirus pandemic in Lynn, MA on Oct. 19, 2020. (Photo by Pat Greenhouse/The Boston Globe via Getty Images)

That comes amid other bleak patterns including rising hospitalizations and daily death tolls across the country, with experts warning that the worst is yet to come.

Friday’s case count of at least 80,005 surpasses the country’s previous one-day high of 77,362, reported July 16, according to Johns Hopkins University.

US Surgeon General Dr. Jerome Adams cautioned earlier Friday that hospitalizations are starting to go up in 75% of the jurisdictions across the country, and officials are concerned that in a few weeks, deaths will also start to increase.

The good news, Adams said, is that the country’s Covid-19 mortality rate has decreased by about 85% thanks to multiple factors, including the use of remdesivir, steroids and better management of patients.

More than 41,000 Covid-19 patients were in hospitals across the country Thursday, according to the Covid Tracking Project. This is the highest level of nationwide coronavirus hospitalizations since August 20.

The number of people hospitalized has increased by 33% since the beginning of October, the CTP says.

Deaths are also creeping upward, with 856 on Thursday, Johns Hopkins says. The seven-day average of daily deaths has climbed to 763 — the highest average in a month.

In White House coronavirus task force reports obtained by CNN this week, officials say there are “early signs of deterioration in the Sun Belt and continued deterioration in the Midwest and across the Northern States.” And more state leaders have sounded the alarm on increasing infections, hospitalizations and deaths.

Dr. Anthony Fauci, the nation’s leading infectious disease expert, said Friday that he’s concerned about a massive surge in Covid-19 cases across the country and urged people to “double down” on measures to prevent the spread of the virus.

“The upticks on the map of more than 30 States that are having upticks is not going to spontaneously turn around unless we do something about it,” Fauci, the director of the National Institute of Allergy and Infectious Diseases, told CNN’s Erin Burnett.

Fauci has previously said he doesn’t think a federal mask mandate would work but on Friday he said it might be time for it — even if such a rule would be tricky to enforce.

“Well, if people are not wearing masks, then maybe we should be mandating it,” Fauci said.

A vaccine trial resumes after being halted

Drug manufacturer AstraZeneca announced Friday it will resume the trial of its experimental coronavirus vaccine in the US.

The company said the US Food and Drug Administration has given approval to continue the trial after reviewing all of the global safety data and concluding it

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Plague history shows how a pandemic’s course can be shaped

Researchers from Canada’s McMaster University analyzed thousands of documents spanning 300 years — including personal wills and testaments, parish registers and the London Bills of Mortality — to search for patterns on how plague was spreading through the population.

Plague, one of the deadliest bacterial infections in human history, caused an estimated 50 million deaths in Europe during the Middle Ages when it was known as the Black Death. The disease, though rare and now treatable with antibiotics, is still around today — cases have been recorded in China and the United States as recently as this year.

There was a “striking acceleration” in plague transmission between the Black Death of 1348 and the Great Plague of 1665, researchers said in findings published Monday in the Proceedings of the National Academy of Sciences journal.

David Earn, a professor in the department of mathematics and statistics at McMaster and lead author of the research, told CNN that while plague cases in London doubled every six weeks in the 14th century, by the 17th century, they were doubling every week and a half.

“That’s an enormous difference,” he said.

But this was not simply a case of the disease becoming more virulent — evolutionary geneticist Hendrik Poinar told CNN that while the spread of the disease accelerated, genetic analysis to date tentatively suggests that it may have become less infectious.

“When there are shifts in the epidemiology of the disease, most of the shifts that occur can be translated to human intervention or things that go on outside of the actual genetics of the bug,” Poinar, a professor in the department of anthropology at McMaster and a co-author of the study, said.

Researchers gathered information from personal wills, parish registers and bills of mortality.

The estimated speed of the epidemics, coupled with what we know about the biology of the plague, suggested that plague did not spread primarily through human-to-human contact during these centuries, but instead, growth rates for early and late epidemics are more consistent with bubonic plague, transmitted by the bites of infected fleas, the researchers said.

Researchers believe that factors including population density, living conditions and cooler temperatures could go toward explaining the acceleration of the disease in London — and could help with our understanding of modern pandemics, such as the current Covid-19 pandemic.

“A given pathogen can cause very different epidemics, whether it’s in the same place over time, or in different places,” Earn explained.

“The characteristics of the community can strongly influence the pattern of the epidemic,” he said. “And of course, the behavioral response of individuals can also influence the pattern of the epidemic,” he added.

The findings could also provide a blueprint to how the current pandemic and future pandemics could behave.

What the 1918 flu pandemic can teach us about coronavirus

“Plague never went away and it won’t ever go away, and (SARS) CoV-2 will never go away,” Poinar told CNN, explaining that the virus, like the plague, has “natural reservoirs” in the population.

“Fortunately we have a phenomenal scientific community, you know across the globe, working … more or less together right now to

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health

How do pandemics end? In different ways, but it’s never quick and never neat

On 7 September 1854, in the middle of a raging cholera epidemic, the physician John Snow approached the board of guardians of St James’s parish for permission to remove the handle from a public water pump in Broad Street in London’s Soho. Snow observed that 61 victims of the cholera had recently drawn water from the pump and reasoned that contaminated water was the source of the epidemic. His request was granted and, even though it would take a further 30 years for the germ theory of cholera to become accepted, his action ended the epidemic.



text: Photograph: Print Collector/Getty Images


© Provided by The Guardian
Photograph: Print Collector/Getty Images

As we adjust to another round of coronavirus restrictions, it would be nice to think that Boris Johnson and Matt Hancock have a similar endpoint in sight for Covid-19. Unfortunately, history suggests that epidemics rarely have such neat endings as the 1854 cholera epidemic. Quite the opposite: as the social historian of medicine Charles Rosenberg observed, most epidemics “drift towards closure”. It is 40 years since the identification of the first Aids cases, for instance, yet every year 1.7 million people are infected with HIV. Indeed, in the absence of a vaccine, the World Health Organization does not expect to call time on it before 2030.

However, while HIV continues to pose a biological threat, it does not inspire anything like the same fears as it did in the early 1980s when the Thatcher government launched its “Don’t Die of Ignorance” campaign, replete with scary images of falling tombstones. Indeed, from a psychological standpoint, we can say that the Aids pandemic ended with the development of antiretroviral drugs and the discovery that patients infected with HIV could live with the virus well into old age.

The Great Barrington declaration, advocating the controlled spread of coronavirus in younger age groups alongside the sheltering of the elderly, taps into a similar desire to banish the fear of Covid-19 and bring narrative closure to this pandemic. Implicit in the declaration signed by scientists at Harvard and other institutions is the idea that pandemics are as much social as biological phenomena and that if we were willing to accept higher levels of infection and death we would reach herd immunity quicker and return to normality sooner.

But other scientists, writing in the Lancet, say the Great Barrington strategy rests on a “dangerous fallacy”. There is no evidence for lasting “herd immunity” to the coronavirus following natural infection. Rather than ending the pandemic, they argue, uncontrolled transmission in younger people could merely result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccines.



‘Water! Water! Everywhere; and not a Drop to Drink’: Another Punch cartoon, this one on the London outbreak of 1849. Photograph: Print Collector/Getty Images


© Provided by The Guardian
‘Water! Water! Everywhere; and not a Drop to Drink’: Another Punch cartoon, this one on the London outbreak of 1849. Photograph: Print Collector/Getty Images

Video: The world needs to trust science, urges historian and philosopher Yuval Noah Harari (France 24)

The world needs to trust science, urges historian and philosopher Yuval Noah Harari

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